2011 Potpourri X

A paper presented at the American Academy of Orthopedic Surgeons examined the defensive use of imaging in orthopedic practices, meaning the ordering of tests largely to avoid potential malpractice suits.  This was a prospective study of physicians in Pennsylvania.  Overall, 20% of imaging was defensive, but the rate was much higher in the more expensive modalities of MRI, at 38%, CT at 33%, and bone scans at 56%.  Thirty-five percent of imaging costs were attributable to these defensive orders, using the Medicare fee schedule.  Being sued in the last five years was associated with a greater use of defensive imaging.  (AASO Paper)

A review of the military’s PATH system, which provides provider to provider teleconsultation services in the Pacific region, found that quality was improved and savings created.  The system was used for about 1000 pediatric teleconsultations between 2006 and early 2009.  Most of the requests related to diagnostic issues and the median response time was around 14 hours.  In some cases, patients were recommended to be sent for additional testing and in some cases a transfer to an inpatient or other facility was prevented.  Overall, about $500,000 annually was believed to have been saved.  (Telehealth Study)

About 800,000 Americans a year have strokes and two-thirds of those people have trouble walking after the stroke.  A study compared high-tech treadmill therapy at a rehab facility with physical therapy at home for over 400 randomly assigned stroke victims.  The amount and rate of improvement was similar, but the home care group had fewer adverse events and were far less likely to drop out of therapy.  The home therapy also probably cost less.  Another strike against costly medicine with no extra benefits and a checkmark for home therapy and care.  (Stroke Care Study)

Thomson Reuters does a recurring survey of about 100,000 households on various matters, including perceptions on health issues.  One aspect of the survey measures whether consumers avoided care for cost reasons in the past three months and whether they believe they will be more or less able to afford health care in the next three months.  Perceived difficulty in paying for health care reached an all-time high last year, primarily reflected in delays in filling and not filling prescriptions.  Consumers said they would do that less frequently in the coming months.  (Thomson Survey)

A study published in the American Journal of Managed Care looked at the relationship between patient satisfaction results and clinical performance measures and 30 day hospital readmission rates.  The study covered heart attack, heart failure and pneumonia patients, and looked at around 2000 hospitals and hundreds of thousands of patients.  The patients and hospitals with higher overall satisfaction and discharge planning satisfaction had fewer readmissions, and these were more associated with lower readmissions than was performance on the clinical measures.   (AJMC Article)

Qualcomm reported on a study using its mobile phone technology and a VOCEL mobile phone medication adherence application at George Washington University Medical Center to improve drug compliance among Medicaid hypertensive patients.  The app included visual and audible reminders and provided information to patients and recordkeeping capabilities.  There was a trend toward increased prescription fill rates during the term of the study.   (Qualcomm Release)