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2012 Potpourri XXXII

By October 26, 2012Commentary

The American Association of Retired Persons issued a report on family caregivers, finding that many are providing medical and nursing care for primarily elderly persons, often with chronic diseases and cognitive problems.  About 1700 caregivers were surveyed for the report.  Forty-six percent are providing medical and nursing tasks, including medication management like administering IVs and injections.  Many are also doing wound care and using specialized medical equipment.  About two-thirds of such caregivers say they do this with no assistance from a health professional.  Obviously there can be quality implications of these practices.  Many of the caregivers experience significant stress and report that their own health is poor.    (AARP Report)

CMS and Congress have yet to find a replacement for the Sustainable Growth Rate formula for adjusting Medicare’s payments to physicians.  For years scheduled cuts have been delayed and we are coming up on another one that would total almost 30%.  The Medical Group Management Association released a survey showing that if the cut goes through many physicians, over half, are at least somewhat likely to stop accepting new Medicare patients and even more would restrict appointments for Medicare patients.  Almost a quarter said they might stop seeing Medicare patients altogether.  The doctors also described adverse effects of the uncertainty of Medicare reimbursement on their practices.  (MGMA Survey)

A Journal of the American College of Surgeons article examines factors for hospital readmissions within 30 days after surgery.  Reviewing 1442 patients who had general surgery at one hospital, the authors found that 163, or about 11%, were readmitted within 30 days.  The three general reasons for readmissions were pre-existing conditions, complications developed in the hospital and complications developed after discharge.  Gastro-intestinal complications were the main reason for about 28% of readmissions, followed by surgical infection in 22% and failure to thrive in 10.4%.  Comorbidities associated with readmissions included cancer, dyspnea and preoperative open wound.  The authors hope to develop decision support software that identifies and manages cases with higher readmission risks.     (JACS Article)

Sometimes research on health care products or procedures shows large treatment effects.  In a study reported in the Journal of the American Medical Association, the authors used the Cochrane database of research to identify the characteristics of research showing either large effects for benefits or harms.  The authors found that about 9.7% of products or treatments studied had a large effect in the first published trial and about another 6.1% did after the first published trial.  But almost all large treatment effects emerged from relatively small trials, and with subsequent trials, the large effects usually become smaller.  Any well-validated large effects usually pertain to nonfatal outcomes.  In fact of all the trials looked at, only 1 had large beneficial effects on mortality and no quality of evidence concerns.   (JAMA Article)

And the week would not be complete without one more mention of a highly-touted innovation, this one the use of computerized point of entry order systems.  An article in the Journal of the American Medical Informatics Association examined physician and nurse reaction to and views of these systems.  Doctors started out liking the systems more than the nurses, but nurses caught up in satisfaction after a year, although both groups were only modestly satisfied.  Neither group thought that CPOE either improved patient care or improved productivity and many felt it actually increased their work effort and time.   (JAMIA Article)

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