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Discharged elderly patients are less likely to be readmitted if they receive comprehensive discharge planning and home follow-up visits, according to a recent study conducted at the University of Pennsylvania.1
Researchers analyzed the effectiveness of a special discharge plan in two urban, academically affiliated hospitals in Philadelphia that included contact with one advanced practice nurse throughout the hospitalization plus at least two home visits, the first occurring in the first 48 hours post-discharge and the second occurring seven to 10 days following discharge. The plan also included additional home visits by the nurse on an as-needed basis, plus everyday telephone availability and a call from the nurse once a week. A control group of elderly patients received standard discharge planning.
By 24 weeks after discharge, 37% of the control group had been rehospitalized, compared with 20% of the intervention group. Comprehensive, nurse-centered discharge planning also increased the time between initial discharge and readmission and decreased health care costs. At six months, savings in Medicare reimbursements were almost $600,000 for the intervention group beneficiaries, or $3,000 per patient.
One of the investigators said in a statement that the findings show that elderly patients with complex chronic conditions need someone who can act as a broker — someone who can negotiate for them, not only around the clinical issues, but also around assistance issues after they leave. Planning, she added, can stop the cycle of ongoing rehospitalization.
1. Naylor MD, Brooten D, Campbell R, et al. Comprehens ive discharge planning and home follow-up of hospitalized elders. JAMA 1999; 281:613-620.
The company that manufactures the blood substitute HemAssist conducted a trial of its product without the informed consent of patients in the study. Of the 52 critically ill patients given the substitute, 24 died — a 46.2% mortality rate. Deerfield, IL-based Baxter International was able to test its product without consent because of a 1996 change in federal Food and Drug Administration (FDA) regulations that changed a 50-year rule requiring consent for nearly all experiments on humans.
The rule change was designed to help research in emergency medicine that could not take place if doctors had to take time to get consent. But the outcomes of the HemAssist trial are prompting some medical ethicists to question the rule change. No other company has conducted a no-consent experiment under the rule, FDA officials said. Baxter officials halted their clinical trial after reviewing data. The trial came on the heels of an intense push to find an effective blood substitute that could ease the effects of whole-blood shortages. The artificial substance lasts longer than conventional blood, eliminates the time-consuming need to match blood types, and does away with the risk of contamination with such viruses as HIV and hepatitis. No lawsuits have arisen from the blood substitute trial, Baxter officials said.
Beginning in 2000, health plans seeking accreditation will most likely have to allow patients to appeal medical decisions to an outside body and allow patients to continue to see a physician who has left the plan.
Those two provisions were added to draft accreditation standards issued by the National Committee for Quality Assurance (NCQA). The new standards are projected to go into effect July 1, 2000.
Under the proposed standards, a patient who exhausts a plan’s internal appeals process will have the right to a hearing before an independent review organization. Patients already have that right in about 20 states, and it is afforded to all federal employees and Medicare beneficiaries enrolled in managed care plans. It is also included in the Patient’s Bill of Rights legislation being considered by Congress.
The draft also stipulates that members who are currently under an active course of treatment, such as new mothers, pregnant women, or patients receiving chemotherapy, would be allowed to continue seeing their physician for up to 90 days after the physician leaves the health plan.
Patients are at increased risk of acquiring infections with Clostridium difficile if they receive tube feedings, say researchers at the University of Minnesota School of Nursing in Minneapolis who compared those patients’ data to that of patients not tube-fed.1
Investigators compared 76 tube-fed patients with 76 non-tube-fed patients at a Veterans Affairs Medical Center in Chicago. They found that those who were tube-fed acquired infection significantly more often (15 out of 76, or 20%) than those who weren’t (6 out of 76, or 8%). The proportion of patients who developed C. difficile-associated diarrhea was also greater among tube-fed patients. The research team examined the connection between the location of the feeding-tube tip and the development of infection and found that postpyloric tube placement was a risk factor. The researchers speculated that food delivery below the gastric acid barrier may facilitate the introduction and survival of C. difficile organisms.
Comparable numbers of both tube-fed and non-tube-fed patients had been on antibiotic regimens, especially third-generation cephalo spor ins and aminoglycosides, according to the report.
1. Bliss DZ, Johnson S, Savik K, et al. Acquisition of Clostridium difficile and Clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med 1998; 129:1,012-1,019.
Asthma patients over 45 are at greater risk of hospitalization than younger asthma patients, and their average costs per hospital stay are higher as well, according to a recent study report.1
The one-year study tracked 3,223 asthma patients who sought care in emergency departments at 27 different hospitals. Thirty-three percent of the patients were hospitalized, with an average length of stay of 3.8 days. For patients aged 18 to 45, the hospitalization rate was 28.8%. Among patients older than 45, the rate was 42.3%. The average cost per hospital stay for younger patients was $3,102, compared to $3,601 for the older group. Three areas accounted for a majority of the cost of acute care for the entire group of asthma patients: nursing care (43.6% of total costs), respiratory therapy (13.6%), and medication (10.4%).
The study authors wrote that because most of the inpatient costs of treating asthma are una voidable, the most effective cost reduction strategy would be to target older asthma sufferers for prevention efforts aimed at reducing the rate of hospitalization.
1. Stanford R, McLaughlin T, Okamoto LJ. The cost of asthma in the emergency department and hospital. Am J Respir Crit Care Med 1999; 160:211-215.