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From the January ACP Hospitalist, copyright © 2008 by the American College of Physicians

Hospitals meeting quality reporting goals, CMS says

Most of the acute care hospitals in the U.S. are participating in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program and will qualify for a full increase in payment rate in 2008, CMS recently reported.

Under RHQDAPU, hospitals that voluntarily reported data on a set of quality measures are eligible for a 3.3% increase, while those that opted not to participate or that did not meet reporting goals would see a rate increase of only 1.3%. Of the 3,506 acute care hospitals eligible for RHQDAPU nationwide, 93% participated and met reporting requirements, 6% participated but did not meet requirements and 1% did not participate.

In a press release, a CMS official lauded the hospitals' efforts, saying "Quality of care is critical and we must continue our efforts to provide appropriate measures that are clearly defined and widely agreed upon and which benefit all consumers of health care." CMS plans to expand the quality reporting program by requiring hospitals to report on 27 quality measures in fiscal year 2008, including data on mortality and patient satisfaction.

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FDA issues stronger warnings and label changes for anemia drugs

The FDA in November approved changes to the boxed warnings and labels of erythropoiesis-stimulating agents (ESAs) to reflect risks for patients with cancer and chronic kidney failure.

For cancer patients, the drugs, epoetin alfa (Epogen, Procrit) and darbepoetin alfa (Aranesp), caused tumor growth and shortened survival in patients with advanced breast, head and neck, lymphoid and non-small-cell lung cancer at doses that aimed for a hemoglobin level of 12 g/dL or more. It's unclear if the risk exists for smaller doses, the FDA said.

The boxed warning also states that ESAs should be used in cancer patients only when treating anemia specifically caused by chemotherapy, and they should be stopped when the chemotherapy course is done. ESAs haven't been shown to improve quality of life, fatigue or well-being for cancer patients or HIV patients undergoing AZT therapy, the new labels say.

For kidney failure patients, ESAs should be used to maintain a hemoglobin level between 10 g/dL to 12 g/dL, the warning says. Maintaining higher levels raises the risk of death and serious cardiovascular reactions like stroke, heart attack or heart failure.

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First silver-coated breathing tube approved for marketing

The FDA cleared for marketing a breathing tube that is coated with a thin layer of silver to help prevent ventilator-associated pneumonia in hospitals.

The coating on the Agento endotracheal tube is meant for patients who must rely on a ventilator to breathe for 24 hours or more. Its silver lining is known to have antimicrobial properties, the FDA said.

In a multicenter clinical trial comparing the silver-coated tube to an uncoated tube, the percentage of patients who developed pneumonia was reduced from 7.5% to 4.8%. The silver tube also delayed the onset of pneumonia, the FDA said.

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Record number of chlamydia infections reported

Chlamydia infections in the U.S. set a new record last year for the number of reported cases of a sexually transmitted disease, according to a report from the CDC.

The 2006 statistics work out to an incidence rate of 347.8 cases [of chlamydia] per 100,000 population, but CDC experts warned that more than half of chlamydia infections may go unreported.

In 2006, the CDC received reports of 1,030,911 diagnoses of chlamydia, an increase of 5.6% from 2005. The 2006 statistics work out to an incidence rate of 347.8 cases per 100,000 population, but CDC experts warned that more than half of chlamydia infections may go unreported. The CDC attributed the increase to greater use of screening and more sensitive diagnostic tests, although it noted that the number of reported cases may also reflect an increase in actual infections.

The CDC report, "Trends in Reportable Sexually Transmitted Diseases," also found increases in the reported rates of gonorrhea and syphilis. Between 1975 and 1997, gonorrhea rates had shown a steady decline, dropping a total of 74%. In the past two years, the rates have increased to reach 120.9 cases per 100,000 population. An increasing number of gonorrhea cases (13.8%) also demonstrate resistance to fluoroquinolones, the CDC said. The syphilis rate has been increasing for the past six years, reaching 3.3 cases per 100,000 population, with higher rates in men than women.

Based on these statistics, CDC officials urge health care providers to test their patients for these infections, especially since the vast majority of chlamydia cases are asymptomatic. Providers who do identify an infection should encourage their patients to come back for follow-up testing and try to ensure that the patient's partner also receives treatment, the experts said.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated