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HospitalistWeekly 6-25-08
Highlights
- More hospitals employing physicians, survey finds
- CMS announces three-year results from quality improvement project
- Asthma more prevalent in hospitalized patients, AHRQ reports
Cardiology
- Rhythm control no better than rate control in heart failure, study finds
Disparities
- Young blacks experiencing fewer injuries, suicides; rate among whites increasing
FDA updates
- Boxed warnings added to conventional antipsychotics
- Diaphragm-pacing device approved
- Warnings issued on fake cancer cures
From ACP Hospitalist
- June issue online and in the mail
- Recommend your colleagues as Hospitalists of the Year
From ACP Internist
- What they’re saying on the blogs
Cartoon caption contest
- June’s winning entry
Highlights
.More hospitals employing physicians, survey finds
The number of hospitals employing physicians has increased dramatically over the past three years, according to the latest survey from recruiting firm Merritt, Hawkins & Associates.
The firm reviewed 3,146 nationwide physician search assignments from April 1, 2007 to March 31, 2008 and found that 45% involved hospital employment, an increase from 19% three years ago. Hospitalists were the third most requested group in searches by specialty at 208 and had the largest percentage increase from the previous year at 93%. Family practitioners topped the list of searches by specialty with 492 searches during the 12-month review period (up 62% over 2006-07), followed by general internists at 314 searches (up 87%), said a June 17 Merritt Hawkins news release.
Average salaries offered primary care physicians during the review period were $176,000 for general internists, $181,000 for hospitalists and $172,000 for family practitioners. Signing bonuses were offered as a recruiting incentive in 74% of the search assignments, up from 46% three years ago.
A complete copy of the report is available on Merritt, Hawkins’ Web site.
.CMS announces three-year results from quality improvement project
Hospitals participating in the Premier Hospital Quality Incentive Demonstration (HQID) continue to improve, according to the latest results released by CMS.
HQID is a pay-for-performance pilot program begun in 2003 by CMS and the Premier Inc. Healthcare Alliance. Two hundred fifty participating hospitals in 36 states report quality data on acute myocardial infarction (MI), coronary artery bypass grafting (CABG), heart failure, pneumonia, and hip and knee replacement. The average composite quality scores for these five conditions improved as follows from 2003 to 2006, according to a CMS press release:
- Acute MI, 87% to 96%
- CABG, 85% to 97%
- Heart failure, 64% to 89%
- Pneumonia, 69% to 90%
- Hip and knee replacement, 85% to 97%.
Overall, the average composite quality scores have improved 15.8 percentage points over the life of the project, with an average increase of 4.4 percentage points between years two and three, CMS reported.
The top 20% of hospitals in each of the five clinical areas receive financial incentives, with the top 10% of hospitals receiving a 2% incentive payment, according to a Premier press release. One percent incentive payments are awarded to hospitals in the second decile, while hospitals in the top 50% of each clinical area are publicly recognized on CMS’s Web site.
CMS has awarded a total of more than $24.5 million in incentive payments to participating hospitals over the first three years of the project, with the 112 top-performing hospitals earning $7 million in incentive payments during year three. HQID has been extended another three years, through September 2009.
The CMS press release is online.
The Premier press release is online.
.Asthma more prevalent in hospitalized patients, AHRQ reports
More adults admitted to the hospital for other conditions are also being diagnosed with asthma, according to recent data from the Agency for Healthcare Research and Quality.
In 2000, 753,800 hospitalized patients were found to have asthma as a secondary condition. In 2005, this number was 1,609,200, a 113% increase. During this same time period, hospitalizations in which asthma was the primary diagnosis increased 18%, from 247,200 to 290,600. The data are taken from “Hospital Stays Related to Asthma for Adults, 2005,” which uses statistics from the 2005 Nationwide Inpatient Sample. Other findings include the following, according to an AHRQ press release:
- Asthma was present in approximately 123,000 adult patients hospitalized for pneumonia, 62,000 hospitalized for congestive heart failure, 59,000 hospitalized for chest pain, 54,000 hospitalized for osteoarthritis and 53,500 hospitalized for depression or bipolar disorder.
- Adults living in the Northeast were at least 60% more likely than those living in the West to be diagnosed with asthma as a secondary condition at hospitalization.
- Hospitalization for asthma was 63% more likely among poorer communities than in wealthier communities.
AHRQ’s statistical brief is online.
Cardiology
.Rhythm control no better than rate control in heart failure, study finds
Patients with heart failure and atrial fibrillation survive just as well on rate control therapy as rhythm control, a new study found.
The randomized trial included 1,376 patients who had a left ventricular ejection fraction of 35% or less, symptoms of congestive heart failure, and a history of atrial fibrillation. Patients were randomized to either rate or rhythm control and followed for a mean of 37 months. On the study’s primary outcome, death from cardiovascular causes, 27% of the rhythm-control group died, compared with 25% in the rate-control population. The groups had similar rates of death from any cause, stroke, worsening heart failure and composite outcomes.
Researchers concluded that, contrary to their hypothesis, rhythm control does not reduce the rate of death and that rate control should be considered a primary approach for patients with atrial fibrillation and congestive heart failure. They cautioned that their results could not be generalized to patients with heart failure and preserved left ventricular function. The study was published in the June 19 New England Journal of Medicine.
An accompanying editorial noted that the study’s findings probably indicate the shortcomings of current antiarrhythmic therapies, rather than proof of the absence of benefit from maintaining a sinus rhythm. The editorialist said that new therapies, particularly catheter ablation, could eliminate the low efficacy and high toxicity that are currently associated with antiarrhythmic therapy. The study and the editorial are online.
Disparities
.Young blacks experiencing fewer injuries, suicides; rate among whites increasing
Injury-related deaths among blacks ages 15 to 24 decreased between 1999 and 2005, while injury-related deaths among whites increased, according to a study by researchers at the Johns Hopkins Bloomberg School of Public Health.
The study found that between 1999 and 2005 injury-related deaths among black males experienced a steady decline, while the injury death rate among white males increased by 7%. When compared to rates in 1999, the gap between injury rates of black males and white males decreased by 24%.
Using a Web-based injury statistics query and reporting system, as well as mortality data from several agencies, researchers examined injury mortality rates among Americans between the ages of 15 and 24. Mortality resulting from the 10 most common causes of injury-related death was analyzed by race, sex, age, type of injury and state.
The reduction in racial disparity resulted from a decrease in motor vehicle crashes and firearm suicides among black males and an increase in suicide by suffocation (typically hanging) and unintentional poisoning, such as a drug overdose, among white males. Among young women, black females experienced a decrease in the rate of firearm suicide, while white females experienced an increase in unintentional poisoning and suicidal suffocation.
The total injury mortality rate among whites did not change significantly; however, there was an 11% decrease among blacks. In two of the 10 injury categories, unintentional poisoning among males and hanging among females, increases both doubled.
The study was published in the June 2008 issue of Injury Prevention and was funded by a grant from the CDC’s Center for Injury Research and Prevention. An abstract is online.
FDA updates
.Boxed warnings added to conventional antipsychotics
Conventional antipsychotic will now be required to carry a boxed warning about the risk of death associated with their off-label use in patients with dementia, the FDA announced last week.
The conventional antipsychotics will now carry the same warning as atypical antipsychotics, which received a boxed warning in 2005. The new language warns that clinical studies indicate that antipsychotic drugs of both types are associated with an increased risk of death when used in elderly patients treated for dementia-related psychosis.
The change is based on two recent observational epidemiological studies which compared elderly patients’ risk of death on conventional antipsychotics, atypical antipsychotics and no antipsychotics, an FDA press release said. Labeling on the atypical drugs will be changed so that both types of medication carry uniform warning language.
A press release with a list of the affected medications is online.
.Diaphragm-pacing device approved
The implantable electronic device which allowed actor Christopher Reeve to spend time off a ventilator was approved last week by the FDA.
The NeuRx DPS RA/4 Respiratory Stimulation System uses electrodes implanted in the muscle of the diaphragm to stimulate contraction and allow some spinal cord injury patients to breathe without a ventilator for at least four hours a day. The FDA approved the device under a Humanitarian Device Exemption, an approval process for devices which treat or diagnose conditions affecting fewer than 4,000 people per year.
A multi-center trial found the device to be safe and have a probable benefit to patients, an FDA press release said. The device manufacturer is working on expanding the use of the device to patients with amyotrophic lateral sclerosis, a company representative told the June 18 Washington Post.
The FDA release is online. The Washington Post is online.
.Warnings issued on fake cancer cures
The FDA has cracked down on sellers of fake cancer cures, issuing warning letters to 23 U.S. companies and two foreign individuals who have marketed products which claim to prevent and cure cancer.
The products include tablets, teas, tonics, black salves and creams and contain ingredients such as bloodroot, shark cartilage, coral calcium, cesium, ellagic acid, Cat’s Claw and mushrooms. The products are marketed through the Internet and violate FDA regulations by claiming to cure, treat, mitigate or prevent disease.
Examples of the fraudulent claims include:
- “Causes cancer cells to commit suicide!”
- “80% more effective than the world’s number one cancer drug”
- “Avoid painful surgery, radiotherapy, chemotherapy, or other conventional treatments”
A list of the products and a consumer article about health scams are online.
From ACP Hospitalist
.June issue online and in the mail
Check out this month’s issue of ACP Hospitalist for stories on disparities in stroke outcomes and hospital price comparison tools, as well as conference coverage from Hospital Medicine 2008. The June issue also features a CME supplement on managing hyperglycemia in hospitalized patients.
The full June issue of ACP Hospitalist is online.
.Recommend your colleagues as Hospitalists of the Year
ACP Hospitalist is seeking candidates for its first annual Hospitalists of the Year issue. To recommend a colleague who made notable contributions to the field in 2008, whether through cost savings, improved work flow, patient safety, leadership, mentorship or quality improvement, readers can fill out the online form. All recommendations must be received by July 14. Hospitalists of the Year will be profiled in our November 2008 issue.
From ACP Internist
.What they’re saying on the blogs
Join the ACP Internist’s community on its blogs, featuring daily updates on news that just can’t wait. Get all the breaking news from ENDO ’08 in San Francisco. From basic research to weight loss to hormone replacement therapy, we’ve got it covered.
Cartoon caption contest
.June’s winning entry
We’ve compiled the results from our latest cartoon contest, where readers are invited to match wits against their peers to provide the most original and amusing caption.
This issue’s winning cartoon caption was submitted by Colin Carracher, a third-year medical student at the University of Cincinnati College of Medicine. He will receive a copy of “Medicine in Quotations,” ACP’s comprehensive collection of famous sayings relating to sickness and health, disease and treatment and a portrait of medicine throughout recorded history. Readers cast 180 ballots online to choose the winning entry. Thanks to all who voted!
The winning entry:
“And no one thought to get a potassium level?”
The winning caption received 36.1% of the votes cast. The three runners up were:
“You guessed it, universal health coverage!” (27.8%)
“This patient is a perfect candidate for a banana bag.” (24.4%)
“Who’s the curious one, now?” (11.7%)
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