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Emergency Department Visits for Motor Vehicle Traffic Injuries: United States, 2010–2011

February 25, 2015 Comments off

Emergency Department Visits for Motor Vehicle Traffic Injuries: United States, 2010–2011
Source: National Center for Health Statistics

Key findings
Data from the National Hospital Ambulatory Medical Care Survey, 2010–2011

  • In 2010–2011, the emergency department (ED) visit rate for motor vehicle traffic injuries was highest among persons aged 16–24 years. The rates declined with age after 16–24, with rates for those aged 0–15 similar to those 65 and over.
  • The overall ED visit rate for motor vehicle traffic injuries was higher among non-Hispanic black persons compared with non-Hispanic white and Hispanic persons.
  • Imaging services were ordered or provided at 70.2% of ED visits for motor vehicle traffic injuries, which was higher than for other injury-related ED visits (55.9%).
  • About one-half of ED visits for motor vehicle traffic injuries had a primary diagnosis of sprains and strains of the neck and back, contusion with intact skin surface, or spinal disorders.

Utilization of Intensive Care Services, 2011 (December 2014)

February 16, 2015 Comments off

Utilization of Intensive Care Services, 2011
Source: Agency for Healthcare Research and Quality

Highlights

  • In 2011, 26.9 percent of hospital stays in 29 States involved intensive care unit (ICU) charges, accounting for 47.5 percent of aggregate total hospital charges.
  • Common conditions and procedures with high ICU utilization varied across body systems. The highest rate of ICU use (93.3 percent) was for respiratory disease with ventilator support.
  • Cardiac conditions accounted for 8 of the 18 conditions and procedures with high ICU utilization. ICU utilization for cardiac conditions ranged from 40.6 percent for stays for chest pain to 70.3 percent for stays for acute myocardial infarction with major complications or comorbidities.
  • Hospital stays that involved ICU services were 2.5 times more costly than other hospital stays.
  • ICU services were on average three times more likely when patients experienced major complications or comorbidities.
  • Greater utilization of ICUs tended to occur in hospitals that were large, private/for profit, located in metropolitan areas, trained medical students, and had a high-level trauma center.

Use of Social Media Across US Hospitals: Descriptive Analysis of Adoption and Utilization

January 29, 2015 Comments off

Use of Social Media Across US Hospitals: Descriptive Analysis of Adoption and Utilization
Source: Journal of Medical Internet Research

Background:
Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health.

Objective:
The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics.

Methods:
We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews.

Results:
Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts.

Conclusions:
Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the quality of hospital care and services.

HHS OIG — Medicare’s Oversight of Compounded Pharmaceuticals Used in Hospitals

January 28, 2015 Comments off

Medicare’s Oversight of Compounded Pharmaceuticals Used in Hospitals
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
A 2012 nationwide meningitis outbreak caused by contaminated injections, which were produced by a standalone compounding pharmacy, raised concerns about compounded sterile preparations (CSPs). Subsequent OIG work found that almost all acute-care hospitals use CSPs and most contract with standalone compounding pharmacies to provide at least some of these products. CMS oversees the safety of CSPs prepared and used in Medicare-participating hospitals through the hospital certification process, in which State survey agencies or CMS-approved accreditors assess hospital compliance with requirements for drug compounding. This study provides information about the extent to which Medicare’s oversight of hospitals addresses recommended practices for CSPs. In 2013, Congress passed the Drug Quality and Security Act, which clarifies the Food and Drug Administration’s authority over standalone compounding pharmacies.

HOW WE DID THIS STUDY
We reviewed the practices of the five entities that oversee hospitals that participate in Medicare-namely, CMS and the four hospital accreditors approved by CMS. Through consultation with experts in CSP oversight, OIG identified 55 recommended practices for CSP oversight in acute-care hospitals. Representatives from each oversight entity participated in a structured interview and completed a questionnaire about how their respective surveys of hospitals incorporate these recommended practices. We analyzed the data from the interviews and the questionnaire to determine the extent to which Medicare’s oversight addresses recommended practices for CSP oversight.

WHAT WE FOUND
Oversight entities address most of the recommended CSP-related practices at least some of the time. However, only one oversight entity always reviews hospital contracts with standalone compounding pharmacies. Oversight entities may also lack the human capital required to thoroughly review hospitals’ preparation and use of CSPs. Surveyors receive limited training specific to compounding, and most oversight entities do not routinely include pharmacists on hospital surveys. Finally, although most oversight entities are considering changes to how they oversee hospitals’ preparation and use of CSPs, none of them are considering changes to how they oversee hospitals’ contracts with standalone compounding pharmacies.

WHAT WE RECOMMEND
CMS should (1) ensure that hospital surveyors receive training on standards from nationally recognized organizations related to safe compounding practices and (2) amend its interpretive guidelines to address hospitals’ contracts with standalone compounding pharmacies. CMS concurred with both recommendations.

Hospitalizations for Patients Aged 85 and Over in the United States, 2000–2010

January 21, 2015 Comments off

Hospitalizations for Patients Aged 85 and Over in the United States, 2000–2010
Source: National Center for Health Statistics

Key findings
Data from the National Hospital Discharge Survey

  • In 2010, adults aged 85 and over accounted for only 2% of the U.S. population but 9% of hospital discharges.
  • From 2000 through 2010, the rate of hospitalizations for adults aged 85 and over declined from 605 to 553 hospitalizations per 1,000 population, a 9% decrease.
  • The rate of fractures and other injuries was higher for adults aged 85 and over (51 per 1,000 population) than for adults aged 65–74 (9 per 1,000 population) and 75–84 (23 per 1,000 population).
  • Adults aged 85 and over were less likely than those aged 65–74 and 75–84 to be discharged home and more likely to die in the hospital.

From 2000 through 2010, the number of adults aged 85 and over in the United States rose 31%, from 4.2 million to 5.5 million, and in 2010, this age group represented almost 14% of the population aged 65 and over (1). It is estimated that by 2050, more than 21% of adults over age 65 will be aged 85 and over (2). Given this increase, adults aged 85 and over are likely to account for an increasing share of hospital utilization and costs in the coming years (3). This report describes hospitalizations for adults aged 85 and over with comparisons to adults aged 65–74 and 75–84.

CRS — Hospital-Based Emergency Departments: Background and Policy Considerations (December 8, 2014)

December 17, 2014 Comments off

Hospital-Based Emergency Departments: Background and Policy Considerations (PDF)
Source: Congressional Research Service (via Federation of American Scientists)

Hospital-based Emergency Departments (EDs) are required to stabilize patients with emergent conditions regardless of the patients’ ability to pay as a requirement of the Emergency Medical Treatment and Active Labor Act (EMTALA). Given this requirement, EDs play an important part in the health care safety net by serving the uninsured, the underserved, and those enrolled in Medicaid. Open 24 hours a day, EDs provide emergency care, urgent care, primary care, and behavioral health care services in communities where these services are unavailable or unavailable after hours. EDs also play a key role during emergencies, such as natural disasters.

Some EDs are challenged to provide effective care. For example, EDs provide a disproportionate amount of health care to the U.S. population, in general, and to the safety net population, in particular. Specifically, while 4% of all U.S. physicians are ED physicians, they are the treating physicians in 28% of all acute care visits. Some EDs face financial challenges. ED services are costly both to payers, because services provided in an ED are more costly than those provided in community-based settings, and to hospitals, because operating an ED has high fixed costs and because if patients enter with an emergent condition, hospitals are required by EMTALA to stabilize the patient regardless of the patient’s ability to pay.

Narrow Networks, Access to Hospitals and Premiums: An Analysis of Marketplace Products in Six Cities

December 16, 2014 Comments off

Narrow Networks, Access to Hospitals and Premiums: An Analysis of Marketplace Products in Six Cities
Source: Urban Institute

This report examines which hospitals are included within marketplace plans in six cities (Denver; New York City (Manhattan); Portland, Ore.; Providence; Baltimore; and Richmond, Va.). The report finds that nearly all insurers offering plans through the insurance Marketplaces in six cities include many highly ranked hospitals within their provider networks. The report also concludes that every hospital in the cities studied is included in at least one Marketplace plan network. The authors also looked at how the size of a plan’s provider network affected the cost of premiums. The report shows that the size of a plan’s network is not necessarily tied to premiums. The authors note that although narrowing networks (i.e., limiting the amount of providers covered under a specific plan) generally led to more-competitive, lower-cost premiums, some plans with broader networks had low premiums and some plans with narrow networks had high premiums.

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