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HHS OIG — Hospital Emergency Preparedness and Response During Superstorm Sandy

September 18, 2014 Comments off

Hospital Emergency Preparedness and Response During Superstorm Sandy
Source: U.S. Department of Health and Human Services, Office of Inspector General

WHY WE DID THIS STUDY
Federal regulations require that hospitals prepare for emergencies including natural disasters. The strength of Superstorm Sandy and the population density of the affected areas placed high demands on hospitals and related services. Prior studies by OIG found substantial challenges in health care facility emergency preparedness and response. In a 2006 study, we found that many nursing homes had insufficient emergency plans or did not follow their plans. In a 2012 followup study, we found that gaps continued to exist in nursing home emergency preparedness and response.

HOW WE DID THIS STUDY
For this study, we surveyed 174 Medicare-certified hospitals located in declared disaster areas in Connecticut, New Jersey, and New York during Superstorm Sandy. We also conducted site visits to 10 purposively selected hospitals located in areas most affected by the storm. Additionally, we examined information from State survey agency and accreditation organization surveys of hospitals conducted prior to the storm and spoke to surveyors about their survey process related to emergency preparedness. We also interviewed State hospital associations and health care coalitions in the three States.

WHAT WE FOUND
Most hospitals in declared disaster areas sheltered in place during Superstorm Sandy, and 7 percent evacuated. Eighty-nine percent of hospitals in these areas reported experiencing substantial challenges in responding to the storm. These challenges represented a range of interrelated problems from infrastructure breakdowns, such as electrical and communication failures, to community collaboration issues over resources, such as fuel, transportation, hospital beds, and public shelters. Hospitals reported that prior emergency planning was valuable during the storm and that they subsequently revised their plans as a result of lessons learned. Prior to the storm, most hospitals received emergency-related deficiency citations from hospital surveyors, some of which related to the challenges reported by hospitals during Superstorm Sandy.

WHAT WE RECOMMEND
The experiences of hospitals during Superstorm Sandy and the deficiencies cited prior to the storm reveal gaps in emergency planning and execution that might be applicable to hospitals nationwide. Given that insufficient community-wide coordination among affected entities was a common thread through the challenges identified by hospital administrators, we recommend that ASPR continue to promote Federal, State, and community collaboration in major disasters. We also recommend that CMS examine existing policies and provide guidance regarding flexibility for reimbursement under disaster conditions. ASPR and CMS concurred with the recommendations.

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After Midnight: A Regression Discontinuity Design in Length of Postpartum Hospital Stays

September 17, 2014 Comments off

After Midnight: A Regression Discontinuity Design in Length of Postpartum Hospital Stays (PDF)
Source: Columbia University (Almond), MIT (Doyle)

Estimates of moral hazard in health insurance markets can be confounded by adverse selection. This paper considers a plausibly exogenous source of variation in insurance coverage for childbirth in California. We find that additional health insurance coverage induces substantial extensions in length of hospital stay for mother and newborn. However, remaining in the hospital longer has no effect on readmissions or mortality, and the estimates are precise. Our results suggest that for uncomplicated births, minimum insurance mandates incur substantial costs without detectable health benefits.

Emergency department visits linked to zolpidem overmedication nearly doubled

September 3, 2014 Comments off

Emergency department visits linked to zolpidem overmedication nearly doubled
Source: Substance Abuse and Mental Health Services Administration

The estimated number of emergency department visits involving zolpidem overmedication (taking more than the prescribed amount) nearly doubled from 21,824 visits in 2005-2006 to 42,274 visits in 2009-2010, according to a new study by the Substance Abuse and Mental Health Services Administration (SAMHSA).

The report also indicates that 68 percent of all zolpidem overmedication visits in 2010 involved females, the number of zolpidem overmedication emergency department visits for males increased 150 percent from 2005-2006 to 2009-2010 compared to an increase of 69 percent for females over the same time period.

In 2010 there were a total of 4,916,328 drug-related visits to emergency departments throughout the nation.

Other prescription drugs were involved in 57 percent of the emergency department visits involving zolpidem overmedication. These medications included benzodiazepines (26 percent) and narcotic pain relievers (25 percent). Alcohol was also combined with zolpidem in 14 percent of these hospital emergency department visits.

The changing hospital landscape: An exploration of international experiences

August 20, 2014 Comments off

The changing hospital landscape: An exploration of international experiences
Source: RAND Corporation

The nature of hospital activity is changing in many countries, with some experiencing a broad trend towards the creation of hospitals groups or chains and multi-hospital networks. This report seeks to contribute to the understanding of experiences in other countries about the extent to which different hospital ‘models’ may provide lessons for hospital provision in England by means of a review of four countries: France, Germany, Ireland and the United States, with England included for comparison. We find that here has been a trend towards privatisation and the formation of hospital groups in France, Germany and the United States although it is important to understand the underlying market structure in these countries explaining the drivers for hospital consolidation. Thus, and in contrast to the NHS, in France, Germany and the United States, private hospitals contribute to the delivery of publicly funded healthcare services. There is limited evidence suggesting that different forms of hospital cooperation, such as hospital groups, networks or systems, may have different impacts on hospital performance. Available evidence suggests that hospital consolidation may lead to quality improvements as increased size allows for more costly investments and the spreading of investment risk. There is also evidence that a higher volume of certain services such as surgical procedures is associated with better quality of care. However, the association between size and efficiency is not clear-cut and there is a need to balance ‘quality risk’ associated with low volumes and ‘access risk’ associated with the closure of services at the local level.

Reasons for Emergency Room Use Among U.S. Children: National Health Interview Survey, 2012

August 19, 2014 Comments off

Reasons for Emergency Room Use Among U.S. Children: National Health Interview Survey, 2012
Source: National Center for Health Statistics

Key findings
Data from the National Health Interview Survey, 2012

  • In 2012, children with Medicaid coverage were more likely than uninsured children and those with private coverage to have visited the emergency room (ER) at least once in the past year.
  • About 75% of children’s most recent visits to an ER in the past 12 months took place at night or on a weekend, regardless of health insurance coverage status.
  • The seriousness of the medical problem was less likely to be the reason that children with Medicaid visited the ER at their most recent visit compared with children with private insurance.
  • Among children whose most recent visit to the ER was for reasons other than the seriousness of the medical problem, the majority visited the ER because the doctor’s office was not open.

Emergency department visits for drug-related suicide attempts rise over six year period

August 11, 2014 Comments off

Emergency department visits for drug-related suicide attempts rise over six year period
Source: Substance Abuse and Mental Health Services Administration

Two new reports highlight the rise in drug-related suicide attempt visits to hospital emergency departments especially among certain age groups. The reports by the Substance Abuse and Mental Health Services Administration (SAMHSA) show that overall there was a 51 percent increase for these types of visits among people 12 and older — from 151,477 visits in 2005 to 228,277 visits in 2011.

One report analyzed the increase in emergency department visits by age and found that the overall rise resulted from increases in visits by people aged 18 to 29 and people aged 45 to 64. Visits involving 18 to 29 year olds increased from 47,312 in 2005 to 75,068 — a 58 percent increase. Visits involving people aged 45 to 64 increased from 28,802 in 2005 to 58,776 visits in 2011 — a 104 percent increase. In 2011, these two age groups comprised approximately 60 percent of all drug-related emergency department visits involving suicide attempts.

The other SAMHSA report focused on the 45 to 64 age group, which had the largest increase in emergency department visits involving drug related suicide attempts, and characterized these visits. The report found that the majority (96 percent in 2011) of these visits involved the non-medical use of prescription drugs and over-the-counter-medications. In 2011, these drugs included anti-anxiety and insomnia medications (48 percent), pain relievers (29 percent) and antidepressants (22 percent).

Other substances involved in these drug-related suicide attempt emergency department visits during the same year included alcohol (39 percent) and illicit drugs (11 percent).

The report also found that these visits by patients aged 45 to 64 doubled for both men and women during this time period.

Rural Residents Who Are Hospitalized in Rural and Urban Hospitals: United States, 2010

August 6, 2014 Comments off

Rural Residents Who Are Hospitalized in Rural and Urban Hospitals: United States, 2010
Source: National Center for Health Statistics

Key findings
Data from the National Hospital Discharge Survey, 2010

  • Sixty percent of the 6.1 million rural residents who were hospitalized in 2010 went to rural hospitals; the remaining 40% went to urban hospitals.
  • Rural residents who remained in rural areas for their hospitalization were more likely to be older and on Medicare compared with those who went to urban areas.
  • Almost three-quarters of rural residents who traveled to urban areas received surgical or nonsurgical procedures during their hospitalization (74%), compared with only 38% of rural residents who were hospitalized in rural hospitals.
  • More than 80% of rural residents who were discharged from urban hospitals had routine discharges (81%), generally to their homes, compared with 63% of rural residents discharged from rural hospitals.
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