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Research confirms rise in number of new physicians
Research shows that an influx of fledgling physicians to hospitals nationwide each July contributes to a rise in patient deaths and inefficiencies in care. But the extent of those increases and the reasons behind them remain unclear, says an Annals of Internal Medicine study. Many researchers have studied the so-called July effect, in which patient outcomes decline as a result of hospitals undergoing major work-force changes as new residents come in and older ones complete their training. "Teaching hospitals experience a massive exodus of highly experienced physician trainees who are also familiar with the working environment of the hospital," said John Q. Young, MD, lead study author and associate program director of the University of California, San Francisco, School of Medicine's psychiatry residency program. "Those that remain assume new, more responsible roles in treating patients. And many newly minted physicians arrive to begin their training." He likened it to a footba [Read more]
Texas refuses to launch health insurance exchange
Texas declined to create a health insurance exchange during the legislative session that ended June 30, but the state did advance its own version of accountable care organizations. Gov. Rick Perry strongly opposes the health system reform law and threatened to veto any legislation that would help implement the law's health insurance exchanges. The exchanges will serve as one-stop marketplaces for qualifying health coverage beginning in 2014. Perry did not want to be seen as aiding the implementation of the health reform law in any way, said Texas Rep. John Zerwas, MD, sponsor of the leading bill to create an exchange, and Texas Medical Assn. President Bruce Malone, MD, in separate interviews. "They definitely were just very entrenched on this idea," Dr. Zerwas said. At least one other governor, Bobby Jindal of Louisiana, opposes creating a locally controlled exchange in his state. The Texas Medical Assn. supported Dr. Zerwas' measure to authorize a state insurance exchange. Ho [Read more]
Checklists more effective when physicians are prompted to use them
Checklists have been used successfully to improve surgical safety and cut infection rates in the intensive care unit, but a study suggests that checklists are even more effective when physicians are prompted by a colleague to take action on information gathered using the quality improvement tool. A study of 265 critical care patients at Northwestern Memorial Hospital in Chicago found that intensivists who relied on checklists alone did not reduce mortality rates. However, the death rate was cut in half when the checklist was accompanied by residents who asked the attending physicians how to act on information related to matters such as antibiotic prescribing, ventilator use and central-line placement. The residents were asked to nudge physicians if the checklist indicated a need for a question, and the residents were given a script of what to ask. "We always saw the checklist as sort of a data repository meant to trigger a decision," said Curtis H. Weiss, MD, lead author of th [Read more]
GAO urges tighter antibiotic resistance checks
The federal government should step up monitoring of antibiotic use and antibiotic resistance to help stem overuse of the drugs, which is rendering them ineffective, says a report by the U.S. Government Accountability Office. The GAO is calling on the Centers for Disease Control and Prevention to better track human antibiotic use and antimicrobial-resistant infections in inpatient health care facilities. "Without more comprehensive information about the occurrence of cases of antibiotic resistant infections and the use of antibiotics, the agency's ability to understand the overall scope of the public health problem, detect emerging trends, and plan and implement prevention activities is impeded," said the June report. The Dept. of Health and Human Services responded with a letter detailing several initiatives, including a survey of acute care hospitals and enhancements to surveillance systems such as the CDC's National Antimicrobial Monitoring System. "We believe that when t [Read more]
HHS awards $95 million to school health centers
Washington -- The Obama administration awarded $95 million to build or renovate 278 school-based health centers across the country, the Dept. of Health and Human Services announced July 14. Grants, which range from $10,000 to $500,000, were awarded to centers in 41 states and the District of Columbia. Clinics receiving the money serve communities where a large percentage of the population is eligible for assistance from Medicaid or the Children's Health Insurance Program. For example, Health Establishments at Local Schools received a $313,000 grant that will help the organization's clinics become part of a medical home project in Huntsville, Ala., said HEALS Executive Director Connie Carnes. HEALS is working to coordinate patient care with physician practices and other facilities through its electronic medical record system. "We'll be part of a model that will keep our kids healthy and keep them out of the ERs," Carnes said. HEALS operates four clinics and is planning to launc [Read more]
Youths with mental health conditions often turn to EDs
Creating an action plan for young patients with behavioral or emotional problems could help them receive appropriate care when they need it most and keep them out of the emergency department, says the lead author of a study. An action plan could address how patients should monitor their symptoms, what constitutes an emergency for the family and whom to contact in that situation. The study, in the June issue of Psychiatric Services, found that many youths who repeatedly go to the ED for mental health care are not there for what are considered psychiatric emergencies such as a suicide attempt or psychotic symptoms. Instead, they often have behavioral issues, which include verbal altercations and running away from home. Many patients already were being treated by an outpatient mental health professional. Although the study did not define this group, pediatric psychiatrist and study lead author Emily Frosch, MD, said it could include primary care physicians who are increasingly tr [Read more]
National prevention strategy unveiled
Washington -- The Obama administration has released a national plan that aims to improve the health of children, adults and seniors. The national prevention strategy was drafted over the past year by a public health council composed of more than a dozen federal agencies and various stakeholders. The report, which was authorized by the national health system reform law, outlines several basic approaches designed to guide health policy toward quality improvement. "As a family physician, I understand the importance of stopping disease before it starts," U.S. Surgeon General Regina Benjamin, MD, said in a June 16 statement on the report's release. "The leadership of this council and the strategy will help us create a healthy and fit nation by making prevention a part of our daily lives." The strategy offers evidence-based proposals, including several aimed at physicians. The clinical recommendations found in the report are: Support efforts to improve cardiovascular health. [Read more]
Performance measures for coronary artery disease, hypertension released
New performance measures are expected to help physicians care for adult patients who have two of the nation's most widespread chronic conditions -- coronary artery disease and hypertension. The measures were developed by the American College of Cardiology Foundation, the American Heart Assn. and the American Medical Association-convened Physician Consortium for Performance Improvement. They were concurrently published online June 12 in Circulation and June 13 in the Journal of the American College of Cardiology. The measures, which update metrics issued by the three organizations in 2005, examine whether cardiac risk factors are treated and controlled to target levels. Testing of these measurements is expected to start this year, said Joseph Drozda Jr., MD, co-chair of the writing committee. When testing is completed, the metrics can be used in accountability programs, including public reporting and pay-for-performance programs. Coronary artery disease and hypertension "are [Read more]
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