Archive for August 2009

Hospitalists: A Little Slice of Mayo

Much has been made of the superior performance – on both cost and quality – of integrated healthcare organizations like the Mayo and Geisinger Clinics. But since the defining characteristic of these standout systems is at least 50 years of integrated history, few believe that the rest of us – namely the docs and hospitals that provide the bulk of American healthcare – can quickly achieve such seamless integration, even if the perfect bill emerges from the Congressional sausage factory.And it’s increasingly clear that the perfect bill will not be coming out of Washington this year.Is hope lost? Is it possible to create tighter integration between hospitals and doctors without a legislative Attaboy? Can healthcare organizations and physicians be incented to deliver the highest quality, safest, most reliable, most patient-centric care at the lowest possible cost without Atul Gawande reading the findings of the Dartmouth Atlas into the Congressional Record?…

Oral care protocol reduces ventilator-associated pneumonia

In this before-after study of ventilated patients, an oral care protocol (q4 hours) reduced the incidence of ventilator-associated pneumonia from 12.6 to 1.3 cases / 1000 ventilator days. This adds to the literature that evidence-based protocols can improve quality (abstract).

Typhoid fever in the US

In this cross sectional analysis of salmonella typhi samples submitted to the Centers for Disease Control, 79% of patients had traveled within 30 days, and 73% were hospitalized (mean age 22). Susceptibility testing showed that 13% were multi-drug resistant, and 97% had decreased susceptibility to ciprofloxacin. Multi-drug resistance was more common in travelers to the Indian continent (abstract). Salmonella typhi in recent travelers is likely to have a high incidence of drug resistance.

Survey data is often much more complicated to interpret than it first appears

John Nelson writes... Compensation and production surveys generally set the standard on physician compensation and production.  The longer I spend looking at survey methodologies and results, the more I’m convinced that there are a lot of devils in the details that may misled many people who rely on these surveys.  As an example, I’ve adapted below something originally written by, Leslie Flores, who is the director of SHM’s Practice Management Institute and my consulting colleague.  What follows was written in response to a question about the differences in the SHM and MGMA surveys of hospitalist productivity and compensation, especially related to their results in the South.  It serves an example of the complexity of interpreting the surveys. (more…)

Novel H1N1 vaccine delays expected

There are now expected to only be 45 million vaccine dose available by October (short of the initial 120 million expected), but the full 195 million are expected to be available by December (full story)