News & Trends Health-System Edition

DeKalb Medical and Walgreens Unite to Improve Patient Outcomes

DeKalb Medical has teamed up with Walgreens pharmacists to help improve medication adherence in patients after leaving the hospital. During the 3-month period following the program’s launch, DeKalb improved its top box scores pertaining to patient communications on medication from 50% to 63%, according to the Hospital Consumer Assessment of Healthcare Providers and Systems. Scores have continued to trend upward beyond the initial 90-day period, the company said.

In July 2011, Walgreens, which operates a full-service outpatient pharmacy on the DeKalb campus, implemented a patientcentered discharge medication program. The service provides patients with instructions for their medication prior to hospital discharge and delivers prescriptions to the patient at their bedside. By eliminating the need to travel to a pharmacy following a hospital stay, the service can improve the patient’s ability to comply with medication therapy. In addition, Walgreens pharmacists conduct follow-up phone calls to patients within 72 hours of discharge from the hospital to answer questions on medications, potential side effects, and treatment programs.

“A patient who is informed and secure in their treatment program following a hospital stay is more likely to stay adherent to their medications and to achieve a better health outcome,” said Cathleen Wheatley, MS, RN, DeKalb Medical’s senior vice president and chief nurse executive. “By working with Walgreens, we’ve been able to ease the burden on DeKalb Medical patients and their families during challenging times by offering simple and easy access to medications and to health and pharmacy professionals who can address concerns and questions that can follow a hospital stay.”

Tracking System Enables Hospitals to Monitor Antibiotic Use

The Centers for Disease Control and Prevention (CDC) launched an antibiotic tracking system that will enable hospitals to monitor antibiotic use electronically, which can lead to more informed decisions about how to improve antibiotic use and analyze trends.

Although antibiotics can be extremely beneficial in helping patients fight infections, overuse and misuse can lead to resistance, which increases the risk of an infection that can prolong a patient’s hospital stay. Patients who take antibiotics can also experience side effects such as allergic reactions, and may be at increased risk for Clostridium difficile infection.

“Antibiotic use leads to antibiotic resistance, which is a major public health problem,” said CDC Director Thomas R. Frieden, MD, MPH. “Hospitals and other health care facilities should monitor the antibiotics used in their facilities. This new system is a powerful tool that will enhance providers’ ability to monitor and improve patterns of antibiotic use so that these essential drugs will still be effective in the years to come.”

The antibiotic use tracking system is part of CDC’s National Healthcare Safety Network, a surveillance system for monitoring infections in health care facilities that includes more than 4800 hospitals. The CDC has provided funding for 4 health departments and their academic partners to implement the tracking system in 70 hospitals. In addition, any hospital that participates in the National Healthcare Safety Network can utilize the tool by working directly with its pharmacy software vendor to transmit data electronically from drug administration or bar coding records.

Elderly Patients Less Likely to Receive Pain Meds in the ED

Individuals 75 years and older are less likely to receive any pain medication in hospital emergency departments (EDs) than middle-aged patients, according to a study published online in the Annals of Emergency Medicine (October 28, 2011). The disparity remained even after researchers considered the amount of pain a patient was experiencing. Among older adults reporting severe pain, 67% received pain medication compared with 79% of those 35 to 54 years old.

“We’re not exactly sure why this happens,” said lead investigator Timothy F. Platts-Mills, MD. “It may be because physicians are more concerned about potential side effects in this population.”

In the study, Dr. Platts-Mills and colleagues conducted a secondary analysis of data collected from US EDs between 2003 and 2009 to test the hypothesis that older adults who present to the ED with a primary complaint of pain are less likely to receive pain medication than younger patients.

They found that 49% of patients 75 years and older received an analgesic, compared with 68% of middle-aged patients. Similarly, 34.8% of elderly patients received an opioid compared with 49.3% of middle-aged individuals. After adjusting for a number of factors, including sex, race/ethnicity, and pain severity, researchers determined that elderly patients were 19.6% less likely to receive an analgesic and 14.6% less likely to receive an opioid than middleaged patients.

The gap researchers observed in pain management for older patients underscores the need for improved understanding on how to best manage pain in this population, as well as the barriers that exist to providing optimal care, Dr. Platts-Mills noted.

“All patients, regardless of age, deserve to have relief from pain, especially when it is severe,” he said.

Patients Failing to Follow Up After Hospital Discharge

New data from the Center for Studying Health System Change (HSC) indicate that 1 in 3 adult patients do not see a physician within 30 days of being discharged from the hospital. After 3 months, 17.6% still had not seen a physician, nurse practitioner, or physician assistant, despite the fact that many of these patients are at high risk of readmission because of chronic conditions or physical activity limitations.

The study, which used 2000-2008 data from the nationally representative Medical Expenditure Panel Survey to estimate the prevalence of hospital readmissions for all causes—other than obstetrical care—in adults 21 years and older, also found that 1 in 12 adults (8.2%) discharged from a hospital to the community was readmitted within 30 days, and 1 in 3 adults (32.9%) was rehospitalized within a year of discharge.

The study findings indicate that gaps in care after discharge are common for adults covered by all types of insurance, and that the lack of a usual source of care does not appear to be a barrier to receiving follow-up care. However, many patients discharged from a hospital to home face challenges accessing their usual source of care, the authors noted.

“The implication is that reforms specific to 1 payer and focusing only on care processes within hospitals may fall short unless efforts to coordinate with community providers—and to encourage patients’ access to these providers— receive at least as much attention,” said HSC Senior Researcher Anna Sommers, PhD, coauthor of the study.

Strategies that could address gaps in care after discharge include bundled payments and patient-centered medical home efforts, which can help hospitals and community-based clinicians to work together to lower rates of avoidable readmissions or rehospitalizations for other conditions.

Study Identifies Risk Factors for In-Hospital Falls

Patients who undergo joint replacement revision surgery or who have certain comorbid conditions are at an increased risk for in-hospital falls, according to research published online ahead of print on November 24, 2011, in the Journal of Arthroplasty.

In-hospital falls have been shown to increase morbidity, lengthen hospital stays, and increase health care costs, and can cause wound complications and other issues such as concussions that are not related to the primary procedure. According to the study, falls occur in 2% to 17% of patients during short-term hospitalization.

In the study, a team of researchers from the Hospital for Special Surgery led by Stavros Memtsoudis, MD, PhD, analyzed a large national database of patients between 1998 and 2007 to obtain more in-depth information about falls in those undergoing orthopedic procedures.

The investigators found that the following patients were more likely to suffer a fall:

• Patients who experienced a total hip or knee replacement

• Men

• Older patients

• Individuals belonging to a minority race

• Patients with comorbid conditions, including congestive heart failure, a clotting or bleeding disorder, liver disease, neurologic disease, electrolyte/ fluid abnormalities, and recent weight loss

Individuals with pulmonary circulatory disease were at the greatest risk, according to the study. Postoperative complications, including deep vein thrombosis, adult respiratory distress syndrome, and pulmonary embolism, were also associated with higher fall rates, although it remains unclear whether they were the reason for or the consequence of the event, the authors noted.

“We detected an alarming increase in the national prevalence of this potentially preventable problem and identified a number of patient factors that were associated with an increased risk of falling during a hospital stay,” said Alejandro Gonzalez Della Valle, MD, one of the study’s authors. “The information in our study can be used by health care professionals to design or perfect in-hospital fall prevention programs.” PTHS