In the Literature
In This Edition
- Pay-for-performance associated with limited benefits on quality in acute myocardial infarction patients.
- Meta-analysis finds increased risk of acute myocardial infarction with use of rosiglitazone.
- Rosiglitazone increases risk of heart failure, but not acute myocardial infarction or death, interim analysis shows.
- Surgery versus prolonged conservative treatment for severe sciatica.
- Predicting poor outcomes in upper gastrointestinal bleeds.
- Discharging patients with unresolved medical issues.
Low incidence of heparin-induced thombocytopenia in hospitalized patients
This one-year single institution retrospective study found an overall incidence of heparin-induced thombocytopenia of 0.2% (0.76% with IV unfractionated heparin and <0.1% with subcutaneous heparin) with half occurring in coronary artery bypass graft and/or valve replacement patients, and none in hip/knee arthroplasty patients.
Citation: Smythe MA, Koerber JM, Mattson JC. The incidence of recognized heparin-induced thrombocytopenia in a large, tertiary care teaching hospital. Chest 2007;131(6):1644-1649.
Prognostic indication of platelet decline in ICU patients
In this single institution study, researchers found a 30% platelet decline independently predicted death in a multivariable model of ICU patients (OR 1.54, confidence interval 1.12-2.14).
Citation: Moreau D, Jean-François T, Aurélien V. Platelet count decline: an early prognostic marker in critically ill patients with prolonged ICU stays. Chest 2007;131(6):1735-1741.
Hospitals and prevention of central venous catheter-related bloodstream infections
A random survey of infection control coordinators found that only 62% of VA hospitals and 44% of non-VA hospitals were routinely making concurrent use of three techniques (maximal sterile barrier precautions, chlorhexidine gluconate, and avoidance of routine central line changes) to prevent CR-BSIs. Prevention strategy use was higher in hospitals that had a higher safety culture score, those with certified infection control professionals, and those that participated in a prevention collaborative.
Citation: Krein SL, Hofer TP, Kowalski CP. Use of central venous catheter-related bloodstream infection prevention practices by U.S. hospitals. Mayo Clin Proc. 2007;82(6):672-678.
Does Pay for Performance Improve Hospital Quality?
Background: In 2003, the Centers for Medicare and Medicaid Services (CMS) instituted a pay-for-performance (P4P) pilot program in which participating hospitals would be reimbursed more if they met specific quality standards of care for patients with certain conditions, including acute myocardial infarction (AMI). It is unknown if this type of financial incentive produces improvements in the processes or outcomes of care.
Study design: Observational cohort.
Setting: 500 hospitals across the U.S.
Synopsis: This study compared compliance with CMS quality indicators in the treatment of more than 100,000 patients with acute non-ST-elevation myocardial infarction at 54 participating and 446 non-participating hospitals in the P4P pilot. They found no significant difference in mortality or in a composite measure of the six quality indicators but a slight improvement in two of the six quality indicators (aspirin at discharge and smoking cessation counseling). They did not find that P4P adversely affected indicators not subject to financial incentives.
Bottom line: P4P is associated with limited improvements in compliance with CMS quality indicators in patients with AMI.
Citation: Glickman SW, Ou F-S, DeLong ER, et al. Pay for performance, quality of care, and outcomes in acute myocardial infarction. JAMA. 2007 Jun;297(21):2373-2380.
Is Rosiglitazone Associated with Adverse Cardiovascular Outcomes in a Meta-analysis?
Background: Rosiglitazone (Avandia) is one of two approved oral thiazolidinedione drugs used for diabetic control. Muraglitazar, another thiazolidinedione drug, was not approved for market due to adverse cardiovascular outcomes. The cardiovascular effects of rosiglitazone had not previously been evaluated.
