Hospitalizations related to superbug infections double over six years
Hospitalizations related to MRSA—methicillin-resistant Staphylococcus aureus—infections increased from 127,000 in 1999 to nearly 280,000 in 2005, a study finds. During that same period, hospitalizations of patients with general staph infections increased 62 percent across the country.
Staph, or Staphylococcus aureus, is a kind of bacteria that attacks wounds and causes life-threatening infections, such as blood poisoning and pneumonia. MRSA is a “superbug” that has evolved resistance to most commonly used antibiotics, so it is more difficult and expensive to treat.
The study found that such infections are now “endemic, and in some cases epidemic” in many U.S. hospitals, long-term care facilities and communities. Researchers say that control of the infection should be made a “national priority.”
Researchers at Resources for the Future and the University of Florida found that the pattern of infection is changing. “Antibiotic-resistant infections are spreading more rapidly in the community while the epidemic of drug-resistant infections in hospitals continues unabated,” says senior study author Ramanan Laxminarayan of Extending the Cure, a project of Resources for the Future.
Antibiotic-resistant infections increase direct costs by 30 percent to 100 percent, according to various studies. MRSA-specific studies suggest that the additional cost of treating an antibiotic-resistant staph infection versus an antibiotic-sensitive infection range from a minimum of $3,000 to more than $35,000 per case. This suggests that such infections cost the health care system an extra $830 million to $9.7 billion in 2005, even without taking into account indirect costs related to patient pain, illness and time spent in the hospital.
The researchers offer several suggestions to address the spread of both staph and MRSA infections. These include national surveillance or reporting requirements for these infections, more research to explore the interaction between community- and hospital-associated infection, stepped-up efforts to control hospital infection, and increased investment in the development of a staph vaccine.—The study was published in the December 2007 issue of the journal Emerging Infectious Diseases.
Relatives of ICU patients want more information and emotional support from staff
At first glance, the results of a recent study of intensive care units seem paradoxical: Family members of patients who died in the ICU were more satisfied with the care they and the patient received than were relatives of patients who survived the ICU. However, researchers say, there is a logic to the response.
“These findings do not necessarily indicate that dying patients in the ICU receive better care, but they suggest that ICU clinicians may devote extra time and attention to the needs of patients and their families when death is imminent,” says Patricia A. Grady, R.N., director of the National Institute of Nursing Research. The study, Grady says, shows how ICU staff can ease the stress of all ICU patients and their families.
A common theme among all family members is the desire for information and emotional support, says J. Randall Curtis, M.D., principal investigator of the study. “In fact, clinician-family communication is possibly the most important factor driving family satisfaction in the ICU,” he says.
The largest differences between families of patients who died and those who survived occurred in the responses to family-centered items: inclusion in decision-making; clinician communication; emotional support; staff respect and compassion; willingness of staff to answer questions; and consideration of family needs.—The study was reported in the Nov. 13, 2007, issue of the journal Chest.
What doctors say is proper behavior isn’t always what they practice
American physicians overwhelmingly believe that incompetence and mistakes among peers should be reported. However, when they witness those problems, nearly one-half fail to do anything, according to a survey of 1,600 physicians.
Those were among numerous gaps between what physicians believe is professional and ethical and what many do in practice, including:
•Although physicians say they don’t want to waste scarce medical resources, 36 percent said they would order unneeded magnetic resonance imaging for back pain, not because it was necessary, but because the patient requested it.
•98 percent of the responding physicians believe in minimizing disparities in care due to a patient’s race or gender. However, only 25 percent said that they even look for that gap in their own practice.
•Although 96 percent of physicians said they would put a patient’s welfare above their own financial interest, a large majority of physicians also said they would refer patients to an imaging facility with which they had a financial connection.
•Between 93 percent and 96 percent of physicians said they believe they should report all instances of significant incompetence or medical errors that they observe to the proper authorities, yet nearly half did not do so.
•93 percent believe they should provide necessary care regardless of a patient’s ability to pay. However, only 69 percent are currently accepting uninsured patients.
•77 percent of physicians believe they should undergo recertification examinations periodically, but only 33 percent have undergone a competency assessment by a provider organization or health plan since graduating from medical school.
•Nearly all physicians believe they should participate in peer evaluations of the quality of care provided by colleagues and should be willing to work on quality improvement projects. But only a little more than half have participated in a formal medical error reduction initiative or have reviewed other physicians’ medical records for quality improvement reasons.
The findings are from the Institute on Medicine as a Profession’s Survey on Medical Professionalism. IMAP is a New York City-based organization affiliated with Columbia University.
“There is a measurable disconnect between what physicians say they think is the right thing to do and what they actually do,” says lead author Eric Campbell, associate professor at Massachusetts General Hospital’s Institute for Health Policy and Harvard Medical School. “This raises serious questions about the ability of the medical profession to regulate itself.”—The study can be found at www.imapny.org.
Osteoporosis study makes clear case for EMR, follow-up program
Electronic medical records and outreach programs of e-mail messages, letters and phone calls to patients and their primary care providers after a bone fracture can dramatically improve the diagnosis and management of the patients’ osteoporosis, according to a Kaiser Permanente study. This is the largest study to show that electronic medical records improve the continuity of care for osteoporosis.
“Often when a patient sustains a fracture, there is a disconnect between the treating orthopedist and the patient’s primary care physician. With Kaiser Permanente’s computerized database and integrated care delivery system, we can closely monitor and follow patients with fractures and prevent that disconnect,” says Adrianne Feldstein, M.D., an investigator at the Kaiser Permanente Center for Health Research in Portland, Ore., and the lead author of the study.
The study of 3,588 women shows that an outreach program targeted to patients with a previous fracture led to an improvement from 13.4 percent to 44 percent of patients being evaluated and/or treated for osteoporosis. Osteoporosis management is the receipt of a bone mineral density measurement or osteoporosis medication in the six months after a fracture. If widely implemented, the approach could substantially improve the secondary prevention of osteoporosis, say the study authors.—The study was published in the September 2007 issue of the Journal of the American Geriatrics Society.
This article 1st appeared in the January 2008 issue of HHN Magazine.
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