After trauma, uninsured patients more apt to die

Hospitalized trauma patients without insurance are more likely to die than those who are insured, a new study in the Archives of Surgery finds.

Most research has focused on access-to-care as a likely cause of care disparities between the insured and uninsured. By looking at hospitalized patients, however, this study suggests other factors may be at play.

Researchers analyzed records from the National Trauma Data Bank, assessing demographic info, medical history, injury severity, outcomes and charges for 687,091 adult admitted between 2002 and 2006. Patients were divided into five insurance categories: uninsured, a managed care organization, commercial indemnity insurance, Medicare or Medicaid. Overall, the uninsured had the highest death rates after controlling for sex, age, race and severity and type of injury. This held true for young adults (age 18-30 years), too, who were less apt to have co-morbid illnesses.

The study authors speculate that patients without insurance may be at higher risk due to treatment delay, lower health literacy, and receipt of fewer diagnostic tests. "Treatment often is initiated before payer status is recognized; thus, this provokes the question of whether differences exist in processes of care during the hospital stay,” the authors said.

Labels: mortality, trauma, uninsured

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posted by Jessica Berthold at 8:00 AM   0 Comments

Great American Smokeout is today

As you may know, today is the Great American Smokeout....a great time to nag those co-workers who congregate outside the hospital and light up. (I don't know about other places, but despite rules that prohibit smoking within a certain distance of hospital entrances, plenty of folks here in Philly still puff away near the doors.)

By the way, look in the January issue of ACP Hospitalist for tips on helping hospitalized patients quit smoking. ACP Internist recently ran an article on smoking cessation tips, as well.

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posted by Jessica Berthold at 10:22 AM   0 Comments

More jobs on the horizon for hospitalists?

In what seems to be another vote of confidence that the worst of the recession is behind us, most hospital CEOs plan to hire more doctors and nurses in the next six months, a new survey reports.

In the survey of 285 hospital CEOs conducted by healthcare staffing company AMN Healthcare, a majority report a shortage of nurses (91%), pharmacists (86%) and allied healthcare professionals (79%). While 24% of CEOs report cutting back on nurse recruitment in the last six months, the same percentage report they have increased physician recruiting efforts in that time period.

Looking ahead, 93% expect to maintain or increase physician recruiting, while 89% expect to maintain or increase nurse recruiting, in the next six months. Only 11% say they will decrease recruitment of health professionals in the near future.

Labels: recession, recruitment

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posted by Jessica Berthold at 2:55 PM   0 Comments

Medical news of the obvious

Sadly, we found no news of the obvious for this week. Maybe that's a good thing for medicine, but it means we don't get to highlight one of our favorite features. Send us your ideas and check back every Monday.

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posted by Ryan DuBosar at 9:00 AM   0 Comments

Seeing red, or fading to black?

Are hospitals starting to recover from the recession? Depends on whom you ask.

A report issued this week by Thomson Reuters states that the median profit margin for U.S. hospitals rose to 8.4% in the second quarter of 2009, compared to 0.37% in the third quarter of 2008. The recovery, says a news release, occurred in various settings, from large academic hospitals to small community hospitals.

But the AHA reports that 34% of community hospital CEOs surveyed in August expect losses for the first half of 2009, up from 29% in the first half of 2008. While 11% of those CEOs report an improvement in their hospitals' ability to access capital since December 2008, 31% say their ability to do so is "continuing to get worse" and 58% say it is the same.

Other findings from the Thomson Reuters analysis:

• About 20% of hospitals had negative total margins in Q2 09-- similar to the rate seen before the recession started in late 2007. In Q1 09, 30% of hospitals were operating with negative margins. In Q3 08, half of U.S. hospitals were in the red.
• Hospitals' median days-cash-on-hand has increased from 90 days in Q1 09 to 146 days in Q2 09, which is higher than the historic long-term average.
• Hospitals have maintained a stable ratio of staffing levels per occupied bed during the recession, but total labor costs are down about 2.25% in Q2 09 due to reduced lengths of stay.
• Mean patient discharge volumes for all hospitals began declining shortly after the recession started, but moved into positive territory in Q2 09.
  

Additional findings from the AHA survey of 768 community hospital CEOs:

• 52% of hospitals see an increased need for subsidized services.
• 51% have reduced staff in response to economic challenges.
• 46% report a moderate to significant decrease in operating margins.
• 39% report a decrease in days-cash-on-hand.
• 79% of hospitals have had doctors seek an increase in pay for on-call or other service to the hospital.

Labels: finances, recession

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posted by Jessica Berthold at 4:27 PM   0 Comments

End-of-Life Hospitalizations: New data

Septicemia was the major cause of mortality in the hospital in 2007, accounting for 15% of total deaths, according to some cheery new data by the AHRQ.

The other top causes were respiratory failure (8% of deaths), stroke (6% of deaths), pneumonia (5%), heart attack (5%); and congestive heart failure (4%).

More interesting facts, courtesy of AHRQ's analysis of more than 765K in-hospital deaths:

• 32% of all deaths in the U.S. in 2007 were inpatient hospital deaths.
• 12% of patients who died had been admitted for elective procedures or other non-urgent reasons; 72% were ED admissions.
• The average cost of hospital stays that led to death was $26,035. For those discharged alive, the average cost was $9,447. The cost difference is mainly due to length of stay: 8.8 days for those who died, compared to 4.5 days for those who lived.
• 67% of patients who died in the hospital were on Medicare; 20% were privately insured; 2% were on Medicaid; 3% were uninsured. Not sure about that other 8%.
• A Medicaid patient who died cost $38,939, on average, which is about $15,000 more than a Medicare or uninsured patient, and $10,000 more than a privately insured patient.
  

The above information comes from the AHRQ report The Costs of End-of-Life Hospitalizations, 2007.

Labels: AHRQ, costs

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posted by Jessica Berthold at 12:23 PM   0 Comments

Medical news of the obvious

Men who get their sleep apnea treated golf better. Twelve golfers with moderate to severe obstructive sleep apnea who started nasal positive airway pressure (NPAP) treatment saw a drop in their mean handicap from 12.4 to 11.0 (P=0.01), compared to 12 controls. The rested duffers said they felt more alert, and NPAP compliance was 85%, said researcher, who added he wants to conduct a larger, multicenter study to explore what drives high treatment compliance. (It must be those really powerful tee shots.)

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posted by Ryan DuBosar at 9:00 AM   0 Comments