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JAMA study gives good marks to VA hospitals


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Despite occasional controversies, veterans’ hospitals compare  favorably with others in treating older men with three common conditions — heart attacks, heart failure and pneumonia, says a study on death rates and readmissions.

The study, in the Journal of the American Medical Association, said that chances of dying or being readmitted within 30 days of treatment for those conditions varied only slightly  between patients hospitalized within the VA system and outside hospitals.

The Associated Press reported that the results contrast with news stories  about quality questions and long waits for care. They suggest that VA hospitals “are still able to deliver high-quality care for some of the sickest most complicated patients,” Ashish Jha, M.D., a Harvard health-policy expert, said in an editorial published with the JAMA study.

At VA hospitals, death rates were marginally lower after a heart attack — 13.5 percent vs 13.7 percent for outside hospitals; and for heart failure — 11.4 percent vs 11.9 percent. They were slightly higher for pneumonia — 12.6 percent vs. 12.2 percent at non-VA hospitals.

Readmission rates ranged from about 17 percent to 25 percent for the three conditions and were highest at VA hospitals, but only by about 1 percentage point or less.

“Both groups are now working on quality in ways they didn’t a decade ago and the levels of good performance are quite comparable” for the conditions studied, said lead author Harlan Krumholz,  M.D., a Yale University cardiologist and researcher.

Trying to address hospitals’ perilous ‘weekend effect’


Chuck Lauer, a former Modern Healthcare publisher, writes about how to combat “weekend effect” in hospitals.

“Simply put, there are fewer physicians and nurses {on weekends} to treat patients, and fewer technicians to operate life-saving equipment on the weekend. However, people don’t have fewer medical problems on the weekend. They still have heart attacks, accidents and other emergencies, and there are plenty of patients admitted for elective procedures over the weekend.

“So it doesn’t surprise me that there’s a markedly higher death rate for patients admitted on the weekend ….”

“In an industry like healthcare, where you are dealing with life and death issues, is it permissible to reduce the availability of services and use second-string staffing for two days of every week?”

“Examining policies at 117 Florida hospitals and their outcomes for 126,666 patients, researchers concluded that by boosting specific services, hospitals could lower the rate of complications on the weekend.

“These strategies involved raising the nurse-to-bed ratio, fully adopting EHRs and improving inpatient physical rehabilitation, home health and pain management.

“Interestingly, simply hiring more staff — increasing the nurse-to-bed ratio — was not the most effective of these strategies. While hospitals that raised the nurse-to-bed ratio were 1.44 times more likely to overcome the weekend effect, the likelihood rose to 2.37 times for hospitals that had home health programs and 4.74 times for hospitals that fully adopted EHR.”


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