Archive for November 2011

30 day readmission risks after PCI

In this large single center analysis of all PCI patient (elective or after acute coronary syndrome), ~10% were readmitted within 30 days after discharge. They found risk factors for readmission included female sex, Medicare, unstable angina, LOS>3 days, low education, and some co-morbid conditions (history of CVA/TIA, COPD, metastatic cancer, peptic ulcer, kidney disease). These can help stratify patients for readmission risk and can help design strategies to reduce that risk (abstract)

Steroids beneficial in ventilated COPD patients

In this randomized trial of patients with COPD receiving ventilatory support in the ICU, those randomized to steroids (methylprednisolone versus placebo) had fewer days of ventilation, shorter ICU LOS, and were less likely to fail non-invasive ventilation. Not surprisingly, but now definitively proven, steroids are beneficial for COPD patients in the ICU receiving ventilatory support (abstract).

Top meds causing hospitalizations

In this nationally representative sample of US hospitals, elderly patient hospitalized for an adverse drug event were caused by warfarin, anti-platelets, insulin, and hypoglycemic agents in 2/3 of cases. System checks should be built in for these medications at all care transitions (abstract)

Follow Up To Annals of IM Hospitalist Study

The August 2nd citation, Association of Hospitalist Care With Medical Utilization After Discharge: Evidence of Cost Shift From a Cohort Study, generated an enormous amount of attention.The response was significant, and many of the letters published are worth reading (in particular, Dan Brotman's).   (more…)

“I’m the Main Breadwinner”: The British Primary Care System and Its Lessons for America

I’ve heard a lot of shocking things since arriving in England five months ago on my sabbatical. But nothing has had me more gobsmacked than when, earlier this month, I was chatting with James Morrow, a Cambridge-area general practitioner. We were talking about physicians’ salaries in the UK and he casually mentioned that he was the primary breadwinner in his family. His wife, you see, is a surgeon. This more than any other factoid captures the Alice in Wonderland world of GPs here in England. Yes—and it’s a good thing you’re sitting down—the average GP makes about 20% more than the average subspecialist (though the specialists sometimes earn more through private practice—more on this in a later blog). This is important in and of itself, but the pay is also a metaphor for a well-considered decision by the National Health Service (NHS) nearly a decade ago to nurture a contented,…