Archive for May 2013

Patient participation in medical decision making

This large single center study found 29% of patients wanted to participate in medical decision making, which was more likely in those highly educated and with private insurance. This preference was associated with a longer LOS (0.26 days) and higher cost ($865). This is the first study to link preference with medical decision making and utilization (abstract).

How UCSF is Solving the Quality-Cost-Value Jigsaw Puzzle

I sometimes explain to medical students that they are entering a profession being transformed, like coal to diamonds, under the pressure of a new mandate. “The world is going to push us, relentlessly and without mercy, to deliver the highest quality, safest, most satisfying care at the lowest cost,” I’ll say gravely, trying to get their attention. “What exactly were you trying to do before?” some have asked, in that wonderful way that smart students blend naiveté with blinding insight. It is pretty amazing that healthcare has been insulated from the business pressures that everybody from Yahoo! to my father’s garment business have experienced since the days of Adam Smith. We experienced a bit of this pressure in the mid-1990s, when pundits declared healthcare inflation “unsustainable” (sound familiar?) and we invented managed care to slay it. We know how that story ended – the public and professional backlash against HMOs…

No benefit to intensivist staffing overnight in academic ICUs

This trial found no difference in patient outcomes (mortality or LOS) if admitted during a time of 24/7 intensivist coverage, or during a time with only daytime intensivist coverage (with home call at night) in a medical ICU. This study does not show a patient benefit to a 24/7 intensivist staffing model in an academic medical ICU (abstract).

Prone best for severe ARDS

This trial of patients with severe ARDS randomized them to prone (at least 16 hours a day) or supine positioning. Those in the prone position had significantly lower 28 day mortality (16% vs 33%), and 90 day mortality (24% vs 41%) with no difference in complications (abstract).

Music for ICU patients

This study of patients intubated in the ICU randomized them to patient-initiated/directed music, noise canceling headsets, or usual care. Those in the music group had significantly lower anxiety scores and use of sedatives compared to usual care. Those in the music group also had lower sedation frequency (but not sedation intensity or anxiety scores) compared to the noise canceling headset group. Both noise canceling headsets and music therapy can be beneficial in intubated ICU patients (abstract).