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Benefits Seen With Patient Activation

Benefits Seen With Patient Activation

Reducing 30-day readmission rates has become an important mission to helping improve quality of care and containing healthcare costs. Previous studies have suggested that patients who have the know­ledge, skills, and confidence to manage their own care after hospital discharge—a concept dubbed patient activation—can result in better health outcomes and lower rates of health service utilization. “It’s possible that greater patient activation can help decrease rates of 30-day hospital readmissions among those with chronic illnesses,” says Suzanne E. Mitchell, MD, MS. An In-Depth Analysis In a study published in the Journal of General Internal Medicine, Dr. Mitchell and colleagues sought to determine the role of patient activation in the rate of hospital readmissions within 30 days of hospital discharge. The study team used an abbreviated version of the Patient Activation Measure (PAM), an assessment that was developed to measure how actively patients are involved in their healthcare. Based on PAM responses, participants were assigned a PAM level between 1 and 4, with level 1 being the least engaged and level 4 being the most engaged. The total 30-day post-discharge hospital utilization was defined as total ED visits plus hospital readmissions, including observation stays. According to the study results, 30-day post-discharge hospital utilization was higher for those with lower levels of activation (PAM level 1) when compared with highly activated patients (PAM level 4). The rate ratio for PAM level 1 patients was also higher when compared with PAM level 4 patients for ED use alone and for hospital readmissions alone. “We observed a dose-effect between patient activation and readmissions in that the rate of readmissions decreased with increasing levels...
GI Cancer: Avoiding Potential Hospitalizations

GI Cancer: Avoiding Potential Hospitalizations

Hospitalizations are a distressing experience for patients with cancer and their families, especially when they occur near the end of life. Studies show that hospitalizations are the largest single component of spending for cancer care in the United States. Hospital admissions for patients with cancer vary substantially from region to region. This variability suggests that many hospitalizations are avoidable, according to Gabriel A. Brooks, MD. “Effective strategies to reduce potentially avoidable hospitalizations would increase our ability to provide high-quality, patient-centered care that is conscious of costs.” Potentially avoidable hospitalizations have been examined broadly in published research, but conclusions from these studies are often poorly generalizable to oncology care. Such studies tend to focus on chemotherapy-related hospitalizations when conducted in patients with cancer. While it has been estimated that as many as one-third of hospitalizations in patients receiving chemotherapy are toxicity-related, these analyses have not addressed the extent to which chemotherapy-related hospitalizations are avoidable. Looking at GI Cancers Colorectal and pancreatic cancer are two gastrointestinal (GI) cancers that are among the five leading causes of cancer-related death in the United States. These diseases contribute substantially to inpatient hospitalizations in patients with cancer. In the Journal of Clinical Oncology, Dr. Brooks and colleagues had a study published that examined the incidence and characteristics of potentially avoidable hospitalizations in patients with GI cancers. “Characterizing potentially avoidable hospitalizations in patients with GI cancer will enhance our knowledge base and inform the design of future interventions,” says Dr. Brooks. In the study, Dr. Brooks and colleagues evaluated 201 hospitalizations in 154 unique patients with GI cancer. Colorectal cancer was the most common diagnosis, and...
Reality Check: Hospital Patient Safety Scores

Reality Check: Hospital Patient Safety Scores

Imagine you are sick and live in the upper Manhattan section of New York City. Your doctor tells you that you need major surgery. Luckily, you have excellent insurance and can go anywhere in the city for that operation. Being an intelligent consumer, you decide to check HospitalSafetyScore.org, which is sponsored by the Leapfrog Group, a nationally known patient safety organization. You pull up a handy map of upper Manhattan and the lower Bronx to check the safety scores of hospitals in the area near your neighborhood. A hospital on the Manhattan side (orange arrow) has a safety score of only “C,” whereas another upper Manhattan hospital (green arrow) has a “B” rating, and over in the Bronx, there is an “A”-rated hospital (blue arrow). It’s a no-brainer, right? Clearly, the least safe of the three is the one with the “C” rating. But consider this. The “A”-rated hospital is Lincoln Medical and Mental Health Center, and the “B”-rated Hospital is Harlem Hospital Center. Both are teaching hospitals owned and run by the city of New York. But there is little research going on in either, and there are no regionally or nationally recognized experts in just about any specialty of medicine or surgery practicing there. The “C”-rated hospital is New York Presbyterian, the main teaching hospital of Columbia University’s medical school. A 2012 patient safety study by Consumer Reports listed the 30 worst hospitals for patient safety in the New York metropolitan area. Lincoln was the 16th worst, and Harlem was 23rd. Presbyterian did not make that list. Healthgrades rated New York Presbyterian as #5 of 203 hospitals in...
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