Don’t get sick over the weekend, or go to a hospital with a lot of sick people already in beds. Flemming Madsen of the Allergy and Lung Clinic in Helsingoer, Denmark, and coauthors examined the effects of hospital bed shortages on patient outcomes using 2.65 million admissions to Danish hospitals from 1995–2012. They found that while high rates of bed occupancy (above 85 percent) can be a sign of more efficient care, they were also associated with a 9 percent increase in rates of both inhospital mortality and thirty-day mortality. In addition, they found that patients who were admitted outside of normal working hours had higher inpatient and thirty-day mortality rates, especially among the elderly. The authors further suggest that chronic bed shortages are likely a product of a self-regulating mechanism and deliberate planning to keep occupancy rates high. They recommend approaching high-occupancy rates as a public health issue as opposed to a purely economic one. They point out that the rapidly aging US population will put further strain on hospitals both with and without emergency departments.
Turns out fears of widespread hospital “upcoding” with EHRs were unfounded. Julia Adler-Milstein of the University of Michigan Schools of Information and Public Health and Ashish K. Jha of the Harvard School of Public Health analyzed national longitudinal data to determine whether new adoption of electronic health records (EHRs) would result in hospitals selecting billing codes for more intensive care or sicker patients to increase their Medicare payments, or “upcoding.” Despite widespread stories and concerns among policy makers about this potential behavior, the authors found that both EHR adopters and non-EHR adopters increased their billing to Medicare at comparable rates over the period examined. They also found no appreciable difference between adopters and non-adopters in coded patient acuity. They conclude that resources for policy interventions to reduce this type of presumed fraud are likely better applied to ensure the use of EHRs for better quality of care and reduced health care spending.
More Federally Qualified Health Centers are adopting EHRs—but could use help making them “meaningful.” Emily B. Jones of the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services and Michael F. Furukawa of the Agency for Healthcare Research and Quality found a 25 percent increase in the number of federally qualified health centers (FQHCs) with an EHR system between 2010 and 2012 (90 percent versus 64.8 percent). They also found that 49.5 percent reported meeting the basic EHR system criteria, up from 29.7 percent over the same period. The authors uncovered new disparities in EHR adoption, with smaller centers, those with higher percentages of lower-income patients, and centers in the Midwest lagging behind their counterparts. Despite strong growth overall, they noted that only one-third of the centers were ready for Stage 1 “meaningful use” standards as determined by the Centers for Medicare and Medicaid Services. In addition, Stage 1 readiness was found to be associated with quality recognition. They recommend targeting resources to centers with slower uptake and connecting providers with technical assistance to better prepare FHQCs for compliance with meaningful use requirements.
A series of papers focus on comparative effectiveness and predictive analysis:
- Implementing Electronic Health Care Predictive Analytics: Considerations And Challenges by Ruben Amarasingham of the Parkland Center for Clinical Innovation and coauthors
- The Legal And Ethical Concerns That Arise From Using Complex Predictive Analytics In Health Care by I. Glenn Cohen of Harvard Law School and colleagues
- Insights From Advanced Analytics At The Veterans Health Administration by Stephan Fihn of the Veterans Health Administration and colleagues
- Patient-Powered Research Networks Aim To Improve Patient Care And Health Research by Rachael L. Fleurence of the Patient-Centered Outcomes Research Institute and colleagues
- Assessing The Value Of Patient-Generated Data To Comparative Effectiveness Research by Lynn Howie of Duke University and colleagues
- Optum Labs: Building A Novel Node In The Learning Health Care System by Paul J. Wallace of Optum Labs and colleagues
The July issue of Health Affairs was supported by the Gordon and Betty Moore Foundation, United Health Foundation, the Patient-Centered Outcomes Research Institute, Merck, Pfizer, IBM, the John A. Hartford Foundation, the California Health Care Foundation, and the Robert Wood Johnson Foundation.
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