Ontario (Canada) ombudsman could hold hospitals to account - thestar.com

Ontario ombudsman could hold hospitals to account - thestar.com

"Ontario is also the only province whose ombudsman cannot investigate hospitals and long-term care facilities."

abstract: Study: Vast Majority of C difficile Infections Occur in Medical Settings, April 4, 2012, Voelker 307 (13): 1356 — JAMA

Study: Vast Majority of C difficile Infections Occur in Medical Settings, April 4, 2012

Most Clostridium difficile infections, often assumed to be community acquired, actually occur in medical settings, according to recent data from the Centers for Disease Control and Prevention (CDC). 

In fact, 94% of the potentially fatal infections are in people who recently received care in facilities such as hospitals, nursing homes, physicians' offices, and outpatient surgical centers. To stem the rising tide of C difficile infections, CDC officials say hospitals and other health care settings need greater adherence to infection control practices and improved communication to notify each other whenever they transfer an infected patient. 

“These infections are now a patient safety concern everywhere medical care is given,” said Clifford McDonald, MD, a CDC medical epidemiologist and lead author of the study in the Morbidity and Mortality Weekly Report (http://tinyurl.com/7dh83hh). “About 25% of C difficile infections first show symptoms among patients in hospitals; 75% first show symptoms among patients in nursing …"

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Bloomberg News: Canadian Hospitals That Spend More on Patients Get More - Businessweek

Canadian Hospitals That Spend More on Patients Get More - Businessweek

Bloomberg News

Canadian Hospitals That Spend More on Patients Get More

By Drew Armstrong on March 13, 2012

Canadian hospitals that spent the most on patient care may be getting a bigger bang for their buck than their U.S. counterparts, researchers suggested.

A study reported today in the Journal of the American Medical Association compared patient results between Canadian hospitals that spent more on care, and those that spent less. It found patients in the first category had lower death rates and were less likely to be admitted to intensive care.
Research on the U.S. health-care system, however, has shown that higher spending at hospital systems doesn’t guarantee better results, according to the study’s author, Therese Stukel.
“When we spend more, and when we place these specialized resources, we’re doing it in an efficient way,” said Stukel, a senior scientist at the Institute for Clinical Evaluative Sciences in Toronto, in a telephone interview. “That’s in contrast to the U.S.”
Under Canada’s system of universal health care, patients at high-spend hospitals had longer lengths of stay and more specialist visits, the study found. That’s because the health plan in Canada, where per capita health expenditures are 57 percent of those in the U.S., better allocates expensive specialists and technology, Stukel said.
While the U.S. has a 3- to 4-times higher per capita supply of expensive, specialized technology, such as MRIs, it has a similar supply of hospital beds and nurses as Canadian hospitals, according to the study.

Dartmouth Atlas

The Canadian findings may help to better understand studies such as the Dartmouth Atlas of Healthcare, a 20-year research project that has documented variations in how medical resources are distributed in the U.S. The data has shown that the parts of the country that spent the most per patient have worse patient outcomes than low-spending areas.
Today’s study “breaks through the generalization,” that all spending is bad, said David Goodwin, co-principal investigator at the Dartmouth Atlas, in a telephone interview. “It’s important that we look at spending in the aggregate and where more is better, and where more is worse.”
The U.S. health-care law signed in 2010 has several components designed to slow spending and have U.S. hospitals emulate the coordinated care of their Canadian brethren. Those measures haven’t been without controversy. Republicans are seeking to repeal the law’s Independent Payment Advisory Board, which will cut Medicare rates with limited oversight from lawmakers.
The law’s Accountable Care Organizations have Medicare pay hospitals bonuses when they coordinate to provide better care and save money. Health systems are penalized if they overspend or produce worse outcomes.

Misinterpreting Dartmouth

In an editorial accompanying the research, Karen Joynt and Ashish Jha, researchers at the Harvard School of Public Health, said some policymakers have drawn wrong conclusions from the Dartmouth data.
“What Dartmouth investigators have documented through careful work is that dysfunctional systems produce expensive, poor-quality care,” Joynt and Jha wrote.
Stukel’s Canadian study examined nearly 400,000 cases of heart attack, heart failure, hip fracture and colon cancer in Ontario hospitals over 10 years, looking at whether the patients died or were readmitted.
The most expensive Canadian hospitals in the study spent about twice as much per patient than their lower-spending counterparts. For every condition the study looked at, patients died less often and were readmitted less often at the more expensive hospitals.

Expensive Hospitals

Those more expensive hospitals had something else in common -- they were often academic hospitals, or community hospitals that saw more patients than others, they had cancer centers attached, lots of specialists on staff, performed more advanced procedures, had more technology and nurses that spent more time with patients. Patients were also more likely to get a follow-up visit within a year and get more intensive discharge care.
That’s not to say that putting more money into lower- spending Canadian hospitals would produce better care there.
“It would be facile to interpret this study as demonstrating that higher spending is causally related to better outcomes and providing more money to lower spending hospitals would necessarily improve their outcomes,” Stukel and her co- authors said in the study.
Instead, it’s better care coordination and spending on the right types of care that improve outcomes, as well as limited budgets on overall spending, Stukel said.

Coordinated Systems

Stukel said she doesn’t advocate a Canadian-style system of universal coverage in the U.S. She said that coordinated U.S. managed care systems, like Kaiser Permanente in California, Intermountain Healthcare in Salt Lake City, and Geisinger Health System in Pennsylvania are models the rest of the country emulate.
She predicts that Canadian hospitals will likely use her study to ask the government there for more money, even though that’s not the point of her research.

“If we put more dollars into the acute care system, it might still improve, it might peak,” she said. “It’s not just putting money into the system, it’s where we spend it.”

BMC Cancer | open access - Chemotherapeutic errors in hospitalised cancer patients: attributable damage and extra costs

Background

"The report, "To Err is Human", from the Institute of Medicine estimated that between 44, 000 and 98, 000 patients die each year in the USA as a result of medical errors [1]. Although certain adverse events are unavoidable, many are preventable, with medication errors being a major cause of such accidents [2]. Medication errors may occur anytime and at any stage during the medication use process, from the prescription of the drug to its preparation, dispensing, and final administration to the patient. Moreover, the medication process involves the whole medical team, involving physicians, pharmacists, and nurses [3].

Medication errors with antineoplastic drugs may be catastrophic due to the drugs' high toxicity and small therapeutic index in addition to the health status of cancer patients. A study revealed that antineoplastic agents were the second most common cause of fatal medication errors [4]. While overdosage is likely to result in permanent damage to the patient, underdosage may compromise the success of therapy. Although several individual case reports focused on medication errors [5-8], some of which were fatal [9-12], an overview of the issue is still needed......."

Public, patients have right to know hospitals' infection rates | Op-Ed | Kentucky.com (C. difficile/MRSA)

Ovarian cancer care for the underserved: Are surgical patterns of care different in a public hospital setting? abstract

CONCLUSIONS:

Ovarian cancer patients treated in public hospitals are less likely to have gynecologic oncologists and high-volume surgeons involved in their care. This is a preliminary finding that warrants further investigation.

Are Some Hospitals Afraid of “Powerful Patients”?--Editorial - EmpowHER.com

Institutional financial conflicts of interest policies at Canadian academic health science centres: a national survey | Rochon | Open Medicine

amednews: Hospitals exchange of cost data clears antitrust hurdle :: May 17, 2010 ... American Medical News

"Quality-adjusted pricing also should be taken into account, he said. "From an antitrust perspective, when dealing with a service industry ... just looking at cost may say very little."

Dying at home: community nurses' views on the impact of informal carers on cancer patients' place of death European Journal of Cancer Care

Note: abstract; one of the few articles which challenges mainstream research discussing the issues of dying at home and the wishes of patients/caregiver.

Healthcare-Associated Infection: Not on My Watch - Kimberly-Clark Health Care

"When someone develops an infection at a hospital or other patient care facility that they did not have prior to treatment, this is referred to as a healthcare-associated (sometimes hospital-acquired) infection (HAI).
Healthcare-associated infections (HAIs) are a global crisis affecting both patients and healthcare workers.
According to the World Health Organization (WHO), at any point in time, 1.4 million people worldwide suffer from infections acquired in hospitals."

Doctor and Patient - Holding Doctors Accountable for Medical Errors - NYTimes.com

Editorial Comment: The emphasis of this article seems to place a rather large burden on physicians which is not totally warranted.

Doctor and Patient - Holding Doctors Accountable for Medical Errors - NYTimes.com

Q. What is a major patient safety area that still needs to be addressed?
A. Ten years ago, we approached patient safety as a series of system flaws; we believed that most errors were committed by good competent people doing something no more complicated than forgetting a cellphone. But in the last few years some of us in the patient safety field have begun to feel uneasy about that approach. When there are reasonably safe standards available, what do you do when people simply don’t adhere to them? At some point, it’s no longer a “systems problem.”

2007 One Women In Three Under-Treated For Ovarian Cancer - CME Teaching Brief® - MedPage Today

One Women In Three Under-Treated For Ovarian Cancer - CME Teaching Brief® - MedPage Today