Alicia Ault

WASHINGTON – More than a quarter (28%) of all acute care visits in the United States are made to the emergency department, while slightly less than half (42%) take place in primary care physicians’ offices, according to a study released Sept. 7.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts, who spoke at a briefing sponsored by the journal Health Affairs.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta. However, the ED is frequently the only option for care, he said, noting that, “too often, patients can’t get the care they need, when they need it, from their family doctor.”

Two-thirds of acute care ED occurred on weekends or on weekdays after office hours, Dr. Pitts and his colleagues found.

Uninsured patients received more than half their acute care in EDs, according to the study, which appears in the journal’s September issue.

The authors based their study on data from the three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting.

Presenting complaints including stomach and abdominal pain, chest pain, and fever dominated the list of what brought patients to the ED. Conversely, patients who presented to their primary care physician’s office for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Seventy-five percent of patients with acute respiratory problems received care in a primary care practice or hospital outpatient department, the authors found.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet make up only 4% of the physician workforce, the authors said.

Previous studies have shown that emergency care accounts for only 3% of all health spending, Dr. Arthur L. Kellermann, a study coauthor, said at the briefing.

“The fact that 3% of our dollars and 4% of our doctors are delivering that percentage of care is not such a bad deal,” said Dr. Kellermann, an emergency physician and the Paul O’Neill Alcoa Chair in Policy Analysis at the Rand Corp. But, he said, it might not be the best possible care for patients or the optimum use of dollars for the health system.

In a separate study, Dr. Ateev Mehrotra and his colleagues reported that 14%-27% of ED visits could have been handled at either a retail clinic or an urgent care center. Switching to these alternate sites could save the system $4.4 billion a year, said Dr. Mehrotra of the University of Pittsburgh and a policy analyst at Rand.

The authors determined that most visits for nine common conditions treated at EDs could be switched easily to those alternate sites. Those conditions include upper-respiratory infections; musculoskeletal conditions such as strains, fractures, and back pain; dermatologic conditions; abdominal pain, headache, and other symptoms without a specific diagnosis; urinary tract infections, some chronic illnesses, and psychiatric conditions; lower-respiratory conditions; such minor problems as insect bites and conjunctivitis; and preventive care.

Dr. Mehrotra and his coauthors disclosed that they received funding from the California HealthCare Foundation for their study.

One of Dr. Pitts’ coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

Dr. Stephen R. Pitts speaks at a briefing. He is an associate professor in the department of emergency medicine, Emory University School of Medicine.

WASHINGTON – More than a quarter (28%) of all acute care visits in the United States are made to the emergency department, while slightly less than half (42%) take place in primary care physicians’ offices, according to a study released Sept. 7.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts, who spoke at a briefing sponsored by the journal Health Affairs.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta. However, the ED is frequently the only option for care, he said, noting that, “too often, patients can’t get the care they need, when they need it, from their family doctor.”

Two-thirds of acute care ED occurred on weekends or on weekdays after office hours, Dr. Pitts and his colleagues found.

Uninsured patients received more than half their acute care in EDs, according to the study, which appears in the journal’s September issue.

The authors based their study on data from the three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting.

Presenting complaints including stomach and abdominal pain, chest pain, and fever dominated the list of what brought patients to the ED. Conversely, patients who presented to their primary care physician’s office for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Seventy-five percent of patients with acute respiratory problems received care in a primary care practice or hospital outpatient department, the authors found.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet make up only 4% of the physician workforce, the authors said.

Previous studies have shown that emergency care accounts for only 3% of all health spending, Dr. Arthur L. Kellermann, a study coauthor, said at the briefing.

“The fact that 3% of our dollars and 4% of our doctors are delivering that percentage of care is not such a bad deal,” said Dr. Kellermann, an emergency physician and the Paul O’Neill Alcoa Chair in Policy Analysis at the Rand Corp. But, he said, it might not be the best possible care for patients or the optimum use of dollars for the health system.

In a separate study, Dr. Ateev Mehrotra and his colleagues reported that 14%-27% of ED visits could have been handled at either a retail clinic or an urgent care center. Switching to these alternate sites could save the system $4.4 billion a year, said Dr. Mehrotra of the University of Pittsburgh and a policy analyst at Rand.

The authors determined that most visits for nine common conditions treated at EDs could be switched easily to those alternate sites. Those conditions include upper-respiratory infections; musculoskeletal conditions such as strains, fractures, and back pain; dermatologic conditions; abdominal pain, headache, and other symptoms without a specific diagnosis; urinary tract infections, some chronic illnesses, and psychiatric conditions; lower-respiratory conditions; such minor problems as insect bites and conjunctivitis; and preventive care.

Dr. Mehrotra and his coauthors disclosed that they received funding from the California HealthCare Foundation for their study.

One of Dr. Pitts’ coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

Dr. Stephen R. Pitts speaks at a briefing. He is an associate professor in the department of emergency medicine, Emory University School of Medicine.

WASHINGTON – More than a quarter (28%) of all acute care visits in the United States are made to the emergency department, while slightly less than half (42%) take place in primary care physicians’ offices, according to a study released Sept. 7.

Another 20% of acute care visits are made to subspecialist offices, lead study author Dr. Stephen R. Pitts, who spoke at a briefing sponsored by the journal Health Affairs.

It appears that the more severe a complaint, the more likely a patient will seek care in the ED, said Dr. Pitts of the department of medicine at Emory University, Atlanta. However, the ED is frequently the only option for care, he said, noting that, “too often, patients can’t get the care they need, when they need it, from their family doctor.”

Two-thirds of acute care ED occurred on weekends or on weekdays after office hours, Dr. Pitts and his colleagues found.

Uninsured patients received more than half their acute care in EDs, according to the study, which appears in the journal’s September issue.

The authors based their study on data from the three federal surveys of ambulatory medical care in the outpatient, ED, and physician office setting.

Presenting complaints including stomach and abdominal pain, chest pain, and fever dominated the list of what brought patients to the ED. Conversely, patients who presented to their primary care physician’s office for acute care most frequently complained of cough, throat symptoms, rash, and earache.

Seventy-five percent of patients with acute respiratory problems received care in a primary care practice or hospital outpatient department, the authors found.

Overall, emergency physicians took care of 11% of all ambulatory care visits, yet make up only 4% of the physician workforce, the authors said.

Previous studies have shown that emergency care accounts for only 3% of all health spending, Dr. Arthur L. Kellermann, a study coauthor, said at the briefing.

“The fact that 3% of our dollars and 4% of our doctors are delivering that percentage of care is not such a bad deal,” said Dr. Kellermann, an emergency physician and the Paul O’Neill Alcoa Chair in Policy Analysis at the Rand Corp. But, he said, it might not be the best possible care for patients or the optimum use of dollars for the health system.

In a separate study, Dr. Ateev Mehrotra and his colleagues reported that 14%-27% of ED visits could have been handled at either a retail clinic or an urgent care center. Switching to these alternate sites could save the system $4.4 billion a year, said Dr. Mehrotra of the University of Pittsburgh and a policy analyst at Rand.

The authors determined that most visits for nine common conditions treated at EDs could be switched easily to those alternate sites. Those conditions include upper-respiratory infections; musculoskeletal conditions such as strains, fractures, and back pain; dermatologic conditions; abdominal pain, headache, and other symptoms without a specific diagnosis; urinary tract infections, some chronic illnesses, and psychiatric conditions; lower-respiratory conditions; such minor problems as insect bites and conjunctivitis; and preventive care.

Dr. Mehrotra and his coauthors disclosed that they received funding from the California HealthCare Foundation for their study.

One of Dr. Pitts’ coauthors disclosed that she received a training grant from the Centers for Disease Control and Prevention; others reported no conflicts.

Dr. Stephen R. Pitts speaks at a briefing. He is an associate professor in the department of emergency medicine, Emory University School of Medicine.

Allergan agreed on Sept. 1 to plead guilty to charges that it had illegally promoted Botox Therapeutic for uses not approved by the Food and Drug Administration.

The U.S. Department of Justice announced the plea and said that the company would pay a total of $600 million – $375 million in criminal fines and $225 million in a civil settlement with the federal government and all of the states.

The plea came as the result of three lawsuits filed by five “whistle-blowers,” including Dr. Amy Lang, a pain management physician in Lawrenceville, Ga. The whistle-blowers will receive $37.8 million from the federal settlement.

In a statement, the Department of Justice said Allergan had made it a “top corporate priority” to maximize Botox off-label sales. The company was cited for promoting the therapy for headache, pain, spasticity, and juvenile cerebral palsy.

Allergan also held workshops to teach physicians and their staffs how to bill for off-label uses, wined and dined physicians in an effort to encourage off-label use, and “created a purportedly independent online neurotoxin education organization to stimulate increased use of Botox for off-label indications,” according to the statement.

Allergan “demanded tremendous growth in these off-label sales year after year, even when there was little clinical evidence that these uses were effective,” said Sally Q. Yates, U.S. Attorney for the Northern District of Georgia, in a statement. The Georgia district is prosecuting the criminal case.

As a result of the investigation and settlement, Allergan has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services. Under the terms of the 5-year agreement, its board will be charged with reviewing the company’s compliance each year.

The company will also have to post information on its Web site disclosing payments to physicians and send a letter to physicians notifying them about the settlement.

Last fall, Allergan sued the FDA, claiming that restrictions on discussions of off-label use violated the company’s first amendment right to freedom of speech, and its ability to “proactively share truthful and relevant information with the medical community,” according to a company statement.

Allergan agreed on Sept. 1 to plead guilty to charges that it had illegally promoted Botox Therapeutic for uses not approved by the Food and Drug Administration.

The U.S. Department of Justice announced the plea and said that the company would pay a total of $600 million – $375 million in criminal fines and $225 million in a civil settlement with the federal government and all of the states.

The plea came as the result of three lawsuits filed by five “whistle-blowers,” including Dr. Amy Lang, a pain management physician in Lawrenceville, Ga. The whistle-blowers will receive $37.8 million from the federal settlement.

In a statement, the Department of Justice said Allergan had made it a “top corporate priority” to maximize Botox off-label sales. The company was cited for promoting the therapy for headache, pain, spasticity, and juvenile cerebral palsy.

Allergan also held workshops to teach physicians and their staffs how to bill for off-label uses, wined and dined physicians in an effort to encourage off-label use, and “created a purportedly independent online neurotoxin education organization to stimulate increased use of Botox for off-label indications,” according to the statement.

Allergan “demanded tremendous growth in these off-label sales year after year, even when there was little clinical evidence that these uses were effective,” said Sally Q. Yates, U.S. Attorney for the Northern District of Georgia, in a statement. The Georgia district is prosecuting the criminal case.

As a result of the investigation and settlement, Allergan has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services. Under the terms of the 5-year agreement, its board will be charged with reviewing the company’s compliance each year.

The company will also have to post information on its Web site disclosing payments to physicians and send a letter to physicians notifying them about the settlement.

Last fall, Allergan sued the FDA, claiming that restrictions on discussions of off-label use violated the company’s first amendment right to freedom of speech, and its ability to “proactively share truthful and relevant information with the medical community,” according to a company statement.

Allergan agreed on Sept. 1 to plead guilty to charges that it had illegally promoted Botox Therapeutic for uses not approved by the Food and Drug Administration.

The U.S. Department of Justice announced the plea and said that the company would pay a total of $600 million – $375 million in criminal fines and $225 million in a civil settlement with the federal government and all of the states.

The plea came as the result of three lawsuits filed by five “whistle-blowers,” including Dr. Amy Lang, a pain management physician in Lawrenceville, Ga. The whistle-blowers will receive $37.8 million from the federal settlement.

In a statement, the Department of Justice said Allergan had made it a “top corporate priority” to maximize Botox off-label sales. The company was cited for promoting the therapy for headache, pain, spasticity, and juvenile cerebral palsy.

Allergan also held workshops to teach physicians and their staffs how to bill for off-label uses, wined and dined physicians in an effort to encourage off-label use, and “created a purportedly independent online neurotoxin education organization to stimulate increased use of Botox for off-label indications,” according to the statement.

Allergan “demanded tremendous growth in these off-label sales year after year, even when there was little clinical evidence that these uses were effective,” said Sally Q. Yates, U.S. Attorney for the Northern District of Georgia, in a statement. The Georgia district is prosecuting the criminal case.

As a result of the investigation and settlement, Allergan has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services. Under the terms of the 5-year agreement, its board will be charged with reviewing the company’s compliance each year.

The company will also have to post information on its Web site disclosing payments to physicians and send a letter to physicians notifying them about the settlement.

Last fall, Allergan sued the FDA, claiming that restrictions on discussions of off-label use violated the company’s first amendment right to freedom of speech, and its ability to “proactively share truthful and relevant information with the medical community,” according to a company statement.

Allergan agreed on Sept. 1 to plead guilty to charges that it had illegally promoted Botox Therapeutic for uses not approved by the Food and Drug Administration.

The U.S. Department of Justice announced the plea and said that the company would pay a total of $600 million – $375 million in criminal fines and $225 million in a civil settlement with the federal government and all of the states.

The plea came as the result of three lawsuits filed by five “whistle-blowers,” including Dr. Amy Lang, a pain management physician in Lawrenceville, Ga. The whistle-blowers will receive $37.8 million from the federal settlement.

In a statement, the Department of Justice said Allergan had made it a “top corporate priority” to maximize Botox off-label sales. The company was cited for promoting the therapy for headache, pain, spasticity, and juvenile cerebral palsy.

Allergan also held workshops to teach physicians and their staffs how to bill for off-label uses, wined and dined physicians in an effort to encourage off-label use, and “created a purportedly independent online neurotoxin education organization to stimulate increased use of Botox for off-label indications,” according to the statement.

Allergan “demanded tremendous growth in these off-label sales year after year, even when there was little clinical evidence that these uses were effective,” said Sally Q. Yates, U.S. Attorney for the Northern District of Georgia, in a statement. The Georgia district is prosecuting the criminal case.

As a result of the investigation and settlement, Allergan has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services. Under the terms of the 5-year agreement, its board will be charged with reviewing the company’s compliance each year.

The company will also have to post information on its Web site disclosing payments to physicians and send a letter to physicians notifying them about the settlement.

Last fall, Allergan sued the FDA, claiming that restrictions on discussions of off-label use violated the company’s first amendment right to freedom of speech, and its ability to “proactively share truthful and relevant information with the medical community,” according to a company statement.

Allergan agreed on Sept. 1 to plead guilty to charges that it had illegally promoted Botox Therapeutic for uses not approved by the Food and Drug Administration.

The U.S. Department of Justice announced the plea and said that the company would pay a total of $600 million – $375 million in criminal fines and $225 million in a civil settlement with the federal government and all of the states.

The plea came as the result of three lawsuits filed by five “whistle-blowers,” including Dr. Amy Lang, a pain management physician in Lawrenceville, Ga. The whistle-blowers will receive $37.8 million from the federal settlement.

In a statement, the Department of Justice said Allergan had made it a “top corporate priority” to maximize Botox off-label sales. The company was cited for promoting the therapy for headache, pain, spasticity, and juvenile cerebral palsy.

Allergan also held workshops to teach physicians and their staffs how to bill for off-label uses, wined and dined physicians in an effort to encourage off-label use, and “created a purportedly independent online neurotoxin education organization to stimulate increased use of Botox for off-label indications,” according to the statement.

Allergan “demanded tremendous growth in these off-label sales year after year, even when there was little clinical evidence that these uses were effective,” said Sally Q. Yates, U.S. Attorney for the Northern District of Georgia, in a statement. The Georgia district is prosecuting the criminal case.

As a result of the investigation and settlement, Allergan has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services. Under the terms of the 5-year agreement, its board will be charged with reviewing the company’s compliance each year.

The company will also have to post information on its Web site disclosing payments to physicians and send a letter to physicians notifying them about the settlement.

Last fall, Allergan sued the FDA, claiming that restrictions on discussions of off-label use violated the company’s first amendment right to freedom of speech, and its ability to “proactively share truthful and relevant information with the medical community,” according to a company statement.

Allergan agreed on Sept. 1 to plead guilty to charges that it had illegally promoted Botox Therapeutic for uses not approved by the Food and Drug Administration.

The U.S. Department of Justice announced the plea and said that the company would pay a total of $600 million – $375 million in criminal fines and $225 million in a civil settlement with the federal government and all of the states.

The plea came as the result of three lawsuits filed by five “whistle-blowers,” including Dr. Amy Lang, a pain management physician in Lawrenceville, Ga. The whistle-blowers will receive $37.8 million from the federal settlement.

In a statement, the Department of Justice said Allergan had made it a “top corporate priority” to maximize Botox off-label sales. The company was cited for promoting the therapy for headache, pain, spasticity, and juvenile cerebral palsy.

Allergan also held workshops to teach physicians and their staffs how to bill for off-label uses, wined and dined physicians in an effort to encourage off-label use, and “created a purportedly independent online neurotoxin education organization to stimulate increased use of Botox for off-label indications,” according to the statement.

Allergan “demanded tremendous growth in these off-label sales year after year, even when there was little clinical evidence that these uses were effective,” said Sally Q. Yates, U.S. Attorney for the Northern District of Georgia, in a statement. The Georgia district is prosecuting the criminal case.

As a result of the investigation and settlement, Allergan has entered into a Corporate Integrity Agreement with the U.S. Department of Health and Human Services. Under the terms of the 5-year agreement, its board will be charged with reviewing the company’s compliance each year.

The company will also have to post information on its Web site disclosing payments to physicians and send a letter to physicians notifying them about the settlement.

Last fall, Allergan sued the FDA, claiming that restrictions on discussions of off-label use violated the company’s first amendment right to freedom of speech, and its ability to “proactively share truthful and relevant information with the medical community,” according to a company statement.

The Accreditation Council for Graduate Medical Education has revisited its standards for resident duty hours and determined that some modifications should be made, mostly for first-year residents. All other residents should still be subject to an 80-hour work week and up to 24 hours of continuous duty.

The 16-member ACGME task force that wrote the standards will review public comments and make any modifications considered necessary before July 2011, when the new standards will go into effect.

The original ACGME standards, established in 2003, have been the subject of much consternation in the medical community, with opinions differing over whether they have been too restrictive or too loose to properly protect patients and ensure a good quality of life for residents.

According to the latest report, written by Dr. Thomas J. Nasca, Dr. Susan H. Day, and Dr. E. Stephen Amis Jr. on behalf of the ACGME task force, the 2003 standards had the following three “problematic” elements, as identified by the educational community and the public:

▸ The limits on duty hours may have created a shift mentality among residents, which tends to conflict with the duty to serve patients.

▸ Many academic programs began focusing on meeting the duty hour restrictions, perhaps at the expense of education.

▸ The 80-hour work week, with up to 24 hours of continuous duty, was seen by many as compromising patient safety.

In 2008, the Institute of Medicine took a hard look at the ACGME standards and, among other things, recommended that no residents should exceed 16 hours of continuous duty.

The ACGME convened the task force to consider the IOM recommendations. One of the biggest challenges, according to the authors, was to reconcile the IOM's suggestion for an across-the-board restriction on duty hours with the continuing plea from academic programs that duty hours needed to be tailored to each specialty (N. Engl. J. Med. 2010 [doi:10.1056/NEJMsb1005800]).

For surgery, in particular, it would be difficult—and contrary to learning—to have a resident leave in the midst of a procedure because his or her duty hours had been reached.

The ACGME panel also had to weigh whether there was sufficient evidence to show that working more than 16 hours or up to 30 hours continuously led to more medical errors, as has been suggested by many critics of the duty hour standards.

According to the ACGME panel, the data thus far indicate only that first-year residents are more prone to mistakes as a result of sleep deprivation. Therefore, the task force urged a new paradigm for the first year of residency, whereby residents cannot be on duty for longer than 16 hours continuously and should have 10 hours off and 8 hours free of duty between their scheduled duty periods. First-year residents are not allowed to moonlight, and they must have direct, in-house, attending-level supervision.

All residents are allowed to work up to an additional 4 hours to facilitate patient handoffs—an area of concern for patient safety.

The panel decided not to tailor duty hours to specialties “because studies have not shown that the safety effect of current standards varies with specialty.”

The IOM had also criticized the ACGME for not properly enforcing the duty hours. The task force said that enforcement is an “inherent” challenge, partly because there are some 9,000 accredited programs. However, the ACGME is now undertaking annual site visits and analyzing whether institutions can comply. Eventually, the organization will give each institution a report on its compliance status and recommendations for resolving problems.

Wake Up Doctor, a coalition of public interest and patient safety groups that has been pushing the ACGME to further restrict resident hours, said that the new standards don't go far enough. The group gave the ACGME an “F” for failing to comply with the IOM recommendation that continuous duty be restricted to 16 hours for all residents.

The Accreditation Council for Graduate Medical Education has revisited its standards for resident duty hours and determined that some modifications should be made, mostly for first-year residents. All other residents should still be subject to an 80-hour work week and up to 24 hours of continuous duty.

The 16-member ACGME task force that wrote the standards will review public comments and make any modifications considered necessary before July 2011, when the new standards will go into effect.

The original ACGME standards, established in 2003, have been the subject of much consternation in the medical community, with opinions differing over whether they have been too restrictive or too loose to properly protect patients and ensure a good quality of life for residents.

According to the latest report, written by Dr. Thomas J. Nasca, Dr. Susan H. Day, and Dr. E. Stephen Amis Jr. on behalf of the ACGME task force, the 2003 standards had the following three “problematic” elements, as identified by the educational community and the public:

▸ The limits on duty hours may have created a shift mentality among residents, which tends to conflict with the duty to serve patients.

▸ Many academic programs began focusing on meeting the duty hour restrictions, perhaps at the expense of education.

▸ The 80-hour work week, with up to 24 hours of continuous duty, was seen by many as compromising patient safety.

In 2008, the Institute of Medicine took a hard look at the ACGME standards and, among other things, recommended that no residents should exceed 16 hours of continuous duty.

The ACGME convened the task force to consider the IOM recommendations. One of the biggest challenges, according to the authors, was to reconcile the IOM's suggestion for an across-the-board restriction on duty hours with the continuing plea from academic programs that duty hours needed to be tailored to each specialty (N. Engl. J. Med. 2010 [doi:10.1056/NEJMsb1005800]).

For surgery, in particular, it would be difficult—and contrary to learning—to have a resident leave in the midst of a procedure because his or her duty hours had been reached.

The ACGME panel also had to weigh whether there was sufficient evidence to show that working more than 16 hours or up to 30 hours continuously led to more medical errors, as has been suggested by many critics of the duty hour standards.

According to the ACGME panel, the data thus far indicate only that first-year residents are more prone to mistakes as a result of sleep deprivation. Therefore, the task force urged a new paradigm for the first year of residency, whereby residents cannot be on duty for longer than 16 hours continuously and should have 10 hours off and 8 hours free of duty between their scheduled duty periods. First-year residents are not allowed to moonlight, and they must have direct, in-house, attending-level supervision.

All residents are allowed to work up to an additional 4 hours to facilitate patient handoffs—an area of concern for patient safety.

The panel decided not to tailor duty hours to specialties “because studies have not shown that the safety effect of current standards varies with specialty.”

The IOM had also criticized the ACGME for not properly enforcing the duty hours. The task force said that enforcement is an “inherent” challenge, partly because there are some 9,000 accredited programs. However, the ACGME is now undertaking annual site visits and analyzing whether institutions can comply. Eventually, the organization will give each institution a report on its compliance status and recommendations for resolving problems.

Wake Up Doctor, a coalition of public interest and patient safety groups that has been pushing the ACGME to further restrict resident hours, said that the new standards don't go far enough. The group gave the ACGME an “F” for failing to comply with the IOM recommendation that continuous duty be restricted to 16 hours for all residents.

The Accreditation Council for Graduate Medical Education has revisited its standards for resident duty hours and determined that some modifications should be made, mostly for first-year residents. All other residents should still be subject to an 80-hour work week and up to 24 hours of continuous duty.

The 16-member ACGME task force that wrote the standards will review public comments and make any modifications considered necessary before July 2011, when the new standards will go into effect.

The original ACGME standards, established in 2003, have been the subject of much consternation in the medical community, with opinions differing over whether they have been too restrictive or too loose to properly protect patients and ensure a good quality of life for residents.

According to the latest report, written by Dr. Thomas J. Nasca, Dr. Susan H. Day, and Dr. E. Stephen Amis Jr. on behalf of the ACGME task force, the 2003 standards had the following three “problematic” elements, as identified by the educational community and the public:

▸ The limits on duty hours may have created a shift mentality among residents, which tends to conflict with the duty to serve patients.

▸ Many academic programs began focusing on meeting the duty hour restrictions, perhaps at the expense of education.

▸ The 80-hour work week, with up to 24 hours of continuous duty, was seen by many as compromising patient safety.

In 2008, the Institute of Medicine took a hard look at the ACGME standards and, among other things, recommended that no residents should exceed 16 hours of continuous duty.

The ACGME convened the task force to consider the IOM recommendations. One of the biggest challenges, according to the authors, was to reconcile the IOM's suggestion for an across-the-board restriction on duty hours with the continuing plea from academic programs that duty hours needed to be tailored to each specialty (N. Engl. J. Med. 2010 [doi:10.1056/NEJMsb1005800]).

For surgery, in particular, it would be difficult—and contrary to learning—to have a resident leave in the midst of a procedure because his or her duty hours had been reached.

The ACGME panel also had to weigh whether there was sufficient evidence to show that working more than 16 hours or up to 30 hours continuously led to more medical errors, as has been suggested by many critics of the duty hour standards.

According to the ACGME panel, the data thus far indicate only that first-year residents are more prone to mistakes as a result of sleep deprivation. Therefore, the task force urged a new paradigm for the first year of residency, whereby residents cannot be on duty for longer than 16 hours continuously and should have 10 hours off and 8 hours free of duty between their scheduled duty periods. First-year residents are not allowed to moonlight, and they must have direct, in-house, attending-level supervision.

All residents are allowed to work up to an additional 4 hours to facilitate patient handoffs—an area of concern for patient safety.

The panel decided not to tailor duty hours to specialties “because studies have not shown that the safety effect of current standards varies with specialty.”

The IOM had also criticized the ACGME for not properly enforcing the duty hours. The task force said that enforcement is an “inherent” challenge, partly because there are some 9,000 accredited programs. However, the ACGME is now undertaking annual site visits and analyzing whether institutions can comply. Eventually, the organization will give each institution a report on its compliance status and recommendations for resolving problems.

Wake Up Doctor, a coalition of public interest and patient safety groups that has been pushing the ACGME to further restrict resident hours, said that the new standards don't go far enough. The group gave the ACGME an “F” for failing to comply with the IOM recommendation that continuous duty be restricted to 16 hours for all residents.

Imaging Project to Close Bids

The Centers for Medicare and Medicaid Services is about to close off bids from physician groups wishing to participate in a Medicare demonstration project to test whether real-time decision-support systems ensure appropriate use of imaging, improve quality of care, and reduce radiation exposure. Participating practices will be paid for reporting data. The project will cover SPECT-MPI, MRI, and CT of the lumbar spine; MRI and CT of the brain; CT of the sinus, abdomen, and pelvis; and MRI of the knee and shoulder. All these exams are covered by specialty society guidelines that can be part of the systems, and they account for high use and costs among Medicare enrollees. Applications must be submitted by Sept. 21.

Bill Targets Radiation Dose

Sen. Mike Enzi (R-Wyo.) and Sen. Tom Harkin (D-Iowa) have introduced a proposal to create education and credentialing standards for people who deliver radiation therapy and imaging procedures to Medicare patients. The CARE (Consistency, Accuracy, Responsibility, and Excellence) in Medical Imaging and Radiation Therapy Act, S. 3737, would, however, grandfather in technicians and others who do not meet the bill's standards. “This bill will reduce the risk of medical errors associated with misdiagnosis or inappropriate exposure to medical radiation, and save millions of health care dollars by decreasing the number of examinations that must be repeated due to poor quality,” said Sen. Harkin in a statement. The CARE act was first introduced in September 2009 in the House, as H.R. 3652, by Rep. John Barrow (D-Ga.).

CABG Mortality Down

The Agency for Healthcare Research and Quality says that there was a huge decline in mortality among patients undergoing coronary artery bypass graft surgery from 2000 to 2006. In 2000, the death rate was 42 per 1,000 admissions; 6 years later, it had declined to 24 per 1,000. Women still had higher mortality (36 per 1,000) than men (21 per 1,000), and, despite a 92% decline in the death rate, rural hospitals still posted a 38 per 1,000 mortality figure in 2006. There were few differences in death rates among whites, African Americans, and Hispanics. Perhaps surprisingly, uninsured patients had the lowest death rate by insurance status, 23 per 1,000. Medicaid patients had the highest, at 29 per 1,000. The data are contained in the 2009 National Healthcare Quality and Disparities Report, published by the agency.

Low Income Trumps Race in Risk

An epidemiological study by researchers at the University of California, Los Angeles has shown that socioeconomic status is a bigger risk factor in cardiovascular disease than is race or ethnicity. The researchers looked at data on 12,154 people from the National Health and Nutrition Examination Survey (2001-2006), focusing on 10-year risk for coronary heart disease as predicted by National Cholesterol Education Program Adult Treatment Panel III guidelines. People with a lower socioeconomic status turned out to have a higher risk of cardiovascular disease, regardless of race or ethnicity. Most of the increase comes from greater rates of smoking and less physical activity in low-income/low-education groups. The National Institutes of Health–funded study appeared in the August issue of the Annals of Epidemiology.

Hypothermia Therapy Going Mobile

New York City's paramedics are now using hypothermia therapy on eligible cardiac arrest patients outside hospitals. In cooperation with Greater New York Hospital Association, Emergency Medical Service personnel have begun administering cold intravenous liquids to people in cardiac arrest who have not responded to CPR or a defibrillator. The treatment was already being used in city hospitals, where it has saved “hundreds of lives during the past 18 months,” according to a statement from the City Health and Hospitals Corporation. Since the in-hospital project began in January 2009, there has been a 20% increase in survival of arrest patients admitted after being stabilized in emergency departments, the statement said.

Imaging Project to Close Bids

The Centers for Medicare and Medicaid Services is about to close off bids from physician groups wishing to participate in a Medicare demonstration project to test whether real-time decision-support systems ensure appropriate use of imaging, improve quality of care, and reduce radiation exposure. Participating practices will be paid for reporting data. The project will cover SPECT-MPI, MRI, and CT of the lumbar spine; MRI and CT of the brain; CT of the sinus, abdomen, and pelvis; and MRI of the knee and shoulder. All these exams are covered by specialty society guidelines that can be part of the systems, and they account for high use and costs among Medicare enrollees. Applications must be submitted by Sept. 21.

Bill Targets Radiation Dose

Sen. Mike Enzi (R-Wyo.) and Sen. Tom Harkin (D-Iowa) have introduced a proposal to create education and credentialing standards for people who deliver radiation therapy and imaging procedures to Medicare patients. The CARE (Consistency, Accuracy, Responsibility, and Excellence) in Medical Imaging and Radiation Therapy Act, S. 3737, would, however, grandfather in technicians and others who do not meet the bill's standards. “This bill will reduce the risk of medical errors associated with misdiagnosis or inappropriate exposure to medical radiation, and save millions of health care dollars by decreasing the number of examinations that must be repeated due to poor quality,” said Sen. Harkin in a statement. The CARE act was first introduced in September 2009 in the House, as H.R. 3652, by Rep. John Barrow (D-Ga.).

CABG Mortality Down

The Agency for Healthcare Research and Quality says that there was a huge decline in mortality among patients undergoing coronary artery bypass graft surgery from 2000 to 2006. In 2000, the death rate was 42 per 1,000 admissions; 6 years later, it had declined to 24 per 1,000. Women still had higher mortality (36 per 1,000) than men (21 per 1,000), and, despite a 92% decline in the death rate, rural hospitals still posted a 38 per 1,000 mortality figure in 2006. There were few differences in death rates among whites, African Americans, and Hispanics. Perhaps surprisingly, uninsured patients had the lowest death rate by insurance status, 23 per 1,000. Medicaid patients had the highest, at 29 per 1,000. The data are contained in the 2009 National Healthcare Quality and Disparities Report, published by the agency.

Low Income Trumps Race in Risk

An epidemiological study by researchers at the University of California, Los Angeles has shown that socioeconomic status is a bigger risk factor in cardiovascular disease than is race or ethnicity. The researchers looked at data on 12,154 people from the National Health and Nutrition Examination Survey (2001-2006), focusing on 10-year risk for coronary heart disease as predicted by National Cholesterol Education Program Adult Treatment Panel III guidelines. People with a lower socioeconomic status turned out to have a higher risk of cardiovascular disease, regardless of race or ethnicity. Most of the increase comes from greater rates of smoking and less physical activity in low-income/low-education groups. The National Institutes of Health–funded study appeared in the August issue of the Annals of Epidemiology.

Hypothermia Therapy Going Mobile

New York City's paramedics are now using hypothermia therapy on eligible cardiac arrest patients outside hospitals. In cooperation with Greater New York Hospital Association, Emergency Medical Service personnel have begun administering cold intravenous liquids to people in cardiac arrest who have not responded to CPR or a defibrillator. The treatment was already being used in city hospitals, where it has saved “hundreds of lives during the past 18 months,” according to a statement from the City Health and Hospitals Corporation. Since the in-hospital project began in January 2009, there has been a 20% increase in survival of arrest patients admitted after being stabilized in emergency departments, the statement said.

Imaging Project to Close Bids

The Centers for Medicare and Medicaid Services is about to close off bids from physician groups wishing to participate in a Medicare demonstration project to test whether real-time decision-support systems ensure appropriate use of imaging, improve quality of care, and reduce radiation exposure. Participating practices will be paid for reporting data. The project will cover SPECT-MPI, MRI, and CT of the lumbar spine; MRI and CT of the brain; CT of the sinus, abdomen, and pelvis; and MRI of the knee and shoulder. All these exams are covered by specialty society guidelines that can be part of the systems, and they account for high use and costs among Medicare enrollees. Applications must be submitted by Sept. 21.

Bill Targets Radiation Dose

Sen. Mike Enzi (R-Wyo.) and Sen. Tom Harkin (D-Iowa) have introduced a proposal to create education and credentialing standards for people who deliver radiation therapy and imaging procedures to Medicare patients. The CARE (Consistency, Accuracy, Responsibility, and Excellence) in Medical Imaging and Radiation Therapy Act, S. 3737, would, however, grandfather in technicians and others who do not meet the bill's standards. “This bill will reduce the risk of medical errors associated with misdiagnosis or inappropriate exposure to medical radiation, and save millions of health care dollars by decreasing the number of examinations that must be repeated due to poor quality,” said Sen. Harkin in a statement. The CARE act was first introduced in September 2009 in the House, as H.R. 3652, by Rep. John Barrow (D-Ga.).

CABG Mortality Down

The Agency for Healthcare Research and Quality says that there was a huge decline in mortality among patients undergoing coronary artery bypass graft surgery from 2000 to 2006. In 2000, the death rate was 42 per 1,000 admissions; 6 years later, it had declined to 24 per 1,000. Women still had higher mortality (36 per 1,000) than men (21 per 1,000), and, despite a 92% decline in the death rate, rural hospitals still posted a 38 per 1,000 mortality figure in 2006. There were few differences in death rates among whites, African Americans, and Hispanics. Perhaps surprisingly, uninsured patients had the lowest death rate by insurance status, 23 per 1,000. Medicaid patients had the highest, at 29 per 1,000. The data are contained in the 2009 National Healthcare Quality and Disparities Report, published by the agency.

Low Income Trumps Race in Risk

An epidemiological study by researchers at the University of California, Los Angeles has shown that socioeconomic status is a bigger risk factor in cardiovascular disease than is race or ethnicity. The researchers looked at data on 12,154 people from the National Health and Nutrition Examination Survey (2001-2006), focusing on 10-year risk for coronary heart disease as predicted by National Cholesterol Education Program Adult Treatment Panel III guidelines. People with a lower socioeconomic status turned out to have a higher risk of cardiovascular disease, regardless of race or ethnicity. Most of the increase comes from greater rates of smoking and less physical activity in low-income/low-education groups. The National Institutes of Health–funded study appeared in the August issue of the Annals of Epidemiology.

Hypothermia Therapy Going Mobile

New York City's paramedics are now using hypothermia therapy on eligible cardiac arrest patients outside hospitals. In cooperation with Greater New York Hospital Association, Emergency Medical Service personnel have begun administering cold intravenous liquids to people in cardiac arrest who have not responded to CPR or a defibrillator. The treatment was already being used in city hospitals, where it has saved “hundreds of lives during the past 18 months,” according to a statement from the City Health and Hospitals Corporation. Since the in-hospital project began in January 2009, there has been a 20% increase in survival of arrest patients admitted after being stabilized in emergency departments, the statement said.

The Accreditation Council for Graduate Medical Education has revisited its standards for resident duty hours and determined that some modifications should be made, mostly for first-year residents. All other residents should still be subject to an 80-hour work week and up to 24 hours of continuous duty.

The 16-member ACGME task force that wrote the standards will review public comments and make any modifications considered necessary before July 2011, when the new standards will go into effect.

The original ACGME standards, established in 2003, have been the subject of much consternation in the medical community, with opinions differing over whether they have been too restrictive or too loose to properly protect patients and ensure a good quality of life for residents.

According to the latest report, written by Dr. Thomas J. Nasca, Dr. Susan H. Day, and Dr. E. Stephen Amis Jr. on behalf of the ACGME task force, the 2003 standards had the following three “problematic” elements, as identified by the educational community and the public:

▸ The limits on duty hours may have created a shift mentality among residents, which tends to conflict with the duty to serve patients.

▸ Many academic programs began focusing on meeting the duty hour restrictions, perhaps at the expense of education.

▸ The 80-hour work week, with up to 24 hours of continuous duty, was seen by many as compromising patient safety.

In 2008, the Institute of Medicine took a hard look at the ACGME standards and, among other things, recommended that no residents should exceed 16 hours of continuous duty.

The ACGME convened the task force to consider the IOM recommendations. One of the biggest challenges, according to the authors, was to reconcile the IOM's suggestion for an across-the-board restriction on duty hours with the continuing plea from academic programs that duty hours needed to be tailored to each specialty (N. Engl. J. Med. 2010 [doi:10.1056/NEJMsb1005800]).

The ACGME panel also had to weigh whether there was sufficient evidence to show that working more than 16 hours or up to 30 hours continuously led to more medical errors, as has been suggested by many critics.

According to the ACGME panel, the data thus far indicate only that first-year residents are more prone to mistakes as a result of sleep deprivation. Therefore, the task force urged a new paradigm for the first year of residency, whereby residents cannot be on duty for longer than 16 hours continuously and should have 10 hours off and 8 hours free of duty between their scheduled duty periods. First-year residents are not allowed to moonlight, and they must have direct, in-house, attending-level supervision.

All residents are allowed to work up to an additional 4 hours to facilitate patient handoffs—an area of concern for patient safety.

The panel decided not to tailor duty hours to specialties “because studies have not shown that the safety effect of current standards varies with specialty,” said the authors.

The IOM had also criticized the ACGME for not properly enforcing the duty hours. The task force said that enforcement is an “inherent” challenge, partly because there are some 9,000 accredited programs.

Wake Up Doctor, a coalition of public interest and patient safety groups that has been pushing the ACGME to further restrict resident hours, said that the new standards don't go far enough.

The Accreditation Council for Graduate Medical Education has revisited its standards for resident duty hours and determined that some modifications should be made, mostly for first-year residents. All other residents should still be subject to an 80-hour work week and up to 24 hours of continuous duty.

The 16-member ACGME task force that wrote the standards will review public comments and make any modifications considered necessary before July 2011, when the new standards will go into effect.

The original ACGME standards, established in 2003, have been the subject of much consternation in the medical community, with opinions differing over whether they have been too restrictive or too loose to properly protect patients and ensure a good quality of life for residents.

According to the latest report, written by Dr. Thomas J. Nasca, Dr. Susan H. Day, and Dr. E. Stephen Amis Jr. on behalf of the ACGME task force, the 2003 standards had the following three “problematic” elements, as identified by the educational community and the public:

▸ The limits on duty hours may have created a shift mentality among residents, which tends to conflict with the duty to serve patients.

▸ Many academic programs began focusing on meeting the duty hour restrictions, perhaps at the expense of education.

▸ The 80-hour work week, with up to 24 hours of continuous duty, was seen by many as compromising patient safety.

In 2008, the Institute of Medicine took a hard look at the ACGME standards and, among other things, recommended that no residents should exceed 16 hours of continuous duty.

The ACGME convened the task force to consider the IOM recommendations. One of the biggest challenges, according to the authors, was to reconcile the IOM's suggestion for an across-the-board restriction on duty hours with the continuing plea from academic programs that duty hours needed to be tailored to each specialty (N. Engl. J. Med. 2010 [doi:10.1056/NEJMsb1005800]).

The ACGME panel also had to weigh whether there was sufficient evidence to show that working more than 16 hours or up to 30 hours continuously led to more medical errors, as has been suggested by many critics.

According to the ACGME panel, the data thus far indicate only that first-year residents are more prone to mistakes as a result of sleep deprivation. Therefore, the task force urged a new paradigm for the first year of residency, whereby residents cannot be on duty for longer than 16 hours continuously and should have 10 hours off and 8 hours free of duty between their scheduled duty periods. First-year residents are not allowed to moonlight, and they must have direct, in-house, attending-level supervision.

All residents are allowed to work up to an additional 4 hours to facilitate patient handoffs—an area of concern for patient safety.

The panel decided not to tailor duty hours to specialties “because studies have not shown that the safety effect of current standards varies with specialty,” said the authors.

The IOM had also criticized the ACGME for not properly enforcing the duty hours. The task force said that enforcement is an “inherent” challenge, partly because there are some 9,000 accredited programs.

Wake Up Doctor, a coalition of public interest and patient safety groups that has been pushing the ACGME to further restrict resident hours, said that the new standards don't go far enough.

The Accreditation Council for Graduate Medical Education has revisited its standards for resident duty hours and determined that some modifications should be made, mostly for first-year residents. All other residents should still be subject to an 80-hour work week and up to 24 hours of continuous duty.

The 16-member ACGME task force that wrote the standards will review public comments and make any modifications considered necessary before July 2011, when the new standards will go into effect.

The original ACGME standards, established in 2003, have been the subject of much consternation in the medical community, with opinions differing over whether they have been too restrictive or too loose to properly protect patients and ensure a good quality of life for residents.

According to the latest report, written by Dr. Thomas J. Nasca, Dr. Susan H. Day, and Dr. E. Stephen Amis Jr. on behalf of the ACGME task force, the 2003 standards had the following three “problematic” elements, as identified by the educational community and the public:

▸ The limits on duty hours may have created a shift mentality among residents, which tends to conflict with the duty to serve patients.

▸ Many academic programs began focusing on meeting the duty hour restrictions, perhaps at the expense of education.

▸ The 80-hour work week, with up to 24 hours of continuous duty, was seen by many as compromising patient safety.

In 2008, the Institute of Medicine took a hard look at the ACGME standards and, among other things, recommended that no residents should exceed 16 hours of continuous duty.

The ACGME convened the task force to consider the IOM recommendations. One of the biggest challenges, according to the authors, was to reconcile the IOM's suggestion for an across-the-board restriction on duty hours with the continuing plea from academic programs that duty hours needed to be tailored to each specialty (N. Engl. J. Med. 2010 [doi:10.1056/NEJMsb1005800]).

The ACGME panel also had to weigh whether there was sufficient evidence to show that working more than 16 hours or up to 30 hours continuously led to more medical errors, as has been suggested by many critics.

According to the ACGME panel, the data thus far indicate only that first-year residents are more prone to mistakes as a result of sleep deprivation. Therefore, the task force urged a new paradigm for the first year of residency, whereby residents cannot be on duty for longer than 16 hours continuously and should have 10 hours off and 8 hours free of duty between their scheduled duty periods. First-year residents are not allowed to moonlight, and they must have direct, in-house, attending-level supervision.

All residents are allowed to work up to an additional 4 hours to facilitate patient handoffs—an area of concern for patient safety.

The panel decided not to tailor duty hours to specialties “because studies have not shown that the safety effect of current standards varies with specialty,” said the authors.

The IOM had also criticized the ACGME for not properly enforcing the duty hours. The task force said that enforcement is an “inherent” challenge, partly because there are some 9,000 accredited programs.

Wake Up Doctor, a coalition of public interest and patient safety groups that has been pushing the ACGME to further restrict resident hours, said that the new standards don't go far enough.

Hospital-acquired infections are the leading cause of preventable mortality in pediatric patients, according to an analysis of data from hospitals in 19 states.

Out of 5 million pediatric patient records from the period 2006–2008, there were 25,367 events identified, and of those, 1,465 potentially preventable inpatient deaths, according to HealthGrades, the independent health care ratings organization that conducted the review.

Seventy percent of the deaths were associated with hospital-acquired infections, the Golden, Colo.–based company concluded.

Overall, 1 in 208 pediatric patients experienced a potentially preventable event.

The organization cautioned that while this may seem like a low rate, it is calculated only for 19 states and only for eight safety measures developed by the Agency for Healthcare Research and Quality.

The eight indicators were accidental puncture or laceration; pressure ulcer; avoidance of collapsed lung; postoperative hemorrhage or hematoma; postoperative respiratory failure; postoperative sepsis; postoperative wound dehiscence; and central venous catheter-related infections.

Four incidents that occurred with the most frequency per 1,000 patients were postoperative sepsis (at a rate of 24 per 1,000), postoperative respiratory failure (18), pressure ulcers (3), and central venous catheter-related infections (2).

There was improvement in four of the measures over the study period: selected infections due to medical care, postop hemorrhage or hematoma, postop respiratory failure, and postop wound dehiscence.

But four indicators worsened: accidental puncture, pressure ulcer, iatrogenic pneumothorax, and postop sepsis.

HealthGrades said it decided to undertake its first-ever review of pediatric safety because families and health care providers might not be familiar with the magnitude of errors in the pediatric population.

There are more than 6 million pediatric hospitalizations each year, 40% of which come through the emergency department.

Pediatric hospitals and programs largely have been overlooked or excluded from quality improvement efforts, according to the company.

The states with the best-rated pediatric safety performance were California, Florida, Iowa, Oregon, Utah, and Wisconsin.

Wide variation in quality was noted among the 2,080 hospitals that reported data.

HealthGrades conferred patient safety awards on 97 hospitals that had rates that were statistically lower than those of the other facilities studied.

Children at those hospitals had a 29% lower risk of experiencing one or more of the events compared with patients at the other facilities.

A venture capital company, Vestar Capital Partners, recently agreed to purchase HealthGrades.

Hospital-acquired infections are the leading cause of preventable mortality in pediatric patients, according to an analysis of data from hospitals in 19 states.

Out of 5 million pediatric patient records from the period 2006–2008, there were 25,367 events identified, and of those, 1,465 potentially preventable inpatient deaths, according to HealthGrades, the independent health care ratings organization that conducted the review.

Seventy percent of the deaths were associated with hospital-acquired infections, the Golden, Colo.–based company concluded.

Overall, 1 in 208 pediatric patients experienced a potentially preventable event.

The organization cautioned that while this may seem like a low rate, it is calculated only for 19 states and only for eight safety measures developed by the Agency for Healthcare Research and Quality.

The eight indicators were accidental puncture or laceration; pressure ulcer; avoidance of collapsed lung; postoperative hemorrhage or hematoma; postoperative respiratory failure; postoperative sepsis; postoperative wound dehiscence; and central venous catheter-related infections.

Four incidents that occurred with the most frequency per 1,000 patients were postoperative sepsis (at a rate of 24 per 1,000), postoperative respiratory failure (18), pressure ulcers (3), and central venous catheter-related infections (2).

There was improvement in four of the measures over the study period: selected infections due to medical care, postop hemorrhage or hematoma, postop respiratory failure, and postop wound dehiscence.

But four indicators worsened: accidental puncture, pressure ulcer, iatrogenic pneumothorax, and postop sepsis.

HealthGrades said it decided to undertake its first-ever review of pediatric safety because families and health care providers might not be familiar with the magnitude of errors in the pediatric population.

There are more than 6 million pediatric hospitalizations each year, 40% of which come through the emergency department.

Pediatric hospitals and programs largely have been overlooked or excluded from quality improvement efforts, according to the company.

The states with the best-rated pediatric safety performance were California, Florida, Iowa, Oregon, Utah, and Wisconsin.

Wide variation in quality was noted among the 2,080 hospitals that reported data.

HealthGrades conferred patient safety awards on 97 hospitals that had rates that were statistically lower than those of the other facilities studied.

Children at those hospitals had a 29% lower risk of experiencing one or more of the events compared with patients at the other facilities.

A venture capital company, Vestar Capital Partners, recently agreed to purchase HealthGrades.

Hospital-acquired infections are the leading cause of preventable mortality in pediatric patients, according to an analysis of data from hospitals in 19 states.

Out of 5 million pediatric patient records from the period 2006–2008, there were 25,367 events identified, and of those, 1,465 potentially preventable inpatient deaths, according to HealthGrades, the independent health care ratings organization that conducted the review.

Seventy percent of the deaths were associated with hospital-acquired infections, the Golden, Colo.–based company concluded.

Overall, 1 in 208 pediatric patients experienced a potentially preventable event.

The organization cautioned that while this may seem like a low rate, it is calculated only for 19 states and only for eight safety measures developed by the Agency for Healthcare Research and Quality.

The eight indicators were accidental puncture or laceration; pressure ulcer; avoidance of collapsed lung; postoperative hemorrhage or hematoma; postoperative respiratory failure; postoperative sepsis; postoperative wound dehiscence; and central venous catheter-related infections.

Four incidents that occurred with the most frequency per 1,000 patients were postoperative sepsis (at a rate of 24 per 1,000), postoperative respiratory failure (18), pressure ulcers (3), and central venous catheter-related infections (2).

There was improvement in four of the measures over the study period: selected infections due to medical care, postop hemorrhage or hematoma, postop respiratory failure, and postop wound dehiscence.

But four indicators worsened: accidental puncture, pressure ulcer, iatrogenic pneumothorax, and postop sepsis.

HealthGrades said it decided to undertake its first-ever review of pediatric safety because families and health care providers might not be familiar with the magnitude of errors in the pediatric population.

There are more than 6 million pediatric hospitalizations each year, 40% of which come through the emergency department.

Pediatric hospitals and programs largely have been overlooked or excluded from quality improvement efforts, according to the company.

The states with the best-rated pediatric safety performance were California, Florida, Iowa, Oregon, Utah, and Wisconsin.

Wide variation in quality was noted among the 2,080 hospitals that reported data.

HealthGrades conferred patient safety awards on 97 hospitals that had rates that were statistically lower than those of the other facilities studied.

Children at those hospitals had a 29% lower risk of experiencing one or more of the events compared with patients at the other facilities.

A venture capital company, Vestar Capital Partners, recently agreed to purchase HealthGrades.

The American Medical Association is calling on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting.

The New York delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to re-commit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the code, but spokesman Robert Zirkelbach said many of the principles are covered under the health reform law—formally, the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said.

“We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system,” he added.

The code's principles address topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

Physicians should also have more opportunity to challenge ratings in those systems, according to the principles. The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

'It's time for insurers to re-commit to … the fair business practices necessary to re-establish trust.'

Source Dr. ROHACK

The American Medical Association is calling on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting.

The New York delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to re-commit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the code, but spokesman Robert Zirkelbach said many of the principles are covered under the health reform law—formally, the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said.

“We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system,” he added.

The code's principles address topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

Physicians should also have more opportunity to challenge ratings in those systems, according to the principles. The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

'It's time for insurers to re-commit to … the fair business practices necessary to re-establish trust.'

Source Dr. ROHACK

The American Medical Association is calling on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved out of a resolution put forward and unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting.

The New York delegation called on the AMA to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has already been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, according to the AMA, which added in a statement that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to re-commit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the code, but spokesman Robert Zirkelbach said many of the principles are covered under the health reform law—formally, the Affordable Care Act.

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” Mr. Zirkelbach said.

“We will continue to work with policymakers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system,” he added.

The code's principles address topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems.

Physicians should also have more opportunity to challenge ratings in those systems, according to the principles. The AMA said that it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

'It's time for insurers to re-commit to … the fair business practices necessary to re-establish trust.'

Source Dr. ROHACK

The American Medical Association has called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved from a resolution that was unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the association to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, said the AMA, which added that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to re-commit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But spokesman Robert Zirkelbach said many of the principles are covered under the health reform law (Affordable Care Act).

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” he said. “We will continue to work with policy makers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code's principles address topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems. Physicians should also have more opportunity to review and challenge their ratings in those systems, according to the principles.

The AMA said it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

'It's time for health insurers to re-commit to patients' best interests.'

Source DR. ROHACK

The American Medical Association has called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved from a resolution that was unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the association to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, said the AMA, which added that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to re-commit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But spokesman Robert Zirkelbach said many of the principles are covered under the health reform law (Affordable Care Act).

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” he said. “We will continue to work with policy makers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code's principles address topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems. Physicians should also have more opportunity to review and challenge their ratings in those systems, according to the principles.

The AMA said it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

'It's time for health insurers to re-commit to patients' best interests.'

Source DR. ROHACK

The American Medical Association has called on U.S. health insurance companies to adopt its just-issued code of conduct.

The Health Insurer Code of Conduct Principles evolved from a resolution that was unanimously adopted by the AMA House of Delegates at its 2008 Interim Meeting. The New York Delegation called on the association to develop such a code, get insurers to sign on, and come up with a way to monitor compliance. The code has been endorsed by nearly every state medical society as well as 19 specialty societies, according to the AMA.

The last time the insurance industry issued any kind of internal standards was 15 years ago, said the AMA, which added that the industry has had a “questionable” record of compliance with those standards, known as the Philosophy of Care.

“The health insurance industry has a crisis of credibility,” Dr. J. James Rohack, AMA president, said in the statement. “With the enactment of federal health reform legislation, it's time for insurers to re-commit to patients' best interests and the fair business practices necessary to re-establish trust with the patient and physician communities.”

Americas Health Insurance Plans, the industry trade organization, did not directly address the AMA code. But spokesman Robert Zirkelbach said many of the principles are covered under the health reform law (Affordable Care Act).

“Health plans have pioneered innovative programs to reward quality, promote prevention and wellness, coordinate care for patients with chronic conditions, streamline administrative processes, and provide policyholders with greater peace of mind,” he said. “We will continue to work with policy makers and other health care stakeholders to improve the quality, safety, and efficiency of our health care system.”

The code's principles address topics including cancellations and recissions; medical loss ratios and calculating fair premiums; open access to care, including transparent rules on provider networks and benefit limitations; fairness in contract negotiations with physicians; medical necessity and who can define it; and a call for more administrative simplification, fewer restrictions on benefits, and better risk adjustment mechanisms for “physician profiling” systems. Physicians should also have more opportunity to review and challenge their ratings in those systems, according to the principles.

The AMA said it has written to the eight largest health insurers seeking their pledge to comply with the code.

For more information, visit www.ama-assn.org/ama/pub/advocacy/current-topics-advocacy/private-sector-advocacy/code-of-conduct-principles.shtml

'It's time for health insurers to re-commit to patients' best interests.'

Source DR. ROHACK

The Food and Drug Administration has notified Roche that it will not accept the company’s application for an accelerated approval of trastuzumab-DM1 in advanced HER2-positive breast cancer.

Roche had filed for a fast-track review of T-DM1 in July, after meeting with the FDA in March to discuss such an application. The drug combines the anti-HER2 activity of trastuzumab (Herceptin) with the targeted intracellular delivery of DM1, a potent antimicrotubule agent. The DM1 component is licensed by ImmunoGen Inc.

In seeking the approval, Roche submitted results from a 110-patient single-arm phase II study. In that trial, one-third of women with advanced HER2-positive breast cancer had a tumor response. Results were presented at the 2009 San Antonio Breast Cancer Symposium.

Even though the women had received on average seven prior therapies, including HER2-targeted agents, the FDA told Roche that the trial did not meet the standard for accelerated approval because the patients had not exhausted all approved treatment options for metastatic breast cancer.

Roche said in a statement that it will continue with its phase III study, EMILIA, which compares T-DM1 to lapatinib (Tykerb) in combination with capecitabine (Xeloda) in advanced HER2-positive breast cancer. The study will evaluate overall survival and progression-free survival. Roche said it anticipated filing for approval in various nations, including the United States, in mid-2012.

“We firmly believe in the potential of T-DM1 as a novel HER2-targeted option and remain fully committed to its ongoing development,” said Dr. Hal Barron, Roche’s head of global development and chief medical officer, in a statement.

T-DM1 is being compared to trastuzumab in a phase II study in previously untreated advanced HER2-positive breast cancer as well. It is also in a phase III study, MARIANNE, where it is being compared with trastuzumab as a single agent or in combination with pertuzumab (Omnitarg) in previously untreated advanced HER2-positive breast cancer.

The Food and Drug Administration has notified Roche that it will not accept the company’s application for an accelerated approval of trastuzumab-DM1 in advanced HER2-positive breast cancer.

Roche had filed for a fast-track review of T-DM1 in July, after meeting with the FDA in March to discuss such an application. The drug combines the anti-HER2 activity of trastuzumab (Herceptin) with the targeted intracellular delivery of DM1, a potent antimicrotubule agent. The DM1 component is licensed by ImmunoGen Inc.

In seeking the approval, Roche submitted results from a 110-patient single-arm phase II study. In that trial, one-third of women with advanced HER2-positive breast cancer had a tumor response. Results were presented at the 2009 San Antonio Breast Cancer Symposium.

Even though the women had received on average seven prior therapies, including HER2-targeted agents, the FDA told Roche that the trial did not meet the standard for accelerated approval because the patients had not exhausted all approved treatment options for metastatic breast cancer.

Roche said in a statement that it will continue with its phase III study, EMILIA, which compares T-DM1 to lapatinib (Tykerb) in combination with capecitabine (Xeloda) in advanced HER2-positive breast cancer. The study will evaluate overall survival and progression-free survival. Roche said it anticipated filing for approval in various nations, including the United States, in mid-2012.

“We firmly believe in the potential of T-DM1 as a novel HER2-targeted option and remain fully committed to its ongoing development,” said Dr. Hal Barron, Roche’s head of global development and chief medical officer, in a statement.

T-DM1 is being compared to trastuzumab in a phase II study in previously untreated advanced HER2-positive breast cancer as well. It is also in a phase III study, MARIANNE, where it is being compared with trastuzumab as a single agent or in combination with pertuzumab (Omnitarg) in previously untreated advanced HER2-positive breast cancer.

The Food and Drug Administration has notified Roche that it will not accept the company’s application for an accelerated approval of trastuzumab-DM1 in advanced HER2-positive breast cancer.

Roche had filed for a fast-track review of T-DM1 in July, after meeting with the FDA in March to discuss such an application. The drug combines the anti-HER2 activity of trastuzumab (Herceptin) with the targeted intracellular delivery of DM1, a potent antimicrotubule agent. The DM1 component is licensed by ImmunoGen Inc.

In seeking the approval, Roche submitted results from a 110-patient single-arm phase II study. In that trial, one-third of women with advanced HER2-positive breast cancer had a tumor response. Results were presented at the 2009 San Antonio Breast Cancer Symposium.

Even though the women had received on average seven prior therapies, including HER2-targeted agents, the FDA told Roche that the trial did not meet the standard for accelerated approval because the patients had not exhausted all approved treatment options for metastatic breast cancer.

Roche said in a statement that it will continue with its phase III study, EMILIA, which compares T-DM1 to lapatinib (Tykerb) in combination with capecitabine (Xeloda) in advanced HER2-positive breast cancer. The study will evaluate overall survival and progression-free survival. Roche said it anticipated filing for approval in various nations, including the United States, in mid-2012.

“We firmly believe in the potential of T-DM1 as a novel HER2-targeted option and remain fully committed to its ongoing development,” said Dr. Hal Barron, Roche’s head of global development and chief medical officer, in a statement.

T-DM1 is being compared to trastuzumab in a phase II study in previously untreated advanced HER2-positive breast cancer as well. It is also in a phase III study, MARIANNE, where it is being compared with trastuzumab as a single agent or in combination with pertuzumab (Omnitarg) in previously untreated advanced HER2-positive breast cancer.