Jane Anderson

Children with neurological impairment – especially epilepsy – accounted for more than 21% of all hospital charges in 2006, and their impact on children’s hospitals is growing as utilization shifts to those facilities, according to a retrospective, cross-sectional analysis of multiple years of the Kids’ Inpatient Database.

As more resources are used by children with neurological impairment, particularly at children’s hospitals, the institutions will need to make sure that they provide adequate staffing and education to treat these vulnerable children, Dr. Jay G. Berry of Children Hospital Boston and his coauthors recommended in the study, published online Jan. 17 in PLoS Medicine.

"Children’s hospitals, in particular, will need to ensure that (1) adequate clinical and coordinated expertise is focused on the needs of these children, (2) neurological impairment clinical assessment and care management training is developed for trainees and junior graduates in pediatric postgraduate educational programs, (3) partnerships between families of children with [neurological impairment] and hospitals are developed and implemented, and (4) care treatment strategies of both nervous and non-nervous-system problems are rigorously evaluated for these children," the authors wrote.

Dr. Jeffrey Buchhalter, pediatric neurologist at Phoenix Children’s Hospital, said in an interview that the study provides real data on trends that he’s seen in his own institution.

"It’s confirmed for me my clinical suspicions that these are very frequent admissions and very expensive admissions. The bulk of the admissions relate to epilepsy," he said. There are several reasons this could be happening, including increased incidence of neurological impairment, increased severity of the conditions, and an increased desire to deliver medical care, he said.

The investigators analyzed data from more than 25.7 million hospitalizations in the years 1997, 2000, 2003, and 2006 in the Kids’ Inpatient Database. They found that the proportion of hospitalizations attributable to children with neurological impairment – 5.3% in 2006 – did not change significantly over time (PLoS Med. 2012 Jan. 17 [doi:10.1371/journal.pmed.1001158]).

But even though children with neurological impairment represented less than 6% of admissions during that period, they accounted for a significant rise in the proportion of hospital bed days from 12.9% in 1997 to 13.9% in 2006. There was a statistically insignificant rise in hospital charges for children with neurological impairment across all hospitals during this period from 20.8% to 21.6%, the investigators found.

Between 1997 and 2006, the proportion of hospitalizations attributable to children with neurological impairment decreased within non-children’s hospitals, from 3% in 1997 to 2.5% in 2006, but increased within children’s hospitals from 11.7% in 1997 to 13.5% in 2006.

The proportion of bed days at children’s hospitals for children with neurological impairment also grew from 21.8% in 1997 to 25.0% in 2006. Their proportion of hospital charges rose in parallel from 27.1% to 29.0%.

More than 52% of admissions involved a diagnosis of epilepsy. Almost 16% involved a diagnosis of cerebral palsy.

The study’s authors speculated that patients may be gravitating toward children’s hospitals because most U.S. child neurologists work within those hospitals, and multi-disciplinary care coordination clinics have emerged to provide comprehensive care to children with neurological impairment.

In addition, the study found a trend of rising hospitalizations in adolescent children with neurological impairment that was greater than that for children without neurological impairment. Hospitalizations for children aged 13-18 years with neurological impairment rose 27.8% between 1997 and 2006, compared with a decrease of 8.4% among same-aged children without neurological impairment.

The authors said it’s possible that problems with transitioning care from pediatric specialists to adult providers could contribute to this trend.

"U.S. physicians have demonstrated deficiencies in working knowledge of the most common forms of neurological impairment, and negative provider attitudes toward this population are associated with substandard acute care practices," the authors wrote. "Parents of adolescents with neurological impairment report this as a contributing factor that complicates the transfer of their child’s health care from pediatric to adult providers."

Dr. Buchhalter said that another way to look at the situation portrayed by the study is to consider it "as a failure of ambulatory care," adding that more child neurologists are needed to care for these patients. However, he said, "it’s all a matter of funding being available to support residencies and fellowships." In addition, "reimbursement to be a child neurologist is falling, since it’s mainly a cognitive specialty," and that leads to fewer medical students pursuing a career in child neurology, he said.

"What these children need is people to think about and organize their care," Dr. Buchhalter said. "There’s enormous variation in care, and we need evidence-based care guidelines. There’s also a great need for multi-disciplinary care for these children, but that’s not reimbursed well."

Coauthor Dr. Rajendu Srivastava has received grant funding from the National Institute of Child Health and Human Development, has given talks as Chair of Pediatric Research in Inpatient Settings Network, with his time funded by the Child Health Corporation. He’s also been asked to speak in his capacity as a hospitalist investigator with receipt of an honorarium, and has acted as an expert witness on behalf of a plaintiff for Jackson & Campbell P.C. because of his research with neurological impairment and their care. No other authors had any disclosures.

Children with neurological impairment – especially epilepsy – accounted for more than 21% of all hospital charges in 2006, and their impact on children’s hospitals is growing as utilization shifts to those facilities, according to a retrospective, cross-sectional analysis of multiple years of the Kids’ Inpatient Database.

As more resources are used by children with neurological impairment, particularly at children’s hospitals, the institutions will need to make sure that they provide adequate staffing and education to treat these vulnerable children, Dr. Jay G. Berry of Children Hospital Boston and his coauthors recommended in the study, published online Jan. 17 in PLoS Medicine.

"Children’s hospitals, in particular, will need to ensure that (1) adequate clinical and coordinated expertise is focused on the needs of these children, (2) neurological impairment clinical assessment and care management training is developed for trainees and junior graduates in pediatric postgraduate educational programs, (3) partnerships between families of children with [neurological impairment] and hospitals are developed and implemented, and (4) care treatment strategies of both nervous and non-nervous-system problems are rigorously evaluated for these children," the authors wrote.

Dr. Jeffrey Buchhalter, pediatric neurologist at Phoenix Children’s Hospital, said in an interview that the study provides real data on trends that he’s seen in his own institution.

"It’s confirmed for me my clinical suspicions that these are very frequent admissions and very expensive admissions. The bulk of the admissions relate to epilepsy," he said. There are several reasons this could be happening, including increased incidence of neurological impairment, increased severity of the conditions, and an increased desire to deliver medical care, he said.

The investigators analyzed data from more than 25.7 million hospitalizations in the years 1997, 2000, 2003, and 2006 in the Kids’ Inpatient Database. They found that the proportion of hospitalizations attributable to children with neurological impairment – 5.3% in 2006 – did not change significantly over time (PLoS Med. 2012 Jan. 17 [doi:10.1371/journal.pmed.1001158]).

But even though children with neurological impairment represented less than 6% of admissions during that period, they accounted for a significant rise in the proportion of hospital bed days from 12.9% in 1997 to 13.9% in 2006. There was a statistically insignificant rise in hospital charges for children with neurological impairment across all hospitals during this period from 20.8% to 21.6%, the investigators found.

Between 1997 and 2006, the proportion of hospitalizations attributable to children with neurological impairment decreased within non-children’s hospitals, from 3% in 1997 to 2.5% in 2006, but increased within children’s hospitals from 11.7% in 1997 to 13.5% in 2006.

The proportion of bed days at children’s hospitals for children with neurological impairment also grew from 21.8% in 1997 to 25.0% in 2006. Their proportion of hospital charges rose in parallel from 27.1% to 29.0%.

More than 52% of admissions involved a diagnosis of epilepsy. Almost 16% involved a diagnosis of cerebral palsy.

The study’s authors speculated that patients may be gravitating toward children’s hospitals because most U.S. child neurologists work within those hospitals, and multi-disciplinary care coordination clinics have emerged to provide comprehensive care to children with neurological impairment.

In addition, the study found a trend of rising hospitalizations in adolescent children with neurological impairment that was greater than that for children without neurological impairment. Hospitalizations for children aged 13-18 years with neurological impairment rose 27.8% between 1997 and 2006, compared with a decrease of 8.4% among same-aged children without neurological impairment.

The authors said it’s possible that problems with transitioning care from pediatric specialists to adult providers could contribute to this trend.

"U.S. physicians have demonstrated deficiencies in working knowledge of the most common forms of neurological impairment, and negative provider attitudes toward this population are associated with substandard acute care practices," the authors wrote. "Parents of adolescents with neurological impairment report this as a contributing factor that complicates the transfer of their child’s health care from pediatric to adult providers."

Dr. Buchhalter said that another way to look at the situation portrayed by the study is to consider it "as a failure of ambulatory care," adding that more child neurologists are needed to care for these patients. However, he said, "it’s all a matter of funding being available to support residencies and fellowships." In addition, "reimbursement to be a child neurologist is falling, since it’s mainly a cognitive specialty," and that leads to fewer medical students pursuing a career in child neurology, he said.

"What these children need is people to think about and organize their care," Dr. Buchhalter said. "There’s enormous variation in care, and we need evidence-based care guidelines. There’s also a great need for multi-disciplinary care for these children, but that’s not reimbursed well."

Coauthor Dr. Rajendu Srivastava has received grant funding from the National Institute of Child Health and Human Development, has given talks as Chair of Pediatric Research in Inpatient Settings Network, with his time funded by the Child Health Corporation. He’s also been asked to speak in his capacity as a hospitalist investigator with receipt of an honorarium, and has acted as an expert witness on behalf of a plaintiff for Jackson & Campbell P.C. because of his research with neurological impairment and their care. No other authors had any disclosures.

Children with neurological impairment – especially epilepsy – accounted for more than 21% of all hospital charges in 2006, and their impact on children’s hospitals is growing as utilization shifts to those facilities, according to a retrospective, cross-sectional analysis of multiple years of the Kids’ Inpatient Database.

As more resources are used by children with neurological impairment, particularly at children’s hospitals, the institutions will need to make sure that they provide adequate staffing and education to treat these vulnerable children, Dr. Jay G. Berry of Children Hospital Boston and his coauthors recommended in the study, published online Jan. 17 in PLoS Medicine.

"Children’s hospitals, in particular, will need to ensure that (1) adequate clinical and coordinated expertise is focused on the needs of these children, (2) neurological impairment clinical assessment and care management training is developed for trainees and junior graduates in pediatric postgraduate educational programs, (3) partnerships between families of children with [neurological impairment] and hospitals are developed and implemented, and (4) care treatment strategies of both nervous and non-nervous-system problems are rigorously evaluated for these children," the authors wrote.

Dr. Jeffrey Buchhalter, pediatric neurologist at Phoenix Children’s Hospital, said in an interview that the study provides real data on trends that he’s seen in his own institution.

"It’s confirmed for me my clinical suspicions that these are very frequent admissions and very expensive admissions. The bulk of the admissions relate to epilepsy," he said. There are several reasons this could be happening, including increased incidence of neurological impairment, increased severity of the conditions, and an increased desire to deliver medical care, he said.

The investigators analyzed data from more than 25.7 million hospitalizations in the years 1997, 2000, 2003, and 2006 in the Kids’ Inpatient Database. They found that the proportion of hospitalizations attributable to children with neurological impairment – 5.3% in 2006 – did not change significantly over time (PLoS Med. 2012 Jan. 17 [doi:10.1371/journal.pmed.1001158]).

But even though children with neurological impairment represented less than 6% of admissions during that period, they accounted for a significant rise in the proportion of hospital bed days from 12.9% in 1997 to 13.9% in 2006. There was a statistically insignificant rise in hospital charges for children with neurological impairment across all hospitals during this period from 20.8% to 21.6%, the investigators found.

Between 1997 and 2006, the proportion of hospitalizations attributable to children with neurological impairment decreased within non-children’s hospitals, from 3% in 1997 to 2.5% in 2006, but increased within children’s hospitals from 11.7% in 1997 to 13.5% in 2006.

The proportion of bed days at children’s hospitals for children with neurological impairment also grew from 21.8% in 1997 to 25.0% in 2006. Their proportion of hospital charges rose in parallel from 27.1% to 29.0%.

More than 52% of admissions involved a diagnosis of epilepsy. Almost 16% involved a diagnosis of cerebral palsy.

The study’s authors speculated that patients may be gravitating toward children’s hospitals because most U.S. child neurologists work within those hospitals, and multi-disciplinary care coordination clinics have emerged to provide comprehensive care to children with neurological impairment.

In addition, the study found a trend of rising hospitalizations in adolescent children with neurological impairment that was greater than that for children without neurological impairment. Hospitalizations for children aged 13-18 years with neurological impairment rose 27.8% between 1997 and 2006, compared with a decrease of 8.4% among same-aged children without neurological impairment.

The authors said it’s possible that problems with transitioning care from pediatric specialists to adult providers could contribute to this trend.

"U.S. physicians have demonstrated deficiencies in working knowledge of the most common forms of neurological impairment, and negative provider attitudes toward this population are associated with substandard acute care practices," the authors wrote. "Parents of adolescents with neurological impairment report this as a contributing factor that complicates the transfer of their child’s health care from pediatric to adult providers."

Dr. Buchhalter said that another way to look at the situation portrayed by the study is to consider it "as a failure of ambulatory care," adding that more child neurologists are needed to care for these patients. However, he said, "it’s all a matter of funding being available to support residencies and fellowships." In addition, "reimbursement to be a child neurologist is falling, since it’s mainly a cognitive specialty," and that leads to fewer medical students pursuing a career in child neurology, he said.

"What these children need is people to think about and organize their care," Dr. Buchhalter said. "There’s enormous variation in care, and we need evidence-based care guidelines. There’s also a great need for multi-disciplinary care for these children, but that’s not reimbursed well."

Coauthor Dr. Rajendu Srivastava has received grant funding from the National Institute of Child Health and Human Development, has given talks as Chair of Pediatric Research in Inpatient Settings Network, with his time funded by the Child Health Corporation. He’s also been asked to speak in his capacity as a hospitalist investigator with receipt of an honorarium, and has acted as an expert witness on behalf of a plaintiff for Jackson & Campbell P.C. because of his research with neurological impairment and their care. No other authors had any disclosures.

Physicians in eight countries agree that health care information technology has the potential to improve clinical data and care coordination while reducing medical errors, according to a new survey. However, physicians in the United States and doctors older than 50 voiced considerably more skepticism than did their younger and international colleagues about the technology’s ability to improve care.

The survey, conducted by global consulting firm Accenture, exposed generational and geographic divides among physicians when it comes to their views on the benefits of health information technology. Physicians who haven’t used the technology are most skeptical, but once they start to use health care IT, they begin to see those benefits, said Frances Dare, a senior executive with Accenture Health.

"The value indicators from those [physicians] who have used the technology are very strong," meaning they think the technology can improve care and reduce costs, Ms. Dare said in an interview. "It’s not that physicians try it and don’t like it and stop. We really do need to focus on physicians who haven’t used these technologies; it’s really getting across that first adoption hurdle.

Physicians who use health IT most frequently have the highest opinions of it.

Accenture surveyed 500 doctors per country in Australia, Canada, England, France, Germany, Spain, and the United States, along with 200 doctors in Singapore, in August and September 2011. The researchers measured physicians’ attitudes toward health IT, including whether they thought it would bring access to better-quality data, improved coordination, reductions in medical errors, and improved diagnostic decisions.

The survey found that nearly 71% of physicians in the eight countries surveyed think that health IT will improve data for clinical research, and 69% think it will improve coordination of care. About two-thirds think it will lead to a reduction in medical errors, and about 65% think it will lead to better health care decisions.

However, fewer than 50% of physicians think it will lead to less litigation, and fewer than 50% think it will lead to fewer unnecessary procedures or increased speed of access to health services for patients. Because health IT is frequently touted with promises of improved access and better coordination of care, this finding shows that physicians haven’t fully bought into those promises, according to Accenture.

Finally, fewer than 40% of physicians in the eight countries are not certain that health IT will lead to improved patient outcomes.

Ms. Dare said that policy makers and companies involved in the health IT field have tended to focus on how the technology can reduce costs and unnecessary care, whereas this survey shows that physicians care more about how health IT can improve access to care and care coordination for patients. However, using the technology to improve care – which physicians want – ultimately will address cost issues as well, she said.

"If we say to physicians, ‘This technology will allow you to better coordinate care’ – if we speak to the benefits physicians care about – then we will get the benefits policy makers and industry care about, which are utilization and cost," Ms. Dare said.

Physicians who use health IT most frequently have the highest opinions of it, according to the survey.

For example, more than 72% of physicians younger than age 50 say that electronic medical records and health information exchanges will improve care coordination, the survey found, whereas 73% think those technologies will offer better access to quality data for clinical research. Among older physicians, only 65% think research data will improve, and 68% think care coordination will improve, according to the survey.

Meanwhile, negative opinions about health IT are most pronounced among physicians in the United States, according to Accenture. Fewer than half of all U.S. physicians surveyed said they believed that health IT would improve  care overall, compared with 59% of physicians in all eight countries.

In addition, only 45% of U.S. physicians believe that health IT will improve diagnostic decisions, compared with 61% of all physicians surveyed, and just 47% of U.S. physicians say that technology already has improved the quality of treatment decisions, compared with an average of 61% of physicians in all eight countries. Only 45% of U.S. physicians believe that health IT leads to improved outcomes, compared with 59% of all physicians.

The United States "is behind," Ms. Dare said. "We’re ... a decade late [in having] a national agenda to drive adoption and having a unified approach to drive adoption" of health IT. Still, Ms. Dare said she believes the United States can catch up quickly if more physicians begin to use such technology and see the benefits from it.

Physicians in eight countries agree that health care information technology has the potential to improve clinical data and care coordination while reducing medical errors, according to a new survey. However, physicians in the United States and doctors older than 50 voiced considerably more skepticism than did their younger and international colleagues about the technology’s ability to improve care.

The survey, conducted by global consulting firm Accenture, exposed generational and geographic divides among physicians when it comes to their views on the benefits of health information technology. Physicians who haven’t used the technology are most skeptical, but once they start to use health care IT, they begin to see those benefits, said Frances Dare, a senior executive with Accenture Health.

"The value indicators from those [physicians] who have used the technology are very strong," meaning they think the technology can improve care and reduce costs, Ms. Dare said in an interview. "It’s not that physicians try it and don’t like it and stop. We really do need to focus on physicians who haven’t used these technologies; it’s really getting across that first adoption hurdle.

Physicians who use health IT most frequently have the highest opinions of it.

Accenture surveyed 500 doctors per country in Australia, Canada, England, France, Germany, Spain, and the United States, along with 200 doctors in Singapore, in August and September 2011. The researchers measured physicians’ attitudes toward health IT, including whether they thought it would bring access to better-quality data, improved coordination, reductions in medical errors, and improved diagnostic decisions.

The survey found that nearly 71% of physicians in the eight countries surveyed think that health IT will improve data for clinical research, and 69% think it will improve coordination of care. About two-thirds think it will lead to a reduction in medical errors, and about 65% think it will lead to better health care decisions.

However, fewer than 50% of physicians think it will lead to less litigation, and fewer than 50% think it will lead to fewer unnecessary procedures or increased speed of access to health services for patients. Because health IT is frequently touted with promises of improved access and better coordination of care, this finding shows that physicians haven’t fully bought into those promises, according to Accenture.

Finally, fewer than 40% of physicians in the eight countries are not certain that health IT will lead to improved patient outcomes.

Ms. Dare said that policy makers and companies involved in the health IT field have tended to focus on how the technology can reduce costs and unnecessary care, whereas this survey shows that physicians care more about how health IT can improve access to care and care coordination for patients. However, using the technology to improve care – which physicians want – ultimately will address cost issues as well, she said.

"If we say to physicians, ‘This technology will allow you to better coordinate care’ – if we speak to the benefits physicians care about – then we will get the benefits policy makers and industry care about, which are utilization and cost," Ms. Dare said.

Physicians who use health IT most frequently have the highest opinions of it, according to the survey.

For example, more than 72% of physicians younger than age 50 say that electronic medical records and health information exchanges will improve care coordination, the survey found, whereas 73% think those technologies will offer better access to quality data for clinical research. Among older physicians, only 65% think research data will improve, and 68% think care coordination will improve, according to the survey.

Meanwhile, negative opinions about health IT are most pronounced among physicians in the United States, according to Accenture. Fewer than half of all U.S. physicians surveyed said they believed that health IT would improve  care overall, compared with 59% of physicians in all eight countries.

In addition, only 45% of U.S. physicians believe that health IT will improve diagnostic decisions, compared with 61% of all physicians surveyed, and just 47% of U.S. physicians say that technology already has improved the quality of treatment decisions, compared with an average of 61% of physicians in all eight countries. Only 45% of U.S. physicians believe that health IT leads to improved outcomes, compared with 59% of all physicians.

The United States "is behind," Ms. Dare said. "We’re ... a decade late [in having] a national agenda to drive adoption and having a unified approach to drive adoption" of health IT. Still, Ms. Dare said she believes the United States can catch up quickly if more physicians begin to use such technology and see the benefits from it.

Physicians in eight countries agree that health care information technology has the potential to improve clinical data and care coordination while reducing medical errors, according to a new survey. However, physicians in the United States and doctors older than 50 voiced considerably more skepticism than did their younger and international colleagues about the technology’s ability to improve care.

The survey, conducted by global consulting firm Accenture, exposed generational and geographic divides among physicians when it comes to their views on the benefits of health information technology. Physicians who haven’t used the technology are most skeptical, but once they start to use health care IT, they begin to see those benefits, said Frances Dare, a senior executive with Accenture Health.

"The value indicators from those [physicians] who have used the technology are very strong," meaning they think the technology can improve care and reduce costs, Ms. Dare said in an interview. "It’s not that physicians try it and don’t like it and stop. We really do need to focus on physicians who haven’t used these technologies; it’s really getting across that first adoption hurdle.

Physicians who use health IT most frequently have the highest opinions of it.

Accenture surveyed 500 doctors per country in Australia, Canada, England, France, Germany, Spain, and the United States, along with 200 doctors in Singapore, in August and September 2011. The researchers measured physicians’ attitudes toward health IT, including whether they thought it would bring access to better-quality data, improved coordination, reductions in medical errors, and improved diagnostic decisions.

The survey found that nearly 71% of physicians in the eight countries surveyed think that health IT will improve data for clinical research, and 69% think it will improve coordination of care. About two-thirds think it will lead to a reduction in medical errors, and about 65% think it will lead to better health care decisions.

However, fewer than 50% of physicians think it will lead to less litigation, and fewer than 50% think it will lead to fewer unnecessary procedures or increased speed of access to health services for patients. Because health IT is frequently touted with promises of improved access and better coordination of care, this finding shows that physicians haven’t fully bought into those promises, according to Accenture.

Finally, fewer than 40% of physicians in the eight countries are not certain that health IT will lead to improved patient outcomes.

Ms. Dare said that policy makers and companies involved in the health IT field have tended to focus on how the technology can reduce costs and unnecessary care, whereas this survey shows that physicians care more about how health IT can improve access to care and care coordination for patients. However, using the technology to improve care – which physicians want – ultimately will address cost issues as well, she said.

"If we say to physicians, ‘This technology will allow you to better coordinate care’ – if we speak to the benefits physicians care about – then we will get the benefits policy makers and industry care about, which are utilization and cost," Ms. Dare said.

Physicians who use health IT most frequently have the highest opinions of it, according to the survey.

For example, more than 72% of physicians younger than age 50 say that electronic medical records and health information exchanges will improve care coordination, the survey found, whereas 73% think those technologies will offer better access to quality data for clinical research. Among older physicians, only 65% think research data will improve, and 68% think care coordination will improve, according to the survey.

Meanwhile, negative opinions about health IT are most pronounced among physicians in the United States, according to Accenture. Fewer than half of all U.S. physicians surveyed said they believed that health IT would improve  care overall, compared with 59% of physicians in all eight countries.

In addition, only 45% of U.S. physicians believe that health IT will improve diagnostic decisions, compared with 61% of all physicians surveyed, and just 47% of U.S. physicians say that technology already has improved the quality of treatment decisions, compared with an average of 61% of physicians in all eight countries. Only 45% of U.S. physicians believe that health IT leads to improved outcomes, compared with 59% of all physicians.

The United States "is behind," Ms. Dare said. "We’re ... a decade late [in having] a national agenda to drive adoption and having a unified approach to drive adoption" of health IT. Still, Ms. Dare said she believes the United States can catch up quickly if more physicians begin to use such technology and see the benefits from it.

Modified-risk tobacco products – such as e-cigarettes and tobacco lozenges that may reduce the health risks of using tobacco – could represent part of a comprehensive strategy to combat tobacco-related disease and death, but too little is known about whether they actually pose less risk than do traditional tobacco products, according to a report issued Dec. 14 by the Institute of Medicine.

Consequently, the Food and Drug Administration should require specific types of research on these modified-risk products before allowing tobacco companies to sell or advertise them as being capable of reducing the health effects of tobacco use, the IOM report recommended.

Photo courtesy timur1970/Fotolia.comCredit

The research should determine whether the product really presents a lessened risk for a person who might use it, Dr. Jane Henney, committee chair and professor of medicine and public health sciences at the University of Cincinnati, said in an interview. The product "also should not negatively impact the general public, as in the case of secondhand smoke, and it shouldn’t raise the risk" for nonusers or former users to begin or resume using the product.

Few smokers – only about 6% each year – are able to successfully quit tobacco use. Because quitting is so difficult, many cigarette smokers would welcome products that allow them to continue smoking with less risk to their health. However, there’s no research showing that modified-risk tobacco products are safer; in fact, so-called "light" cigarettes actually turned out to be just as risky as regular cigarettes, the IOM report said.

The Family Smoking Prevention and Control Act of 2009 gave the FDA the authority to ensure that modified-risk tobacco products actually do reduce tobacco-related harm before they can be marketed. The 2009 law also directed the IOM to work with the FDA on the design and conduct of scientific studies of modified-risk tobacco products.

The 330-page report provides details on how such studies should be conducted.

The tobacco industry "is new to regulation, and has a past history that would lead one to believe it can’t be trustworthy," Dr. Henney said. "We speak to the governance tools that should be put in place to really open up this process."

In part because of this trust gap, companies and other sponsors who develop modified-risk tobacco products should consider using FDA-approved, independent third parties to oversee health and safety research on their product, the report recommended. Independent oversight would ensure that the data submitted to the FDA are reliable and credible, the report said, and it might help to lure institutions and scientists back into the field; currently, many refuse to conduct or publish research supported by the tobacco industry.

Tobacco makers currently lack the capacity and expertise to conduct valid scientific research on their own products, according to the IOM report.

The report recommends that studies on modified-risk tobacco products should examine the product’s composition and addiction potential, the amount of human exposure to harmful components, perceptions about the product’s effects and likelihood of addiction, and its effects on human health. Studies should be "generalizable" to the whole population, but also should include populations of special relevance, including current and former smokers, beginning smokers, adolescents, and populations at high risk for tobacco use.

IOM committee member Dr. Bonnie Halpern-Felsher, professor of pediatrics at the University of California, San Francisco, said in an interview that it’s especially critical to understand how these modified-risk products could impact adolescents.

"We do know that the majority of people who start smoking are adolescents," Dr. Halpern-Felsher said. "We need to make sure when these studies are done that they do include the adolescent population, and cover the health effects on adolescents and adolescents’ perceptions of the product and their likelihood of going on to use it."

No disclosures were reported.

Modified-risk tobacco products – such as e-cigarettes and tobacco lozenges that may reduce the health risks of using tobacco – could represent part of a comprehensive strategy to combat tobacco-related disease and death, but too little is known about whether they actually pose less risk than do traditional tobacco products, according to a report issued Dec. 14 by the Institute of Medicine.

Consequently, the Food and Drug Administration should require specific types of research on these modified-risk products before allowing tobacco companies to sell or advertise them as being capable of reducing the health effects of tobacco use, the IOM report recommended.

Photo courtesy timur1970/Fotolia.comCredit

The research should determine whether the product really presents a lessened risk for a person who might use it, Dr. Jane Henney, committee chair and professor of medicine and public health sciences at the University of Cincinnati, said in an interview. The product "also should not negatively impact the general public, as in the case of secondhand smoke, and it shouldn’t raise the risk" for nonusers or former users to begin or resume using the product.

Few smokers – only about 6% each year – are able to successfully quit tobacco use. Because quitting is so difficult, many cigarette smokers would welcome products that allow them to continue smoking with less risk to their health. However, there’s no research showing that modified-risk tobacco products are safer; in fact, so-called "light" cigarettes actually turned out to be just as risky as regular cigarettes, the IOM report said.

The Family Smoking Prevention and Control Act of 2009 gave the FDA the authority to ensure that modified-risk tobacco products actually do reduce tobacco-related harm before they can be marketed. The 2009 law also directed the IOM to work with the FDA on the design and conduct of scientific studies of modified-risk tobacco products.

The 330-page report provides details on how such studies should be conducted.

The tobacco industry "is new to regulation, and has a past history that would lead one to believe it can’t be trustworthy," Dr. Henney said. "We speak to the governance tools that should be put in place to really open up this process."

In part because of this trust gap, companies and other sponsors who develop modified-risk tobacco products should consider using FDA-approved, independent third parties to oversee health and safety research on their product, the report recommended. Independent oversight would ensure that the data submitted to the FDA are reliable and credible, the report said, and it might help to lure institutions and scientists back into the field; currently, many refuse to conduct or publish research supported by the tobacco industry.

Tobacco makers currently lack the capacity and expertise to conduct valid scientific research on their own products, according to the IOM report.

The report recommends that studies on modified-risk tobacco products should examine the product’s composition and addiction potential, the amount of human exposure to harmful components, perceptions about the product’s effects and likelihood of addiction, and its effects on human health. Studies should be "generalizable" to the whole population, but also should include populations of special relevance, including current and former smokers, beginning smokers, adolescents, and populations at high risk for tobacco use.

IOM committee member Dr. Bonnie Halpern-Felsher, professor of pediatrics at the University of California, San Francisco, said in an interview that it’s especially critical to understand how these modified-risk products could impact adolescents.

"We do know that the majority of people who start smoking are adolescents," Dr. Halpern-Felsher said. "We need to make sure when these studies are done that they do include the adolescent population, and cover the health effects on adolescents and adolescents’ perceptions of the product and their likelihood of going on to use it."

No disclosures were reported.

Modified-risk tobacco products – such as e-cigarettes and tobacco lozenges that may reduce the health risks of using tobacco – could represent part of a comprehensive strategy to combat tobacco-related disease and death, but too little is known about whether they actually pose less risk than do traditional tobacco products, according to a report issued Dec. 14 by the Institute of Medicine.

Consequently, the Food and Drug Administration should require specific types of research on these modified-risk products before allowing tobacco companies to sell or advertise them as being capable of reducing the health effects of tobacco use, the IOM report recommended.

Photo courtesy timur1970/Fotolia.comCredit

The research should determine whether the product really presents a lessened risk for a person who might use it, Dr. Jane Henney, committee chair and professor of medicine and public health sciences at the University of Cincinnati, said in an interview. The product "also should not negatively impact the general public, as in the case of secondhand smoke, and it shouldn’t raise the risk" for nonusers or former users to begin or resume using the product.

Few smokers – only about 6% each year – are able to successfully quit tobacco use. Because quitting is so difficult, many cigarette smokers would welcome products that allow them to continue smoking with less risk to their health. However, there’s no research showing that modified-risk tobacco products are safer; in fact, so-called "light" cigarettes actually turned out to be just as risky as regular cigarettes, the IOM report said.

The Family Smoking Prevention and Control Act of 2009 gave the FDA the authority to ensure that modified-risk tobacco products actually do reduce tobacco-related harm before they can be marketed. The 2009 law also directed the IOM to work with the FDA on the design and conduct of scientific studies of modified-risk tobacco products.

The 330-page report provides details on how such studies should be conducted.

The tobacco industry "is new to regulation, and has a past history that would lead one to believe it can’t be trustworthy," Dr. Henney said. "We speak to the governance tools that should be put in place to really open up this process."

In part because of this trust gap, companies and other sponsors who develop modified-risk tobacco products should consider using FDA-approved, independent third parties to oversee health and safety research on their product, the report recommended. Independent oversight would ensure that the data submitted to the FDA are reliable and credible, the report said, and it might help to lure institutions and scientists back into the field; currently, many refuse to conduct or publish research supported by the tobacco industry.

Tobacco makers currently lack the capacity and expertise to conduct valid scientific research on their own products, according to the IOM report.

The report recommends that studies on modified-risk tobacco products should examine the product’s composition and addiction potential, the amount of human exposure to harmful components, perceptions about the product’s effects and likelihood of addiction, and its effects on human health. Studies should be "generalizable" to the whole population, but also should include populations of special relevance, including current and former smokers, beginning smokers, adolescents, and populations at high risk for tobacco use.

IOM committee member Dr. Bonnie Halpern-Felsher, professor of pediatrics at the University of California, San Francisco, said in an interview that it’s especially critical to understand how these modified-risk products could impact adolescents.

"We do know that the majority of people who start smoking are adolescents," Dr. Halpern-Felsher said. "We need to make sure when these studies are done that they do include the adolescent population, and cover the health effects on adolescents and adolescents’ perceptions of the product and their likelihood of going on to use it."

No disclosures were reported.

More than one-third of adolescents aged 12-17 have used alcohol or drugs in the past year, with adolescents of Native American, white, Hispanic, and multiple race/ethnic backgrounds most at risk for substance use and substance-related disorders, according to a study released Nov. 7.

The study, published in the Archives of General Psychiatry, found that nearly 8% of adolescents meet the criteria for a substance-related disorder. Native American teenagers had the highest prevalence of substance use – more than 47% – and the highest level of drug or alcohol disorders (Arch. Gen. Psychiatry 2011;68:1176-85).

Photo (c)godfer/fotolia.com

"Adolescence marks the period of life with the highest risk for initiating substance abuse," wrote Li-Tzy Wu, Sc.D., and colleagues. "Thus, adolescents constitute a high-risk group requiring research to guide prevention efforts and health policy making."

Dr. Wu of Duke University Medical Center in Durham, N.C., and colleagues examined the number of substance-related disorders among 72,561 adolescents of white, Hispanic, African American, Native American, Asian or Pacific Islander, and multiple race/ethnic backgrounds. They noted that "young racial/ethnic groups are the fastest growing population in the United States."

The study, which used data from the 2005-2008 National Survey on Drug Use and Health (NSDUH), found that 37% of adolescents aged 12-17 reported using drugs or alcohol in the past year. About one-third of all adolescents reported using alcohol, 19% said they used any illicit or nonmedical drugs, and 15% said they had used both alcohol and drugs.

Those using drugs most frequently reported using marijuana; approximately 13% of all adolescents said they’d used marijuana in the past year, and adolescents reported using marijuana more frequently throughout the year than alcohol or other drugs. In fact, "marijuana use has been increasing after a few years of decline," the researchers wrote. Analgesic opioids were the second most frequently abused illegal drugs in all racial/ethnic groups, although Native American adolescents and adolescents of multiple race/ethnicity were slightly more likely to use opioids than were other ethnic groups.

Dr. Wu and colleagues noted that analgesics have replaced inhalants as the second-most commonly used drug, behind marijuana. Users of marijuana, heroin, cocaine, or sedatives also showed an elevated rate of abuse or dependence on those drugs, the study found.

Native Americans were most likely to have a substance abuse–related disorder; 15% of those adolescents met the criteria. About 9% of white adolescents and adolescents of multiple race/ethnicity had a substance-related disorder, while about 8% of Hispanics, 5% of African Americans, and less than 4% of Asians or Pacific Islanders met the criteria for such a disorder.

The study’s results support rising concerns about adolescent marijuana use, according to the authors. More than 25% of marijuana users in the study exhibited a marijuana use disorder, with the high rate possibly related to frequency of use; marijuana users on average spent the most days using the drug, compared with other substance users.

"Research is needed to closely monitor marijuana use and associated disorders among adolescents and identify prevention programs that truly work," the authors concluded.

In addition, the study authors recommended educational or prevention programs that incorporate effective messages about the health risk for nonmedical use of prescription drugs, and said screening for nonmedical drug use of analgesic opioids should be considered for high-risk adolescents.

One of the limitations of the study is that it relied on self-reports. In addition, the findings do not apply to adolescents who are homeless or institutionalized, because that population was not included in the NSDUH.

"Substance use is widespread among adolescents of Native American, white, Hispanic, and multiple race/ethnicity," the authors concluded. "Taken together, these findings call for efforts to identify and expand prevention measures that are culturally effective and address the quality and acceptability of treatment for adolescents with substance use problems."

Dr. Wu reported no relevant financial disclosures. One of the authors, Dr. George E. Woody, is a member of the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS) system postmarketing study scientific advisory group, whose job is to assess abuse of prescription medications. Denver Health administers RADARS, and pharmaceutical companies support its work.

The study was supported by several grants from the National Institutes of Health.

More than one-third of adolescents aged 12-17 have used alcohol or drugs in the past year, with adolescents of Native American, white, Hispanic, and multiple race/ethnic backgrounds most at risk for substance use and substance-related disorders, according to a study released Nov. 7.

The study, published in the Archives of General Psychiatry, found that nearly 8% of adolescents meet the criteria for a substance-related disorder. Native American teenagers had the highest prevalence of substance use – more than 47% – and the highest level of drug or alcohol disorders (Arch. Gen. Psychiatry 2011;68:1176-85).

Photo (c)godfer/fotolia.com

"Adolescence marks the period of life with the highest risk for initiating substance abuse," wrote Li-Tzy Wu, Sc.D., and colleagues. "Thus, adolescents constitute a high-risk group requiring research to guide prevention efforts and health policy making."

Dr. Wu of Duke University Medical Center in Durham, N.C., and colleagues examined the number of substance-related disorders among 72,561 adolescents of white, Hispanic, African American, Native American, Asian or Pacific Islander, and multiple race/ethnic backgrounds. They noted that "young racial/ethnic groups are the fastest growing population in the United States."

The study, which used data from the 2005-2008 National Survey on Drug Use and Health (NSDUH), found that 37% of adolescents aged 12-17 reported using drugs or alcohol in the past year. About one-third of all adolescents reported using alcohol, 19% said they used any illicit or nonmedical drugs, and 15% said they had used both alcohol and drugs.

Those using drugs most frequently reported using marijuana; approximately 13% of all adolescents said they’d used marijuana in the past year, and adolescents reported using marijuana more frequently throughout the year than alcohol or other drugs. In fact, "marijuana use has been increasing after a few years of decline," the researchers wrote. Analgesic opioids were the second most frequently abused illegal drugs in all racial/ethnic groups, although Native American adolescents and adolescents of multiple race/ethnicity were slightly more likely to use opioids than were other ethnic groups.

Dr. Wu and colleagues noted that analgesics have replaced inhalants as the second-most commonly used drug, behind marijuana. Users of marijuana, heroin, cocaine, or sedatives also showed an elevated rate of abuse or dependence on those drugs, the study found.

Native Americans were most likely to have a substance abuse–related disorder; 15% of those adolescents met the criteria. About 9% of white adolescents and adolescents of multiple race/ethnicity had a substance-related disorder, while about 8% of Hispanics, 5% of African Americans, and less than 4% of Asians or Pacific Islanders met the criteria for such a disorder.

The study’s results support rising concerns about adolescent marijuana use, according to the authors. More than 25% of marijuana users in the study exhibited a marijuana use disorder, with the high rate possibly related to frequency of use; marijuana users on average spent the most days using the drug, compared with other substance users.

"Research is needed to closely monitor marijuana use and associated disorders among adolescents and identify prevention programs that truly work," the authors concluded.

In addition, the study authors recommended educational or prevention programs that incorporate effective messages about the health risk for nonmedical use of prescription drugs, and said screening for nonmedical drug use of analgesic opioids should be considered for high-risk adolescents.

One of the limitations of the study is that it relied on self-reports. In addition, the findings do not apply to adolescents who are homeless or institutionalized, because that population was not included in the NSDUH.

"Substance use is widespread among adolescents of Native American, white, Hispanic, and multiple race/ethnicity," the authors concluded. "Taken together, these findings call for efforts to identify and expand prevention measures that are culturally effective and address the quality and acceptability of treatment for adolescents with substance use problems."

Dr. Wu reported no relevant financial disclosures. One of the authors, Dr. George E. Woody, is a member of the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS) system postmarketing study scientific advisory group, whose job is to assess abuse of prescription medications. Denver Health administers RADARS, and pharmaceutical companies support its work.

The study was supported by several grants from the National Institutes of Health.

More than one-third of adolescents aged 12-17 have used alcohol or drugs in the past year, with adolescents of Native American, white, Hispanic, and multiple race/ethnic backgrounds most at risk for substance use and substance-related disorders, according to a study released Nov. 7.

The study, published in the Archives of General Psychiatry, found that nearly 8% of adolescents meet the criteria for a substance-related disorder. Native American teenagers had the highest prevalence of substance use – more than 47% – and the highest level of drug or alcohol disorders (Arch. Gen. Psychiatry 2011;68:1176-85).

Photo (c)godfer/fotolia.com

"Adolescence marks the period of life with the highest risk for initiating substance abuse," wrote Li-Tzy Wu, Sc.D., and colleagues. "Thus, adolescents constitute a high-risk group requiring research to guide prevention efforts and health policy making."

Dr. Wu of Duke University Medical Center in Durham, N.C., and colleagues examined the number of substance-related disorders among 72,561 adolescents of white, Hispanic, African American, Native American, Asian or Pacific Islander, and multiple race/ethnic backgrounds. They noted that "young racial/ethnic groups are the fastest growing population in the United States."

The study, which used data from the 2005-2008 National Survey on Drug Use and Health (NSDUH), found that 37% of adolescents aged 12-17 reported using drugs or alcohol in the past year. About one-third of all adolescents reported using alcohol, 19% said they used any illicit or nonmedical drugs, and 15% said they had used both alcohol and drugs.

Those using drugs most frequently reported using marijuana; approximately 13% of all adolescents said they’d used marijuana in the past year, and adolescents reported using marijuana more frequently throughout the year than alcohol or other drugs. In fact, "marijuana use has been increasing after a few years of decline," the researchers wrote. Analgesic opioids were the second most frequently abused illegal drugs in all racial/ethnic groups, although Native American adolescents and adolescents of multiple race/ethnicity were slightly more likely to use opioids than were other ethnic groups.

Dr. Wu and colleagues noted that analgesics have replaced inhalants as the second-most commonly used drug, behind marijuana. Users of marijuana, heroin, cocaine, or sedatives also showed an elevated rate of abuse or dependence on those drugs, the study found.

Native Americans were most likely to have a substance abuse–related disorder; 15% of those adolescents met the criteria. About 9% of white adolescents and adolescents of multiple race/ethnicity had a substance-related disorder, while about 8% of Hispanics, 5% of African Americans, and less than 4% of Asians or Pacific Islanders met the criteria for such a disorder.

The study’s results support rising concerns about adolescent marijuana use, according to the authors. More than 25% of marijuana users in the study exhibited a marijuana use disorder, with the high rate possibly related to frequency of use; marijuana users on average spent the most days using the drug, compared with other substance users.

"Research is needed to closely monitor marijuana use and associated disorders among adolescents and identify prevention programs that truly work," the authors concluded.

In addition, the study authors recommended educational or prevention programs that incorporate effective messages about the health risk for nonmedical use of prescription drugs, and said screening for nonmedical drug use of analgesic opioids should be considered for high-risk adolescents.

One of the limitations of the study is that it relied on self-reports. In addition, the findings do not apply to adolescents who are homeless or institutionalized, because that population was not included in the NSDUH.

"Substance use is widespread among adolescents of Native American, white, Hispanic, and multiple race/ethnicity," the authors concluded. "Taken together, these findings call for efforts to identify and expand prevention measures that are culturally effective and address the quality and acceptability of treatment for adolescents with substance use problems."

Dr. Wu reported no relevant financial disclosures. One of the authors, Dr. George E. Woody, is a member of the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS) system postmarketing study scientific advisory group, whose job is to assess abuse of prescription medications. Denver Health administers RADARS, and pharmaceutical companies support its work.

The study was supported by several grants from the National Institutes of Health.

Most models currently used to predict hospital readmission risk perform poorly, and better approaches are needed as policy makers increasingly use hospital readmission rates to calculate and publicize quality of care comparison information.

Twenty-six different methods to calculate readmission risk were reviewed, yet only one model specifically addressed preventable readmissions, according to the study by Dr. Devan Kansagara of the Portland (Ore.) Veterans Affairs Medical Center and colleagues published in the Oct. 16 issue of JAMA. Meanwhile, most models performed poorly when used to predict readmission rates, regardless of whether they were developed to compare hospitals or to improve quality of care, the researchers said.

Still, several of these models are being used in clinical settings, in research projects, and for policy making. "Readmission risk prediction remains a poorly understood and complex endeavor," Dr. Kansagara said. "Although in certain settings such models may prove useful, better approaches are needed to assess hospital performance in discharging patients, as well as to identify patients at greater risk of avoidable readmission."

The analysis broke the models down into three groups: models relying on retrospective administrative data, models using real-time administrative data, and models incorporating primary data collection (JAMA 2001;306:1688-98).

In the group relying on retrospective administrative data, most of the 14 models studied included variables for medical comorbidity and use of prior medical services, while a few models also considered mental health, functional status, and other social variables, all of which may be important when determining readmission risk. All performed poorly except in specific subsets of patients; for example, one model was able to predict some readmissions in asthma patients, the researchers noted.

Three models attempted to identify high-risk patients during their initial hospitalizations in an effort to target them for interventions that might be able to prevent readmissions. Two of these – including a model implemented in one urban U.S. hospital to predict readmissions for heart failure – worked modestly well, especially in certain populations, but none had excellent predictive ability overall, the study said.

Finally, in the group of nine models that incorporated primary data collection, hospitals used questionnaires and other data in an effort to predict potential readmission risks early in patients’ initial hospital stays. Although several of these models had some predictive value, according to the study, none are in wide use, and a couple were developed more than 20 years ago.

Most of the models examined in the study included data on medical comorbidity, but few considered variables associated with illness severity, overall health and function, and socioeconomic factors that can affect a patient’s health, according to the study.

Public reporting of readmission rates, coupled with financial penalties for hospitals with high 30-day readmission rates, both are spurring organizations to implement quality improvement programs, Dr. Kansagara said. However, since the current available models for predicting readmission risk don’t work well, it may not be fair to use them to compare hospitals and possibly penalize them.

"Use of readmission rates as a quality metric assumes that readmissions are related to poor quality care and are potentially preventable," Dr. Kansagara said. "However, the preventability of readmissions remains unclear and understudied. We found only one validated prediction model that explicitly examined potentially preventable readmissions as an outcome, and it found that only about one-quarter of readmissions were clearly preventable."

The researchers noted that hospital and health system–level factors likely contribute to readmission risk, but are not included in any current models used to calculate readmission risk. For example, coordination with the patient’s primary care physician, plus the timing and frequency of postdischarge follow-up visits, can help determine if a patient will be readmitted or not, they said.

No conflicts of interest were reported. The study was supported by funding from the Department of Veterans Affairs and the National Institutes of Health.

Most models currently used to predict hospital readmission risk perform poorly, and better approaches are needed as policy makers increasingly use hospital readmission rates to calculate and publicize quality of care comparison information.

Twenty-six different methods to calculate readmission risk were reviewed, yet only one model specifically addressed preventable readmissions, according to the study by Dr. Devan Kansagara of the Portland (Ore.) Veterans Affairs Medical Center and colleagues published in the Oct. 16 issue of JAMA. Meanwhile, most models performed poorly when used to predict readmission rates, regardless of whether they were developed to compare hospitals or to improve quality of care, the researchers said.

Still, several of these models are being used in clinical settings, in research projects, and for policy making. "Readmission risk prediction remains a poorly understood and complex endeavor," Dr. Kansagara said. "Although in certain settings such models may prove useful, better approaches are needed to assess hospital performance in discharging patients, as well as to identify patients at greater risk of avoidable readmission."

The analysis broke the models down into three groups: models relying on retrospective administrative data, models using real-time administrative data, and models incorporating primary data collection (JAMA 2001;306:1688-98).

In the group relying on retrospective administrative data, most of the 14 models studied included variables for medical comorbidity and use of prior medical services, while a few models also considered mental health, functional status, and other social variables, all of which may be important when determining readmission risk. All performed poorly except in specific subsets of patients; for example, one model was able to predict some readmissions in asthma patients, the researchers noted.

Three models attempted to identify high-risk patients during their initial hospitalizations in an effort to target them for interventions that might be able to prevent readmissions. Two of these – including a model implemented in one urban U.S. hospital to predict readmissions for heart failure – worked modestly well, especially in certain populations, but none had excellent predictive ability overall, the study said.

Finally, in the group of nine models that incorporated primary data collection, hospitals used questionnaires and other data in an effort to predict potential readmission risks early in patients’ initial hospital stays. Although several of these models had some predictive value, according to the study, none are in wide use, and a couple were developed more than 20 years ago.

Most of the models examined in the study included data on medical comorbidity, but few considered variables associated with illness severity, overall health and function, and socioeconomic factors that can affect a patient’s health, according to the study.

Public reporting of readmission rates, coupled with financial penalties for hospitals with high 30-day readmission rates, both are spurring organizations to implement quality improvement programs, Dr. Kansagara said. However, since the current available models for predicting readmission risk don’t work well, it may not be fair to use them to compare hospitals and possibly penalize them.

"Use of readmission rates as a quality metric assumes that readmissions are related to poor quality care and are potentially preventable," Dr. Kansagara said. "However, the preventability of readmissions remains unclear and understudied. We found only one validated prediction model that explicitly examined potentially preventable readmissions as an outcome, and it found that only about one-quarter of readmissions were clearly preventable."

The researchers noted that hospital and health system–level factors likely contribute to readmission risk, but are not included in any current models used to calculate readmission risk. For example, coordination with the patient’s primary care physician, plus the timing and frequency of postdischarge follow-up visits, can help determine if a patient will be readmitted or not, they said.

No conflicts of interest were reported. The study was supported by funding from the Department of Veterans Affairs and the National Institutes of Health.

Most models currently used to predict hospital readmission risk perform poorly, and better approaches are needed as policy makers increasingly use hospital readmission rates to calculate and publicize quality of care comparison information.

Twenty-six different methods to calculate readmission risk were reviewed, yet only one model specifically addressed preventable readmissions, according to the study by Dr. Devan Kansagara of the Portland (Ore.) Veterans Affairs Medical Center and colleagues published in the Oct. 16 issue of JAMA. Meanwhile, most models performed poorly when used to predict readmission rates, regardless of whether they were developed to compare hospitals or to improve quality of care, the researchers said.

Still, several of these models are being used in clinical settings, in research projects, and for policy making. "Readmission risk prediction remains a poorly understood and complex endeavor," Dr. Kansagara said. "Although in certain settings such models may prove useful, better approaches are needed to assess hospital performance in discharging patients, as well as to identify patients at greater risk of avoidable readmission."

The analysis broke the models down into three groups: models relying on retrospective administrative data, models using real-time administrative data, and models incorporating primary data collection (JAMA 2001;306:1688-98).

In the group relying on retrospective administrative data, most of the 14 models studied included variables for medical comorbidity and use of prior medical services, while a few models also considered mental health, functional status, and other social variables, all of which may be important when determining readmission risk. All performed poorly except in specific subsets of patients; for example, one model was able to predict some readmissions in asthma patients, the researchers noted.

Three models attempted to identify high-risk patients during their initial hospitalizations in an effort to target them for interventions that might be able to prevent readmissions. Two of these – including a model implemented in one urban U.S. hospital to predict readmissions for heart failure – worked modestly well, especially in certain populations, but none had excellent predictive ability overall, the study said.

Finally, in the group of nine models that incorporated primary data collection, hospitals used questionnaires and other data in an effort to predict potential readmission risks early in patients’ initial hospital stays. Although several of these models had some predictive value, according to the study, none are in wide use, and a couple were developed more than 20 years ago.

Most of the models examined in the study included data on medical comorbidity, but few considered variables associated with illness severity, overall health and function, and socioeconomic factors that can affect a patient’s health, according to the study.

Public reporting of readmission rates, coupled with financial penalties for hospitals with high 30-day readmission rates, both are spurring organizations to implement quality improvement programs, Dr. Kansagara said. However, since the current available models for predicting readmission risk don’t work well, it may not be fair to use them to compare hospitals and possibly penalize them.

"Use of readmission rates as a quality metric assumes that readmissions are related to poor quality care and are potentially preventable," Dr. Kansagara said. "However, the preventability of readmissions remains unclear and understudied. We found only one validated prediction model that explicitly examined potentially preventable readmissions as an outcome, and it found that only about one-quarter of readmissions were clearly preventable."

The researchers noted that hospital and health system–level factors likely contribute to readmission risk, but are not included in any current models used to calculate readmission risk. For example, coordination with the patient’s primary care physician, plus the timing and frequency of postdischarge follow-up visits, can help determine if a patient will be readmitted or not, they said.

No conflicts of interest were reported. The study was supported by funding from the Department of Veterans Affairs and the National Institutes of Health.

Hair stylists are on the lookout for suspicious lesions on their customers’ scalps, necks, and faces, and are "very" interested in receiving formal skin cancer education, according to a study published Oct. 17 in the Archives of Dermatology.

Although only 28% of hair professionals have received any formal skin cancer education, many reported routinely looking for problematic spots or changing moles, according to Dr. Elizabeth E. Bailey of the department of medicine at Brigham and Women’s Hospital in Boston.

Dr. Bailey and her colleagues received 203 completed surveys from hair professionals in January 2010 on skin cancer practice and knowledge. The hair professionals were from a chain of 17 salons in the greater Houston area.

© Dean Bertoncelj/iStockphoto

Hair stylists who frequently talked with their customers about health issues, including personal skin protection practices, were more likely to scan for suspicious lesions. However, it didn’t seem to matter whether or not the stylists had basic skin cancer knowledge, possibly because most already knew the basics, the investigators reported (Arch. Dermatol. 2011;147:1159-65).

According to the study, about 90% agreed or strongly agreed that a customer should see a health professional for a mole that is changing in size or frequently bleeds. A total of 89% said customers should see a health professional if they have a mole that is changing in color, and 78% said moles that itch frequently should be checked out.

A total of 37% of the hair professionals surveyed had scanned more than half of their customers’ scalps, 29% had scanned more than half of their customers’ necks, and 15% had scanned more than half of their customers’ faces for suspicious lesions in the past month.

Survey participants who knew the ABCD rule for melanoma were more likely to look at customers’ skin, and "understanding the difference between melanoma and ordinary skin growths and disagreeing that skin cancer was more difficult to detect than other types of cancer was also associated with a higher likelihood of customer observation," the investigators wrote.

Hair stylists who were confident looking at their own moles also tended to look at their customers’ skin, and stylists who had a personal history of skin cancer or experience with a friend or family member’s skin cancer also looked for potential problem spots on customers’ skin more often, the study found.

About half (49%) of survey participants said they were "very" or "extremely" interested in participating in a skin cancer education program, indicating that dermatologists should consider investigating hair stylists’ potential role in skin cancer prevention and detection.

"Hair professionals are currently acting as lay health advisors for skin cancer detection and prevention and are willing to become more involved in skin cancer education in the salon," said the investigators. "As professionals who have a natural view of difficult-to-see areas and who develop a close rapport with their customers, hair professionals are ideally suited to this role."

Melanoma of the scalp and neck accounted for 6% of all melanoma and for 10% of melanoma deaths in the United States between 1973 and 2003, likely because it’s difficult to find suspicious lesions in these locations during self-examinations by patients and routine exams by physicians, the investigators noted.

Therefore, hair stylists – who typically see areas of the head and scalp that patients and physicians might miss – are in a unique position to detect skin cancers that might otherwise go unnoticed.

"Through the many active professional education venues within the hair industry, the infrastructure exists to educate them," wrote Dr. Bailey and her colleagues. "Future research should focus on creating a program that provides hair professionals with expert training and effective health communication tools to become confident and skilled lay skin cancer educators."

The investigators did not report having any conflicts of interest.

Hair stylists are on the lookout for suspicious lesions on their customers’ scalps, necks, and faces, and are "very" interested in receiving formal skin cancer education, according to a study published Oct. 17 in the Archives of Dermatology.

Although only 28% of hair professionals have received any formal skin cancer education, many reported routinely looking for problematic spots or changing moles, according to Dr. Elizabeth E. Bailey of the department of medicine at Brigham and Women’s Hospital in Boston.

Dr. Bailey and her colleagues received 203 completed surveys from hair professionals in January 2010 on skin cancer practice and knowledge. The hair professionals were from a chain of 17 salons in the greater Houston area.

© Dean Bertoncelj/iStockphoto

Hair stylists who frequently talked with their customers about health issues, including personal skin protection practices, were more likely to scan for suspicious lesions. However, it didn’t seem to matter whether or not the stylists had basic skin cancer knowledge, possibly because most already knew the basics, the investigators reported (Arch. Dermatol. 2011;147:1159-65).

According to the study, about 90% agreed or strongly agreed that a customer should see a health professional for a mole that is changing in size or frequently bleeds. A total of 89% said customers should see a health professional if they have a mole that is changing in color, and 78% said moles that itch frequently should be checked out.

A total of 37% of the hair professionals surveyed had scanned more than half of their customers’ scalps, 29% had scanned more than half of their customers’ necks, and 15% had scanned more than half of their customers’ faces for suspicious lesions in the past month.

Survey participants who knew the ABCD rule for melanoma were more likely to look at customers’ skin, and "understanding the difference between melanoma and ordinary skin growths and disagreeing that skin cancer was more difficult to detect than other types of cancer was also associated with a higher likelihood of customer observation," the investigators wrote.

Hair stylists who were confident looking at their own moles also tended to look at their customers’ skin, and stylists who had a personal history of skin cancer or experience with a friend or family member’s skin cancer also looked for potential problem spots on customers’ skin more often, the study found.

About half (49%) of survey participants said they were "very" or "extremely" interested in participating in a skin cancer education program, indicating that dermatologists should consider investigating hair stylists’ potential role in skin cancer prevention and detection.

"Hair professionals are currently acting as lay health advisors for skin cancer detection and prevention and are willing to become more involved in skin cancer education in the salon," said the investigators. "As professionals who have a natural view of difficult-to-see areas and who develop a close rapport with their customers, hair professionals are ideally suited to this role."

Melanoma of the scalp and neck accounted for 6% of all melanoma and for 10% of melanoma deaths in the United States between 1973 and 2003, likely because it’s difficult to find suspicious lesions in these locations during self-examinations by patients and routine exams by physicians, the investigators noted.

Therefore, hair stylists – who typically see areas of the head and scalp that patients and physicians might miss – are in a unique position to detect skin cancers that might otherwise go unnoticed.

"Through the many active professional education venues within the hair industry, the infrastructure exists to educate them," wrote Dr. Bailey and her colleagues. "Future research should focus on creating a program that provides hair professionals with expert training and effective health communication tools to become confident and skilled lay skin cancer educators."

The investigators did not report having any conflicts of interest.

Hair stylists are on the lookout for suspicious lesions on their customers’ scalps, necks, and faces, and are "very" interested in receiving formal skin cancer education, according to a study published Oct. 17 in the Archives of Dermatology.

Although only 28% of hair professionals have received any formal skin cancer education, many reported routinely looking for problematic spots or changing moles, according to Dr. Elizabeth E. Bailey of the department of medicine at Brigham and Women’s Hospital in Boston.

Dr. Bailey and her colleagues received 203 completed surveys from hair professionals in January 2010 on skin cancer practice and knowledge. The hair professionals were from a chain of 17 salons in the greater Houston area.

© Dean Bertoncelj/iStockphoto

Hair stylists who frequently talked with their customers about health issues, including personal skin protection practices, were more likely to scan for suspicious lesions. However, it didn’t seem to matter whether or not the stylists had basic skin cancer knowledge, possibly because most already knew the basics, the investigators reported (Arch. Dermatol. 2011;147:1159-65).

According to the study, about 90% agreed or strongly agreed that a customer should see a health professional for a mole that is changing in size or frequently bleeds. A total of 89% said customers should see a health professional if they have a mole that is changing in color, and 78% said moles that itch frequently should be checked out.

A total of 37% of the hair professionals surveyed had scanned more than half of their customers’ scalps, 29% had scanned more than half of their customers’ necks, and 15% had scanned more than half of their customers’ faces for suspicious lesions in the past month.

Survey participants who knew the ABCD rule for melanoma were more likely to look at customers’ skin, and "understanding the difference between melanoma and ordinary skin growths and disagreeing that skin cancer was more difficult to detect than other types of cancer was also associated with a higher likelihood of customer observation," the investigators wrote.

Hair stylists who were confident looking at their own moles also tended to look at their customers’ skin, and stylists who had a personal history of skin cancer or experience with a friend or family member’s skin cancer also looked for potential problem spots on customers’ skin more often, the study found.

About half (49%) of survey participants said they were "very" or "extremely" interested in participating in a skin cancer education program, indicating that dermatologists should consider investigating hair stylists’ potential role in skin cancer prevention and detection.

"Hair professionals are currently acting as lay health advisors for skin cancer detection and prevention and are willing to become more involved in skin cancer education in the salon," said the investigators. "As professionals who have a natural view of difficult-to-see areas and who develop a close rapport with their customers, hair professionals are ideally suited to this role."

Melanoma of the scalp and neck accounted for 6% of all melanoma and for 10% of melanoma deaths in the United States between 1973 and 2003, likely because it’s difficult to find suspicious lesions in these locations during self-examinations by patients and routine exams by physicians, the investigators noted.

Therefore, hair stylists – who typically see areas of the head and scalp that patients and physicians might miss – are in a unique position to detect skin cancers that might otherwise go unnoticed.

"Through the many active professional education venues within the hair industry, the infrastructure exists to educate them," wrote Dr. Bailey and her colleagues. "Future research should focus on creating a program that provides hair professionals with expert training and effective health communication tools to become confident and skilled lay skin cancer educators."

The investigators did not report having any conflicts of interest.

Adults who report frequent mental distress – regardless of whether it’s accompanied by physical stress – are far more likely to be uninsured than those reporting only physical distress or none at all, according to researchers at the Centers for Disease Control and Prevention.

Almost one-quarter (22.6%) of survey respondents reporting frequent mental distress or both frequent mental and physical distress (21.8%) said they lacked health insurance, the researchers reported Oct. 3 in Psychiatric Services. Meanwhile, in the four surveys making up the study, only 17.7% of people reporting frequent physical distress and 16.6% of people reporting no distress said they were without health insurance (Psychiatr. Serv. 2011;62:1131-7).

The incidence of frequent mental distress may affect an individual’s insurance prospects over time, said the authors, including researchers at the CDC and Emory University, Atlanta.

"The prevalence of uninsurance did not differ markedly between those with only frequent mental distress and those with both frequent mental distress and frequent physical distress, suggesting that frequent mental distress may be the driving factor in the prevalence of uninsurance in this population," they wrote.

Among people with mental distress, members of several groups – including adults with less than a high school education and blacks and Hispanics – were more likely to lack health insurance. For example, 40% of adults without a high school diploma who had frequent mental distress lacked health insurance, and 35% of Hispanics with frequent mental distress were without coverage, the researchers found.

The proportion of adults with frequent mental distress who were uninsured increased between 1993, when the CDC did the first survey, and 2009, the year of the most recent survey: 21.6% of adults with frequent mental distress were uninsured in 1993 and 23.8% were in 2009. Women, people aged 18-34, white non-Hispanics, and high school graduates saw the greatest decreases in insurance coverage. Healthy young adults without mental or physical distress also declined in insurance coverage, indicating members of this age group "increasingly have chosen to opt out of buying health insurance," the authors reported.

It’s not clear why people with frequent mental distress lack health insurance coverage more often than people who don’t suffer such a mental health problem, the researchers said. It’s possible that insurers may be denying coverage to people with frequent mental distress, they speculated. Or being without enough money to purchase health insurance might lead to mental distress.

"Persons with frequent physical or mental distress or both may not seek health insurance coverage or may be denied insurance because of a preexisting condition, or people who cannot afford insurance may be more likely to subsequently develop frequent distress," the report concluded.

The authors reported having no conflict of interest.

Adults who report frequent mental distress – regardless of whether it’s accompanied by physical stress – are far more likely to be uninsured than those reporting only physical distress or none at all, according to researchers at the Centers for Disease Control and Prevention.

Almost one-quarter (22.6%) of survey respondents reporting frequent mental distress or both frequent mental and physical distress (21.8%) said they lacked health insurance, the researchers reported Oct. 3 in Psychiatric Services. Meanwhile, in the four surveys making up the study, only 17.7% of people reporting frequent physical distress and 16.6% of people reporting no distress said they were without health insurance (Psychiatr. Serv. 2011;62:1131-7).

The incidence of frequent mental distress may affect an individual’s insurance prospects over time, said the authors, including researchers at the CDC and Emory University, Atlanta.

"The prevalence of uninsurance did not differ markedly between those with only frequent mental distress and those with both frequent mental distress and frequent physical distress, suggesting that frequent mental distress may be the driving factor in the prevalence of uninsurance in this population," they wrote.

Among people with mental distress, members of several groups – including adults with less than a high school education and blacks and Hispanics – were more likely to lack health insurance. For example, 40% of adults without a high school diploma who had frequent mental distress lacked health insurance, and 35% of Hispanics with frequent mental distress were without coverage, the researchers found.

The proportion of adults with frequent mental distress who were uninsured increased between 1993, when the CDC did the first survey, and 2009, the year of the most recent survey: 21.6% of adults with frequent mental distress were uninsured in 1993 and 23.8% were in 2009. Women, people aged 18-34, white non-Hispanics, and high school graduates saw the greatest decreases in insurance coverage. Healthy young adults without mental or physical distress also declined in insurance coverage, indicating members of this age group "increasingly have chosen to opt out of buying health insurance," the authors reported.

It’s not clear why people with frequent mental distress lack health insurance coverage more often than people who don’t suffer such a mental health problem, the researchers said. It’s possible that insurers may be denying coverage to people with frequent mental distress, they speculated. Or being without enough money to purchase health insurance might lead to mental distress.

"Persons with frequent physical or mental distress or both may not seek health insurance coverage or may be denied insurance because of a preexisting condition, or people who cannot afford insurance may be more likely to subsequently develop frequent distress," the report concluded.

The authors reported having no conflict of interest.

Adults who report frequent mental distress – regardless of whether it’s accompanied by physical stress – are far more likely to be uninsured than those reporting only physical distress or none at all, according to researchers at the Centers for Disease Control and Prevention.

Almost one-quarter (22.6%) of survey respondents reporting frequent mental distress or both frequent mental and physical distress (21.8%) said they lacked health insurance, the researchers reported Oct. 3 in Psychiatric Services. Meanwhile, in the four surveys making up the study, only 17.7% of people reporting frequent physical distress and 16.6% of people reporting no distress said they were without health insurance (Psychiatr. Serv. 2011;62:1131-7).

The incidence of frequent mental distress may affect an individual’s insurance prospects over time, said the authors, including researchers at the CDC and Emory University, Atlanta.

"The prevalence of uninsurance did not differ markedly between those with only frequent mental distress and those with both frequent mental distress and frequent physical distress, suggesting that frequent mental distress may be the driving factor in the prevalence of uninsurance in this population," they wrote.

Among people with mental distress, members of several groups – including adults with less than a high school education and blacks and Hispanics – were more likely to lack health insurance. For example, 40% of adults without a high school diploma who had frequent mental distress lacked health insurance, and 35% of Hispanics with frequent mental distress were without coverage, the researchers found.

The proportion of adults with frequent mental distress who were uninsured increased between 1993, when the CDC did the first survey, and 2009, the year of the most recent survey: 21.6% of adults with frequent mental distress were uninsured in 1993 and 23.8% were in 2009. Women, people aged 18-34, white non-Hispanics, and high school graduates saw the greatest decreases in insurance coverage. Healthy young adults without mental or physical distress also declined in insurance coverage, indicating members of this age group "increasingly have chosen to opt out of buying health insurance," the authors reported.

It’s not clear why people with frequent mental distress lack health insurance coverage more often than people who don’t suffer such a mental health problem, the researchers said. It’s possible that insurers may be denying coverage to people with frequent mental distress, they speculated. Or being without enough money to purchase health insurance might lead to mental distress.

"Persons with frequent physical or mental distress or both may not seek health insurance coverage or may be denied insurance because of a preexisting condition, or people who cannot afford insurance may be more likely to subsequently develop frequent distress," the report concluded.

The authors reported having no conflict of interest.

Some people wear their hearts on their sleeves. Doctors and nurses wear a lot more there, it seems.

Sixty percent of doctors’ hospital uniforms and 65% of nurses’ uniforms tested contained potentially pathogenic bacteria in at least one place, according to research published this month in the American Journal of Infection Control.

(c) Lars Lindblad/Fotolia.com

It’s not clear whether these bacteria pose an infection risk, but the authors of a study on pathogens recommended that physicians and nurses wear clean uniforms daily, improve hand hygiene practices, and use plastic aprons when performing tasks that may involve splashing or contact with body fluids.

"Wearing short-sleeved coats or even having physicians discard their white coats could further reduce the cloth-borne transmission of pathogens," reported researchers led by Dr. Yonit Wiener-Well of Shaare Zedek Medical Center, Jerusalem.

They collected swab samples from three parts of the uniforms of 75 registered nurses and 60 physicians by pressing standard blood agar plates to the uniforms’ abdominal areas, sleeve ends, and pockets (Am. J. Infect. Control 2011;39:555-9).

All the uniforms tested contained nonpathogenic common skin bacteria, and half of the samples included some sort of pathogen in addition to the nonpathogenic bacteria, the researchers noted. Of the 238 total samples taken from uniforms, 14% from nurses’ gowns and 6% from physicians’ gowns contained multidrug resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), the study found.

"It remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection," the authors wrote. "The high prevalence of contaminated uniforms might be related to inadequate compliance with hand hygiene, given that the sampled sites (i.e., abdominal zone, sleeve ends, and pockets on the dominant side) are characterized by frequent hand touches."

There were no significant differences in the number of positive samples between staff from medical departments and surgical departments, the study said.

The researchers also tested four uniforms immediately after they had been cleaned by the hospital laundry, and found only common skin bacteria on those uniforms. "Bacterial loads were significantly lower than on the uniforms being worn," the investigators said.

Fifty-eight percent of those who participated in the study said they changed their uniform every day, and 77% said their attire reached a "fair to excellent" level of hygiene.

Some people wear their hearts on their sleeves. Doctors and nurses wear a lot more there, it seems.

Sixty percent of doctors’ hospital uniforms and 65% of nurses’ uniforms tested contained potentially pathogenic bacteria in at least one place, according to research published this month in the American Journal of Infection Control.

(c) Lars Lindblad/Fotolia.com

It’s not clear whether these bacteria pose an infection risk, but the authors of a study on pathogens recommended that physicians and nurses wear clean uniforms daily, improve hand hygiene practices, and use plastic aprons when performing tasks that may involve splashing or contact with body fluids.

"Wearing short-sleeved coats or even having physicians discard their white coats could further reduce the cloth-borne transmission of pathogens," reported researchers led by Dr. Yonit Wiener-Well of Shaare Zedek Medical Center, Jerusalem.

They collected swab samples from three parts of the uniforms of 75 registered nurses and 60 physicians by pressing standard blood agar plates to the uniforms’ abdominal areas, sleeve ends, and pockets (Am. J. Infect. Control 2011;39:555-9).

All the uniforms tested contained nonpathogenic common skin bacteria, and half of the samples included some sort of pathogen in addition to the nonpathogenic bacteria, the researchers noted. Of the 238 total samples taken from uniforms, 14% from nurses’ gowns and 6% from physicians’ gowns contained multidrug resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), the study found.

"It remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection," the authors wrote. "The high prevalence of contaminated uniforms might be related to inadequate compliance with hand hygiene, given that the sampled sites (i.e., abdominal zone, sleeve ends, and pockets on the dominant side) are characterized by frequent hand touches."

There were no significant differences in the number of positive samples between staff from medical departments and surgical departments, the study said.

The researchers also tested four uniforms immediately after they had been cleaned by the hospital laundry, and found only common skin bacteria on those uniforms. "Bacterial loads were significantly lower than on the uniforms being worn," the investigators said.

Fifty-eight percent of those who participated in the study said they changed their uniform every day, and 77% said their attire reached a "fair to excellent" level of hygiene.

Some people wear their hearts on their sleeves. Doctors and nurses wear a lot more there, it seems.

Sixty percent of doctors’ hospital uniforms and 65% of nurses’ uniforms tested contained potentially pathogenic bacteria in at least one place, according to research published this month in the American Journal of Infection Control.

(c) Lars Lindblad/Fotolia.com

It’s not clear whether these bacteria pose an infection risk, but the authors of a study on pathogens recommended that physicians and nurses wear clean uniforms daily, improve hand hygiene practices, and use plastic aprons when performing tasks that may involve splashing or contact with body fluids.

"Wearing short-sleeved coats or even having physicians discard their white coats could further reduce the cloth-borne transmission of pathogens," reported researchers led by Dr. Yonit Wiener-Well of Shaare Zedek Medical Center, Jerusalem.

They collected swab samples from three parts of the uniforms of 75 registered nurses and 60 physicians by pressing standard blood agar plates to the uniforms’ abdominal areas, sleeve ends, and pockets (Am. J. Infect. Control 2011;39:555-9).

All the uniforms tested contained nonpathogenic common skin bacteria, and half of the samples included some sort of pathogen in addition to the nonpathogenic bacteria, the researchers noted. Of the 238 total samples taken from uniforms, 14% from nurses’ gowns and 6% from physicians’ gowns contained multidrug resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), the study found.

"It remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection," the authors wrote. "The high prevalence of contaminated uniforms might be related to inadequate compliance with hand hygiene, given that the sampled sites (i.e., abdominal zone, sleeve ends, and pockets on the dominant side) are characterized by frequent hand touches."

There were no significant differences in the number of positive samples between staff from medical departments and surgical departments, the study said.

The researchers also tested four uniforms immediately after they had been cleaned by the hospital laundry, and found only common skin bacteria on those uniforms. "Bacterial loads were significantly lower than on the uniforms being worn," the investigators said.

Fifty-eight percent of those who participated in the study said they changed their uniform every day, and 77% said their attire reached a "fair to excellent" level of hygiene.

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study.

The investigators found that U.S. medical practices spend nearly $83,000 per year per physician to deal with health plans. In contrast, practices in Ontario spend about $22,200 to interact with Canada's single-payer health care system.

“If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year,” wrote Dr. Dante Morra of the University of Toronto, and his colleagues (Health Aff. August 2011 [doi:10. 1377/hlthaff.2010.0893]).

Most of the problems U.S. physicians face relate to the fact that they're trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country's single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study. U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members worked 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

The authors reported no financial conflicts of interest. The study was funded by the Robert Wood Johnson Foundation and the Commonwealth Fund.

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study.

The investigators found that U.S. medical practices spend nearly $83,000 per year per physician to deal with health plans. In contrast, practices in Ontario spend about $22,200 to interact with Canada's single-payer health care system.

“If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year,” wrote Dr. Dante Morra of the University of Toronto, and his colleagues (Health Aff. August 2011 [doi:10. 1377/hlthaff.2010.0893]).

Most of the problems U.S. physicians face relate to the fact that they're trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country's single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study. U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members worked 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

The authors reported no financial conflicts of interest. The study was funded by the Robert Wood Johnson Foundation and the Commonwealth Fund.

Physician practices in the United States spend four times as much money as do those in Ontario, Canada, to cope with paperwork and communications involving health insurers and payers, according to a study.

The investigators found that U.S. medical practices spend nearly $83,000 per year per physician to deal with health plans. In contrast, practices in Ontario spend about $22,200 to interact with Canada's single-payer health care system.

“If U.S. physicians had similar administrative costs to Ontario physicians, the total savings would be approximately $27.6 billion per year,” wrote Dr. Dante Morra of the University of Toronto, and his colleagues (Health Aff. August 2011 [doi:10. 1377/hlthaff.2010.0893]).

Most of the problems U.S. physicians face relate to the fact that they're trying to cope with multiple payers, while Canadian physicians must deal with only one, said Dr. Morra and colleagues, who added that U.S. insurers could help by taking steps to improve the efficiency of transactions, such as implementing electronic transactions.

U.S. physicians spent an average of 3.4 hours per week interacting with multiple insurers, while Canadian physicians spent an average of 2.2 hours per week dealing with that country's single payer. The main difference in time is the 1 hour per week that U.S. physicians spent obtaining prior authorizations, which accounted for most of the difference in the results, the study said.

In addition, practice staff members in the United States spent far more time on insurance issues than did their Canadian peers, according to the study. U.S. nursing staff, including medical assistants, spent 20.6 hours per physician in the practice per week interacting with payers, nearly 10 times the 2.5 hours per week spent by Ontario nursing staff.

The study found that the U.S. nursing staff members spent more time in every possible category, including prior authorizations, which cost them 13.1 hours per physician in the practice per week. In Canada, nursing staff members spent no time on prior authorizations.

Clerical staff members worked 53.1 hours per physician per week in the United States, mainly on billing issues and obtaining prior authorizations, the study said. Meanwhile, clerical staff members in Canada worked only 15.9 hours per week, and only on claims and billing issues.

The authors reported no financial conflicts of interest. The study was funded by the Robert Wood Johnson Foundation and the Commonwealth Fund.