Robert Finn

LONG BEACH, CALIF. – Women with urinary incontinence who were successfully treated nonsurgically showed significantly greater improvement in sexual function than women whose incontinence did not improve, a study has shown.

Three months after treatment with behavioral therapy, a continence pessary, or both, women whose treatment was successful had a 2.3-point mean improvement in their score on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Women whose incontinence treatment was not successful had a 0.5-point mean improvement on the PISQ-12. The difference was statistically significant, said Dr. Victoria L. Handa of Johns Hopkins University, Baltimore.

Dr. Handa’s study was a planned, prospective secondary analysis of results from the Ambulatory Treatments for Leakage Associated With Stress (ATLAS) trial. That trial involved 445 women with stress urinary incontinence (SUI) or mixed incontinence in which SUI predominated. The women were randomized to receive behavioral therapy, consisting mostly of pelvic muscle training; a continence pessary; or both. The women were a mean of 50 years old, and about 46% had SUI only.

At baseline, women with mixed incontinence scored significantly worse on the PISQ-12 than those with SUI. In particular, they were more likely to report urinary incontinence with sexual activity, and to say that they restricted their sexual activity because of fears of incontinence.

After 3 months of follow-up, there were no significant differences among the three treatment groups on any measure of sexual function.

"I think there is this perception that Kegel exercises are good for sexual function, but in a separate analysis, we didn’t see any association between improvement in pelvic muscle function as measured by Brink score and any measure of sexual function," Dr. Handa said at the annual meeting of the American Urogynecologic Society.

In addition to showing significant improvements in total PISQ-12 scores, women who were successfully treated had significant improvements in two specific symptoms. They were less likely to report urinary incontinence with sexual activity, and less likely to say that they restricted their sexual activity because of fears of incontinence.

The National Institute of Child Health and Human Development sponsored the trial. Dr. Handa said she had no financial disclosures.

LONG BEACH, CALIF. – Women with urinary incontinence who were successfully treated nonsurgically showed significantly greater improvement in sexual function than women whose incontinence did not improve, a study has shown.

Three months after treatment with behavioral therapy, a continence pessary, or both, women whose treatment was successful had a 2.3-point mean improvement in their score on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Women whose incontinence treatment was not successful had a 0.5-point mean improvement on the PISQ-12. The difference was statistically significant, said Dr. Victoria L. Handa of Johns Hopkins University, Baltimore.

Dr. Handa’s study was a planned, prospective secondary analysis of results from the Ambulatory Treatments for Leakage Associated With Stress (ATLAS) trial. That trial involved 445 women with stress urinary incontinence (SUI) or mixed incontinence in which SUI predominated. The women were randomized to receive behavioral therapy, consisting mostly of pelvic muscle training; a continence pessary; or both. The women were a mean of 50 years old, and about 46% had SUI only.

At baseline, women with mixed incontinence scored significantly worse on the PISQ-12 than those with SUI. In particular, they were more likely to report urinary incontinence with sexual activity, and to say that they restricted their sexual activity because of fears of incontinence.

After 3 months of follow-up, there were no significant differences among the three treatment groups on any measure of sexual function.

"I think there is this perception that Kegel exercises are good for sexual function, but in a separate analysis, we didn’t see any association between improvement in pelvic muscle function as measured by Brink score and any measure of sexual function," Dr. Handa said at the annual meeting of the American Urogynecologic Society.

In addition to showing significant improvements in total PISQ-12 scores, women who were successfully treated had significant improvements in two specific symptoms. They were less likely to report urinary incontinence with sexual activity, and less likely to say that they restricted their sexual activity because of fears of incontinence.

The National Institute of Child Health and Human Development sponsored the trial. Dr. Handa said she had no financial disclosures.

LONG BEACH, CALIF. – Women with urinary incontinence who were successfully treated nonsurgically showed significantly greater improvement in sexual function than women whose incontinence did not improve, a study has shown.

Three months after treatment with behavioral therapy, a continence pessary, or both, women whose treatment was successful had a 2.3-point mean improvement in their score on the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Women whose incontinence treatment was not successful had a 0.5-point mean improvement on the PISQ-12. The difference was statistically significant, said Dr. Victoria L. Handa of Johns Hopkins University, Baltimore.

Dr. Handa’s study was a planned, prospective secondary analysis of results from the Ambulatory Treatments for Leakage Associated With Stress (ATLAS) trial. That trial involved 445 women with stress urinary incontinence (SUI) or mixed incontinence in which SUI predominated. The women were randomized to receive behavioral therapy, consisting mostly of pelvic muscle training; a continence pessary; or both. The women were a mean of 50 years old, and about 46% had SUI only.

At baseline, women with mixed incontinence scored significantly worse on the PISQ-12 than those with SUI. In particular, they were more likely to report urinary incontinence with sexual activity, and to say that they restricted their sexual activity because of fears of incontinence.

After 3 months of follow-up, there were no significant differences among the three treatment groups on any measure of sexual function.

"I think there is this perception that Kegel exercises are good for sexual function, but in a separate analysis, we didn’t see any association between improvement in pelvic muscle function as measured by Brink score and any measure of sexual function," Dr. Handa said at the annual meeting of the American Urogynecologic Society.

In addition to showing significant improvements in total PISQ-12 scores, women who were successfully treated had significant improvements in two specific symptoms. They were less likely to report urinary incontinence with sexual activity, and less likely to say that they restricted their sexual activity because of fears of incontinence.

The National Institute of Child Health and Human Development sponsored the trial. Dr. Handa said she had no financial disclosures.

LONG BEACH, CALIF. — If present trends continue, U.S. surgeons will be performing 179,000 more incontinence and prolapse surgeries annually in 2050 than they are today.

The projected increase results primarily from an aging population, Dr. Jennifer Wu said at the meeting.

Stress incontinence surgeries are predicted to increase from an estimated 211,000 in 2010 to 310,000 in 2050. Similarly, surgeries for pelvic floor prolapse are predicted to increase from 166,000 this year to 246,000 in 2050.

Dr. Wu of Duke University, Durham, N.C., and her colleagues used three sources of data in making their forecast. The U.S. Census Bureau provided estimates of the female population in various age groups between 2006 and 2050. Data on the number of women undergoing these surgeries, broken down by age group, came from the Nationwide Inpatient Sample of 2007 and the National Survey of Ambulatory Surgery of 2006.

The largest number of surgeries occurred among women aged 40–59 years. During the survey years, 48,050 women in that age group underwent inpatient surgery and 53,790 underwent outpatient surgery for incontinence. Similarly, 49,490 women underwent inpatient surgery and 20,700 underwent outpatient surgery for prolapse.

“These estimates will provide public health officials and policy makers with important information regarding the future disease burden as well as the economic impact of these procedures,” Dr. Wu said. The projections rested on assumptions such as that surgery rates would remain constant. That assumption could be overturned by changes in the incidence of disease, advances in technology and surgical technique, or implementation of successful prevention strategies.

Dr. Wu stated that she had no relevant financial disclosures.

LONG BEACH, CALIF. — If present trends continue, U.S. surgeons will be performing 179,000 more incontinence and prolapse surgeries annually in 2050 than they are today.

The projected increase results primarily from an aging population, Dr. Jennifer Wu said at the meeting.

Stress incontinence surgeries are predicted to increase from an estimated 211,000 in 2010 to 310,000 in 2050. Similarly, surgeries for pelvic floor prolapse are predicted to increase from 166,000 this year to 246,000 in 2050.

Dr. Wu of Duke University, Durham, N.C., and her colleagues used three sources of data in making their forecast. The U.S. Census Bureau provided estimates of the female population in various age groups between 2006 and 2050. Data on the number of women undergoing these surgeries, broken down by age group, came from the Nationwide Inpatient Sample of 2007 and the National Survey of Ambulatory Surgery of 2006.

The largest number of surgeries occurred among women aged 40–59 years. During the survey years, 48,050 women in that age group underwent inpatient surgery and 53,790 underwent outpatient surgery for incontinence. Similarly, 49,490 women underwent inpatient surgery and 20,700 underwent outpatient surgery for prolapse.

“These estimates will provide public health officials and policy makers with important information regarding the future disease burden as well as the economic impact of these procedures,” Dr. Wu said. The projections rested on assumptions such as that surgery rates would remain constant. That assumption could be overturned by changes in the incidence of disease, advances in technology and surgical technique, or implementation of successful prevention strategies.

Dr. Wu stated that she had no relevant financial disclosures.

LONG BEACH, CALIF. — If present trends continue, U.S. surgeons will be performing 179,000 more incontinence and prolapse surgeries annually in 2050 than they are today.

The projected increase results primarily from an aging population, Dr. Jennifer Wu said at the meeting.

Stress incontinence surgeries are predicted to increase from an estimated 211,000 in 2010 to 310,000 in 2050. Similarly, surgeries for pelvic floor prolapse are predicted to increase from 166,000 this year to 246,000 in 2050.

Dr. Wu of Duke University, Durham, N.C., and her colleagues used three sources of data in making their forecast. The U.S. Census Bureau provided estimates of the female population in various age groups between 2006 and 2050. Data on the number of women undergoing these surgeries, broken down by age group, came from the Nationwide Inpatient Sample of 2007 and the National Survey of Ambulatory Surgery of 2006.

The largest number of surgeries occurred among women aged 40–59 years. During the survey years, 48,050 women in that age group underwent inpatient surgery and 53,790 underwent outpatient surgery for incontinence. Similarly, 49,490 women underwent inpatient surgery and 20,700 underwent outpatient surgery for prolapse.

“These estimates will provide public health officials and policy makers with important information regarding the future disease burden as well as the economic impact of these procedures,” Dr. Wu said. The projections rested on assumptions such as that surgery rates would remain constant. That assumption could be overturned by changes in the incidence of disease, advances in technology and surgical technique, or implementation of successful prevention strategies.

Dr. Wu stated that she had no relevant financial disclosures.

Major Finding: Among medical students who completed a survey, 14% were moderately or severely depressed. Among those students, 83% agreed with a statement that if they were depressed, others would find them unable to handle medical school responsibilities, compared with 55% of students who were not depressed.

Data Source: Cross-sectional, Internet-based survey of all 769 students enrolled in the medical school at the University of Michigan in September-November 2009.

Disclosures: The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published Sept. 15.

For example, 53% of the students with moderate to severe depression agreed with the statement, “Telling a counselor I am depressed would be risky,” compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students in the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, “If I were depressed and asked for help, I would be admitting that my coping skills are inadequate.”

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, “Medical students with depression are dangerous to their patients,” compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was significant.

“These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment,” the authors said.

“The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician, and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism.”

Major Finding: Among medical students who completed a survey, 14% were moderately or severely depressed. Among those students, 83% agreed with a statement that if they were depressed, others would find them unable to handle medical school responsibilities, compared with 55% of students who were not depressed.

Data Source: Cross-sectional, Internet-based survey of all 769 students enrolled in the medical school at the University of Michigan in September-November 2009.

Disclosures: The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published Sept. 15.

For example, 53% of the students with moderate to severe depression agreed with the statement, “Telling a counselor I am depressed would be risky,” compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students in the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, “If I were depressed and asked for help, I would be admitting that my coping skills are inadequate.”

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, “Medical students with depression are dangerous to their patients,” compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was significant.

“These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment,” the authors said.

“The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician, and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism.”

Major Finding: Among medical students who completed a survey, 14% were moderately or severely depressed. Among those students, 83% agreed with a statement that if they were depressed, others would find them unable to handle medical school responsibilities, compared with 55% of students who were not depressed.

Data Source: Cross-sectional, Internet-based survey of all 769 students enrolled in the medical school at the University of Michigan in September-November 2009.

Disclosures: The study was funded by the department of family medicine at the University of Michigan. The authors reported no financial disclosures.

A survey of more than 700 medical students found that 14% were moderately or severely depressed. Those depressed students were significantly more likely than students who were not depressed to express concern about stigmas associated with depression, according to the survey, published Sept. 15.

For example, 53% of the students with moderate to severe depression agreed with the statement, “Telling a counselor I am depressed would be risky,” compared with 17% of students with no or minimal depression.

The results come from a survey of all 769 students in the medical school of the University of Michigan, Ann Arbor, in September-November 2009. Of the students surveyed, 505 (66%) responded, reported Dr. Thomas L. Schwenk and his colleagues at the university (JAMA 2010;304:1181-90).

First- and second-year students were no more likely than third- or fourth-year students to report moderate to severe depression (13% vs. 15%). But significantly more women than men scored in the moderate to severe range (18% vs. 9%).

Third- and fourth-year students with moderate to severe depression were more likely to report suicidal ideation than were first- and second-year students (7.9% vs. 1.4%).

Significant differences were found on several other stigma-related statements. For example, 62% of the students with moderate to severe depression, compared with 34% of those with no or minimal depression, agreed with the statement, “If I were depressed and asked for help, I would be admitting that my coping skills are inadequate.”

Depressed students also expressed significantly more concern about being less competitive in their residency applications.

On the other hand, 86% of students with moderate to severe depression disagreed with the statement, “Medical students with depression are dangerous to their patients,” compared with 74% of students with no or minimal depression who disagreed with that statement. The difference was significant.

“These results suggest that new approaches may be needed to reduce the stigma of depression and to enhance its prevention, detection, and treatment,” the authors said.

“The effective care of mental illness, the maintenance of mental health and effective emotional function, and the care of professional colleagues with mental illness could be taught as part of the ethical and professional responsibilities of the outstanding physician, and become a critical component of the teaching, role modeling, and professional guidance that medical students receive as part of their curriculum and professionalism.”

LONG BEACH, Calif. – A randomized controlled trial found no advantage for vaginal prolapse repair using mesh colpopexy compared with no-mesh repair, said Dr. Andrew I. Sokol of Washington (D.C.) Hospital Center.

After an average follow-up of 14.7 months in this study of 65 women, 96% of women undergoing mesh colpopexy with Prolift (Ethicon Women’s Health and Urology) and 92% of women undergoing vaginal colpopexy without mesh were free of bulge symptoms; 25% of the mesh group and 22% of the no-mesh group experienced recurrent prolapse beyond the hymen. Neither of these differences was significant.

A total of 38% of women in the mesh group, compared with 30% of women in the no-mesh group, achieved optimal scores (stage 1 or below) on the pelvic organ prolapse quantification (POP-Q) scale, a difference that was not significant.

On the other hand, the vaginal mesh erosion rate was relatively high at 15.6%, and the data safety monitoring board (DSMB) terminated the study early because of this, Dr. Sokol said at the annual meeting of the American Urogynecologic Society.

In addition, there were three reoperations for erosion and three reoperations for prolapse among patients in the mesh group, compared with no reoperations in the no-mesh group, a significant difference.

In October 2008 the Food and Drug Administration issued a formal notification on reported complications from mesh use. Recognizing the high complication rate, mesh manufacturers have developed lighter-weight and mixed composite meshes. They have also developed trocarless mesh kits to minimize risks of visceral injury and groin pain, Dr. Sokol said. But long-term data are not yet available on these products.

The study included 65 women who were at POP-Q stages 2-4 uterovaginal or vaginal prolapse and who desired vaginal reconstructive surgery; the mean age in both groups was 64 years. The patients were randomized in the operating room after they had received anesthesia, and the research staff and the patient were blinded to the treatment assignment.

While investigators planned to enroll 90 women in the study, only 65 had been enrolled when the DSMB terminated the study. Dr. Sokol and his colleagues published a paper with results from a mean follow-up of 9.7 months (Obstet. Gynecol. 2010;116:293-303). The paper that Dr. Sokol presented at the AUGS meeting included updated results after a mean follow-up of 14.7 months.

Dr. Sokol also reported on the women’s satisfaction with the results of their surgery. There were no differences between the mesh and no-mesh groups on these measures either. Of the combined cohort, 95% said they achieved their goals for appearance, activity, and self-image; 94% achieved their goals for prolapse symptoms; and 70% achieved their goals for urinary symptoms.

The study was supported by research grants from the AUGS Foundation and the MedStar Health Research Institute. Ethicon Women’s Health and Urology donated the Prolift mesh kits for this study. Dr. Sokol stated that he had no conflicts of interest.

LONG BEACH, Calif. – A randomized controlled trial found no advantage for vaginal prolapse repair using mesh colpopexy compared with no-mesh repair, said Dr. Andrew I. Sokol of Washington (D.C.) Hospital Center.

After an average follow-up of 14.7 months in this study of 65 women, 96% of women undergoing mesh colpopexy with Prolift (Ethicon Women’s Health and Urology) and 92% of women undergoing vaginal colpopexy without mesh were free of bulge symptoms; 25% of the mesh group and 22% of the no-mesh group experienced recurrent prolapse beyond the hymen. Neither of these differences was significant.

A total of 38% of women in the mesh group, compared with 30% of women in the no-mesh group, achieved optimal scores (stage 1 or below) on the pelvic organ prolapse quantification (POP-Q) scale, a difference that was not significant.

On the other hand, the vaginal mesh erosion rate was relatively high at 15.6%, and the data safety monitoring board (DSMB) terminated the study early because of this, Dr. Sokol said at the annual meeting of the American Urogynecologic Society.

In addition, there were three reoperations for erosion and three reoperations for prolapse among patients in the mesh group, compared with no reoperations in the no-mesh group, a significant difference.

In October 2008 the Food and Drug Administration issued a formal notification on reported complications from mesh use. Recognizing the high complication rate, mesh manufacturers have developed lighter-weight and mixed composite meshes. They have also developed trocarless mesh kits to minimize risks of visceral injury and groin pain, Dr. Sokol said. But long-term data are not yet available on these products.

The study included 65 women who were at POP-Q stages 2-4 uterovaginal or vaginal prolapse and who desired vaginal reconstructive surgery; the mean age in both groups was 64 years. The patients were randomized in the operating room after they had received anesthesia, and the research staff and the patient were blinded to the treatment assignment.

While investigators planned to enroll 90 women in the study, only 65 had been enrolled when the DSMB terminated the study. Dr. Sokol and his colleagues published a paper with results from a mean follow-up of 9.7 months (Obstet. Gynecol. 2010;116:293-303). The paper that Dr. Sokol presented at the AUGS meeting included updated results after a mean follow-up of 14.7 months.

Dr. Sokol also reported on the women’s satisfaction with the results of their surgery. There were no differences between the mesh and no-mesh groups on these measures either. Of the combined cohort, 95% said they achieved their goals for appearance, activity, and self-image; 94% achieved their goals for prolapse symptoms; and 70% achieved their goals for urinary symptoms.

The study was supported by research grants from the AUGS Foundation and the MedStar Health Research Institute. Ethicon Women’s Health and Urology donated the Prolift mesh kits for this study. Dr. Sokol stated that he had no conflicts of interest.

LONG BEACH, Calif. – A randomized controlled trial found no advantage for vaginal prolapse repair using mesh colpopexy compared with no-mesh repair, said Dr. Andrew I. Sokol of Washington (D.C.) Hospital Center.

After an average follow-up of 14.7 months in this study of 65 women, 96% of women undergoing mesh colpopexy with Prolift (Ethicon Women’s Health and Urology) and 92% of women undergoing vaginal colpopexy without mesh were free of bulge symptoms; 25% of the mesh group and 22% of the no-mesh group experienced recurrent prolapse beyond the hymen. Neither of these differences was significant.

A total of 38% of women in the mesh group, compared with 30% of women in the no-mesh group, achieved optimal scores (stage 1 or below) on the pelvic organ prolapse quantification (POP-Q) scale, a difference that was not significant.

On the other hand, the vaginal mesh erosion rate was relatively high at 15.6%, and the data safety monitoring board (DSMB) terminated the study early because of this, Dr. Sokol said at the annual meeting of the American Urogynecologic Society.

In addition, there were three reoperations for erosion and three reoperations for prolapse among patients in the mesh group, compared with no reoperations in the no-mesh group, a significant difference.

In October 2008 the Food and Drug Administration issued a formal notification on reported complications from mesh use. Recognizing the high complication rate, mesh manufacturers have developed lighter-weight and mixed composite meshes. They have also developed trocarless mesh kits to minimize risks of visceral injury and groin pain, Dr. Sokol said. But long-term data are not yet available on these products.

The study included 65 women who were at POP-Q stages 2-4 uterovaginal or vaginal prolapse and who desired vaginal reconstructive surgery; the mean age in both groups was 64 years. The patients were randomized in the operating room after they had received anesthesia, and the research staff and the patient were blinded to the treatment assignment.

While investigators planned to enroll 90 women in the study, only 65 had been enrolled when the DSMB terminated the study. Dr. Sokol and his colleagues published a paper with results from a mean follow-up of 9.7 months (Obstet. Gynecol. 2010;116:293-303). The paper that Dr. Sokol presented at the AUGS meeting included updated results after a mean follow-up of 14.7 months.

Dr. Sokol also reported on the women’s satisfaction with the results of their surgery. There were no differences between the mesh and no-mesh groups on these measures either. Of the combined cohort, 95% said they achieved their goals for appearance, activity, and self-image; 94% achieved their goals for prolapse symptoms; and 70% achieved their goals for urinary symptoms.

The study was supported by research grants from the AUGS Foundation and the MedStar Health Research Institute. Ethicon Women’s Health and Urology donated the Prolift mesh kits for this study. Dr. Sokol stated that he had no conflicts of interest.

LONG BEACH, Calif. – Among women who underwent midurethral sling surgery for stress incontinence, failure at 12 months was twice as likely if they also had urge incontinence symptoms at baseline, a study has shown.

In a multivariate analysis of 12-month outcomes of the Trial of Mid-Urethral Slings (TOMUS), Dr. Holly E. Richter determined that the risk of treatment failure increased by 94% for every 10-point increase in the MESA (Medical, Epidemiologic, and Social Aspects of Aging) urge score.

Three other baseline factors also emerged as significant independent predictors of treatment failure. Women who had prior urinary incontinence surgery were 96% more likely to experience treatment failure. Those with decreased urethral motility, as judged by a maximum Q-tip excursion angle of less than 30 degrees were 89% more likely to fail. And every 10-g increase in pad weight increased the risk of treatment failure by 6%. The results were adjusted for treatment site and treatment group.

At the annual meeting of the American Urogynecologic Society, Dr. Richter of the University of Alabama at Birmingham pointed out that TOMUS and the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) yielded similar results in predicting treatment failure.

“There is one covariate to me that really stands out,” she said at the meeting. “We’ve spent millions of dollars, two big trials, almost 1,200 patients, and I think if we learned one thing, [it’s that] urge incontinence symptoms are problematic. I think that in studies we do in the future regarding women [who] undergo stress incontinence surgery, we need to take a more robust look at this.”

In the TOMUS study, investigators randomized 597 women to receive a transobturator or retropubic midurethral sling. All patients suffered from stress-predominant urinary incontinence.

Twelve months following the surgery, investigators were able to evaluate 563 of the women for objective and subjective cure. Objective cure consisted of a negative stress test, a negative 24-hour pad test, and no behavioral, pharmacologic, or surgical retreatment for stress urinary incontinence (SUI). Subjective cure consisted of no self-reported symptoms of SUI, no self-reported leakage on a 3-day voiding diary, and no retreatment for SUI.

Of the 563 women examined at 12 months, 54% met all the criteria for objective and subjective cure. Of the remaining 46% of women, 42% had both objective and subjective failure, 50% had subjective failure only, and 6% had objective failure only. (No objective failure data were available for the remaining 2% of women in that group).

There were no significant differences between the retropubic and midurethral sling groups in the relationships between each covariate and treatment failure.

Several factors emerged as significant independent predictors of objective versus subjective failure. They included no concomitant surgery (odds ratio, 2.22); increased age (OR, 1.46 per 10 years); increased bother (OR, 1.10 for every 10 points in Urinary Distress Inventory scores); and pad weight (OR, 1.08 for every 10 g).

“This information may assist in counseling women regarding efficacy and setting appropriate expectations for women at increased risk for failure,” Dr. Richter said.

He disclosed receiving research support from Pfizer Inc. and serving as a consultant for Astellas Pharma Inc., Xanodyne Pharmaceuticals Inc., and IDEO. The TOMUS study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

LONG BEACH, Calif. – Among women who underwent midurethral sling surgery for stress incontinence, failure at 12 months was twice as likely if they also had urge incontinence symptoms at baseline, a study has shown.

In a multivariate analysis of 12-month outcomes of the Trial of Mid-Urethral Slings (TOMUS), Dr. Holly E. Richter determined that the risk of treatment failure increased by 94% for every 10-point increase in the MESA (Medical, Epidemiologic, and Social Aspects of Aging) urge score.

Three other baseline factors also emerged as significant independent predictors of treatment failure. Women who had prior urinary incontinence surgery were 96% more likely to experience treatment failure. Those with decreased urethral motility, as judged by a maximum Q-tip excursion angle of less than 30 degrees were 89% more likely to fail. And every 10-g increase in pad weight increased the risk of treatment failure by 6%. The results were adjusted for treatment site and treatment group.

At the annual meeting of the American Urogynecologic Society, Dr. Richter of the University of Alabama at Birmingham pointed out that TOMUS and the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) yielded similar results in predicting treatment failure.

“There is one covariate to me that really stands out,” she said at the meeting. “We’ve spent millions of dollars, two big trials, almost 1,200 patients, and I think if we learned one thing, [it’s that] urge incontinence symptoms are problematic. I think that in studies we do in the future regarding women [who] undergo stress incontinence surgery, we need to take a more robust look at this.”

In the TOMUS study, investigators randomized 597 women to receive a transobturator or retropubic midurethral sling. All patients suffered from stress-predominant urinary incontinence.

Twelve months following the surgery, investigators were able to evaluate 563 of the women for objective and subjective cure. Objective cure consisted of a negative stress test, a negative 24-hour pad test, and no behavioral, pharmacologic, or surgical retreatment for stress urinary incontinence (SUI). Subjective cure consisted of no self-reported symptoms of SUI, no self-reported leakage on a 3-day voiding diary, and no retreatment for SUI.

Of the 563 women examined at 12 months, 54% met all the criteria for objective and subjective cure. Of the remaining 46% of women, 42% had both objective and subjective failure, 50% had subjective failure only, and 6% had objective failure only. (No objective failure data were available for the remaining 2% of women in that group).

There were no significant differences between the retropubic and midurethral sling groups in the relationships between each covariate and treatment failure.

Several factors emerged as significant independent predictors of objective versus subjective failure. They included no concomitant surgery (odds ratio, 2.22); increased age (OR, 1.46 per 10 years); increased bother (OR, 1.10 for every 10 points in Urinary Distress Inventory scores); and pad weight (OR, 1.08 for every 10 g).

“This information may assist in counseling women regarding efficacy and setting appropriate expectations for women at increased risk for failure,” Dr. Richter said.

He disclosed receiving research support from Pfizer Inc. and serving as a consultant for Astellas Pharma Inc., Xanodyne Pharmaceuticals Inc., and IDEO. The TOMUS study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

LONG BEACH, Calif. – Among women who underwent midurethral sling surgery for stress incontinence, failure at 12 months was twice as likely if they also had urge incontinence symptoms at baseline, a study has shown.

In a multivariate analysis of 12-month outcomes of the Trial of Mid-Urethral Slings (TOMUS), Dr. Holly E. Richter determined that the risk of treatment failure increased by 94% for every 10-point increase in the MESA (Medical, Epidemiologic, and Social Aspects of Aging) urge score.

Three other baseline factors also emerged as significant independent predictors of treatment failure. Women who had prior urinary incontinence surgery were 96% more likely to experience treatment failure. Those with decreased urethral motility, as judged by a maximum Q-tip excursion angle of less than 30 degrees were 89% more likely to fail. And every 10-g increase in pad weight increased the risk of treatment failure by 6%. The results were adjusted for treatment site and treatment group.

At the annual meeting of the American Urogynecologic Society, Dr. Richter of the University of Alabama at Birmingham pointed out that TOMUS and the Stress Incontinence Surgical Treatment Efficacy Trial (SISTEr) yielded similar results in predicting treatment failure.

“There is one covariate to me that really stands out,” she said at the meeting. “We’ve spent millions of dollars, two big trials, almost 1,200 patients, and I think if we learned one thing, [it’s that] urge incontinence symptoms are problematic. I think that in studies we do in the future regarding women [who] undergo stress incontinence surgery, we need to take a more robust look at this.”

In the TOMUS study, investigators randomized 597 women to receive a transobturator or retropubic midurethral sling. All patients suffered from stress-predominant urinary incontinence.

Twelve months following the surgery, investigators were able to evaluate 563 of the women for objective and subjective cure. Objective cure consisted of a negative stress test, a negative 24-hour pad test, and no behavioral, pharmacologic, or surgical retreatment for stress urinary incontinence (SUI). Subjective cure consisted of no self-reported symptoms of SUI, no self-reported leakage on a 3-day voiding diary, and no retreatment for SUI.

Of the 563 women examined at 12 months, 54% met all the criteria for objective and subjective cure. Of the remaining 46% of women, 42% had both objective and subjective failure, 50% had subjective failure only, and 6% had objective failure only. (No objective failure data were available for the remaining 2% of women in that group).

There were no significant differences between the retropubic and midurethral sling groups in the relationships between each covariate and treatment failure.

Several factors emerged as significant independent predictors of objective versus subjective failure. They included no concomitant surgery (odds ratio, 2.22); increased age (OR, 1.46 per 10 years); increased bother (OR, 1.10 for every 10 points in Urinary Distress Inventory scores); and pad weight (OR, 1.08 for every 10 g).

“This information may assist in counseling women regarding efficacy and setting appropriate expectations for women at increased risk for failure,” Dr. Richter said.

He disclosed receiving research support from Pfizer Inc. and serving as a consultant for Astellas Pharma Inc., Xanodyne Pharmaceuticals Inc., and IDEO. The TOMUS study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

LONG BEACH, CALIF. – If present trends continue, U.S. surgeons will be performing 179,000 more incontinence and prolapse surgeries annually in 2050 than they are today.

The projected increase results primarily from an aging population, Dr. Jennifer Wu said at the meeting.

Stress incontinence surgeries are predicted to increase from about 211,000 in 2010 to 310,000 in 2050, and surgeries for pelvic floor prolapse are predicted to increase from 166,000 this year to 246,000 in 2050.

Dr. Wu of Duke University, Durham, N.C., and her colleagues used three sources of data in making their forecast. The U.S. Census Bureau provided estimates of the female population in various age groups between 2006 and 2050. Data on the number of women undergoing these surgeries, broken down by age group, came from the Nationwide Inpatient Sample of 2007 and the National Survey of Ambulatory Surgery of 2006.

The largest number of surgeries were in women aged 40-59 years. During the survey years, 48,050 women in that age group had inpatient surgery, and 53,790 had outpatient surgery for incontinence. Similarly, 49,490 women had inpatient surgery and 20,700 had outpatient surgery for prolapse.

“One out of 10 women will undergo surgery for incontinence or prolapse in her lifetime,” Dr. Wu said. The estimates would provide health officials and policy makers with important information about the future disease burden and economic impact of these procedures.

Dr. Wu stated that she had no relevant financial disclosures.

LONG BEACH, CALIF. – If present trends continue, U.S. surgeons will be performing 179,000 more incontinence and prolapse surgeries annually in 2050 than they are today.

The projected increase results primarily from an aging population, Dr. Jennifer Wu said at the meeting.

Stress incontinence surgeries are predicted to increase from about 211,000 in 2010 to 310,000 in 2050, and surgeries for pelvic floor prolapse are predicted to increase from 166,000 this year to 246,000 in 2050.

Dr. Wu of Duke University, Durham, N.C., and her colleagues used three sources of data in making their forecast. The U.S. Census Bureau provided estimates of the female population in various age groups between 2006 and 2050. Data on the number of women undergoing these surgeries, broken down by age group, came from the Nationwide Inpatient Sample of 2007 and the National Survey of Ambulatory Surgery of 2006.

The largest number of surgeries were in women aged 40-59 years. During the survey years, 48,050 women in that age group had inpatient surgery, and 53,790 had outpatient surgery for incontinence. Similarly, 49,490 women had inpatient surgery and 20,700 had outpatient surgery for prolapse.

“One out of 10 women will undergo surgery for incontinence or prolapse in her lifetime,” Dr. Wu said. The estimates would provide health officials and policy makers with important information about the future disease burden and economic impact of these procedures.

Dr. Wu stated that she had no relevant financial disclosures.

LONG BEACH, CALIF. – If present trends continue, U.S. surgeons will be performing 179,000 more incontinence and prolapse surgeries annually in 2050 than they are today.

The projected increase results primarily from an aging population, Dr. Jennifer Wu said at the meeting.

Stress incontinence surgeries are predicted to increase from about 211,000 in 2010 to 310,000 in 2050, and surgeries for pelvic floor prolapse are predicted to increase from 166,000 this year to 246,000 in 2050.

Dr. Wu of Duke University, Durham, N.C., and her colleagues used three sources of data in making their forecast. The U.S. Census Bureau provided estimates of the female population in various age groups between 2006 and 2050. Data on the number of women undergoing these surgeries, broken down by age group, came from the Nationwide Inpatient Sample of 2007 and the National Survey of Ambulatory Surgery of 2006.

The largest number of surgeries were in women aged 40-59 years. During the survey years, 48,050 women in that age group had inpatient surgery, and 53,790 had outpatient surgery for incontinence. Similarly, 49,490 women had inpatient surgery and 20,700 had outpatient surgery for prolapse.

“One out of 10 women will undergo surgery for incontinence or prolapse in her lifetime,” Dr. Wu said. The estimates would provide health officials and policy makers with important information about the future disease burden and economic impact of these procedures.

Dr. Wu stated that she had no relevant financial disclosures.

Trastuzumab-DM1 (T-DM1), a new type of targeted therapy for breast cancer, has shown encouraging results as a first-line treatment for metastatic breast cancer. Study results were presented today at a meeting of the European Society for Medical Oncology in Milan. More details to come.

Trastuzumab-DM1 (T-DM1), a new type of targeted therapy for breast cancer, has shown encouraging results as a first-line treatment for metastatic breast cancer. Study results were presented today at a meeting of the European Society for Medical Oncology in Milan. More details to come.

Trastuzumab-DM1 (T-DM1), a new type of targeted therapy for breast cancer, has shown encouraging results as a first-line treatment for metastatic breast cancer. Study results were presented today at a meeting of the European Society for Medical Oncology in Milan. More details to come.

LONG BEACH, CALIF. – If present trends continue, U.S. surgeons will be performing 179,000 more incontinence and prolapse surgeries annually in 2050 than they are today.

The projected increase results primarily from an aging population, Dr. Jennifer Wu said at the annual meeting of the American Urogynecologic Society.

Stress incontinence surgeries are predicted to increase from an estimated 211,000 in 2010 to 310,000 in 2050. Similarly, surgeries for pelvic floor prolapse are predicted to increase from 166,000 this year to 246,000 in 2050.

Dr. Wu of Duke University, Durham, N.C., and her colleagues used three sources of data in making their forecast. The U.S. Census Bureau provided estimates of the female population in various age groups between 2006 and 2050. Data on the number of women undergoing these surgeries, broken down by age group, came from the Nationwide Inpatient Sample of 2007 and the National Survey of Ambulatory Surgery of 2006.

The largest number of surgeries occurred among women aged 40-59 years. During the survey years, 48,050 women in that age group underwent inpatient surgery and 53,790 underwent outpatient surgery for incontinence. Similarly, 49,490 women underwent inpatient surgery and 20,700 underwent outpatient surgery for prolapse.

“One out of every 10 women will undergo surgery for incontinence or prolapse in her lifetime,” Dr. Wu said. “These estimates will provide public health officials and policy makers with important information regarding the future disease burden as well as the economic impact of these procedures.”

Dr. Wu acknowledged that the projections rested on a number of assumptions. For example, the investigators assumed that surgery rates would remain constant. That assumption could be overturned by changes in the incidence of disease, advances in technology and surgical technique, or implementation of successful prevention strategies.

Disclosures: Dr. Wu stated that she had no relevant financial disclosures.

LONG BEACH, CALIF. – If present trends continue, U.S. surgeons will be performing 179,000 more incontinence and prolapse surgeries annually in 2050 than they are today.

The projected increase results primarily from an aging population, Dr. Jennifer Wu said at the annual meeting of the American Urogynecologic Society.

Stress incontinence surgeries are predicted to increase from an estimated 211,000 in 2010 to 310,000 in 2050. Similarly, surgeries for pelvic floor prolapse are predicted to increase from 166,000 this year to 246,000 in 2050.

Dr. Wu of Duke University, Durham, N.C., and her colleagues used three sources of data in making their forecast. The U.S. Census Bureau provided estimates of the female population in various age groups between 2006 and 2050. Data on the number of women undergoing these surgeries, broken down by age group, came from the Nationwide Inpatient Sample of 2007 and the National Survey of Ambulatory Surgery of 2006.

The largest number of surgeries occurred among women aged 40-59 years. During the survey years, 48,050 women in that age group underwent inpatient surgery and 53,790 underwent outpatient surgery for incontinence. Similarly, 49,490 women underwent inpatient surgery and 20,700 underwent outpatient surgery for prolapse.

“One out of every 10 women will undergo surgery for incontinence or prolapse in her lifetime,” Dr. Wu said. “These estimates will provide public health officials and policy makers with important information regarding the future disease burden as well as the economic impact of these procedures.”

Dr. Wu acknowledged that the projections rested on a number of assumptions. For example, the investigators assumed that surgery rates would remain constant. That assumption could be overturned by changes in the incidence of disease, advances in technology and surgical technique, or implementation of successful prevention strategies.

Disclosures: Dr. Wu stated that she had no relevant financial disclosures.

LONG BEACH, CALIF. – If present trends continue, U.S. surgeons will be performing 179,000 more incontinence and prolapse surgeries annually in 2050 than they are today.

The projected increase results primarily from an aging population, Dr. Jennifer Wu said at the annual meeting of the American Urogynecologic Society.

Stress incontinence surgeries are predicted to increase from an estimated 211,000 in 2010 to 310,000 in 2050. Similarly, surgeries for pelvic floor prolapse are predicted to increase from 166,000 this year to 246,000 in 2050.

Dr. Wu of Duke University, Durham, N.C., and her colleagues used three sources of data in making their forecast. The U.S. Census Bureau provided estimates of the female population in various age groups between 2006 and 2050. Data on the number of women undergoing these surgeries, broken down by age group, came from the Nationwide Inpatient Sample of 2007 and the National Survey of Ambulatory Surgery of 2006.

The largest number of surgeries occurred among women aged 40-59 years. During the survey years, 48,050 women in that age group underwent inpatient surgery and 53,790 underwent outpatient surgery for incontinence. Similarly, 49,490 women underwent inpatient surgery and 20,700 underwent outpatient surgery for prolapse.

“One out of every 10 women will undergo surgery for incontinence or prolapse in her lifetime,” Dr. Wu said. “These estimates will provide public health officials and policy makers with important information regarding the future disease burden as well as the economic impact of these procedures.”

Dr. Wu acknowledged that the projections rested on a number of assumptions. For example, the investigators assumed that surgery rates would remain constant. That assumption could be overturned by changes in the incidence of disease, advances in technology and surgical technique, or implementation of successful prevention strategies.

Disclosures: Dr. Wu stated that she had no relevant financial disclosures.

Major Finding: The share of hospitals adopting at least basic EHRs rose from 8.7% in 2008 to 11.9% in 2009. Only 2% of hospitals surveyed would have met the federal government's current “meaningful use” criteria to qualify for stimulus funding.

Data Source: Survey of 4,493 acute-care, nonfederal hospitals conducted by the American Hospital Association between March and September, 2009

Disclosures: The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 “core” objectives and an additional 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey's response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote.

In addition, they noted, “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

Major Finding: The share of hospitals adopting at least basic EHRs rose from 8.7% in 2008 to 11.9% in 2009. Only 2% of hospitals surveyed would have met the federal government's current “meaningful use” criteria to qualify for stimulus funding.

Data Source: Survey of 4,493 acute-care, nonfederal hospitals conducted by the American Hospital Association between March and September, 2009

Disclosures: The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 “core” objectives and an additional 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey's response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote.

In addition, they noted, “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

Major Finding: The share of hospitals adopting at least basic EHRs rose from 8.7% in 2008 to 11.9% in 2009. Only 2% of hospitals surveyed would have met the federal government's current “meaningful use” criteria to qualify for stimulus funding.

Data Source: Survey of 4,493 acute-care, nonfederal hospitals conducted by the American Hospital Association between March and September, 2009

Disclosures: The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012.

Those criteria include a set of 14 “core” objectives and an additional 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In completing the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the meaningful use criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were only able to analyze responses related to nine of the core measures and three of the menu measures.

The survey's response rate was 69%. Nonresponders differed significantly from responders on several measures, but the investigators took this into account, creating national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502]).

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings.

However, only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The investigators wrote that their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote.

In addition, they noted, “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

Major Finding: The share of hospitals adopting at least basic EHRs rose from 8.7% in 2008 to 11.9% in 2009. Only 2% of hospitals surveyed would have met the federal government's current “meaningful use” criteria to qualify for stimulus funding.

Data Source: Survey of 4,493 acute-care, nonfederal hospitals conducted by the American Hospital Association between March and September, 2009.

Disclosures: The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012. Those criteria include a set of 14 “core” objectives and 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were able to analyze only the responses related to nine of the core measures and three of the menu measures.

The survey's response rate was 69%. Nonresponders differed significantly from responders on several measures, but the researchers created national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings. Only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The researchers said their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote. “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

“Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer,” they wrote.

Major Finding: The share of hospitals adopting at least basic EHRs rose from 8.7% in 2008 to 11.9% in 2009. Only 2% of hospitals surveyed would have met the federal government's current “meaningful use” criteria to qualify for stimulus funding.

Data Source: Survey of 4,493 acute-care, nonfederal hospitals conducted by the American Hospital Association between March and September, 2009.

Disclosures: The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012. Those criteria include a set of 14 “core” objectives and 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were able to analyze only the responses related to nine of the core measures and three of the menu measures.

The survey's response rate was 69%. Nonresponders differed significantly from responders on several measures, but the researchers created national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings. Only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The researchers said their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote. “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

“Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer,” they wrote.

Major Finding: The share of hospitals adopting at least basic EHRs rose from 8.7% in 2008 to 11.9% in 2009. Only 2% of hospitals surveyed would have met the federal government's current “meaningful use” criteria to qualify for stimulus funding.

Data Source: Survey of 4,493 acute-care, nonfederal hospitals conducted by the American Hospital Association between March and September, 2009.

Disclosures: The U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation supported the survey.

Only 2% of U.S. hospitals surveyed between March and September 2009 would have qualified for federal stimulus funding incentive payments on the basis of their use of electronic health records, according to a survey of 4,493 hospitals.

The American Recovery and Reinvestment Act (ARRA) authorized incentive payments from Medicare and Medicaid to hospitals that both implement certified electronic health records (EHRs) and demonstrate their “meaningful use.” The survey, whose results were published online, was conducted before the U.S. Department of Health and Human Services formally adopted the meaningful use criteria for 2011 and 2012. Those criteria include a set of 14 “core” objectives and 10 “menu” criteria. Hospitals must meet all 14 core criteria and 5 of the 10 menu criteria to qualify for ARRA funds.

In the survey, each hospital indicated which of 32 clinical functions of an electronic health record it had implemented. Because the survey was conducted before the criteria were finalized, the investigators, led by Dr. Ashish K. Jha of Harvard Medical School, Boston, were able to analyze only the responses related to nine of the core measures and three of the menu measures.

The survey's response rate was 69%. Nonresponders differed significantly from responders on several measures, but the researchers created national estimates that were adjusted for nonresponse (Health Affairs 2010 October [doi:10.1377/hlthaff.2010.0502

Adoption of basic or comprehensive electronic health records increased from 8.7% of hospitals in 2008 to 11.9% in 2009. The most commonly implemented EHR functions were viewing of laboratory reports (82% of hospitals had fully implemented this in at least one of their units), viewing of radiology images (83%), and viewing of radiology reports (85%). Two-thirds of the hospitals had implemented medication lists, 63% had implemented drug allergy alerts, and 63% had implemented drug-drug interaction warnings. Only 33% of hospitals had implemented physician notes, 34% had implemented physician medication orders, and 32% had made clinical guidelines available through their EHR systems.

Large hospitals, major teaching hospitals, nonprofit hospitals, and urban hospitals were most likely to have implemented EHR systems. Small and medium hospitals, public hospitals, rural hospitals, and those that were not major teaching hospitals were significantly less likely to have implemented EHR. For example, the odds that a small hospital had implemented EHR were 70% lower than for a large hospital. Public hospitals had 40% lower odds than did nonprofit hospitals, and the rural hospitals had 40% lower odds than did urban hospitals.

The researchers said their 2% estimate was conservative, because they did not survey hospitals about all of the criteria. “Thus, it is likely that the actual number of hospitals currently able to qualify as meaningful users is lower than our projection,” they wrote. “If we wait until after 2011 to identify the early recipients of meaningful use incentives, it may be too late to reverse these trends in a timely fashion.”

They listed several policies that could, if implemented, make it easier for hospitals to adopt EHR systems and to meet meaningful use criteria. One approach would be to enlist the assistance of regional extension centers. Another would be to offer incentive payments or loans to smaller, public, or rural hospitals to assist them in purchasing or upgrading an EHR system.

“Federal policy makers need to take concrete actions now to address this emerging digital divide and to ensure that all Americans, regardless of where they receive care, derive the benefits that health [information technology] has to offer,” they wrote.