Breaking News
December 18, 2018 - From Machines to Cyclic Compounds
December 18, 2018 - New study reveals best assessment tools to establish delirium severity
December 18, 2018 - Rice University scientists develop synthetic protein switches to control electron flow
December 18, 2018 - Home-based pulmonary function monitoring for teens with Duchenne muscular dystrophy
December 18, 2018 - National Biofilms Innovation Centre award grant to Neem Biotech for novel anti-biofilm drug development
December 18, 2018 - Artificial intelligence and the future of medicine
December 18, 2018 - Montana State doctoral student receives grant for her work to improve neuroscience tool
December 18, 2018 - Early postpartum initiation of opioids associated with persistent use
December 18, 2018 - Russian scientists identify molecular ‘switch’ that could be target for treatment of allergic asthma
December 18, 2018 - Surgeons make more mistakes in the operating room during stressful moments, shows study
December 18, 2018 - Immune cells explode themselves to inform about the danger of invading bacteria
December 18, 2018 - Malnutrition in children with Crohn’s disease linked with increased risk of surgical complications
December 18, 2018 - FDA Approves Motegrity (prucalopride) for Adults with Chronic Idiopathic Constipation (CIC)
December 18, 2018 - The long and short of CDK12
December 18, 2018 - Hologic’s Cynosure division introduces TempSure Surgical RF technology in North America
December 18, 2018 - CMR Surgical partners with Nicholson Center to launch U.S.-based training program for Versius
December 18, 2018 - Findings reinforce guidelines for cautious use of antipsychotics in younger populations
December 18, 2018 - Study finds new strains of hepatitis C virus in sub-Saharan Africa
December 18, 2018 - New battery-free, implantable device aids weight loss
December 18, 2018 - Parental alcohol use disorder associated with offspring marital outcomes
December 18, 2018 - Novel Breast Imaging Technique Might Cut Unnecessary Biopsies
December 18, 2018 - What can a snowflake teach us about how cancer spreads in the body?
December 18, 2018 - Management of nausea and vomiting in pregnancy costs the NHS more than previously thought
December 18, 2018 - Green leafy vegetables may reduce risk of developing liver steatosis
December 18, 2018 - Veganism linked to nutrient deficiencies and malnutrition if not planned correctly
December 18, 2018 - Coming Soon: A Tiny Robot You Swallow to Help You Stay Healthy
December 18, 2018 - Modified malaria drug proven effective at inhibiting Ebola
December 18, 2018 - Study finds epigenetic differences in the brains of individuals with schizophrenia
December 18, 2018 - Fitness instructors’ motivational comments influence women’s body satisfaction
December 18, 2018 - Study focuses on modification of lipid nanoparticles for successful brain cell targeting
December 18, 2018 - New gut bacteria may be effective against obesity, metabolic and mental disorders
December 18, 2018 - New two-in-one powder aerosol to upgrade fight against deadly superbugs in lungs
December 18, 2018 - Biofilms feed with swirling flows
December 17, 2018 - Study identifies specific neurological changes related to traumatic brain injury
December 17, 2018 - New study confirms geographic bias in lung allocation for transplant
December 17, 2018 - Research focuses on optimization of solid lipid nanoparticle that encapsulates Vinorelbine bitartrate
December 17, 2018 - Carpal tunnel syndrome – Genetics Home Reference
December 17, 2018 - A novel insulin accelerant
December 17, 2018 - Tips for caring for patients with disabilities, from a mother and physician
December 17, 2018 - Menopause-related sexual, urinary problems tied to worse quality of life
December 17, 2018 - In-school nutrition programs among students limit increases in BMI, finds study
December 17, 2018 - Risk for Hospitalization for Heart Failure Greater With Diabetes
December 17, 2018 - Food assistance may help older adults adhere to diabetes meds
December 17, 2018 - Supporting a family’s goals during a difficult pregnancy
December 17, 2018 - Neurons with Good Housekeeping Are Protected from Alzheimer’s
December 17, 2018 - New approach to tumor analysis could improve prognosis for bowel cancer patients
December 17, 2018 - New ‘epigenetics-based’ cervical cancer test outperforms Pap smear and HPV tests
December 17, 2018 - Ten year follow-up after negative colonoscopy related to reduced risk of colorectal cancer
December 17, 2018 - CTF along with NTAP and Sage announce first-ever open data portal for neurofibromatosis
December 17, 2018 - Intimacy: The Elusive Fountain of Youth?
December 17, 2018 - Will saliva translate to a real diagnostic tool?
December 17, 2018 - DFG establishes nine new Research Units and one new Clinical Research Unit
December 17, 2018 - Assisted living’s breakneck growth leaves patient safety behind
December 17, 2018 - America’s teens report dramatic increase in their use of vaping devices in just one year
December 17, 2018 - Enlarged heart linked to a higher risk of dementia
December 17, 2018 - Prostate cancer detection using MRI now first-line investigation tool
December 17, 2018 - Loughborough academics part of new project investigating effectiveness of personalized breast cancer screening
December 17, 2018 - Adolescents who use cognitive reappraisal had better metabolic measures, shows study
December 17, 2018 - Probiotics may offer therapeutic benefits for biopolar patients
December 17, 2018 - Stealth BioTherapeutics Granted Fast Track Designation for Elamipretide for the Treatment of Dry Age-Related Macular Degeneration with Geographic Atrophy
December 17, 2018 - Studies reveal role of red meat in gut bacteria, heart disease development
December 17, 2018 - Eisai enters into agreement with Eurofarma for its anti-obesity agent lorcaserin
December 17, 2018 - Researchers use brain connectome to reassess neuroimaging findings of Alzheimer’s disease
December 17, 2018 - “Miracle” baby survives Ebola in Congo and rapid a new Ebola detection device
December 17, 2018 - Mechanisms behind neonatal diabetes uncovered
December 17, 2018 - AHF urges the WHO to expedite approval process for vaccine effective against Ebola
December 17, 2018 - Study finds misuse of benzodiazepines to be highest among young adults
December 17, 2018 - TGen receives PayPal grant to underwrite costs of genetic tests for children with rare disorders
December 17, 2018 - New research highlights why HIV-infected patients suffer higher rates of cancer
December 17, 2018 - Antibiotic-resistant bacteria could soon be targeted with Alzheimer’s drug
December 17, 2018 - Rutgers scientists take an important step in making diseased hearts heal themselves
December 17, 2018 - Tailored Feedback at CRC Screen Improves Lifestyle Behaviors
December 17, 2018 - Loss of two genes drives a deadly form of colorectal cancer, reveals a potential treatment
December 17, 2018 - How the Mediterranean Diet Can Help Women’s Hearts
December 17, 2018 - Sustained connections associated with symptoms of autism
December 17, 2018 - Concussion rates among young football players were higher than previously reported
December 17, 2018 - Cresco Labs granted approval to operate marijuana dispensary in Ohio
December 17, 2018 - Study provides insight into health risks facing new mothers
December 17, 2018 - AMSBIO expands Wnt signaling pathway product range to aid research
December 16, 2018 - Surgical treatment unnecessary for many prostate cancer patients
New long-term analysis at heart attack care in America shows more survival and spending

New long-term analysis at heart attack care in America shows more survival and spending

image_pdfDownload PDFimage_print

A new long-term look at heart attack care and spending in America since the turn of the century shows more survival, more spending, and more variation between hospitals on both scores.

And while some of that spending – on rapid angioplasty to open clogged heart arteries – appears to be paying off, a lot of the dollars spent in the six months after a heart attack don’t seem to be making much of a difference in the long-term death rate for patients.

The findings are published in JAMA Cardiology by a team led by members of the University of Michigan Institute for Healthcare Policy and Innovation and the Dartmouth Institute for Health Policy and Clinical Practice. The team analyzed data from nearly 480,000 people covered by traditional Medicare who were treated for acute myocardial infarction at 1,220 hospitals nationwide between 1999 and 2014.

The findings come out just a month after the federal government announced the cancellation of a “bundled payment” program that was supposed to incentivize better and more cost-effective care across all settings for the first three months after a heart attack.

Recent government programs to incentivize better heart attack care have focused on capping the total payment a hospital or health system can get for the first 30 days of post-heart attack care, and publicly reporting how hospitals stack up against others in heart attack deaths.

And indeed, the study shows, in the years since these programs rolled out, 30-day heart attack care spending has stayed flat while mortality has dropped.

Lead author Donald Likosky, Ph.D. of U-M’s Department of Cardiac Surgery says, “while healthcare policies have resulted in little variation in 30-day hospital expenditures for heart attacks, they have had little impact on spending beyond 30 days. We see unwarranted variation in spending by hospitals beyond 30 days without much measurable benefit in mortality.”

Survival and spending

Overall, the percentage of heart attack patients who survive the first six months after their attack has gone up since 1999 – from 73 percent to 78.5 percent. Americans, in fact, are much more likely to survive the immediate aftermath of a heart attack than people in other developed countries, according to the World Health Organization.

Spending on the care of heart attack patients has gone up in that time, too – nearly 14 percent across the 15 years of the study, with a plateau in costs in the last six years.

But these across-the-board numbers mask huge variation in both mortality and dollars depending on which hospital patients were treated at, and what kind of care they received.

For instance, Medicare spending rose 44 percent in 15 years for one group of hospitals at the high end of spending growth. But Medicare heart attack spending dropped nearly 19 percent for those at the low end.

Early PCI: Cost-effective but varying use

Hospitals that focused on getting heart attack patients diagnosed and onto the angioplasty table within the first 24 hours after their first symptoms achieved the biggest gains in survival. As a whole, these hospitals actually lowered the average cost for a patient’s post-heart attack care measured over six months, the analysis shows.

The percentage of patients getting this procedure done rapidly — called early percutaneous coronary intervention or PCI — doubled in the time period of the study. And hospitals that increased their use of early PCI the most actually had lower spending on several types of post-hospital care for their patients, including nursing home and in-home care.

“We also find that patients at high-volume hospitals benefit the most from early stenting treatments by interventional cardiologists”, says co-author Jessica Van Parys, Ph.D. of Hunter College. “This finding is most likely because physician and nursing staff learn over time what works best for their heart attack patients.”

Meanwhile, when looking across all hospitals, spending on skilled nursing facility care and home care doubled during the study period, and spending on outpatient care tripled.

But patients who saw doctors in outpatient visits more often after their heart attack were no less likely to die in those first six months, on average.

Going forward

The analysis also reveals a lot of opportunity to improve the care heart attack patients get in the first six months, and the value that the nation gets from the dollars spent on it.

Part of that effort could include providing hospitals and individual providers regular reports on their patterns of care their patients are receiving across all health care settings, and the related costs. This would also offer a chance to inform providers and administrators about the evidence behind – or against – certain practices.

“If we don’t provide feedback they won’t know where to improve,” says Likosky. “We need to develop and implement models for evaluating ways to address both quality and spending. Better involvement of frontline providers in designing and implementing change is crucial, especially if we seek to reduce variability in quality and spending. Clinical providers are likely best suited to both know what works, and why.”

Likosky and colleagues note that in Michigan and northern New England, cardiac care providers and hospitals have come together across their regions to pool data and feed reports back to each hospital and provider to drive improvement efforts. A similar effort for heart attack care nationwide could start with looking at what differentiates hospitals from one another, and what the low-cost/low-mortality hospitals can teach their peers.

“Right now, there’s no disincentive to use cost-ineffective types of care,” says Likosky. “Providers are well-intentioned, but many of the current management and treatment strategies are both expensive and don’t appear to be effective at reducing mortality following heart attacks.”

Source:

http://www.med.umich.edu/

Tagged with:

About author

Related Articles