Bold Voices - January 2011 - (Page 10)

AT THE BEDSIDE EOL Care Rises for Heart Failure Patients on Medicare The study adds that unadjusted mean costs to Medicare per patient rose 26 percent — from $28,766 to $36,216. “After adjustment for age, sex, race, comorbid conditions, and geographic region, costs increased by 11 percent,” it states. What is your practice regarding end-of-life care for HF patients? Use the auto-reply blue bubble in the digital edition or write to AACN Advocates to Revise ICU Quality Measures The National Quality Forum (NQF), Washington, D.C., has moved forward with two quality measures — length of stay and in-hospital mortality for intensive care unit patients — as patient outcome measures. AACN joined the American College of Chest Physicians, Northbrook, Ill., and the American Thoracic Society, New York, N.Y., to oppose the measure. The organizations notified NQF of their opposition with an official appeal, strongly suggesting the NQF not endorse ICU length of stay and offering an alternative to in-hospital mortality. These quality ICU length of stay measures carry significant potenand in-hospital tial for adverse mortality should consequences that may ultimately be used as patient harm patients outcome measures. and increase healthcare costs. If adopted, these measures could unfairly reward hospitals that transfer a large number of patients to post-acute-care facilities and encourage overuse of postacute care, potentially increasing healthcare costs. As an alternative to in-hospital mortality, AACN suggests the NQF consider 30-day mortality, a measure much less susceptible to discharge bias. All of the riskadjusted mortality measures adopted by the Centers for Medicare and Medicaid Services, such as pneumonia mortality and acute myocardial infarction mortality, use 30-day mortality, not in-hospital. Full text of the letter is posted on the Testimony/ Support page at Among Medicare beneficiaries who died of heart failure (HF), healthcare resource use at end-of-life increased over time with higher intensive care rates and higher costs, a recent study finds. “Resource Use in the Last 6 Months of Life Among Medicare Beneficiaries With Heart Failure, 2000-2007” in October’s Archives of Internal Medicine adds that “use of hospice services also increased markedly, representing a shift in patterns of care at the end of life.” The retrospective cohort study of 229,543 Medicare beneficiaries, who died between Jan. 1, 2000, and Dec. 31, 2007, found that approximately 80 Hospice use increased from 19 percent to nearly 40 percent. percent of HF patients were hospitalized in the last six months of life, the number of days in intensive care increased from 3.5 to 4.6, and hospice use increased from 19 percent to nearly 40 percent. 10 JANUARY 2011

Table of Contents for the Digital Edition of Bold Voices - January 2011

Front/Digital Edition Viewing Guide
Another Angle
AACN Boards and Contact Information
New HHS-CCSC Awards Recognize HAI Reductions
Zero Tolerance for Preventable Incidents Involves Non-Surgical Specialties
Bold Voice: Chatting with MaryAnn Stump
Facebook Asthma?
EOL Care Rises for Heart Failure Patients on Medicare
More Patient, Family Contact Needed in EOL Care
Chronic Lung Disease of Prematurity Increases Respiratory Risk in Day Care
Childhood Obesity Linked to Viral Infections
Pharmaceutical Safety at Home
DTaP, Tdap: What's in a Name?
In Our Journals
STOP-BANG Helps Identify Surgical Patients at Risk
Fewer Blood Transfusions Can Improve Patient Safety, Reduce Costs
Certification Capsules
Dues, NTI and Certification Fees Will Not Increase
From the President

Bold Voices - January 2011