DAILY UPDATE

HHS-CCSC awards honor efforts to eliminate HAIs

The Critical Care Societies Collaborative (CCSC), in partnership with the U.S. Department of Health and Human Services (HHS), announces recipients in the 2013 National Awards Program to Recognize Achievements in Eliminating Health Care-Associated Infections (HAIs). Eight hospitals and healthcare facilities were honored for successful and sustained efforts to prevent HAIs, specifically infections in critical care settings.

HAIs are infections acquired while patients are receiving medical treatment for other conditions. At any given time, about one in every 20 patients has an infection related to their hospital care. These infections cost the U.S. healthcare system billions of dollars each year and lead to the loss of tens of thousands of lives. In addition, HAIs can have devastating emotional, financial and medical consequences.

"HHS and its government and non-government partners have seen rapid progress in reducing rates of several infections, especially in intensive care settings, since the launch of the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination," said HHS Deputy Assistant Secretary for Health Don Wright, MD, MPH. "This progress is due in large part to the leadership, dedication, and hard work of hospital teams such as those that we honor through this joint HHS-CCSC Awards Program. Thanks to these frontline clinicians and professionals, we are on track to achieve most 2013 national targets and extend the effort beyond hospitals to ambulatory and long-term care settings."

Award recipients  demonstrated success in reducing and eliminating central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP) or catheter-associated urinary tract infections (CAUTI) for 25 months or longer and show national leadership in sharing their evidence-based initiatives to improve clinical practice. These are among the most common HAIs that patients acquire while receiving medical treatment for other conditions.

Leaders of the HHS Office of the Assistant Secretary for Health HAI initiative  partnered with CCSC — a multidisciplinary organization composed of the American Association of Critical-Care Nurses (AACN), American College of Chest Physicians, American Thoracic Society and Society of Critical Care Medicine — to launch the three-year awards program in 2010.

AACN Senior Director Ramon Lavandero, RN, MA, MSN, FAAN, noted the potential impact of the awards program. "During the three years for which it was planned, this interdisciplinary awards program has increased health professionals' awareness of best practices used by peer institutions to reduce or eliminate health care-associated infections."

Awardees were recognized May 20 in Boston during AACN's National Teaching Institute & Critical Care Exposition. Award recipients (alphabetized by state) are:

• Intensive Care Unit, Franciscan St. Francis Health, Mooresville, IN (CAUTI)
• Surgical ICU and Trauma Burn ICU, University of Michigan Health System, Ann Arbor (VAP)
• Medical Surgical ICU, HealthEast St. John's Hospital, Maplewood, MN (CLABSI)
• Beth Israel Medical Center, New York City (CAUTI)
• ICU, Novant Health Presbyterian Medical Center, Charlotte, NC; ICU, Novant Health Matthews Medical Center, Matthews, NC; and ICU, Novant Health Huntersville Medical Center, Huntersville, NC (VAP)
• Cardiac Intermediate Unit, East Carolina Heart Institute at Vidant Medical Center, Greenville, NC (CLABSI)
• Medical Intermediate Unit, Vidant Medical Center, Greenville, NC (VAP)
• Medical University of South Carolina, Charleston (CLABSI)

In addition to the eight awardees, 11 healthcare organizations received honorable mention recognition for their efforts toward eliminating HAIs within their facilities. Facilities receiving honorable mention in this year's awards program are listed online at www.aacn.org/haiawards.

According to the most recent national data, reported in October 2012, CLABSI in hospital ICUs and wards have been reduced by 41 percent, on track to meet or surpass the HAI Action Plan target of a 50-percent reduction by the end of 2013. CAUTI in ICUs and hospital wards have been reduced by 7 percent, on track to meet the year-end target of a 25-percent reduction.

For additional information, visit the HHS Action Plan to Prevent Health Care-Associated Infections and the Partnership for Patients websites.

Forget to take medicine? These pills will tell your doctor

Startup companies are coming up with new technologies aimed at getting people to take medicine only as directed. Taking medication haphazardly—skipping doses, lapsing between refills or taking pills beyond their expiration date—has been linked to health complications and hundreds of millions of wasted dollars for insurers and hospitals.

"After six months' time, only half of people taking prescription medicines are taking them as directed," said Troyen Brennan, chief medical officer of drug retailer CVS Caremark Corp.

Health insurers and pharmacy-benefits managers like CVS have long relied on robo-calls, mailers and face-to-face meetings with pharmacists to keep patients on their dosing schedule.

Now they are evaluating a range of more cost-effective technologies, from pills and bottles with digital sensors, to data analytics software and social games that offer patients rewards.

Insurers and pharmacies are motivated in part by Medicare, which offers financial rewards for proving their members have improved their overall adherence to medication schedules.

They also stand to benefit if their members are healthier. The New England Healthcare Institute estimates that some $290 billion in costs is wasted each year on unnecessary hospital and doctor visits by people who failed to comply with their medication schedule.

CVS is pilot-testing technology from Virginia-based RxAnte Inc., which sells an analytics platform that looks at millions of patients' claims data and clinical data to identify people at highest risk of failing to comply with doctors' orders. These patients include people with a spotty track record of adherence, those who take several different medicines or those facing unwanted side effects, Chief Executive Josh Benner said.

Other companies are coming up with ways to help entice, rather than badger, customers. San Francisco-based Mango Health Inc. just released an app that lets users earn points toward prizes—such as gift cards from Target Corp. or a charitable donation in the patient's name—for adhering to their prescription schedules.

Beyond data and apps, startups are working on digitizing the pills and bottles themselves.

Proteus Digital Health Inc. places tiny, digestible sensors inside of pills to get an objective accounting of who is taking what medicine. The sensors are the size of a grain of sand and are made up of copper, magnesium and silicon, amounts well below a human being's recommended daily allowance of such minerals, said Andrew Thompson, chief executive of the Redwood City, CA, company.

The sensor beams data such as when the pill was ingested to a disposable strip worn on the skin like a Band-Aid that sends the data to a mobile app. With patient permission, doctors or loved ones can access the phone app to track compliance.

"There is no radio, no antenna," Thompson said. "It's literally powered by you." Thompson said the first digital drugs will be available in 2014 or early 2015. Proteus, which is backed by Medtronic Inc., Otsuka Pharmaceutical Co., Novartis AG, Kaiser Permanente and venture firms, has licensing and commercialization deals with Otsuka and Novartis, he said.

Thompson said that sensor-embedded pills are appropriate for older patients, who often take multiple medications, and for sufferers of conditions like tuberculosis, where going off a medication regimen can have disastrous consequences.

Other companies are remaking the medicine bottle. AdhereTech Inc. is developing an automated pill bottle filled with sensors that measure how much medicine is left. The bottle glows blue when it is time to take a dose, and red when the dosage is missed. The bottle can also beam data to AdhereTech's servers and send text alerts as reminders.

Even product-design firm IDEO is thinking about ways to boost prescription adherence. IDEO designers Kuen Chang and Jin Ko have designed a pill bottle that begins to resemble an overripe banana once a medicine is past its expiration date. The bottle is in concept stage and hasn't been developed. "It produces a gut reaction," the husband-and-wife design team said. "Without thinking about it, you just really don't want to eat that banana." Visit the Wall Street Journal for the article.

Drowning caused one-third of deaths from Hurricane Sandy

One-third of the victims who died because of Hurricane Sandy drowned, according to a U.S. report that emphasizes the need for plans that ensure residents are moved to safety.

Of 117 deaths caused by the October storm, 40 were from drowning, the U.S. Centers for Disease Control and Prevention said today in a report. Flooded homes in New York City accounted for almost half the drownings. New York state was the hardest hit by Sandy, with 53 deaths from all causes, followed by New Jersey with 34 and Pennsylvania with 12, the CDC said.

Sandy hit the New York and New Jersey coastlines on Oct. 29 and within 48 hours the region had six to 12 inches of precipitation, as many as 8 million people without power and 20,000 people in shelters, the CDC said. Emergency plans need to make sure evacuation messages are clear and residents are able to leave, according to the report.

“Hurricane-related drowning deaths in evacuation zones are preventable,” the CDC said. “A successful evacuation depends on officials providing timely messaging to all affected persons, on persons receiving those messages, and on persons having the capacity, resources, and willingness to leave.”

Of the 40 drowning deaths, 21 were in people’s homes, 11 were outside, one was in a commercial building and another person drowned while intentionally swimming off a storm-affected beach, according to the report.

The number of deaths attributed to the storm were compiled from American Red Cross reports, the CDC said. The American Red Cross notes listed reasons for not evacuating by 20 people who died in flooded homes in or near New York City’s Evacuation Zone A, including a fear of looters, lack of transportation, and disbelief in the intensity of the storm after a previous one turned out to be mild.

While drowning also was the leading cause of death for Hurricane Katrina in the Gulf Coast in 2005, that has not been the usual case in recent decades, the CDC said. Trauma was the leading cause of deaths for Florida hurricanes in 2004. Visit Bloomberg for the article.

Bronchodilators appear associated with increased risk of cardiovascular events

A study of older patients with chronic obstructive pulmonary disease (COPD) suggests that new use of the long-acting bronchodilators β-agonists and anticholinergics was associated with similar increased risks of cardiovascular events, according to a study published Online First by JAMA Internal Medicine.

COPD affects more than 1 in 4 Americans older than 35 years of age and is the third leading cause of death in the United States. Medications are a mainstay of management of the disease. While there is little controversy about the effectiveness of long-acting β-agonists (LABAs) and long-acting anticholinergics (LAAs), their cardiovascular safety remains a matter of debate, according to the study background.

Andrea Gershon, M.D., M.S., of the Institute for Clinical Evaluative Sciences, Ontario, Canada, and colleagues conducted a nested case control analysis of a retrospective cohort study and compared the risk of cardiovascular events between patients newly prescribed the inhaled long-acting medications.

The study used healthcare databases from Ontario and included all individuals 66 years or older with a diagnosis of COPD who were treated from September 2003 through March 2009.

Of 191,005 eligible patients, 53,532 (28 percent) had a hospitalization or an emergency department visit for a cardiovascular event. According to the results, newly prescribed long-acting inhaled bronchodilators β-agonists and anticholinergics were associated with higher risk of a cardiovascular event compared with nonuse of those medications (respective adjusted odds ratios, 1.31 and 1.14). The results also indicate there was no significant difference in events between the two medications.

"Among older individuals with COPD, new use of long-acting β-agonists and anticholinergics is associated with similar increased risks of cardiovascular events. Close monitoring of COPD patients requiring long-acting bronchodilators is needed regardless of drug class," the study concludes. Visit EurekAlert for the article.

Covidien’s technology platform to diagnose early lung cancer part of new guidelines of American College Of Chest Physicians

Covidien announced that its superDimension Electromagnetic Navigation Bronchoscopy (ENB) system, the first technology of its kind, is included in the new American College of Chest Physicians (ACCP) guidelines to aid in diagnosing and managing lung cancer. The evidence-based clinical practice guidelines were released by the ACCP earlier this month.

Lung cancer is the deadliest form of cancer in the U.S., causing more deaths among men and women than any other type of cancer. In its early stages, lung cancer presents few, if any, symptoms. As a result, the vast majority of lung cancer patients are diagnosed in the late stages, when there is minimal chance for a cure. With early detection, however, an estimated 85 percent of lung cancer cases can be diagnosed in the earliest, more curable stage. Early detection and immediate treatment can dramatically increase the typical long-term survival rate from 15 percent at 5 years to 88 percent at 10 years.

“Electromagnetic Navigation Bronchoscopy has over eight years of clinical use in the United States,” said David S. Wilson, MD, FCCP, Medical Director, The Lung Institute at Columbus Regional Health. “The diagnosis of lung cancer guidelines from the American College of Chest Physicians, which specifically state the increased yields of ENB and historic safety of bronchoscopy, make ENB a preferred diagnostic procedure for lung cancer.  ENB has become a platform technology for further diagnostics and therapeutics in the lung periphery. Guideline status marks a new era of bronchoscopy made possible by ENB.”

Through proprietary software and electromagnetic technology, the superDimension ENB system uses the natural airway access of the lungs to safely locate and more easily obtain a tissue sample of a lesion, even in the areas of the lung that are difficult to reach and where two-thirds of all lung lesions cannot be accessed by a traditional bronchoscope. Moreover, by enabling physicians to perform a tissue biopsy without a scalpel and a needle aspiration through the chest wall, the ENB system minimizes morbidity associated with more invasive procedures.

More than 40,000 patients have undergone a superDimension ENB procedure at over 500 leading medical facilities worldwide. The procedure is most commonly performed by a specialty physician, such as a pulmonologist or thoracic surgeon, and is completed in 30-60 minutes. For more information about the superDimension ENB system, please visit www.superdimension.com.

Cardinal Health Specialty solutions shares powerful new cancer-care research at 2013 ASCO meeting

With the cost of cancer care projected to increase to $170 billion by 2020, many in the healthcare industry are looking for ways to curb that cost curve, while maintaining quality of care for cancer patients and preserving fair compensation for physicians. New research being featured later this month in poster presentations and abstracts at the 49th Annual Meeting of the American Society of Clinical Oncology (ASCO) proves that it is possible to meet all three of these seemingly contrary goals.  

Cardinal Health Specialty Solutions and CareFirst BlueCross BlueShield (CareFirst), one of the largest health insurers in the Mid-Atlantic, recently completed a series of studies on the effectiveness of the nation’s first clinical pathways program for oncology, which they jointly launched in 2008.  Physicians within the CareFirst network worked together to develop clinical pathways – or evidence-based treatment regimens – for the treatment of breast, lung and colon cancers.

The new research shows that through the use of the Clinical Pathways program, CareFirst reduced its overall costs for treating breast, lung and colon cancers by 15 percent. These savings were primarily achieved through a 7 percent decline in emergency room visits, shorter lengths of stay in the hospital, increased use of generic medications and more appropriate use of chemotherapy. Although the overall drug spend was reduced, the reimbursement to physicians increased for both branded and generic drugs, and physicians received higher reimbursement overall.

The authors of the research contend that payor-physician collaboration was a significant factor behind the success of this Clinical Pathways program.

“Bruce Feinberg, D.O., vice president and chief medical officer of Cardinal Health Specialty Solutions, explained that these Clinical Pathways were created by and for physicians within the CareFirst network, not by an outside entity. He also asserts that this collaboration was a leading factor for the program’s high rates of physician participation and 95 percent pathways rate. For example, participating physicians were less likely to administer complex chemotherapy in late-line treatment, and when clinical evidence did not support it. Full abstracts of this research are available at www.abstract.asco.org. To learn more, visit www.cardinalhealth.com/specialtysolutions.

AAMI Foundation names scholarship winners

A mother working on a dual major in biomedical equipment technology and medical imaging technology and a student pursuing his master’s at the University of Connecticut have been selected as the winners of the AAMI Foundation’s Michael J. Miller Scholarship for 2013.

Leslie Carroll and Edward Ryan were selected as the scholarship winners based on their outstanding academic achievements and commitment to the healthcare technology management (HTM) field. With their personal and professional credentials, they stood out from the talented pool of candidates.

Carroll, a mother of four daughters, currently is enrolled at the Texas State Technical College. After working as a customer service professional outside healthcare, she discovered the HTM field after reviewing a list of potential majors and finding herself intrigued by the biomedical equipment technology field. Her instructors say she’s excelling in her classes, actively participating in discussions and assisting other students.

Ryan is studying clinical engineering at the University of Connecticut and interning at Hartford Hospital, where he has worked on a variety of projects—from centralizing the facility’s telemetry system to replacing a large portion of the MedSurg bed fleet.

Every year, the AAMI Foundation awards the $2,500 scholarships to students aspiring to become biomedical equipment technicians and clinical engineers. These scholarships expand access to students who have demonstrated academic excellence, technical aptitude, and commitment to the HTM field.

PartsSource and ARAMARK companies contributed $5,000 each to the scholarship fund. For a complete list of current sponsors, visit www.aami.org/foundation/scholarship/donors.html

The scholarship program is named in honor of Michael J. Miller—a leader in the medical technology field who served as AAMI’s president for 40 years until his retirement in 2009.To learn more about the scholarship, please visit AAMI.

Welch Allyn technology provides connectivity between diagnostic devices and EMR

Welch Allyn, has been working with Epic to connect several of its vital signs devices, monitors and ECG units to Epic’s Electronic Medical Records (EMR) system to help eliminate the need for manual data entry by providers, increase efficiency and alleviate the risk of transcription and latency errors. By establishing connectivity between Welch Allyn devices and the EMR, clinicians are able to transfer patient test results directly between diagnostic devices and the EMR— resulting in immediate access to accurate patient data and improved workflow.

Studies on manual vitals documentation have shown that 4,000 omission and/or transcription errors can occur per year for a 100-bed facility (of which about 80% are lower acuity floors); 3,200 hours were wasted with manual vital sign documentation; and more than $100,000 was lost in productivity due to lack of access to vitals. The availability of an automated system that captures and wirelessly transmits patient data helps eliminate these issues. Providers can visit www.welchallyn.com/connex to calculate a cost estimate using the Welch Allyn Connex Vital Signs Documentation Value Analyzer tool. Visit Welch Allyn for more information.

Happy Memorial Day from our entire staff at HPN

Healthcare Purchasing News wishes you and your families and friends a wonderful and healthy Memorial Day weekend. The HPN's Daily Update will be back on Tuesday, May 28.