Issue link: https://beckershealthcare.uberflip.com/i/1058489
30 QUALITY IMPROVEMENT & MEASUREMENT In-hospital death risk higher among heart failure patients with do-not-resuscitate orders By Anuja Vaidya A study published in the International Journal of General Medicine analyzed the influence of do-not-resuscitate orders on heart failure performance measures. Researchers examined the medical reports of pa- tients with acute heart failure who were admitted between April 2013 and March 2015. They collected demographic data, information on the presence or absence of a do-not-resuscitate order within 24 hours of admission and in-hospital mortality. Of 394 patient reports examined, 30 percent had do-not-resuscitate orders. Additionally, of 183 patients with left ventricular systolic dysfunction, 24 percent had do-not-resuscitate orders. The study shows those with do-not-resuscitate orders had higher in-hospital mortality compared to those who did not have the orders. However, there were no significant differences between the two groups in terms of four key quality measures. "[Do-not-resuscitate] orders did not affect perfor- mance measures, but they were associated with higher in-hospital mortality among acute heart failure patients," the study authors concluded. n US News medical school rankings have little effect on patient outcomes, study finds By Megan Knowles T here is little or no relation between U.S. News & World Report's ranking of the medical school a phy- sician attended and subsequent patient mortality or readmission rates, a study published in The BMJ found. The researchers set out to investigate whether U.S. News medical school rankings are linked to patient out- comes and healthcare spending by examining a random sample of Medicare beneficiaries. The patients were admitted as an emergency to a hospital with a medical condition and treated by general internists. In all, the researchers looked at 996,212 admissions treat- ed by 30,322 physicians. When using U.S. News primary care rankings, physicians who graduated from high- er-ranked schools had slightly lower 30-day readmission rates and lower spending compared to physicians who graduated from lower-ranked schools. The researchers found no difference in 30-day mortality. "Overall, little or no relation was found between the [U.S. News] ranking of the medical school from which a physician graduated and subsequent patient mortality or readmission rates," the researchers concluded. "Physi- cians who graduated from highly ranked medical schools had slightly lower spending than graduates of lower ranked schools." n Hospital-acquired conditions dropped 21% in 5 years By Megan Knowles H ospitals and health systems have significantly reduced hospi- tal-acquired conditions, unplanned readmissions and health- care-associated infections over the last 10 years, according to a report from the American Hospital Association. e report, called Aligning Efforts to Improve Quality, shows progress hospitals and health systems have made in improving care quality over the last decade. It also looks at what conditions inhibit further care improvements and provides recommendations to poli- cymakers and other stakeholders on ways to reduce these barriers. Here are five report insights: 1. Hospitals reported 70,000 fewer unplanned readmissions from 2011-15. 2. Hospital-acquired conditions decreased 21 percent from 2010-15. 3. From 2009-14, the occurrence of central line-associated blood- stream infections dropped 40 percent. 4. Hospitals reported a 77 percent decrease in early elective deliv- eries (scheduled cesarean sections/medical inductions performed before 39 weeks of gestation without medical need). 5. e AHA made several recommendations to policymakers, including: • Improving CMS hospital star ratings to demonstrate trans- parency and validity in methodology for patients • Enhancing infrastructure supporting electronic clinical quality measures, which use data from EHRs • Reviewing Medicare conditions of participation and stan- dards to ensure they promote safety n