Friday, November 23, 2012

Smokers fare worse after knee surgery

From Reuters

Smokers have worse outcomes after knee surgery than non-smokers, including less-complete healing and more surgical complications, according to a new analysis.
Smoking has a profound effect on circulation, so that means it even affects musculoskeletal healing.
Surgeons had a hunch smoking was related to worse outcomes after knee surgery.
They gathered the results of 14 studies, eight of which looked at surgical repair of knee ligaments, including the anterior cruciate ligament (ACL), and six of which examined repair of knee cartilage.
For instance, smokers were less likely to return to their pre-injury level of sport and experienced more pain. One study from the University of Pittsburgh School of Medicine found surgery patients who smoked were 64 percent less likely to report a successful outcome than non-smokers.
The one study that did not find any difference between smokers and non-smokers examined patients' risk of developing osteoarthritis in the knee.
Four studies on cartilage surgery found that smokers were less likely to have excellent results after surgery, had less improvement in the knee years later or had fewer beneficial proteins in the knee fluid than non-smokers.

Friday, November 16, 2012

Patient Choice an Increasingly Important Factor in the Age of the "Healthcare Consumer"

From Harris Online

The decisions made by the public as "healthcare consumers" are becoming increasingly important, but relatively little is known about what guides their decision making process. This Harris Poll of 2,311 U.S. adults (ages 18 and over) surveyed online between July 16 and 23, 2012 by Harris Interactive represents an important first step in exploring this new category of market behavior.
Satisfaction with healthcare visits compared to other consumer services
Among the 84% of Americans who visited a doctor's office within the past year, nearly half (47%) reported being very satisfied with their last medical visit; an additional 36% described themselves as somewhat satisfied.
As might be expected, satisfaction falls short of levels observed for several other industries, particularly those with more of a focus on providing a pleasurable experience: very satisfied ratings are behind those reported for Americans' last restaurant visit (63%), their last online purchase (62%), and their last bank visit (59%). Very satisfied ratings are comparable to those recorded for U.S. adults' last hotel stay (49%), car purchase (47%) and department store visit (44%), and are ahead of those observed for their most recent health insurance company interaction (29%) and last mobile phone store visit (28%).
Dissatisfaction with most recent healthcare provider visits (17%) is comparable to levels observed for recent mobile phone store visits (also 17%) and health insurance company interactions (18%).
Many factors contribute to patients' experiences with their doctors and other healthcare providers. When asked to rate a series of factors on their importance in driving a positive experience, the clear top issue in patients' minds is their doctor's overall knowledge, training and expertise (with 83% rating it very important). Their doctor's ability to access their overall medical history (62%) and time spent with their doctor (59%) are the next most vital factors, while appearance and atmosphere of the doctor's office (26%) and minimizing paperwork (29%) are the least important issues.

Gap for Online Services: Results show a similar disparity for all of the tested services, including (among others) email access to doctors (12% have; 23% very important, 30% important), online appointment setting (11% have, 21% very important, 30% important) and online billing and payments (10% have, 21% very important, 29% important). 

"Customer experience matters in healthcare and will continue to impact purchasing decisions and customer retention," notes Debra Richman, Senior Vice President, Healthcare Business Development & Strategy, Harris Interactive. "The healthcare consumer is increasingly evaluating brand equity, convenience and product or service value as they make choices. In an increasingly competitive healthcare marketplace, a positive customer experience will serve to differentiate health plans and providers."

Link to entire article ---

Friday, November 9, 2012

Hospitals To Be Rated Like Hotels-Satisfaction Scores Affect Payments

Patient-satisfaction score to help determine Medicare payments to hospitals. 
As of Oct. 1, hospitals must now reckon with a provision that ties Medicare reimbursement to results of patient-satisfaction surveys, reports the Wall Street Journal. Nearly $1 billion is at stake. Many medical professionals say the requirement is unfair, especially to older urban hospitals that take in large numbers of emergency patients. Many also say that medical care delivery isn’t conducive to being rated like resorts or restaurants, and that proper care and a good outcome might not necessarily equate to a “great experience” for the patient. A hospital in South Carolina will reap $87,000 in extra Medicare pay over the next year after scoring well, while a facility in New Jersey will lose $240,000 because of low scores. The program is part of a broader pay-for-performance initiative in the federal healthcare overhaul. 

It is presumed that Commercial insurers such as the Blue Crosses, United Healthcare, Aetna, Cigna will soon follow suit.

 I agree that the system now going into place is unfair for the reason state above -  Good outcomes and proper care does not always equate to a 5 Star hotel experience for a patient.  One has to anticipate that this system will result in some negative unintended outcomes.  What next ?!.

Friday, November 2, 2012

Obesity Doubles Failure Rates After Total Knee Replacement

Complications after Total Knee Replacement (TKR) can require reoperation, implant removal, and months of intravenous antibiotics and months off work.  Avoidance of complications include Patient Health Optimization to address and correct risk factors known to lead to adverse outcomes prior to surgery.  It makes sense for the patient and it makes sense for society (cost and loss of productivity burden is high with TKR complications).  
From J Bone Joint Surg Am, 2012 Oct 

Obesity (body mass index ≥30 kg/m2) is a well-documented risk factor for the development of osteoarthritis.  An increased prevalence of total knee arthroplasty in obese individuals has been observed in the last decades. 
Infection occurred more often in obese patients, with an odds ratio of 1.90.  Deep infection occurred more often in obese patients, with an odds ratio of 2.38. Revision of the total knee arthroplasty, defined as exchange or removal of the components for any reason.   Revision for any reason occurred more often in obese patients, with an odds ratio of 1.30.
Obesity had a negative influence on outcome after total knee arthroplasty.