Hospital perks: How much should hospitals be rewarded for the patient experience?

From a Decemer 2, 2010 Eureka news alert

From hotel-style room service to massage therapy to magnificent views, hospitals are increasingly touting their luxury services in a bid to gain market share, especially those in competitive urban markets. An important new article, published today in the New England Journal of Medicine, raises crucial questions about the role of amenities in hospital care, explaining that how we decide to value the patient experience can have a significant effect on health care costs. “Though amenities have long been relevant to hospital competition, they seem to have increased in importance — perhaps because patients now have more say in selecting hospitals,” explained corresponding author John Romley, an economist with the Schaeffer Center for Health Policy and Economics at USC and research assistant professor in the USC School of Policy, Planning, and Development. Empirical evidence and surveys seem to confirm that patients increasingly value the nonclinical experience more than measures of clinical quality, such as a hospital’s risk-adjusted mortality rate. In a “Perspectives” piece in New England Journal of Medicine, the authors cite their own research showing that Medicare patients often do not choose the hospital nearest to them. They are willing to travel — and not necessarily for better clinical care, even in cases involving heart attack, where risk of death should be an overriding concern. Rather, the proportion of patients who received care at a given hospital was strongly correlated to the quality of amenities. Improved perks also have a significant effect on hospital volume. “On a societal level, the value of amenities is important because our health care system currently pays for them,” explained lead author Dana Goldman, director of the Schaeffer Center at USC and Norman Topping Chair in Medicine and Public Policy at the USC School of Policy, Planning, and Development. “A hospital seeking to strengthen its financial position might view investment in amenities as a sound strategy to attract patients. The question is, however, what effect such a strategy might have on patients’ outcomes as well as on overall health care costs.” The researchers note that if amenities create environments that patients and providers prefer, the result may be better treatment and improved health outcomes. Accounting for patient experience can either help us determine whether amenities are necessary to better performance or tell us if hospitals should shift their focus entirely to clinical quality instead. “As health care reform moves forward, we need to decide whether amenities are a valuable part of the hospital experience,” Romley said. “If they are, policymakers should include them in the measures for overall quality, prices and productivity.” ### Mary Vaiana at RAND was also an author of this paper. Goldman, et al. The Emerging Importance of Patient Amenities in Hospital Care. New England Journal of Medicine. December 2, 2010.

Personalized diets for elderly after hospitalization decreases mortality rates

From a Dec 2 2010 Eureka news alert

BEER-SHEVA, ISRAEL, December 2, 2010 — Intense, individually tailored dietary treatment for acutely hospitalized elderly has a significant impact on mortality, according to a new study by researchers at Ben-Gurion University of the Negev.

The intervention study just published in the prestigious Journal of the American Geriatric Society showed higher death rates six months after discharge (11.6 percent) of the control group compared to the intervention group’s death rate of 3.8 percent, which received intensive nutritional treatment designed and implemented by a registered dietician.

The study recruited 259 hospitalized adults aged 65 and older who were nutritionally at risk. After six months, the rise in the mini-nutritional assessment score (an indicator of nutritional status) was significantly higher in the intervention group than in the control group.

According to BGU researcher Dr. Danit R. Shahar, “This is the first study that used an individually tailored dietary treatment for acutely hospitalized elderly people. The results indicate that intense dietary treatment reduces mortality and can help reduce the need for re-hospitalization.”

In the study, a dietician met each patient upon admission to the hospital. The dietitian then followed the patient in his home, visiting three times after discharge.

The study dieticians (case managers) were the decision-makers regarding appropriate treatment and set up treatment goals. The basic approach was to develop a dietary menu based on inexpensive food sources and recipes. Patients had monthly contact by telephone to improve cooperation and prevent dropout from the study. The dieticians performed follow up assessment three to six months after discharges for all patients.

While the overall dropout rate was 25.8 percent, a standard range for elderly studies, after six months the rise in the mini-nutritional assessment score (an indicator of nutritional status) was significantly higher in the intervention group than in the control group.

 

 

Working With Pesticides May Affect Memory and More

From a December 2, 2010 Health Day news item by Robert Preidt

WEDNESDAY, Dec. 1 (HealthDay News) — Being exposed to pesticides over a long period of time might be linked to dementia, a new study of agricultural workers suggests.

The research effort included 614 vineyard workers in France who were in their 40s and 50s and had worked for at least 20 years in the agricultural sector. Their intellectual abilities were assessed twice, using nine tests designed to measure memory and recall, language retrieval, verbal skills and reaction time.

The workers’ exposure to pesticides during the six-year span of the study varied. About 20 percent were never exposed to pesticides and more than half had been directly exposed, which included mixing or applying pesticides and cleaning or repairing spraying equipment. The rest had either been indirectly exposed by coming into contact with treated plants or possibly indirectly exposed through their work in buildings, offices, cellars and the like.

On seven of the nine tests, workers who had been exposed to pesticides were most likely to do worse the second time they were tested, the researchers found. The study also reported that pesticide-exposed workers were up to five times more likely than the others to have lower test scores on both occasions and were twice as likely to show a drop of two points in the Mini Mental State Examination (MMSE), which tests cognitive functioning and is frequently used to determine if a person has dementia.

The decline in MMSE score “is particularly striking in view of the short duration of follow-up and the relatively young age of the participants,” Isabelle Baldi, of the Institute de Sante Publique d’Epidemiologie et de Developpement in Bordeaux, France, and colleagues wrote in the report published in the Dec. 2 online edition of Occupational and Environmental Medicine.

“The mild [cognitive] impairment we observed raises the question of the potentially higher risks of injury in this population and also of possible evolution towards neurodegenerative diseases such as Alzheimer’s disease or other dementias,” the study authors added.

Related Articles

• Types of Pesticides (everydayhealth.com)
• Dangerous Exposure: Farmworker Children And Pesticides (Medical News Today)