Neal Singh explains why healthcare organizations are turning to this strategy

Contract Lifecycle Management

A family physician offers three case studies in virtual primary care

The New House Call?

In Our Podcast, Sundar Kamak Shares How Technology Can Help

Curing Supply Chain Woes

Exposure to COVID-19-positive household members is a risk factor associated with infection among vaccinated healthcare workers.

The findings of the recent study suggested reconsideration of quarantining vaccinated people who have had significant exposure to household members who tested positive for the virus.

While mass vaccination of Israeli adults who received the BNT162b2 vaccine (Pfizer-BioNTech) is associated with a significantly lower rate of SARS-CoV-2, there are still cases of infection among fully vaccinated adults. And after the vaccination rollout, the CDC eliminated the need for quarantine after exposure.

Yonatan Oster, M.D., and a team of Israel-based investigators studied the association between exposure characteristics and infection risk among vaccinated and non-vaccinated healthcare workers in Israel. To do this, they conducted a case-control study between January and March 2021 at the Hadassah-Hebrew University Medical Center. Hospital executives executed the vaccination program and within two months, it achieved almost complete vaccination coverage and a significant decrease in the number of infected healthcare workers.

The investigators compared all vaccinated healthcare workers who tested positive at least two weeks after getting the second dose. Workers were placed into two control groups — all non-vaccinated workers who had positive test results during the same period and a sample of vaccinated workers who were tested but had negative results. The team collected data including demographic characteristics, symptoms, characteristics of exposure, and disease course.

There were 5,312 vaccinated healthcare workers and 690 non-vaccinated healthcare workers at the end of the study period. Of those vaccinated, .5% had positive test results for COVID-19 and 10% of non-vaccinated healthcare workers had positive test results for the virus.

Among the positive groups, symptoms were the common cause for testing (62% in the non-vaccinated-positive group and 63% in the vaccinate-positive group), but not in the vaccinated-negative group (22%).

Being exposed to a positive household member was significantly more common for healthcare workers in the vaccinated-positive group (56%) compared to the non-vaccinated-positive group (38%) and the vaccinated-negative group (9%). When it came to the odds ratio of exposure to positive household members, vaccinated-positive healthcare workers had an OR of 2.03 compared to non-vaccinated-positive healthcare workers and an OR of 12.5 compared with vaccinated-negative healthcare workers.

Association Between Exposure Characteristics and the Risk for COVID-19 Infection Among Health Care Workers With and Without BN-T162b2 Vaccination

Articles

Vaccinated people should quarantine if they are exposed to household members who tested positive for COVID-19.

Exposure to COVID-Positive Household Members a Big Risk Factor for Vaccinated Healthcare Workers

A partnership between Ochsner Health and Bold aims to leverage digital health to reduce falls and improve health outcomes in older adults.

The platform is one of five interventions in Ochsner’s Connected Stability pilot fall prevention and monitoring programs to help Medicare Advantage members at the highest risk for falls.

Bold’s evidence-based fitness programs keep older adults active to prevent such falls. In fact, findings of a clinical study conducted by Bold demonstrated up to a 60% reduction in annualized fall rate in members enrolled in the program. The digital health program features strength, balance, and mobility exercises, along with education and community support.

According to the CDC, one in three adults over the age of 65 years old fall each year. And the falls come with a high cost — nearly $50 billion annually on non-fatal fall injuries and $754 million is spent on fatal falls. In 2018 alone, Medicare paid $29 billion for treatment and care of non-fatal falls.

“Falls is one of the leading problems facing healthcare today in terms of both cost and mortality,” Richard Milani, M.D., medical director for iO and chief clinical transformation officer for Ochsner Health, said in 

. “Bold’s balance training program was a natural fit as one of multiple interventions in our comprehensive fall prevention and monitoring program as we work to prevent future falls.”

To use Bold, members complete an online assessment about their current health and fitness levels. With the data, the platform designs a personalized program specific to the member’s abilities. The program offers options that are easy to follow and accessible at home. While participating in the program, members can have supportive and motivational check-ins. What’s more, they can join virtual live classes and other community events to encourage social connections.

The partnership is not the first time Ochsner Health used health tech and digital platforms to help its patients.

Through Connected Maternity Online Monitoring, expecting mothers can manage their pregnancy at home without scheduling an appointment. Patients can digitally send weights and blood pressure readings to their medical team.

Ochsner Health was also among the first hospitals to integrate with Apple HealthKit via Epic. And a few years ago, the hospital launched the O Bar, an in-person center for learning about health and wellness apps. The hospital recommends hundreds of apps that range from nutrition tracking, to fitness, to managing chronic conditions. A majority of the apps help patients track their vital signs and integrate with Apple HealthKit.

The new partnership between Ochsner Health and Bold firmly reiterates digital health platforms can improve patient outcomes from outside the traditional four walls of care.

The partnership highlights the importance of leveraging digital health to improve patient outcomes. 

Ochsner Health, Bold Partner to Use Digital Health to Decrease Falls

On this episode of Healthy Bottom Line, Barry Sample, PhD, director of science and technology at Quest Diagnostics, discusses the rise in drug positivity rates among healthcare professionals over the course of 2020 and the consequences of drug use among employees in healthcare settings. He also talks about the role that marijuana legislation has played a role in this increase as well as some solutions to reduce positivity rates.

Podcasts

Barry Sample, PhD, director of science and technology at Quest Diagnostics, discusses the rise in drug positivity rates among healthcare employees, the reasons behind the rise, and what can be done to combat them.

Healthy Bottom Line:  COVID-19 and Marijuana Laws: Why Employee Drug Positivity is on the Rise in Healthcare

Use of a mobile app significantly decreases the rate of medication errors and time to drug delivery for emergency drug preparation in a prehospital setting.

Findings of the recent study suggest such apps have the potential to improve medication safety and change practices in pediatric emergency medicine.

Johan N. Siebert, M.D., and a team of Switzerland-based investigators assessed the efficacy of an evidence-based mobile app in reducing the occurrence of medication errors compared with conventional preparation methods during simulated pediatric out-of-hospital cardiac arrest scenarios. The nationwide, open-label, multicenter, randomized clinical trial took place at 14 emergency medical services centers in Switzerland.

Two methods were evaluated to guide the preparation of emergency drugs for IV administration at pediatric doses. Those included in the study were randomly assigned to prepare the drugs with support of the app (intervention group) or by conventional methods (control group).

Participants were registered advanced paramedics who worked in EMS and had a three-year formal educational program in Switzerland. Paramedics were trained in advanced life support procedures.

Those randomized to the intervention group needed to: (1) complete a survey collecting data about their demographic characteristics, healthcare training, and simulation and computer experience; (2) attend a five-minute training session on how to use the app; and (3) attend a presentation of the simulation manikin characteristics. Paramedics participated in a simulated cardiopulmonary resuscitation scenario on a high-fidelity manikin. The scenario was filmed to be analyzed to verify whether any errors were made.

In the scenario, participants were asked to sequentially prepare and inject four different drugs of varying degrees of preparation difficulty with the support of the mobile app designed to assist with drug preparation. Those in the control group followed conventional pediatric drug preparation methods.

The team’s primary outcome was medication error, defined as failure in drug preparation if at least one error was committed — a deviation in drug dose higher than 10% from the correct weight dose, inability to calculate drug dose without guidance from the paramedic investigator leading the resuscitation room, or a deviation of higher than 10% of the final administered concentration of sodium bicarbonate from the prescribed 4.2% concentration.

There were 150 advanced paramedics randomized to the two study groups — 74 to the mobile app group and 76 to the conventional group.

Overall, 600 drug doses were delivered. More than 62% of doses given using the conventional method and 5.7% of those delivered using the mobile app were associated with medication errors. A majority of errors were due to a dose deviation higher than 10% of the prescribed dose (56.6% using the conventional method and 5.4% using the mobile app). The risk of incorrect preparation of the four drugs was decreased by 66.5% using the mobile app.

All participants in the control group committed at least one preparation error during the scenario, while 18.9% of the intervention group had at least one error. The proportion of those committing several preparation errors was substantially lower with the app (4.1%) than with the conventional method (85.5%).

Use of the mobile app resulted in significantly shorter times for drug preparation and delivery. Such was observed for three of the drugs. The time to drug preparation decreased by 40 seconds and the time to drug delivery decreased by 47 seconds. The decreases represented an overall saving in time of 20% compared with the conventional method.

The study findings emphasized the efficacy and positive outcomes related to medical mobile apps to improve medication safety and change prehospital clinical practice in pediatric emergency medicine.

Effect of a Mobile App on Prehospital Medication Errors During Simulated Pediatric Resuscitation

A mobile health app provides a safer and more timely drug delivery system.

Mobile App Substantially Decreases Medication Errors, Delivery Time

Findings of a new report highlight 40% of hospitals accelerated hiring to meet the increased demand in medical services following COVID-19 lockdowns.

 revealed 36% of hospitals surveyed plan for normal hiring and 24% are being cautious by delaying or issuing a hiring freeze.

The survey findings strongly differentiate from 2020 when hospitals took measures to cut costs during the onset of the COVID-19 pandemic lockdowns. Last year, 54% of hospitals had furloughs, 45% laid off workers, 15% suspended 401(k) or 403(b) retirement plan contributions, and 10% announced voluntary separation programs.

“The top priority in 2020 was to mitigate rising costs for the employer — understandably, given the financial shock that health systems were reeling from,” Sheena Singh, senior vice president of Aon’s national healthcare industry practice, said in a press release. “Now, the pandemic has exacerbated a labor shortage that could impact patient care delivery, delay attainment of organizational objectives, and accelerate burnout among clinical staff.”

A majority of health system employers (77%) expressed concerns with employee burnout and workforce resiliency, while 76% were concerned with employee work/life balance. Additional concerns included financial stress for employees (75%) and benefits to support diversity, equity, and inclusion (73%).

The report demonstrated average health benefit expenses per hospital employee per year may grow 2.7% from nearly $14.5k to more than $15k. This is due to hospitals ramping up to accommodate deferred medical services.

When it comes to healthcare costs, 77% of hospitals plan on paying at least 76% for their employees. And 23% offer a no-cost health plan. Most health systems surveyed (85%) provide a discount to employees through a plan design to access their own facilities and providers.

As far as benefits are concerned, 94% of hospitals offer tuition reimbursement programs and 69% offer flexible work options. Many hospitals (66%) offer cash-out vacation policies and 45% offer adoption benefits. Other employee rewards include on-site daycare, student loan repayment plans, back-up childcare, and back-up elder care.

“Attracting and retaining talent remains a top priority and health systems have prioritized benefits as a mechanism to reward their workforce,” Singh said. “This is a trend that will continue with a shortage of qualified health professionals and rising demand for healthcare services, as these organizations seek to build a resilient workforce in the wake of the COVID-19 pandemic.”

Survey results came from benefit plans for more than 2.4 million health system employees from more than 1,150 hospitals across the U.S.

Tides are changing a year and a half after the COVID-19 onset, as health systems accelerate hiring.

Hospitals Focused on Hiring, Benefits Following COVID-19 Onset

There has been increases in the proportions of women faculty across clinical academic departments over the past three decades.

Further, racial and ethnic diversity among faculty increased, but at a lower rate.

Alexander Yoo, M.D., and a team of investigators evaluated the distribution of women and underrepresented groups in medicine (American Indian or Alaskan Native, Black, Latino or Hispanic, and Native Hawaiian or other Pacific Islander) among U.S. medical school faculty for 16 clinical academic medical departments. To gather the information, the team used the Association of American Medical Colleges Faculty Roster from 1990-2019. Specialties included ranged from anesthesiology, to dermatology, to radiology, to neurology, and many more.

Models were used to estimate the mean change per year in percentages of women and underrepresented groups in medicine. Data included department, time, and a department-by-time interaction. The investigative team collected demographics like race and ethnicity of U.S. resident physicians from 2012-2013 from the Accreditation Council of Graduate Medical Education.

Of the faculty entries reviewed from 1990-2019, 34.6% were women and 71.9% were for White physicians. In five of the clinical academic departments, proportions of women faculty increased, with women making up more than 50% of faculty members.

As of 2019, specialties with more women faculty did not necessarily have high representation compared with residents. The specialty with the highest proportion of women faculty, obstetrics and gynecology, had the third lowest representation ration (.81). And while orthopedic surgery had the lowest overall proportion of women faculty, it had the highest representation ratio (1.48).

When it came to underrepresented groups in medicine, most specialties had representation ratios of less than one, with an overall representation ratio of .76.

The investigators noted the increase in faculty diversity may be due to improvements in diversity among medical students and residents. Still, underrepresented groups in medicine faculty are still underrepresented compared with the resident pipelines for a majority of specialties. Most departments have only a fraction of the available underrepresented groups in medicine resident pipeline. There were also differences in representation ratios across departments for women.

Yoo and the team suggested additional investigation is needed to understand barriers and factors associated with women and underrepresented groups in medicine trainees from pursuing academic careers.

Representation of Women and Underrepresented Groups in US Academic Medicine by Specialty

The increase in a more diverse faculty starts with a more diverse group of medical students and residents.

Increases in Women, Underrepresented Groups in Clinical Academic Departments

Communication interventions at hospital discharge are significantly associated with fewer readmissions, higher treatment adherence, and higher patient satisfaction.

The findings of the new study suggested healthcare systems implement such communication strategies at discharge to facilitate the transition of care.

Although healthcare practitioners explain critical information to patients at the time of discharge, patient may not understand or remember the information provided, which may result in confusion, misinterpretation, and mismanagement of treatment regimen. Christoph Becker, M.D., and a team of investigators conducted a systematic review and meta-analysis on the association of communication interventions at discharge with readmission rates and other patient-relevant outcomes. Randomized controlled trials were included if the effect of any communication intervention assessed readmission, medical adherence, mortality, satisfaction, medical knowledge, or reattendance to the emergency department. Eligible studies if the intervention was performed shortly before or at hospital discharge, if they had a randomized clinical design, and included medical patients.

The investigative team searched PubMed, Embase, CINAHL, and PsycInfo. Two investigators screened titles and abstracts. They independently extracted data of the studies, then assessed the included randomized controlled trials for methodological quality using the Cochrane Risk of Bias Tool.

The primary endpoint was readmission to the hospital. Additional endpoints included adherence to treatment regimen, satisfaction, mortality, and knowledge of medication or diagnoses assessed 30 days after hospital discharge.

Overall, 60 studies were eligible for inclusion and 19 trials were included in quantitative analysis. Of the 60 studies, 32% reported data about readmission within 30 days after discharge. Among them, 58% had low risk of bias, 32% had high risk, and 11% had unclear risk. The results demonstrated a significant association between communication interventions and fewer readmissions to the hospital (RR, .69; 95% CI, .56-.84).

A subgroup analysis was performed to stratify the type of intervention, age, primary disease, use of handouts, study quality, setting of the study, sex, and location of the study. The team reported a significant difference regarding the main disease of patients with trials including those with respiratory conditions (RR, .32; 95% CI, .18-.57) and patients with other illnesses (RR, .78; 95% CI, .64-.96). Trials with cardiac conditions demonstrated no significant difference (RR, .62; 95% CI, .38-1.02). Further, trials with <50% of patients being women, compared to those with >50% women patients, had better outcomes in hospital admission (RR, .55; 95% CI, .39-.77 vs .82; 95% CI, .64-1.06).

Becker and the team reported that, along with lower readmission rates, there was higher adherence to treatment regimen and higher patient satisfaction for those who had a communication intervention.

The results of the review suggested communication interventions at discharge could help to increase patient knowledge regarding disease, its therapy, and further therapeutic regimen.

Interventions to Improve Communication at Hospital Discharge and Rates of Readmission

The results demonstrate such intervention can increase patient knowledge about their disease, treatment, and regimen.

Communication Interventions at Discharge Reduce Hospital Readmission

Telehealth models are associated with positive outcomes for both patients and healthcare professionals, especially in rural communities across the U.S.

Findings of a new study suggested such models were feasible and could be effective.

In rural populations, there are gaps in design and effectiveness of technology for treating diseases and addressing social determinants of health. So, Michael Butzner, Dr.P.H., and a colleague evaluated literature on current applications, therapeutic areas, and outcomes of telehealth interventions in such communities in the U.S.

To conduct the narrative review, the team searched PubMed MEDLINE from January 2017 to December 2020. They searched terms including “telehealth,” “telemedicine,” “rural,” and “outcomes.” Randomized controlled trials, mixed methods studies, qualitative studies, post hoc analyses, and prospective and retrospective cohort studies were included.

Overall, 15 studies reported telehealth intervention outcomes and were reviewed by the investigators. The areas examined were mental health (n=3), HIV (n=2), reproductive care/women’s health (n=3), osteoporosis (n=1), orthopedics (n=1), acute ischemic stroke (n=1), cancer (n=1), substance use disorder (n=1), ophthalmology (n=1), and emergency medicine (n=1). Study outcomes focused on feasibility and acceptability of telehealth, diagnostic and treatment validation of telehealth, patient satisfaction and self-confidence, education and training, and telehealth design features (prevalence and access, type of service, and therapeutic area).

Among the studies that analyzed telehealth interventions in patients, the findings demonstrated internet, electronic adherence monitors, and telelactation were feasible and accepted in rural, underserved populations, and improved access to care. Additional studies highlighted advantages of telemedicine visits, including decreased indirect and direct costs, lower travel costs and travel times, similar patient satisfaction compared to onsite visits, and patient satisfaction among telelactation users.

What’s more, healthcare providers and patients considered the technology convenient and efficient. Use of telehealth resulted in lower onset healthcare resource utilization, improved physician recruitment and retention, improved access to care, and increased education and training of patients and healthcare providers.

Still, several disadvantages to telehealth were reported. Disadvantages included having visits with unknown providers and technological issues like loss of connectivity and limited Wi-Fi access in rural areas.

“The findings support the existing literature on the need to increase and validate telehealth interventions and further update and implement policies to increase access and provide high-quality telehealth programs,” Butzner and his colleague concluded.

Telehealth Interventions and Outcomes Across Rural Communities in the United States: Narrative Review

Rural populations have the opportunity to leverage telemedicine to improve health outcomes.

Telehealth Models Result in Positive Outcomes for Rural Populations

Headspace and Ginger have entered an agreement to merge into Headspace Health to offer an accessible and comprehensive digital mental health and well-being platform.

Headspace, an organization focused on mindfulness and meditation, will join Ginger, a provider of on-demand mental healthcare, to provide the full spectrum of affordable and comprehensive support.

“Headspace and Ginger have a shared recognition that the mental health crisis can’t be solved by simply hiring more therapists or moving care online,” Russell Glass, chief executive officer of Ginger, said in a 

. “Through this merger, we can uniquely tackle the full spectrum of mental health needs — from prevention to clinical care — all from one integrated platform.”

The merged organization, Headspace Health, will leverage technology to provide care to people around the world, reaching an estimated 100 million lives across all 50 U.S. states and in more than 190 countries worldwide. Members will be able to chat through text with a coach live, 24/7, 365 days a year. And users can have a secure video session with a therapist or psychiatrist with more expediency than traditional face-to-face care.

Ginger’s platform is powered by AI and data, enabling the care team to use a system that analyzes chat transcripts, clinical assessments, satisfaction, and engagement data to provide personalized and efficient care for each user. It is reimbursed as a virtual in-network benefit through fully-insured, self-insured, and government-funded programs.

Research and evidence demonstrate Headspace has produced favorable outcomes of interventions, such as reduced stress, improved focus, increased resilience, and reduced burnout. Further, a study conducted by Google and Roche revealed eight weeks of using Headspace resulted in a 31% decrease in anxiety symptoms and a 46% decrease in depressive symptoms in healthy adults.

Ginger’s model of behavioral health coaching, therapy, and psychiatry have produced an average of 59% improvement in anxiety and 70% improvement in depression.

Glass will become the chief executive officer of Headspace Health, which aims to reach consumers, employers, and health plans. The definitive agreement is subject to regulatory approval and customary closing conditions. It is expected to close in the fourth quarter of 2021.

The merge can make mental health treatment more accessible to patients. 

Headspace, Ginger Merge to Offer Comprehensive Digital Mental Health Platform

Telepsychiatry collaborative care and telepsychiatry-enhanced referral significantly and substantially improve outcomes of patients with complex psychiatric disorders.

The findings suggested health system leaders should implement the most sustainable approach.

John C. Fortney, Ph.D., and a team of investigators compared two clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients in primary care clinics. For telepsychiatry/telepsychology-enhanced referral, telepsychiatrists and telepsychologists assumed responsibility for treatment. Telepsychiatry collaborative care was where telepsychiatrists provided consultation to the primary care team.

There were 24 clinics from 12 federally qualified health centers in three states included. Eligible clinics had no psychiatrists or licensed clinical psychologists practicing on site. Participants received up to 12 months of treatment and went to the clinic for interactive video visits. Patients who screened positive for bipolar disorder and/or post-traumatic stress disorder (PTSD) were enrolled. The team randomized participants to telepsychiatry collaborative care and telepsychiatry-enhanced referral using blocking and stratification by health center and screening status. Those who screened positive for both bipolar disorder and PTSD were categorized as having bipolar disorder. At the six-month mark of the study, patients assigned to telepsychiatry-enhanced referral with two or less interactive video encounters were randomized a second time.

In the collaborative care group, on-site behavioral health care managers and off-site telepsychiatrist consultants supported primary care providers who prescribed all psychotropic medications. Care managers have psychoeducation, conducted outreach and treatment engagement activities, and delivered behavioral activation psychotherapy. They used a web-based registry to monitor engagement and symptom severity. Telepsychiatrists met weekly with care managers for case reviews to identify those who were not engaging in or responding to care and suggested treatment recommendations.

Those in the telepsychiatry-enhanced referral group had an encounter to establish diagnosis and develop a treatment plan. If referred, telepsychologists gave either cognitive processing therapy for PTSD or cognitive behavioral therapy for bipolar disorder. Symptoms were monitored and treatment was documented.

The telepsychiatry-enhanced referral group also included phone-enhanced referral for those not engaging in treatment. Phone referral involved telephone outreach and motivational interviewing.

Telephone or web-based surveys were given at baseline and six and 12 months later. Treatment group assignment was masked. Mental health functioning at 12 months was the primary outcome.

Of the 508 patients randomized to the telepsychiatry collaborative care group, 91.3% had at least one care manager encounter. The mean number of encounters was 10.3. Nearly 80% had at least one behavioral action psychotherapy encounter, with a mean of 9.6 encounters. More than 76% had a telepsychiatry consultation, with a mean of 1.4 encounters.

Participants in both groups had large and clinically meaningful improvements from baseline to 12 months. Those not engaging in telepsychiatry-enhanced referral at six months had no significant difference in 12-month mental health scores. Implementing both interventions in primary clinics in rural and underserved areas increased access to and engagement in effective treatments.

The findings emphasized the benefits of telehealth to improve patient outcomes.

Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care

The interventions are especially helpful for patients in rural and underserved populations.

Telepsychiatry Substantially Improves Outcomes for Patients With Complex Psychiatric Disorders

Mary Caffrey is the Associate Editorial Director of AJMC/Managed Care for MJH Life Sciences. Her editorial responsibilities include 

Louisiana Health Officer Joseph Kanter, MD, MPH, on Saturday ordered the immediate closure of seven nursing homes that evacuated patients to a warehouse on August 27 as Hurricane Ida bore down southeast Louisiana. Conditions deteriorated in the warehouse and seven patients died; five deaths have been declared storm-related, according to a statement from the Louisiana Department of Health (LDH).

The warehouse, located in Independence, La., is located in Tangipahoa Parish, which is north of New Orleans and about 100 miles from where Hurricane Ida made landfall. The nursing homes that evacuated were in Orleans, Jefferson, Lafourche, and Terrebonne parishes, all south of Lake Pontchartrain.

All patients taken to the warehouse have since been relocated, following an inspection that was temporarily blocked by the nursing homes' owner, who also owned the warehouse. Bob Dean, the owner, has previously been cited by state officials for evacuating nursing home patients to a facility he owned that proved to be inadequate. 

LDH Secretary Courtney N. Phillips, PhD, MPA

State officials told the Associated Press that water got into the warehouse and generators failed. Meanwhile, tipsters told officials of patients being left on mattresses on the floor without food or clean clothes. Strong odors of feces permeated the building, and conditions declined rapidly as more patients arrived and owners tried to fit them into an increasingly crowded building. Trash and bags of human waste piled up, according to a nurse 

LDH has now confirmed 7 deaths of nursing home residents evacuated to the Independence facility, 5 of which have been classified as storm-related. State law enforcement officials have called for a criminal investigation, and LDH is reaching out to families of the nursing home residents.

The seven nursing homes that evacuated to the warehouse in Independence include:

River Palms Nursing and Rehab, Orleans Parish

South Lafourche Nursing and Rehab, Lafourche Parish

Maison Orleans Healthcare Center, Orleans Parish

Park Place Healthcare Nursing Home, Jefferson Parish

West Jefferson Health Care Center, Jefferson Parish

Maison DeVille Nursing Home, Terrebonne Parish

Maison DeVille Nursing Home of Harvey, Jefferson Parish

“What happened in Independence is reprehensible, and I know there are many families hurting as a result,” said LDH Secretary Courtney N. Phillips, PhD, MPA. “Today’s action against these facilities is needed. There is more to come. Our department’s mission is to advance the health and wellbeing of our residents—and that includes our vulnerable nursing home residents.”

“The lack of regard for these vulnerable residents' wellbeing is an affront to human dignity,” Kanter said. “We have lost trust in these nursing homes to provide adequate care for their residents. We are taking immediate action today to protect public health.”

Reports of the deteriorating conditions at warehouse after Hurricane Ida made landfall prompted LDH inspectors to visit the site, but they were blocked from making a full inspection August 31 and “subject to intimidation by the owner of the seven nursing facilities,” according to state officials.

LDH and other state and local agencies returned September 1 to evacuate local residents and all had been relocated by September 2.

For several days, Louisiana news outlets have covered the evacuation of the warehouse and history of issues with Dean's nursing homes. He has been described as a previously active political donor who more recently has become isolated among the state's powerful network of nursing home operators. News reports said Dean’s nursing homes received 

 from Medicare before the recent evacuation, which the website nola.com said was a part of a plan on file with the state following the deaths of fragile, elderly patients in floodwaters during Hurricane Katrina in 2005.

 at nursing homes he owned due to poor care. News outlets report attempts to reach Dean have been unsuccesful.

Bob Dean, the nursing homes' owner, has previously been cited by state officials for evacuating patients to a facility he owned that proved to be inadequate.

Louisiana Health Officer Shutters Nursing Homes That Sent Patients to Warehouse, Where 7 Died

Massachusetts General Hospital names president.

David Brown, MD, has been named the president of Massachusetts General Hospital (MGH) and executive vice president of Mass General Brigham. His appointment starts September 8. Brown will succeed Peter Slavin, MD, who had served as president for 18 years.

Brown is the current chair of the Department of Emergency Medicine at MGH, interim president of Cooley Dickinson Health Care and the MGH Trustees Professor of Emergency Medicine at Harvard Medical School.

Cotelingam is Cleveland Clinic’s new chief strategy officer.

Cleveland Clinic announced the Jim Cotelingam is the permanent chief strategy officer. He has been serving as interim chief strategy officer since February and initially joined Cleveland Clinic as the executive director of strategy in 2019. He will lead the team responsible for setting Cleveland Clinic’s growth plans. 

Cotelingam has more than 20 years of experience in nonprofit health care. Prior to joining Cleveland Clinic, he was the senior vice president of strategy at Trinity Health.

Inova Loudoun Hospital has a permanent president.

Susan Carroll, who has been serving as the interim president of Inova Loudoun Hospital since July has been named the permanent president of the Leesburg, Virigina-based hospital. While serving as interim president at Inova Loudoun Hospital, Carroll had also been serving as president of Inova Fair Oaks Hospital. She has a long track record at Inova; Carroll began her career at Inova Loudoun Hospital in 1996. In 2010, she was made chief operating officer.

As the permanent president, Carroll will establish areas of clinical growth, participate in recruitment and retention of physicians and will collaborate with medical staff to pursue opportunities that address community needs.

Omer Sultan has been named the chief financial officer at the University of Texas MD Anderson Cancer Center. His appointment is effective October 4. In the role, Sultan will lead financial matters for the institution and serve as a financial strategist.

He is the current vice president of finance at Northwestern Memorial Healthcare, the parent corporation of a $6.7 billion, 11-hospital academic health system serving the greater Chicago area.

Interim CEO of University of Utah (U of U) Health made permanent.

Dan Lundergan, who has been serving as the interim CEO since February, has been appointed CEO of U of U Health Hospitals and Clinics effective immediately. He will oversee 5 hospitals and 12 community clinics.

Lundergan has spent more than four decades at U of U Health and helped guide the organization through the COVID-19 pandemic and the subsequent vaccination rollout.

Interim executives are made permanent at Cleveland Clinic, Inova Loudoun Hospital, and University of Utah (U of U) Health, while Massachusetts General Hospital (MGH) and MD Anderson announce new hires.

MED MOVES: New Leaders at MGH, Inova Loudon Hospital, U of U Health; Cleveland Clinic, MD Anderson Announce Appointments

In the first year of the COVID-19 pandemic, there was an increase in healthcare-associated infections (HAIs) in hospitals, according to new data from the CDC.

The findings highlight a need to return to the infection prevention and control practices that were standard before the pandemic, as well as a need to build these programs to withstand future pandemics, authors wrote in a study 

Infection Control & Hospital Epidemiology

“The unfortunate reality is that in one year we lost nearly a decade of progress against HAIs like central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), methicillin-resistant 

 (MRSA), and ventilator-associated events,” Ann Marie Pettis, BSN, RN, CIC, FAPIC, president of the Association for Professionals in Infection Control and Epidemiology (APIC), 

. “We now have an opportunity to use this data and take action to invest in our public health infrastructure, expand our nation’s infection prevention and control workforce, and put infection preventionists—specialists who are trained and certified to prevent infections—at the center of these efforts.”

The pandemic placed a burden on acute care hospitals (ACHs). From 2015 to 2019, there were consistent reductions in the standardized infection ratios for CLABSIs, CAUTIs and 

 infection (CDI) laboratory-identified events, as well as significant decreases in MRSA since 2010.

The researchers utilized data on events in ACHs from 2019 to 2020 reported to the National Healthcare Safety Network Patient Safety Component as of April 1, 2021. They calculated the change in infection ratios in the states with a high number of hospitalized COVID-19 patients.

There was a drop off in ACHs reporting HAI surveillance data between 2019 and the first half of 2020. As many as 88% of hospitals who reported data in 2019 for CLABSI, CAUTI, MRSA or CDI also reported data for the first half of 2020. By the second half of 2020, reporting levels were close to the pre-pandemic period for most HAIs.

Starting in the second quarter of 2020, there were initial increases in the standardized infection ratios for CLABSI and MRSA. Increases in ventilator-associated events (VAEs) started as early as the first quarter. In the third and fourth quarters, there were large and significant increases in the standardized infection ratios for CLABSI, CAUTI, VAE and MRSA.

CLABSI had the greatest increase among all HAIs. In the second half of 2020, CLABSI standardized infection ratios increased up to 47% compared with the previous year. Meanwhile, there were no significant increases for surgical site infections or CDI for any quarter of 2020 compared with 2019.

“The increased focus on hand hygiene, environmental cleaning, patient isolation, and use of [personal protective equipment] during 2020, combined with continued inpatient antimicrobial stewardship programs and a marked decline in outpatient antibiotic prescribing, may have resulted in decreases in the CDI [standardized infection ratios] during 2020 compared to 2019,” the authors suggested.

In addition to calling on healthcare facilities to reassess their own infection prevention programs, APIC highlighted that additional help is needed from the government.

“APIC also calls on federal and state governments to provide funding to help support healthcare facilities across the continuum of care to ensure that there is adequate surge capacity so that infection prevention and control measures will endure when stressed by future pandemics and disease outbreaks,” Pettis said.

The pandemic caused a jump in healthcare-associated infections in hospitals, highlighting a need to return to infection prevention and control practices that were standard before the pandemic.

Healthcare-Associated Infections Increased in Hospitals During COVID-19 Pandemic

Opportunities exist to improve the selection of transfer destinations for patients with emergency general surgery conditions.

The findings of the recent study suggested optimizing transfer destination in the interhospital transfer network may improve such outcomes.

Cindy Y. Teng, M.D., and a team of Pittsburgh-based investigators examined whether patients with emergency surgery conditions were consistently directed to hospitals with more resources and better outcomes. The team analyzed interhospital transfers among adults with emergency general surgery conditions from January 1 to December 31, 2016. They used all-payer claims data from the 2016 Healthcare Cost and Utilization Project state inpatient and emergency department databases in eight states.

More than 700 hospitals were included in the study. Eligible participants were at least 18 years old and had an acute care hospital encounter with a diagnosis of an emergency general surgery condition.

The primary outcome was hospital-level centrality ratio — the normalized number of incoming transfers divided by the number of outgoing transfers. If the ratio was higher, it meant there were more incoming transfers per outgoing transfer. The team hypothesized higher hospitality centrality ratio was associated with more resources, higher volume, and better outcomes.

There were more than 80,000 patients analyzed, of whom, the median age was 63 years old, 52.1% were male, and 78.8% were White. The median number of outgoing transfers per hospital was 106, while incoming transfers was 36.

As the investigators hypothesized, a higher log-transformed centrality was associated with more resources like higher ICU capacity and higher emergency general surgery volume. But such a ratio was not linked with better outcomes, such as lower in-hospital mortality and lower failure to rescue — the occurrence of a complication followed by in-hospital death for emergency general surgery episodes that involved an operation or procedure.

Hospitals with a higher ICU capacity, higher volume, and higher-quality trauma care were associated with better emergency general surgery outcomes.

The findings emphasized the need for further research into the appropriate selection of transfer destinations as a strategy to improve emergency general surgery outcomes.

“Our results raise questions about whether [emergency general surgery] transfers are consistently directed to appropriate hospitals for further care and new concerns regarding how we determine appropriate hospitals in the absence of standardized guidelines,” Teng and the team wrote.

Assessment of Hospital Characteristics and Interhospital Transfer Patterns of Adults With Emergency General Surgery Conditions

Larger hospitals are associated with more resources for emergency general surgery patients.

Improvements Needed for Selection of Transfer Destinations for Emergency General Surgery

Hispanic and low-income communities have the largest percentage increase in telehealth use in response to the COVID-19 pandemic.

Findings of the study suggested virtual care can potentially mitigate the impact of the pandemic on healthcare use in vulnerable populations.

Due to the COVID-19 pandemic, there were dramatic decreases in outpatient healthcare visits and increases in telehealth visits. Still, healthcare workers and investigators were unsure of whether the changes in healthcare access were different based on patient demographics and socioeconomic status.

Lei Qian, Ph.D., and a team of investigators from Kaiser Permanente Southern California assessed the impact of the pandemic on in-person outpatient and telehealth visits by demographic characteristics and household income in a diverse population. The study cohort comprised patients of all ages who were members from January 5, 2020, to October 31, 2020 and the same period in 2019.

The investigators identified outpatient and telehealth visits using the electronic health record (EHR) data and claims data. Outpatient visits included all in-person outpatient visits and telehealth visits included telephone appointment visits and video visits conducted synchronously using real-time telephone or live video-audio interactions.

Of the more than 4.5 million members enrolled in January 2020, 15% were at least 65 years old, 51.5% were female, 39.4% were Hispanic, and 7.7% lived in census tract areas with a median household income less than $40,000.

After the start of the pandemic, outpatient visit rates had a steep drop-off across all sub-groups. Lowest levels of outpatient visits were in early April 2020, then gradually increased but still remained lower than before the pandemic. Patients at least 65 years old had the smallest decrease in outpatient visits with 6.25 visits per person-year during the later pandemic period versus 8.92 visits per person-year during the pre-pandemic period in 2020. Those aged 6-17 years old had the largest decrease, with 1.92 visits per person-year during the later pre-pandemic period versus 3.86 visits per person-year during the pre-pandemic period in 2020. Outpatient visit decreases did not differ statistically by sex, race/ethnicity, and household income groups.

Virtual care can reduce healthcare disparities even after the pandemic ends.