What distinguishes top-performing hospitals.....

In recent years, public reporting of hospitals' performance is becoming increasingly common in America to improve patient outcomes and accountability. Many hospitals have made substantial efforts in quality improvement including investing in high-tech equipments and systems, but disparities still persist between the highest and lowest performing hospitals in patient mortality rates.

According to a new study, conducted by Yale Global Health Leadership Institute at Yale University, published in the Annals of Internal Medicine, between 2005 and 2007, the 30-day mortality rates for Medicare heart attack patients ranged from 11.4%-14% among the high performers and 17.9%- 20% among the low.

Earlier studies suggested that the high mortality rates in low-performing hospitals could have been caused by factors such as hospital location, bed size, for-profit status, nurse staffing ratio and patient population, eg black, elderly. However, the Yale researchers found that these factors accounted for a small percentage of the variation between the high and low peforming hospitals.

They compared the characteristics of 11 hospitals ranking the top or bottom 5% measured by the 30-day mortality rates for acute myocardial infarction (AMI). They interviewed 158 key staff who were involved with AMI care at the hospitals and found few differences in protocols and processes used in treating heart attacks, but what differentiated the high performers from the low was how they did things - a shared organisational culture that focused on communication and support to improve patient care.

They found that high-performing hospitals were characterised by the followings :
- staff shared organisational values and goals of providing high quality care
- senior management involvement and commitment to high quality care

- broad staff presence and expertise in clinical decision making
- strong communication and coordination across disciplines and departments resulting in seamless transitions in care
- used adverse events and feedback as opportunities for problem solving that focused on nonpunitive learning

The study concluded that protocols and processes are not sufficient for achieving high performace in AMI care but "long-term investment and concerted efforts to create an organisational culture that supports full engagement in quality, strong communication and coordination .... problem solving and learning across the organisation" may be required.

Source: What Distinguishes Top-Performing Hospitals in Acute Myocardial Infarction Mortality Rates? A Qualitative Study. Annals of Internal Medicine. March 14, 2011 vol. 154 no. 6 384-390 ( f/t via Athens)

Low-carb diet rich in meat may may cause higher health risks

Studies show that a low-carbohydrate diet produces weight loss and improves some cardiovascular risk factors, but there has been concern about the Atkin-type low-carb diet that is based on animal fat and animal protein.

Harvard reserachers examined 2 types of low-carb diets in relation to long-term health impact. They examined the data of 2 prospective cohort studies involving 85,168 women for 26 years and 44,548 men 20 yaers on a low-carbohydrate diet, either an animal-based or a vegetable-based low-carbohydrate diet. Diet was assessed via a questionnaire.

The researchers found that animal-based low-carb diets were associated with higher all-cause mortality in both men and women. A vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates. They said the results suggest that the health effects of a low-carb diet may depend on the type of protein and fat. The mixed effects on lipid profiles may have been due to the varying amount of plant or animal fat consumed in low-carb diets.

An accompanying editorial cautioned the interpretation of this study saying that it "addresses a critical, unresolved public health question of diet but cannot satisfy us with a definitive answer", a large- scale randomised clinical trial with meaningful clinical endpoints is needed.

Source: Low-Carbohydrate Diets and All-Cause and Cause-Specific Mortality - Two Cohort Studies. Annals of Internal Medicine. September 7, 2010 vol. 153 no. 5 289-298 (f/t via Athens)

Too much TV viewing shortens lives

Nearly 9,000 Australian adults, divided into 3 groups, were tracked for roughly six and a half years by researchers: those who watched TV less than 2 hours per day, between 2 and 4 hours, and more than 4 hours.

Researchers found that those who watched TV more than 4 hrs had a 46% higher risk of death from all causes and an 80% higher risk of cardiovascular death, each hour watching the TV per day increased the risk of death from cardiovascular disease by 18% and the risk of cancer death by 9%. The study was published online in Circualtion.

Researchers found a strong connection between TV hours and death from cardiovascular disease not only in overweight and obese people, but also among those who had a healthy weight. The lead author said "sitting for long periods has unhealthy influence on blood sugar and blood fats".


Source: Television Viewing Time and Mortality. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Circulation. Published online before print January 11, 2010

Obesity shortens life

Oxford researchers carried out a meta-analysis 0f 57 cohort studies with a total of 894,576 people to examine the relationship between MBI and mortality. Most of the participants were recruited during 1970s and 80s with an average of 8 years further follow up. They were aged 46 in average at enrollment with BMI 24.8kg/sq m ( BMI>30kg/sq m were considered obese).

Researchers found that people with a normal BMI (22.5 - 25kg/sq m) had the lowest overall mortality. Every 5kg/sq m rise in BMI above 25 increased the risk of death by 30% compared with people having normal BMI. They estimated that average lifespan is reduced by 8 - 10 year for people with BMI above 35kg/sq m. The greatest increase in death risk was associated with diabetes, kidney or liver disease, followed by vascular mortality. They concluded that BMI itself is a strong predictor of overall mortality.

Critics say that this research gives actual figures on mortality risk associated with obesity but they argue that the increased death rate cannot be attributed to obesity alone, diabetes, high blood pressure and bad cholesterol are associated particularly with increased risk of cardiovascular mortality with high BMI, also the effects of diet, exercise and socioeconomic status were not taken into acount.

Source: "Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies". The Lancet 2009; early online publication, March 18

Absence from work links to death

UCL researchers studied the sickness records of 6500 employees in 20 Whitehall departments between 1985 and 1988 and comapred with mortality up until 2004.


Researchers found that employees who had extended periods of sick leave had 66% higher risk of early death. They were surprised to find that those who had long absence from work due to psychiatric reasons were twice as likely to die from cancer as the healthy colleagues. The study leader said " it would be useful for this information to be collected because we could identify groups with high risk of serious health problems".


Critics say the recorded reasons of sickness mat not cover the actual causes.


Source: Head J, Ferrie JE, , Alexanderson K, et al. "Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study." BMJ 2008; Oct 3 [Epub ahead of print]

Is coffee bad for health?

Researchers analysed data from two cohort studies, one included 41,736 male health professionals and the other 86,214 female nurses and found that regular coffee consumption was not associated with increased death rate in men or women.

In the female cohort, coffee consumption ( including decaffeinated coffee) were associated with significantly lower risk of death compared with no coffee. The reductions ranged from 7% among nurses drinking 5 to 7 cups a week, to 26% among nurses drinking 4 or 5 cups a day.

According to the findings, coffee seemed to protect both men and women against cardiovascular death but not death from cancer. However, critics said that recent studies have offered a mixed picture on the health benefit of coffee consumption.

Source : "The Relationship of Coffee Consumption with Mortality." Annals of Internal Medicine 17 June 2008:148(12); 904-914 (full text via Athens)

Mediterranean diet can lower mortality rate

According to a large scale cohort study of 380,296 people aged 50 - 71 with no history of chronic disease, eating a Mediterranean diet can cut the risk of dying early.

Participants were divided into three groups according to their dietary habits and were then followed-up over a five-year period. The study found that those who followed a Mediterranean diet closely were less likely to die of cancer or heart disease. The authors concluded that their study provided strong evidence that higher conformity with the Mediterranean diet is associated with lower mortality rate.

Source: "Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population: Results From the NIH-AARP Diet and Health Study" Archives of Internal Medicine. 2007;167(22):2461-2468

Rapid response team reduces death

A children’s hospital in California added a rapid response team (RRT) with experts available 24x7 for hospitalised patients who were not in the intensive care unit. After the implementation of the intervention, there was significant decrease in death and cardiopulmonary arrest rates, according to a new study published in the November 21 issue of JAMA.

However, in an accompanying editorial, the authors said that rigorous and comparable data will need to be collected to determine the best approach for RRTs in pediatrics.


Source: "Effect of a Rapid Response Team on Hospital-wide Mortality and Code Rates Outside the ICU in a Children’s Hospital" JAMA. 2007;298(19):2267-2274 (free full text article)

Overweight men with prostate cancer have higher risk of dying

A new study that tracked 788 men with prostate cancer also looked at their BMI at the start of the trial and followed up for 8 years. The researchers found that men who are overweight when diagnosed with prostate cancer are twice as likely to die from it. The finding was published in the journal Cancer.


Source : "Obesity and Mortality In Men With Locally Advanced Prostate Cancer: Analysis of RTOG 85-31," Cancer; Published Online: November 12, 2007 (DOI: 10.1002/cncr. 23093); Print Issue Date: December 15, 2007

This is the 3rd post this month about overweight and cancer risk.

Health literacy linked to mortality risk in elderly

According to a study in the July 23 issue of Archives of Internal Medicine , "Health Literacy and Mortality Among Elderly Persons", David W. Baker et al, elderly patients who could not read physician's instructions or did not understand health information had a higher mortality rate than patients with adequate reading skills. Read the abstract.

The study found that inadequate health literacy was most strongly associated with death from cardiovascular disease and suggested communication with patients in plain language or using pictures or videos to explain complicated ideas can be used to reduce the high mortality rate associated with low health literacy. Read the press release.

Racial differences in care after heart attack

A large study published in the June 13 issue of JAMA has found that black Medicare patients are less likely than white patients to receive blood vessel opening procedures following a heart attack, whether they are admitted to hospitals that provide or do not provide these procedures, but also have higher mortality rates after 1 year.

The authors suggest that "efforts to standardize post-AMI treatment with evidence-based protocols and aggressive risk-factor management are essential to eliminating racial differences in care for AMI and other coronary syndromes."

Read the press release "Black patients less likely to receive certain coronary procedures following heart attack and have higher mortality rates one year later"