Disease Management Update
Volume V, No. 6
June 5, 2008
Dear Healthcare Intelligence Network Client,
A cruise line I recently traveled with had an interesting method for infection and germ control. Each time we boarded the ship, they sprayed our hands with sanitizer. At the entrances and exits to every restaurant there were hand sanitizer dispensers. In the casinos, in the hallways and in the lounges — hand sanitizer. This isn't too far off from what many hospitals are doing to stamp out outbreaks of MRSA and other infectious diseases.
This week's Disease Management Update highlights some tactics for infection control and how better hand hygiene is reducing MRSA outbreaks. And visit HIN's blog at http://blog.hin.com/?p=325 to learn how you can receive free resources, educational materials and Web links to information regarding infection and disease control.
Your colleague in the business of healthcare,
Guest Editor, Disease Management Update
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Table of Contents
- Infection Control Intervention Keep Kids in School
- Disease Management Q&A: Q&A: Quality of the Primary Care and ER Experiences
- HealthSounds Podcast: Increasing Primary Care Access, Use and Coordination
- MRSA Incidence Reduced By Better Hand Hygiene
- Survey of the Month: Primary Care in 2008
- Healthcare Organizations React to MRSA Outbreak
Infection Control Intervention Keep Kids in School
A study from researchers at Children's Hospital Boston found that a simple infection control intervention in elementary schools --- disinfecting frequently touched surfaces and using alcohol-based hand sanitizers --- helped reduce illness-related student absenteeism. The study was a randomized, controlled trial involving 285 third-, fourth- and fifth-grade students in an elementary school system in Avon, Ohio. Teachers in intervention classrooms used disinfecting wipes on student desks, and students used hand sanitizer in the classroom at key points throughout the school day. Control classrooms followed usual hand-washing and cleaning procedures.
Over eight weeks, researchers tracked the frequency of absences and the reasons for missing school. Study investigators also tested several classroom surfaces for total bacterial counts and for the presence of several common viruses. Researchers found absenteeism rates for gastrointestinal illnesses were 9 percent lower in classrooms that followed the infection control regimen of disinfecting surfaces and using alcohol-based hand sanitizers. The absenteeism rate for respiratory illness was not affected by this intervention.
To learn more about this study, please visit:
2. Disease Management Q&A:
Q&A: Quality of the Primary Care and ER Experiences
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's experts are Dr. Karen Amstutz, M.D., regional vice president and medical director at WellPoint State Sponsored Business, Dr. Lakshmi Dhanvanthari, M.D., staff vice president and medical director at WellPoint State Sponsored Business, and Dr. Jim Glauber, M.D., medical director for Neighborhood Health Plan of Massachusetts
Question: Along with utilization and reducing non-emergency use, how do you ensure high quality work-up of patients in light of shortened office visits, decreased availability and the need for specialized testing more frequently done in the ER but often not ordered in a 10- to 15-minute office visit?
Response: (Dr. James Glauber) That has not been a specific focus of our efforts. It raises a lot of important issues about the quality of the primary care experience and whether individuals feel that their needs are being adequately addressed. There’s a lot of pressures toward those visits being very problem-oriented and brief. My advice in terms of indirect interventions is that we are systematically surveying member satisfaction at the practice level, and incorporating that into our PFP program. We’re seeking to get an adequate sample size of respondents within a practice, not just among their neighborhood health plan members but across their entire membership in order to feed back data to practices on their patients’ experiences over time and whether they’re improving. We are essentially relying on them to identify the strategies necessary to improve their patient care experience.
(Dr. Karen Amstutz) The visits that we’re trying to replace from the ER back to the primary care office are visits that are for typical common problems, such as low-grade fever, mild diarrhea or ear pain. These are things that we typically would handle in a high-quality fashion within the primary care office. We are not looking to divert all members away from the ER because many of our members have problems that require the equipment and expertise available in an emergency setting.
(Dr. James Glauber) WellPoint mentioned they’re offering a nurse triage line. In addition to diverting people from the ER to self-care or primary care, these nurse lines also recommend individuals who were planning to take care of themselves at home or seek their doctor’s appointment based on their presenting symptoms to go to the ER. So it’s not just an ER diversion program, but trying to get members into the ER when they seem to need that level of service.
(Dr. Lakshmi Dhanvanthari) By bringing the patients back to the PCP’s office, even if the visit takes a few minutes, it gives them an opportunity to educate the member about coming back for a well visit and for seeking other services for chronic care or primary care.
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3. HealthSounds Podcast: Increasing Primary Care Access, Use and Coordination
Involving physicians and nurses in an initiative that teaches patients how to manage their own care may initially increase the demand on an already overtaxed primary care system, says Christopher Wise, Ph.D., M.H.A., administrative director of the Medical Management Center at the University of Michigan (U-M) Health System. But ultimately, the patient who better understands the intricacies of their disease and available care alternatives will actually have fewer reasons to access PCPs, he adds. In U-M's model, he explains, social workers and nurses who know the university's health services best function as health navigators, helping the chronically ill find their way through the system. For optimum efficiency and results, the patient's self-management must be linked to a broader aspect of the physician's office and the medical home it provides.
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MRSA Incidence Reduced By Better Hand Hygiene
Hand-hygiene pilots in Australian healthcare institutions have significantly improved hand-hygiene compliance and reduced MRSA infections. A two-year pilot program using alcohol-based hand rub solutions was carried out in six healthcare institutions. After the pilot program, the hand hygiene culture-change program was implemented throughout public hospitals over a 12-month period.
According to study results, average hand-hygiene compliance improved from 21 percent to 48 percent at the end of the two-year trial. Similiar results occurred over the 12-month period throughout the public hospitals. In both initiatives, the number of patients with MRSA decreased by more than 50 percent.
The study also ends doubts about whether hand-hygiene programs could be effectively introduced as a statewide policy initiative. According to the study's authors, their data demonstrates that generic multi-site hand hygiene culture-change programs can be highly effective if they are carefully planned and implemented.
To view more of this study's findings, please visit:
5. Survey of the Month: Primary Care in 2008
Many factors are affecting the primary care system in the United States - a predicted shortfall of primary care physicians, new models of care, unchanged models of reimbursement, a focus on quality initiatives and increased demands for healthcare IT. Complete our survey on primary care and get a FREE executive summary of the compiled results. Complete our online survey on patient registeries by June 30 and receive a free summary of the results.
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6. Healthcare Organizations React to MRSA Outbreak
The Association for Professionals in Infection Control and Epidemiology reported in 2007 that 1.2 million U.S. hospital patients are now affected with MRSA each year. Cognizant of the rise in MRSA cases and increasing concern, the Healthcare Intelligence Network conducted a non-scientific online survey in October 2007 to determine what steps healthcare organizations are taking to prevent the infection.
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