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April 1, 2010 Volume VI, No. 44

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

According to a 2007 CDC fact sheet, about 85 percent of all invasive MRSA infections were associated with healthcare. Of those, about two-thirds occurred outside of the hospital, while about one third occurred during hospitalization. Also, approximately 18,650 persons died during a hospital stay related to serious MRSA infections. The good news, however, is that in this issue, you will learn about an intervention that hospitals can use to reduce "superbug" infection rates. In addition, discover the populations that may be at greater risk for MRSA.

Also this week, we are launching a new feature — Chart of the Week — to track trends and innovations in healthcare, starting with a look at populations targeted by telehealth.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. CA-MRSA Rates Greater in HIV Patients
  2. CA-MRSA Common in Pediatric ICU Patients
  3. Reducing Avoidable Hospital Readmissions
  4. Measuring Patient Engagement
  5. Populations Targeted by Telehealth
  6. Healthcare Responds to MRSA Outbreak
  7. Intervention Decreases Hospital Infections
  8. Obesity and Weight Management 2010

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Please send comments, questions and replies to jpapay@hin.com.

Melanie Matthews, mmatthews@hin.com

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Community-Acquired MRSA Infection Rates Six Times Greater in HIV Patients

HIV-infected patients are at a markedly increased risk for community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, according to a new study by researchers at John H. Stroger, Jr. Hospital of Cook County and Rush University Medical Center. The study, published in the April 1 issue of the journal Clinical Infectious Diseases, found the incidence of CA-MRSA in the Chicago area was six-fold higher among HIV-infected patients than it was among HIV-negative patients.

Using electronic data, the study authors retrospectively studied HIV-infected patients with CA-MRSA who received medical care from 2000 to 2007 in the regional Cook County Health and Hospitals System. Researchers used patientsí zip codes to examine where the cases were distributed geographically. Overall incidence of CA-MRSA increased significantly for all populations in Cook County from the first period (2000- 2003) to the second period (2004-2007). The incidence increased four-fold from 61 cases to 253 cases per 100,000 HIV-negative patients and nearly four-fold from 411 cases to 1474 cases per 100,000 HIV-infected patients, respectively.

The traditional risk factors for CA-MRSA included populations where there is close person-to-person contact, such as children in daycare facilities, prisoners, athletes and military personnel. The study found that the most significant predictors associated with CA-MRSA infection included living in zip codes with a high prevalence of former prison inmates, and living in alternative housing, such as a substance abuse treatment facility, shelters or subsidized housing. However, the study authors note that CA-MRSA has spread throughout Cook County. When the epidemic first started it was clustered in certain zip codes, but has now spread beyond that. During the first period, 10 percent of the zip codes in Cook County had a high rate of MRSA among HIV-infected patients. By the second time period, that percentage had jumped to 21 percent of zip codes.

To learn more about this research, please visit:

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Community-Acquired MRSA More Common in Pediatric ICU Patients

Once considered a hospital anomaly, community-acquired infections with drug-resistant strains of the bacterium Staphylococcus aureus are now turning up regularly among children hospitalized in the ICU, according to research from the Johns Hopkins Childrenís Center.

The Johns Hopkins study found that 6 percent of the 1,674 children admitted to the pediatric ICU (PICU) at Hopkins Childrenís between 2007 and 2008 were colonized with MRSA, meaning they carried MRSA but did not have an active infection. Of the 72 children who tested positive for MRSA, 60 percent harbored the community-acquired strain and 75 percent of all MRSA carriers had no previous history of MRSA. MRSA was more common in younger children, 3 years old on average, and among African-American children. The reasons behind the age and racial disparities in MRSA colonization remain unclear, the investigators say. Patients with MRSA had longer hospital stays (eight days) than MRSA-free patients (five days) and longer PICU stays (three days) than non-colonized patients (two days). Eight patients who were MRSA-free upon admission became colonized with MRSA while in the PICU. Of the eight, four developed clinical signs of infection, meaning that the other four would have never been identified as MRSA carriers if the hospital was not performing weekly screenings of all patients.

The Johns Hopkins Childrenís teamís findings underscore the benefit of screening all patients upon hospital admission and weekly screening thereafter regardless of symptoms because MRSA can be spread easily to other patients on the unit. In 2007, the Johns Hopkins Hospital began screening all patients upon admission and weekly thereafter until discharge. Some states have made patient screening mandatory but the protocols vary widely from hospital to hospital and from state to state.

To learn more about this research, please visit:

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Reducing Avoidable Hospital Readmissions — A Case Study from Priority Health

Priority Health members play an active role in keeping themselves out of the hospital, explains Mary Cooley, manager of case and disease management at Priority Health. She describes the four-point strategy that is reducing readmissions at Priority Health, the challenges that still exist and the essential tool that Priority supplies to help providers identify and close care gaps.

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Measuring Patient Engagement Through Satisfaction Surveys

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Barbara Wall, president and CEO of Hagen Wall Consulting.

Question: How do you measure patient engagement? Should patient satisfaction surveys be administered by somebody in the practice or outside the practice, and how frequently should they be issued?

Response: One of the best patient engagement measurement tools is the Patient Activation Measure™ (PAM), and certainly the activation is a component of engagement. Another aspect of measuring engagement is a well-chosen patient satisfaction survey. Many of the standard surveys do ask questions related to the satisfaction that the patient has with the interaction between the patient and the physician, which certainly is a component of engagement.

There are many good surveys available on a paid basis provided by independent parties. Probably the most important point in patient surveys is making sure that there is randomization in selection of the respondents, meaning that there is no unconscious bias or pattern in who gets the survey. That is one of the problems with having individuals in the practice distribute the survey. Devising a way to make sure that the individuals who are involved in the practice setting are not distributing the satisfaction survey is one consideration.

When you are first starting up, you may want to do the patient satisfaction survey as often as every three or four months once or twice, or every six months. If you are doing it that often, that presumes that you are getting a smaller sample. Smaller samples will not be as statistically valid, but it gives you a quick way to evaluate your patientsí reaction to the changes. Another approach that I have seen — rather than doing the patient satisfaction that early — is to select and ask some patients within your practice to be your testers of practices and to give feedback on an informal basis on the new practice changes. That can be effective because you can do it almost immediately after the changes are implemented as long as those patients are individuals that come in on a regular basis.

For more information on patient engagement, please visit:

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Populations Targeted by Telehealth

Click here to view the chart.

Healthcare Reacts 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 to determine what steps healthcare organizations are taking to prevent the infection.

To download this complimentary white paper, please visit:

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Intervention Decreases Hospital Infection Rate By a Third

Clostridium difficile (C. difficile) is one of the leading pathogens causing hospital-acquired infection in the U.S. However, Mayo Clinic researchers believe that they've found a way to reduce the acquisition of this infection and drop its frequency to a fraction of what it had been. This process involves consistent daily cleaning of all high-touch surfaces with a spore-killing bleach disinfectant wipe for all patients on units with high endemic rates of C. difficile infection.

The hospital rooms in the study were part of two units that housed general, gastrointestinal and pulmonary disease patients, averaging 39 patients a day. Each of these units has had high endemic rates of this infection. When the study began, one unit's infection frequency was 61 per 10,000 patient days. The other was higher, at 106 cases per 10,000 patient days. The bleach wipes — containing 0.55 percent sodium hypochlorite — were selected because the bleach solution is the only product registered with the U.S. Environmental Protection Agency as effective against C. difficile spores. Patients and staff tolerated this daily cleaning with the bleach wipes without significant concerns. Researchers concluded that this type of disinfection process was effective at reducing C. difficile infections on these units and should be instituted in other hospital units with high infection rates.

According to lead investigator Robert Orenstein, D.O., "The goal was to reduce hospital-acquired C. difficile infection rates in two of our highest-incidence units by 30 percent. Our data show we far exceeded that. When the study concluded near the end of last year, one unit had gone 137 days without a hospital-acquired C. difficile infection." The team had hoped to increase the time between hospital-acquired cases to more than 20 days between infections.

To learn more about this research, please visit:

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Obesity and Weight Management 2010

While there are early indicators of success in the prevention and control of obesity, this behavior-related and largely preventable chronic medical condition is tied to an estimated $117 billion in healthcare costs. Newly approved healthcare reform bills will reward prevention-related initiatives, and first lady Michelle Obama's Let's Move campaign hopes to solve the childhood obesity epidemic within a generation. Describe how your organization is working to reduce obesity and obesity-related conditions and costs in your population by taking the Obesity and Weight Management survey by April 30. You'll receive a free e-summary of the results, and your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:

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