December 1997
JOHNS HOPKINS BUSINESS OF MEDICINE TIPS AND BRIEFS
Listed below are story ideas from the Johns Hopkins Medical Institutions. To pursue any of these stories contact Gary M. Stephenson at (410)955-5384 or [email protected]
MANAGED CARE MAY BE REDUCING INPATIENT SURGERIES IN MARYLAND
A Hopkins study of 704,861 operations in Maryland lends strong support to what many health care experts have predicted -- managed care appears to be decreasing overall surgical volume. At the same time, total inpatient days and average length of stay are decreasing for patients who do receive surgery in hospitals. The study looked at surgical discharges among Maryland residents between 1988 and 1994. It found that the number of inpatient surgical discharges dropped by 4,450 (4.3%) during the seven-year study period, and the rate of inpatient surgery per 1,000 population declined by 10.9%, from 22.0 to 19.6. The researchers note that during the same time period, managed care enrollment tripled in Maryland, from 600,000 to 1.8 million enrollees.
However, sharper decreases in the numbers of inpatient surgeries among patients with commercial insurance were partially offset by increases among those under Medicare and Medicaid (medical assistance) programs. Because Medicare and Medicaid patients have higher in-hospital mortality rates than the rest of the population, the net effect of this trend was to increase the risk level of patients undergoing inpatient surgeries, the study concluded.
The average length of a hospital stay also declined among all insurance groups. Interestingly, the authors of the study reported, the total number of inpatient hospital days decreased faster than did the average of length of stay (19.9% overall compared with 16.3%), which indicates that length of stay has dropped faster than declines in the number of surgical admissions, the researchers say.
Also contributing to the decrease in inpatient procedures were increased outpatient surgeries, new technology and drugs, and more elderly patients. The study was presented at the October meeting of the American College of Surgeons.
Said Toby Gordon, Sc.D., vice president for planning and marketing and lead author of the study, "Maryland hospitals should expect more older patients and an increase in resource requirements for the elderly and medical assistance populations."
SURGICAL EXPERIENCE COUNTS IN PANCREATIC CANCER SURGERY
A Hopkins study of Maryland patients seeking surgery for pancreatic cancer found fewer inpatient deaths and shorter lengths of stay without increased costs at hospitals that perform the greatest number of procedures for pancreatic cancer.
According to the study, presented at the October meeting of the American College of Surgeons, short-term clinical and economic outcomes from procedures designed to cure or relieve pancreatic cancer symptoms are significantly better when performed by the most experienced medical teams.
The researchers examined the outcomes of 1,236 patients in Maryland who underwent various medical procedures for pancreatic cancer: 496 had a curative operation (Whipple procedure or a total pancreatectomy), 542 had a palliative bypass (for symptom relief), and 198 had a biliary stent placed. Forty-three percent of the procedures were performed at just one hospital (the high-volume provider); 22% were performed at the seven medium-volume centers, and 35% were done at 40 low-volume hospitals.
In-hospital mortality rates for patients undergoing curative operations were 0.9% at the high-volume hospital, 6.9% at the medium-volume providers, and 18.8% at the low-volume providers. For patients undergoing bypass procedures, the in-hospital mortality rates were 4.2%, 10.5%, and 15.3%, respectively. For patients who received stents, the rates were 1.6%, 10.9%, and 9.8%, respectively.
Even when the researchers took into account differences in patient characteristics, large differences in mortality remained. For example, the relative risk of dying while hospitalized after a curative operation in a low- or medium-volume hospital was eight times that of the high-volume hospital.
How long patients remained in bed after their surgery also was associated with hospital volume for all the pancreatic cancer procedures. Length-of-stay at the high-volume hospital was significantly lower than at the medium-volume (16.3 versus 18.8 days) and low-volume hospitals (19.4 days) for curative operations, and lower than at the low-volume hospitals for bypasses (14.3 versus 16.3 days) and stent procedures (4.6 versus 6.7 days).
What's more, curative operations performed at the high-volume hospital cost significantly less; $20,186, compared to $26,455 at the low-volume providers.
HOPKINS INTRODUCES BUSINESS OF NURSING PROGRAM
The new imperatives of health care economics demand that many physicians have business skills in addition to their medical expertise. A recent trend has witnessed a wave of physicians picking up MBAs along with their medical degrees or taking various business courses -- all in the hope of remaining competitive in the managed care era's relentless demand for increased efficiencies. Beginning in January, Hopkins will introduce a certificate program designed to similarly help the other frontline troops in health care -- nurses. The Business of Nursing Program is designed to address the changing financial and managed care challenges facing nurses and to prepare them for current and expanding roles in the increasingly complex environment of integrated health services. The 12-credit, nine-month program is a partnership between the Hopkins School of Nursing and the School of Continuing Studies, and is designed to apply the theory and practice of sound business principles to the organization of health care delivery and to the clinical and financial outcomes of care.
INTELIHEALTH PICKED AS ONE OF 10 BEST HEALTH AND MEDICAL WEB SITES
Redbook magazine, in its November issue, selected InteliHealth as the third best health and medical Web site in the nation. A joint venture between Aetna U.S. HealthCare and The Johns Hopkins University and Health System, InteliHealth was established in 1996 to provide a comprehensive and timely collection of health information. According to Redbook, the "impressive medical site of Johns Hopkins University e-mails you the latest medical news and provides information on a range of health problems and drugs. Send questions to a Johns Hopkins doctor; access daily pollen and pollution counts; look, too, for upcoming areas such as women's health, men's health, and pediatrics, among others." InteliHealth information for consumers can be found on PointCast's consumer Health Channel, America Online (Keyword: InteliHealth); CompuServe; and at http://www.intelihealth.com.
JOHNS HOPKINS HEALTHCARE LLC HIGHLIGHTED IN COOPERS AND LYBRAND SURVEY AS A MODEL OF SUCCESSFUL MANAGEMENT
A survey by the professional services firm Coopers and Lybrand LLP picked Johns Hopkins HealthCare as a national leader for its "successful practices in change management." Hopkins was one of 47 organizations selected out of 300 "Fortune 1000" corporations and government organizations nationwide surveyed in the study.
The survey identified four areas that, according to polled executives, are essential to the success of an organization's change management effort. These were leadership, consisting of a senior management team that openly advocates, supports and explains the argument for changes to employees and customers; communications, implementation of a strategic communications plan; corporate culture, creating a culture shift by changing employee attitudes and behavior; and customer focus, maintaining a focus on customer service and needs. Besides Hopkins, other honorees include Acacia, Freddie Mac, Shenandoah Life Insurance and T. Rowe Price. The survey was conducted by Coopers and Lybrand Consulting's Center of Excellence for Change Management, an internal think-tank specializing in organization change management based in Arlington, Va; and Opinion Research Corporation International, an independent research organization based in Princeton, N.J.
JOHNS HOPKINS SCHOOL OF MEDICINE TO COLLABORATE IN CARDIAC MUSCLE REGENERATION PROJECT
Researchers at Johns Hopkins will take part in a project to develop cell-based therapies for cardiac muscle regeneration using mesenchymal stem cells. Mesenchymal stem cells are thought to be the progenitor cells responsible for the formation of connective tissue. The project is funded by a $2 million Advanced Technology Program grant from the National Institute of Standards and Technology awarded to Osiris Therapeutics Inc. Osiris is partnering with Hopkins to develop and commercialize cell therapy products and biopharmaceuticals based on its proprietary mesenchymal stem cell technology for the regeneration of connective tissues damaged through injury, aging or degenerative disease. Osiris and Hopkins will investigate whether mesenchymal stem cells can differentiate into cardiac muscle and restore function to damaged heart tissue. The potential market for such technology is vast. More than 300,000 Americans die each year from congestive heart failure, usually within five years of diagnosis, because cardiac muscle has little or no capacity for self-repair and current treatments are often inadequate.
--JHMI--
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