In the Literature: HM-Related Research You Need to Know

The Hospitalist. 2011 June;2011(06):

June 1, 2011 | The Hospitalist

Charles Baillie, MD ; Craig A. Umscheid, MD, MSCE ; Section OF

Bottom line: A positive pneumococcal urinary antigen test result in adult patients hospitalized with CAP can help clinicians narrow antimicrobial therapy with good clinical outcomes.

Citation: Sordé R, Falcó V, Lowak M, et al. Current and potential usefulness of pneumococcal urinary antigen detection in hospitalized patients with community-acquired pneumonia to guide antimicrobial therapy. Arch Intern Med. 2011;171(2):166-172.

Racial Disparities Detected in Hospital Readmission Rates

Clinical question: Do black patients have higher odds of readmission than white patients, and, if so, are these disparities related to where black patients receive care?

Background: Racial disparities in healthcare are well documented. Understanding and eliminating those disparities remains a national priority. Reducing hospital readmissions also is a policy focus, as it represents an opportunity to improve quality while reducing costs. Whether there are racial disparities in hospital readmissions at the national level is unknown.

Study design: Retrospective cohort study.

Setting: Medicare fee-for-service beneficiaries from 2006 to 2008.

Synopsis: Medicare discharge data for more than 3 million Medicare fee-for-service beneficiaries aged 65 years or older discharged from January 1, 2006, to November 30, 2008, with the primary discharge diagnosis of acute myocardial infarction (MI), congestive heart failure, or pneumonia were used to calculate risk-adjusted odds of readmission within 30 days of discharge. Hospitals in the highest decile of proportion of black patients were categorized as minority-serving.

Overall, black patients had 13% higher odds of all-cause 30-day readmission than white patients (24.8% vs. 22.6%, OR 1.13, 95% CI, 1.11-1.14), and patients discharged from minority-serving hospitals had 23% higher odds of readmission than patients from non-minority-serving hospitals (25.5% vs. 22.0%, OR 1.23, 95% CI, 1.20-1.27). Among those with acute MI, black patients had 13% higher odds of readmission (OR 1.13, 95% CI, 1.10-1.16), irrespective of the site of care, while patients from minority-serving hospitals had 22% higher odds of readmissions (OR 1.22, 95% CI, 1.17-1.27), even after adjusting for patient race. Similar disparities were seen for CHF and pneumonia. Results were unchanged after adjusting for hospital characteristics, including markers of caring for poor patients.

Bottom line: Compared with white patients, elderly black Medicare patients have a higher 30-day hospital readmission rate for MI, CHF, and pneumonia that is not fully explained by the higher readmission rates seen among hospitals that disproportionately care for black patients.

Citation: Joynt KE, Orav EJ, Jha AK. Thirty-day readmission rates for Medicare beneficiaries by race and site of care. JAMA. 2011;305(7):675-681.

Clinical Shorts

ROUTINE STERILE GLOVING MIGHT REDUCE BLOOD CULTURE CONTAMINATION

In a randomized crossover trial, the rate of “likely” blood culture contamination was 0.6% with routine use of sterile gloves compared with 1.1% with optional use of sterile gloves (P=0.007).

Citation: Kim NH, Kim M, Lee S, et al. Effect of routine sterile gloving on contamination rates in blood culture: a cluster randomized trial. Ann Intern Med. 2011;154(3):145-151.

RIFAXIMIN THERAPY RELIEVES SYMPTOMS IN NONCONSTIPATED IRRITABLE BOWEL SYNDROME (IBS)

In a double-blind, placebo-controlled study, rifaximin for two weeks in patients with nonconstipated IBS provided significantly better relief of symptoms compared with placebo (40.7% vs. 31.7%, P<0.001).

Citation: Pimentel M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med. 2011;364(1):22-32.

NO BENEFIT TO AXILLARY NODE DISSECTION IN BREAST CANCER

In a trial of 891 women with localized breast cancer and a cancerous sentinel lymph node, axillary node dissection compared with no dissection had no impact on survival or recurrence rates.

Citation: Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569-575.

PALLIATIVE-CARE CONSULTS NOT BENEFICIAL IN CHRONICALLY ILL MEDICAL PATIENTS

A randomized study of 107 elderly patients with heart failure, cancer, chronic obstructive pulmonary disease, or cirrhosis found physician-based palliative medicine consult to be no better than usual care.

Citation: Pantilat SZ, O’Riordan DL, Dibble SL, Landefeld CS. Hospital-based palliative medicine consultation: a randomized controlled trial. Arch Intern Med. 2010;170(22):2038-2040.