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Background Bundles and checklists have been shown to decrease the rates of central line-associated bloodstream infections (CLABSIs), but implementation of these practices and association with CLABSI rates have not been described nationally. We describe implementation and levels of compliance with preventive practices in a sample of US neonatal intensive care units (NICUs) and assess their association with CLABSI rates. Methods An online survey assessing infection prevention practices was sent to hospitals participating in National Healthcare Safety Network CLABSI surveillance in October 2011. Participating hospitals permitted access to their NICU CLABSI rates. Multivariable regressions were used to test the association between compliance with NICU-specific CLABSI prevention practices and corresponding CLABSI rates. Results Overall, 190 level II/III and level III NICUs participated. The majority of NICUs had written policies (84%-93%) and monitored compliance with bundles and checklists (88%-91%). Reporting ≥95% compliance for any of the practices ranged from 50%-63%. Reporting of ≥95% compliance with insertion checklist and assessment of daily line necessity were significantly associated with lower CLABSI rates (P < .05). Conclusions Most of the NICUs in this national sample have instituted CLABSI prevention policies and monitor compliance, although reporting compliance ≥95% was suboptimal. Reporting ≥95% compliance with select CLABSI prevention practices was associated with lower CLABSI rates. Future studies should focus on identifying and improving compliance with effective CLABSI prevention practices in neonates. [ABSTRACT FROM AUTHOR]

Workplace wellness programs are increasingly popular. Employers expect them to improve employee health and well-being, lower medical costs, increase productivity, and reduce absenteeism. To test whether such expectations are warranted, we evaluated the cost impact of the lifestyle and disease management components of PepsiCo's wellness program, Healthy Living. We found that seven years of continuous participation in one or both components was associated with an average reduction of $30 in health care cost per member per month. When we looked at each component individually, we found that the disease management component was associated with lower costs and that the lifestyle management component was not. We estimate disease management to reduce health care costs by $136 per member per month, driven by a 29 percent reduction in hospital admissions. Workplace wellness programs may reduce health risks, delay or avoid the onset of chronic diseases, and lower health care costs for employees with manifest chronic disease. But employers and policy makers should not take for granted that the lifestyle management component of such programs can reduce health care costs or even lead to net savings. [ABSTRACT FROM AUTHOR]

The article discusses an analysis of respirator protection program compliance via Occupational Safety and Health Administration (OSHA) inspection data in 2013. Topics covered include the identification of all inspections and establishments with respiratory protection (RP) violations, a comparison of violation prevalence by industry, and the alignment of noncompliance patterns with respirator use requirements. Also noted are RP standard's requirements for employers.

Medicare's approximately 250 accountable care organizations (ACOs) care for a growing portion of all fee-for-service beneficiaries across the United States. We examined where ACOs have formed and what regional factors are predictive of ACO formation. Understanding these factors could help policy makers foster growth in areas with limited ACO development. We found wide variation in ACO formation, with large areas, such as the Northwest, essentially empty of ACOs, and others, such as the Northeast and Midwest, dense with the organizations. Key regional factors associated with ACO formation include a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups. Area income, Medicare per capita spending, Medicare Advantage enrollment rates, and physician density were not associated with ACO formation. Together, these results imply that underlying provider integration in a region may help drive the formation of ACOs. [ABSTRACT FROM AUTHOR]

The article discusses a study of the utilization of anesthesia services during outpatient endoscopies and colonoscopies and associated payment in the U.S. for the years between 2003 and 2009. The researchers analyzed insurance claims data for Medicare and commercially insured patients (CIP) using the Medicare Limited Data set. They found that the number of gastroenterology procedures per one million enrollees has increased by greater than 50 percent in CIP but remained largely unchanged in Medicare patients. They also observed a regional variation in gastroenterology anesthesia use in both populations.

Background: Hospital associated infections are major problems, which are increasing in incidence and very costly. However, most research has focused only on measuring consequences associated with the initial hospitalization. We explored the long-term consequences of infections in elderly Medicare patients admitted to an intensive care unit (ICU) and discharged alive, focusing on: sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI), and ventilator-associated pneumonia (VAP); the relationships between the infections and long-term survival and resource utilization; and how resource utilization was related to impending death during the follow up period. Methods: Clinical data and one year pre- and five years post-index hospitalization Medicare records were examined. Hazard ratios (HR) and healthcare utilization incidence ratios (IR) were estimated from state of the art econometric models. Patient demographics (i.e., age, gender, race and health status) and Medicaid status (i.e., dual eligibility) were controlled for in these models. Results: In 17,537 patients, there were 1,062 sepsis, 1,802 pneumonia, 42 CLABSI and 52 VAP cases. These subjects accounted for 62,554 person-years post discharge. The sepsis and CLABSI cohorts were similar as were the pneumonia and VAP cohorts. Infection was associated with increased mortality (sepsis HR = 1.39, P < 0.01; and pneumonia HR = 1.58, P < 0.01) and the risk persisted throughout the follow-up period. Persons with sepsis and pneumonia experienced higher utilization than controls (e.g., IR for long-term care utilization for those with sepsis ranged from 2.67 to 1.93 in years 1 through 5); and, utilization was partially related to impending death. Conclusions: The infections had significant and lasting adverse consequences among the elderly. Yet, many of these infections may be preventable. Investments in infection prevention interventions are needed in both community and hospitals settings. [ABSTRACT FROM AUTHOR]

Objective: The study evaluated the accuracy of Medicare claims in identifying elderly patients with depression compared with diagnoses of depression made with validated self-report depression scales. Methods: The study included 1,551 participants in the Medicare Primary and Consumer-Directed Care Demonstration. They resided in 19 counties in three states. Depression diagnoses made by two validated self-rated scales--the Mini-International Neuropsychiatric Interview--Major Depressive Episode Module (MINI-MDE) and the 15-item Geriatric Depression Scale (GDS) were compared with depression identified diagnoses listed in Medicare claims. The main outcome measures were the sensitivity, specificity, and positive and negative predictive values for ICD-9-CM depression codes included in Medicare claims. For validation, two-year periods and additional diagnostic codes were also considered. Results: Compared with the MINI-MDE or GDS, the sensitivity and positive predictive values for Medicare claims were below 50%, and specificity and negative predictive values were over 70%. Conclusions: The study demonstrated the predictive power and limitations of using administrative claims data for identifying patients with depression in the Medicare population. Using Medicare claims to identify patients with depression may lead to underestimation of depression prevalence and may compromise researchers' ability to examine issues related to quality, costs, and utilization. [ABSTRACT FROM AUTHOR]

The article presents a study that examines participation and impacts of Pennsylvania's Certified Safety Committee (CSC) program in work injury rates of insurance firms. The study analyses data of participant firms and performs regression analysis to determine injury rate differences between them and non-participant firms. Result shows that the program effectively reduces rates of firms with good compliance, while revealing large firms and those with higher rates are keen to join the program.

Background: Retail clinics are an increasingly popular source for medical care. Concerns have been raised about the effect of these clinics on the cost, quality, and delivery of preventive care. Objective: To compare the care received at retail clinics for 3 acute conditions with that received at other care settings. Design: Claims data from 2005 and 2006 from the health plan were aggregated into care episodes (units that included initial and follow-up visits, pharmaceuticals, and ancillary tests). After 2100 episodes (700 each) were identified in which otitis media, pharyngitis, and urinary tract infection (UTI) were treated first in retail clinics, these episodes were matched with other episodes in which these illnesses were treated first in physician offices, urgent care centers, or emergency departments. Setting: Enrollees of a large Minnesota health plan. Patients: Enrollees who received care for otitis media, pharyngitis, or UTI. Measurements: Costs per episode, performance on 14 quality indicators, and receipt of 7 preventive care services at the initial appointment or subsequent 3 months. Results: Overall costs of care for episodes initiated at retail clinics were substantially lower than those of matched episodes initiated at physician offices, urgent care centers, and emergency departments ($110 vs. $166, $156, and $570, respectively; P < 0.001 for each comparison). Prescription costs were similar in retail clinics, physician offices, and urgent care centers ($21, $21, and $22), as were aggregate quality scores (63.6%, 61.0%, and 62.6%) and patient's receipt of preventive care (14.5%, 14.2%, and 13.7%) (P > 0.05 vs. retail clinics). In emergency departments, average prescription costs were higher and aggregate quality scores were significantly lower than in other settings. Limitations: A limited number of quality measures and preventive care services were studied. Despite matching, patients at different care sites might differ in their severity of illness. Conclusion: Retail clinics provide less costly treatment than physician offices or urgent care centers for 3 common illnesses, with no apparent adverse effect on quality of care or delivery of preventive care. Primary Funding Source: California HealthCare Foundation. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated that Medicare risk-adjusted capitation models do not adequately compensate programs serving primarily disabled or frail populations. Using the Medicare Current Beneficiary Survey, we demonstrate that the Centers for Medicare and Medicaid Services–Hierarchical Condition Categories (CMS-HCC) model calculates Medicare capitation payments for Parkinson's patients more accurately than for the general population. The discrepancies between the predicted and actual expenditures estimated at various disability levels were smaller for Parkinson's patients than for other beneficiaries. If the CMS-HCC payment model were to apply to programs that draw a significant percentage of their participants from the Parkinson's disease community, these programs likely would be compensated fairly. [ABSTRACT FROM AUTHOR]

A response by Hangsheng Liu to letter to the editor about his article "Utilization of anesthesia services during outpatient endoscopies and colonoscopies and associated spending in 2003-2009," in the 2012 issue of the journal is presented.

Purpose: We aimed to understand how employer characteristics relate to the use of incentives to promote participation in wellness programs and to explore the relationship between incentive type and participation rates. Design: A cross-sectional analysis of nationally representative survey data combined with an administrative business database was employed. Settings/subjects: Random sampling of U.S. companies within strata based on industry and number of employees was used to determine a final sample of 3000 companies. Of these, 19% returned completed surveys. Measures: The survey asked about employee participation rate, incentive type, and gender composition of employees. Incentive types included any incentives, high-value rewards, and rewards plus penalties. Analysis: Logistic regressions of incentive type on employer characteristics were used to determine what types of employers are more likely to offer which type of incentives. A generalized linear model of participation rate was used to determine the relationship between incentive type and participation. Results: Employers located in the Northeast were 5 to 10 times more likely to offer incentives. Employers with a large number of employees, particularly female employees, were up to 1.25 times more likely to use penalties. Penalty and high-value incentives were associated with participation rates of 68% and 52%, respectively. Conclusion: Industry or regional characteristics are likely determinants of incentive use for wellness programs. Penalties appear to be effective, but attention should be paid to what types of employees they affect. [ABSTRACT FROM AUTHOR]

Proposals to use episodes of care as a basis for payment and performance measurement are largely conceptual at this stage, with little empirical work or experience in applied settings to guide their design. Based on analyses of Medicare data, we identified key issues that will need to be considered related to defining episodes and determining which provider is accountable for an episode. We suggest a number of applied studies and demonstrations that would facilitate more rapid movement of episode-based approaches from concept to implementation.