Research roundup: High rates of postdischarge complications; Prescriptions refilled even after discontinued

Nov 30 2012

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Archives Of Surgery: Association Of Postdischarge Complications With Reoperation And Mortality In General Surgery – The authors note that hospitals need detailed data about postdischarge (PD) complications among surgical patients in order to develop "appropriate quality improvement interventions and potentially avoid reimbursement penalties." In attempt to bridge this knowledge gap, researchers from Yale and Stanford Universities evaluated procedure types, rates and risk factors for PD complications occurring within 30 days after 21 groups of inpatient general surgery procedures for more than 500,000 patients. "We found that more than 40% of all postoperative complications occurred PD; approximately 1 in 14 general surgery patients who underwent an inpatient procedure experienced a PD complication," the authors state. They conclude: "Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes" (Kazaure, Roman, and Sosa, 11/2012).

Annals Of Internal Medicine: Pharmacy Dispensing Of Electronically Discontinued Medications – "Most physician offices do not transmit orders for medication discontinuation to the pharmacy, creating the potential for errors in dispensing of previously prescribed medications," write the authors. They analyzed five common prescription medicines and found that, of 83,902 medications that were electronically discontinued, 1.5 percent continue to be refilled by the pharmacy. The authors conclude: "The dispensing of discontinued medications represents an important ambulatory patient safety concern. Electronic health records should be used to facilitate better communication between providers and pharmacies and improve medication safety" (Allen and Sequist, 11/20).  

Journal of Neurosurgery: Association Of A Higher Density Of Specialist Neuroscience Providers With Fewer Deaths From Stroke In The United States Population – Researchers at the Dartmouth-Hitchcock Medical Center sought to identify a relationship between the availability of specialist neuroscience providers and reduction in stroke-related deaths. With a retrospective analysis of data from more than 3,000 counties, the researchers found a link between a higher density of neurologists and neurosurgeons and a decreased risk of death from stroke and concluded that "availability of local neurologists and neurosurgeons may be an important factor in the overall likelihood of survival after stroke, and therefore underlines an importance of promotion specialist clinical neuroscience education and practice throughout the country" (Desai et al., 11/30).  

Kaiser Family Foundation: Premiums, Cost-Sharing And Coverage At Public, Private And Non-Profit Employers: A View From The 2012 Employer Health Benefit Survey – Workers at private firms on average pay more toward their health premiums and face greater cost sharing than those working for public or private non-profit employers, a new Kaiser Family Foundation analysis finds. Workers covered by an employer plan at private firms contribute 30 percent of the premium for family coverage compared to public employees who contribute 23 percent for family coverage, according to data from the annual Kaiser/HRET Employer Health Benefits Survey. The analysis is the second in a series of "snapshots" taking a closer look at data from the benchmark annual study that examines national trends in employer-sponsored coverage (Rae, Panchal, Claxton, 11/2012).