According to a new report published by the Agency for Healthcare Research and Quality (AHRQ, 2007), "heart disease, stroke, deep vein thrombosis and other diseases involving the circulatory system accounted for nearly 7 million hospital stays in 2004-one of every six stays." Only pregnancy and childbirth caused more stays. The five most common diseases that caused hospitalizations were hardening of the arteries (1.2 million), followed by heart failure (1.1 million), nonspecific chest pain (846,000), heart attack (695,000), and irregular heart beat (694,000). Some of the most expensive, in terms of hospitals' average cost per stay, include heart valve disorders ($31,300), aneurysms ($24,700), and heart attacks ($16,200). The cost for hospitals treating patients with circulatory diseases was $71.2 billion in 2004 (AHRQ, 2007).
As consumers become more actively involved in their care, the use of evidence-based guidelines and care will continue. I heard recently of someone at a restaurant who was thought to be having a heart attack (as reported to me by a non-healthcare professional) and "everyone opened purses to offer aspirin"-so consumers are "on it" when it comes to reading, researching, and improving self-care. (It later turned out to be indigestion.) But how long have we heard that the quality measures for heart attack care include aspirin and beta-blocker therapy (on arrival and prescribed at discharge pending no contraindications), along with smoking-cessation counseling and other measures? How hard is it to have a checklist or process to identify patients, guidelines, and discharge plans? The same is true for other health problems, including heart failure and other diseases that we know how best to manage.
The Centers for Medicare and Medicaid Services (CMS, 2007) is still working to realign incentives, which is a long-term process. The "FY 2008 Inpatient Prospective Payment System Proposed Rule" titled "Improving the Quality of Hospital Care" includes required reporting of 27 measures; these measures include quality measures for the care of heart attack (such as aspirin on arrival and discharge), heart failure (measures include discharge instructions and smoking cessation advice/counseling), pneumonia (also smoking cessation advice/counseling), surgical care improvement project measures, mortality measures, and a patient survey (CMS, 2007). Probably the most interesting feature is the language related to hospital-acquired conditions. It appears that the CMS is moving toward paying for quality care (read: desired outcomes) and perhaps not for serious preventable events (objects left in surgery, blood incompatibility). Stay tuned[horizontal ellipsis]
We can all make contributions toward improving quality. Perhaps at some point on referral of a new patient after a heart attack, we can check the medication list for aspirin or ask the patients after a heart attack (or heart failure or pneumonia) admission about attending a smoking-cessation program. I believe the more the systems can work together and with the same information, the better. And remember, it may start in the inpatient setting but it may move to home care, and it could be another step to avoiding a hospitalization, improving care and outcomes. (For an article about "The Role of the Home Healthcare Nurse in Smoking Cessation," readers are referred to the July/August 2006 issue of Home Healthcare Nurse, 24 [7], 424-433).
I want readers to welcome Diana Kornetti, MA, PT to the Editorial Board of Home Healthcare Nurse-welcome, Dee!! Dee is the Administrator and Co-Owner of Integrity Home Health Care in Central Florida and brings her visit skills and hands-on operation expertise to HHN. Another board note is congratulations to Lisa Gorski, who is the new President of the Infusion Nurses Society (INS). Congratulations, Lisa-we are so proud of you!! We look forward to new topics related to best practices involving infusion care.
Tina M. Marrelli
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