Published 2/1/2015

Second Look – Advocacy

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required).

Impact of duty hour reforms on patient safety
Two studies in the Journal of the American Medical Association (JAMA, Dec. 10) examine the effect on quality of resident duty hour limitations enacted in 2011 by the Accreditation Council for Graduate Medical Education (ACGME). Both studies looked at teaching and nonteaching hospitals during the 2 years before and 2 years after the duty hour change. The
first study compared general surgery patient outcomes, and found no significant change in death or serious morbidity. The second study examined 30-day all-location mortality and 30-day all-cause readmission across 2,790,356 patients (6,384,273 admissions), and found “no significant post-reform differences in mortality accounting for teaching hospital intensity for combined medical conditions, combined surgical categories, or any of the individual medical conditions or surgical categories.”

Impact of MOC requirements
According to data in JAMA (Dec. 10), imposition of a 10-year maintenance of certification (MOC) requirement by the American Board of Internal Medicine was not associated with a difference in the increase in ambulatory care–sensitive hospitalizations, but was associated with a small reduction in the growth differences of costs for some Medicare beneficiaries.

EHR adoption
According to the Office of the National Coordinator for Health Information Technology, 71 percent of physicians surveyed (n = 2,399) have already adopted an electronic health record (EHR), while an additional 10 percent have plans to adopt one. Overall, 11 percent of physicians remain undecided, and 8 percent have decided against adopting an EHR. Of physicians who do not plan to adopt an EHR, four in ten plan to retire soon. The report notes that 85 percent of adopters have an EHR certified for meaningful use.

FDA advisory panelists’ ties to industry
An analysis by The Wall Street Journal suggests that some physicians and other experts who participate in U.S. Food and Drug Administration (FDA) medical device advisory panels have undisclosed financial ties to manufacturers. Based on information from corporate, state, and federal sources, the report found that one third of the members who served on panels that evaluated devices between 2012 and 2014 received compensation such as money, research grants, or travel and food from manufacturers; nearly 10 percent of FDA advisers received something of value from the specific company whose product they were evaluating. Overall, the FDA disclosed 1 percent of the connections.

Impact of waits on patient satisfaction
Findings from a study published in Clinical Orthopaedics and Related Research suggest that shorter wait times may be more important to patient satisfaction than amount of face-to-face time. Based on a prospective survey (at visit and at 2-week follow-up) of 51 patients at a single hand and upper extremity surgery outpatient clinic, time spent with the hand surgeon was not associated with patient satisfaction when measured directly after the visit, but longer wait times correlated with decreased patient satisfaction.

Officials charge 14 in meningitis cases
The New Hampshire Union Leader reports that federal officials have arrested and charged 14 people in conjunction with a 2012 outbreak of fungal meningitis linked to New England Compounding Center (NECC). Two of those arrested face murder charges in connection with the outbreak, which affected about 700 patients and was linked to the deaths of 25 people in seven states.

JBJS supplement on device registries
A supplement to The Journal of Bone & Joint Surgery (JBJS) offers data on orthopaedic registries. The included studies analyze performance and safety data from the International Consortium of Orthopedic Registries—a collaborative effort of seven national and regional registries. The findings illustrate the importance of registries and unique device identification implementation for post-market surveillance of medical devices; both are key priorities for the FDA.

ACA impact on ED use
According to data published in the American Journal of Emergency Medicine, patients insured under the Affordable Care Act (ACA) may be more likely than other insured patients to use hospital emergency departments (EDs). The cross-sectional analysis of adult sample respondents to the 2013 National Health Interview Survey who reported on one or more ED visits in the preceding 12 months found that more than a quarter of ED users who had no usual source of care used the ED as a source of primary care.