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Hospitalist specialty code goes live: What ‘C6’ means for you
The long wait for the introduction of the C6 hospitalist specialty code has ended. If you are a provider, hospital, or hospitalist administrator, this new specialty designation is important.
The Centers for Medicare & Medicaid Services tracks specialty utilization and compares providers across the country using codes attached to medical specialties, such as cardiology, emergency medicine, pediatrics, etc. Until the CMS designated hospital medicine as a unique specialty, hospitalists were grouped together with office-based internal medicine physicians and general practitioners. This lack of recognition of the hospitalist specialty created two issues. 
The first is one of location. Hospitalists practice in hospitals and utilize codes that are hospital based, not office based. Yet hospitalists have been benchmarked against their primary care peers’ utilization for many years. At this point in time, most if not all primary care physicians practice exclusively in the office, so comparison of CPT utilization looks unusual when benchmarked nationally. What appeared as a ‘spike’ was actually normal utilization for a hospitalist; however, this coding anomaly can lead to pre- or postpayment audits.
The second issue is being able to benchmark utilization against one’s peers. For the first time, hospitalist utilization will be considered unique, facilitating more accurate comparisons and fairer assessments of hospitalist performance.
Hospitalists can use the C6 specialty code during initial enrollment or as an update, depending on the individual situation. Note that this is a designation for the individual, not the practice, organization, or billing company. The C6 specialty code was recognized as of April 1, 2017, on submitted claims. You may now change your designation and should avoid any disruption or denial of claims.
There are two places to designate the C6 specialty codes, depending on whether the provider is new to Medicare enrollment or is an existing provider:
• Paper: Initial enrollment in the Medicare program on form CMS-855I or CMS 855O (https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html).
• Electronically: Utilizing the PECOS system, provider credentialing offices can update existing specialty codes to C6 (https://pecos.cms.hhs.gov/PECOSWebMaintenance.htm).
This major milestone for hospital medicine demonstrates the continued growth and impact of the specialty. Ensure your self-election in the PECOS system reflects “C6,” your specialty as a hospitalist and your commitment to the hospital medicine movement.
For more information, visit www.hospitalmedicine.org/C6.
Dea Robinson is a member of SHM’s Practice Management Committee, Cultural Competency Workgroup and Physician Burnout Workgroup.
Reference: MLN Matters Number: MM9716 ( https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9716.pdf)
The long wait for the introduction of the C6 hospitalist specialty code has ended. If you are a provider, hospital, or hospitalist administrator, this new specialty designation is important.
The Centers for Medicare & Medicaid Services tracks specialty utilization and compares providers across the country using codes attached to medical specialties, such as cardiology, emergency medicine, pediatrics, etc. Until the CMS designated hospital medicine as a unique specialty, hospitalists were grouped together with office-based internal medicine physicians and general practitioners. This lack of recognition of the hospitalist specialty created two issues.
The first is one of location. Hospitalists practice in hospitals and utilize codes that are hospital based, not office based. Yet hospitalists have been benchmarked against their primary care peers’ utilization for many years. At this point in time, most if not all primary care physicians practice exclusively in the office, so comparison of CPT utilization looks unusual when benchmarked nationally. What appeared as a ‘spike’ was actually normal utilization for a hospitalist; however, this coding anomaly can lead to pre- or postpayment audits.
The second issue is being able to benchmark utilization against one’s peers. For the first time, hospitalist utilization will be considered unique, facilitating more accurate comparisons and fairer assessments of hospitalist performance.
Hospitalists can use the C6 specialty code during initial enrollment or as an update, depending on the individual situation. Note that this is a designation for the individual, not the practice, organization, or billing company. The C6 specialty code was recognized as of April 1, 2017, on submitted claims. You may now change your designation and should avoid any disruption or denial of claims.
There are two places to designate the C6 specialty codes, depending on whether the provider is new to Medicare enrollment or is an existing provider:
• Paper: Initial enrollment in the Medicare program on form CMS-855I or CMS 855O (https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html).
• Electronically: Utilizing the PECOS system, provider credentialing offices can update existing specialty codes to C6 (https://pecos.cms.hhs.gov/PECOSWebMaintenance.htm).
This major milestone for hospital medicine demonstrates the continued growth and impact of the specialty. Ensure your self-election in the PECOS system reflects “C6,” your specialty as a hospitalist and your commitment to the hospital medicine movement.
For more information, visit www.hospitalmedicine.org/C6.
Dea Robinson is a member of SHM’s Practice Management Committee, Cultural Competency Workgroup and Physician Burnout Workgroup.
Reference: MLN Matters Number: MM9716 ( https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9716.pdf)
The long wait for the introduction of the C6 hospitalist specialty code has ended. If you are a provider, hospital, or hospitalist administrator, this new specialty designation is important.
The Centers for Medicare & Medicaid Services tracks specialty utilization and compares providers across the country using codes attached to medical specialties, such as cardiology, emergency medicine, pediatrics, etc. Until the CMS designated hospital medicine as a unique specialty, hospitalists were grouped together with office-based internal medicine physicians and general practitioners. This lack of recognition of the hospitalist specialty created two issues.
The first is one of location. Hospitalists practice in hospitals and utilize codes that are hospital based, not office based. Yet hospitalists have been benchmarked against their primary care peers’ utilization for many years. At this point in time, most if not all primary care physicians practice exclusively in the office, so comparison of CPT utilization looks unusual when benchmarked nationally. What appeared as a ‘spike’ was actually normal utilization for a hospitalist; however, this coding anomaly can lead to pre- or postpayment audits.
The second issue is being able to benchmark utilization against one’s peers. For the first time, hospitalist utilization will be considered unique, facilitating more accurate comparisons and fairer assessments of hospitalist performance.
Hospitalists can use the C6 specialty code during initial enrollment or as an update, depending on the individual situation. Note that this is a designation for the individual, not the practice, organization, or billing company. The C6 specialty code was recognized as of April 1, 2017, on submitted claims. You may now change your designation and should avoid any disruption or denial of claims.
There are two places to designate the C6 specialty codes, depending on whether the provider is new to Medicare enrollment or is an existing provider:
• Paper: Initial enrollment in the Medicare program on form CMS-855I or CMS 855O (https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html).
• Electronically: Utilizing the PECOS system, provider credentialing offices can update existing specialty codes to C6 (https://pecos.cms.hhs.gov/PECOSWebMaintenance.htm).
This major milestone for hospital medicine demonstrates the continued growth and impact of the specialty. Ensure your self-election in the PECOS system reflects “C6,” your specialty as a hospitalist and your commitment to the hospital medicine movement.
For more information, visit www.hospitalmedicine.org/C6.
Dea Robinson is a member of SHM’s Practice Management Committee, Cultural Competency Workgroup and Physician Burnout Workgroup.
Reference: MLN Matters Number: MM9716 ( https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9716.pdf)
If you ask me ...
In a feature article in Pediatric News entitled “What do doctors want from health reform,” Alicia Gallegos reports on the results of a recent online Frontline Medical News poll of 390 physicians who were asked what one thing about the ACA they would change. The answers were scattered, but “Stabilize premiums and out of pocket expenses for patients” garnered 50% of the votes.
I suspect that this result was an anguished cry for some leadership in Washington. It could come from the left or the right or, even better, from a coalition. But please, we just need some clear leadership, some direction, and a plan that would allow all of us – physicians, patients, hospitals, and insurance companies – to get on with our various missions.
The cost of medication is another major driver of health care cost. Any new plan or adjustments to the ACA should more forcefully rein in or outright eliminate the pharmacy benefit managers who needlessly add cost to medication. Although most of us grumble when faced with cookbook recipes for care that constrain our prescribing choices, we must accept that, in most cases, these evidence-based guidelines are necessary evils. At the same time, we should vigorously support and cooperate with the efforts to discipline the flagrant overprescribers in our midst.
It is not surprising that the ACA has had difficulty attracting young healthy people to buy health insurance that is costly even at a discount. Offering a lower price, no frills, catastrophic care option might be more appealing to young people who still see themselves as invincible. While, as pediatricians, we can see the benefit of immunizations and preventive care in the first year of life, it may be time for a more critical look at the cost benefit ratio for other preventive initiatives in older age groups that may sound good but are making health insurance more expensive.
Finally, an improved ACA should make reduction of the administrative burden of prior authorizations a high priority. Michael L. Munger, MD, president-elect of the American Academy of Family Physicians, suggests that a standard process for both private and publicly funded patients would allow physicians to focus their time and talents on more efficient patient care. The failure of the ACA to mandate even basic standardization for electronic health records has left us with a nonsystem made up of mini-systems that are neither user friendly nor capable of effectively communicating with one another.
It appears that this country doesn’t yet have the stomach for a single payer model. While I usually believe that compromise will yield a good result, the ACA is an example of when a leadership vacuum can result in a collection of bad compromises.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].
[polldaddy:9708248]
In a feature article in Pediatric News entitled “What do doctors want from health reform,” Alicia Gallegos reports on the results of a recent online Frontline Medical News poll of 390 physicians who were asked what one thing about the ACA they would change. The answers were scattered, but “Stabilize premiums and out of pocket expenses for patients” garnered 50% of the votes.
I suspect that this result was an anguished cry for some leadership in Washington. It could come from the left or the right or, even better, from a coalition. But please, we just need some clear leadership, some direction, and a plan that would allow all of us – physicians, patients, hospitals, and insurance companies – to get on with our various missions.
The cost of medication is another major driver of health care cost. Any new plan or adjustments to the ACA should more forcefully rein in or outright eliminate the pharmacy benefit managers who needlessly add cost to medication. Although most of us grumble when faced with cookbook recipes for care that constrain our prescribing choices, we must accept that, in most cases, these evidence-based guidelines are necessary evils. At the same time, we should vigorously support and cooperate with the efforts to discipline the flagrant overprescribers in our midst.
It is not surprising that the ACA has had difficulty attracting young healthy people to buy health insurance that is costly even at a discount. Offering a lower price, no frills, catastrophic care option might be more appealing to young people who still see themselves as invincible. While, as pediatricians, we can see the benefit of immunizations and preventive care in the first year of life, it may be time for a more critical look at the cost benefit ratio for other preventive initiatives in older age groups that may sound good but are making health insurance more expensive.
Finally, an improved ACA should make reduction of the administrative burden of prior authorizations a high priority. Michael L. Munger, MD, president-elect of the American Academy of Family Physicians, suggests that a standard process for both private and publicly funded patients would allow physicians to focus their time and talents on more efficient patient care. The failure of the ACA to mandate even basic standardization for electronic health records has left us with a nonsystem made up of mini-systems that are neither user friendly nor capable of effectively communicating with one another.
It appears that this country doesn’t yet have the stomach for a single payer model. While I usually believe that compromise will yield a good result, the ACA is an example of when a leadership vacuum can result in a collection of bad compromises.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].
[polldaddy:9708248]
In a feature article in Pediatric News entitled “What do doctors want from health reform,” Alicia Gallegos reports on the results of a recent online Frontline Medical News poll of 390 physicians who were asked what one thing about the ACA they would change. The answers were scattered, but “Stabilize premiums and out of pocket expenses for patients” garnered 50% of the votes.
I suspect that this result was an anguished cry for some leadership in Washington. It could come from the left or the right or, even better, from a coalition. But please, we just need some clear leadership, some direction, and a plan that would allow all of us – physicians, patients, hospitals, and insurance companies – to get on with our various missions.
The cost of medication is another major driver of health care cost. Any new plan or adjustments to the ACA should more forcefully rein in or outright eliminate the pharmacy benefit managers who needlessly add cost to medication. Although most of us grumble when faced with cookbook recipes for care that constrain our prescribing choices, we must accept that, in most cases, these evidence-based guidelines are necessary evils. At the same time, we should vigorously support and cooperate with the efforts to discipline the flagrant overprescribers in our midst.
It is not surprising that the ACA has had difficulty attracting young healthy people to buy health insurance that is costly even at a discount. Offering a lower price, no frills, catastrophic care option might be more appealing to young people who still see themselves as invincible. While, as pediatricians, we can see the benefit of immunizations and preventive care in the first year of life, it may be time for a more critical look at the cost benefit ratio for other preventive initiatives in older age groups that may sound good but are making health insurance more expensive.
Finally, an improved ACA should make reduction of the administrative burden of prior authorizations a high priority. Michael L. Munger, MD, president-elect of the American Academy of Family Physicians, suggests that a standard process for both private and publicly funded patients would allow physicians to focus their time and talents on more efficient patient care. The failure of the ACA to mandate even basic standardization for electronic health records has left us with a nonsystem made up of mini-systems that are neither user friendly nor capable of effectively communicating with one another.
It appears that this country doesn’t yet have the stomach for a single payer model. While I usually believe that compromise will yield a good result, the ACA is an example of when a leadership vacuum can result in a collection of bad compromises.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].
[polldaddy:9708248]
Genital HPV prevalence tops 42% in adults
The overall prevalence of genital human papillomavirus (HPV) among adults aged 18-59 years was 42.5% in 2013-2014, with more than half of that representing infection with high-risk types, according to the National Center for Health Statistics.
Prevalence of the 14 HPV types (out of 37 total) considered to be high risk was almost 23% in 2013-2014. Men were significantly more likely than women to have any genital HPV (45% vs. 40%) and high-risk genital HPV (25% vs. 20%), the NCHS reported.
Oral rinse samples were collected as well for adults aged 18-69 years, and the overall prevalence was 7.3% for any oral HPV and 4% for high-risk HPV in 2011-2014. Prevalence among men was significantly higher than among women for all oral HPV (11.5% vs. 3.3%) and for high-risk HPV (6.8% vs. 1.2%), the NCHS said.
The overall prevalence of genital human papillomavirus (HPV) among adults aged 18-59 years was 42.5% in 2013-2014, with more than half of that representing infection with high-risk types, according to the National Center for Health Statistics.
Prevalence of the 14 HPV types (out of 37 total) considered to be high risk was almost 23% in 2013-2014. Men were significantly more likely than women to have any genital HPV (45% vs. 40%) and high-risk genital HPV (25% vs. 20%), the NCHS reported.
Oral rinse samples were collected as well for adults aged 18-69 years, and the overall prevalence was 7.3% for any oral HPV and 4% for high-risk HPV in 2011-2014. Prevalence among men was significantly higher than among women for all oral HPV (11.5% vs. 3.3%) and for high-risk HPV (6.8% vs. 1.2%), the NCHS said.
The overall prevalence of genital human papillomavirus (HPV) among adults aged 18-59 years was 42.5% in 2013-2014, with more than half of that representing infection with high-risk types, according to the National Center for Health Statistics.
Prevalence of the 14 HPV types (out of 37 total) considered to be high risk was almost 23% in 2013-2014. Men were significantly more likely than women to have any genital HPV (45% vs. 40%) and high-risk genital HPV (25% vs. 20%), the NCHS reported.
Oral rinse samples were collected as well for adults aged 18-69 years, and the overall prevalence was 7.3% for any oral HPV and 4% for high-risk HPV in 2011-2014. Prevalence among men was significantly higher than among women for all oral HPV (11.5% vs. 3.3%) and for high-risk HPV (6.8% vs. 1.2%), the NCHS said.
Hepatitis Outlook: March 2017
If you work on the front lines of medical care, treating patients with hepatitis, you may not have time to review all the hepatitis research that enters the medical literature every month. Here’s a quick look at some notable news items and journal articles published over the past month, covering the major hepatitis viruses.
Preliver transplant treatment with a highly effective, all-oral direct-acting antiviral agent regimen provides the best health outcomes and is the most cost-effective strategy for the treatment of patients with hepatitis C virus with hepatocellular carcinoma or decompensated cirrhosis who are waitlisted for liver transplant, a study in Hepatology revealed.
A recent study in the Journal of Viral Hepatitis found that patients with chronic HCV and compensated or decompensated cirrhosis who achieve sustained viral response can have clinically meaningful reductions in hepatic venous pressure gradient at long-term follow-up.
The hepatic expressions of cannabinoid receptor 1 and cannabinoid receptor 2 play important roles during the progression of fibrosis induced by chronic hepatitis B virus, according to a study in the International Journal of Infectious Diseases.
A study in the Journal of Viral Hepatitis found that the Pooled Cohort atherosclerotic cardiovascular disease risk equation overestimated the risk of cardiovascular disease among lower-risk patients and underestimated risk among higher-risk patients in both HCV-infected and uninfected groups.
A multinational study in Hepatology found that hemoglobin levels and international normalized ratio values were similar in patients with inherited bleeding disorders and HCV infection who received elbasvir/grazoprevir and placebo.
The number of HBV patients in the United States requiring liver transplantation remained stable, according to a recent study in the Journal of Viral Hepatitis, but the proportion of HBV patients with hepatocellular carcinoma continues to rise.
A research letter in the Morbidity and Mortality Weekly Report reported the transmission of HCV from the inappropriate reuse of saline flush syringes for multiple patients in an acute care hospital in Texas.
A large German study in the Journal of Viral Hepatitis found that ombitasvir/paritaprevir/ritonavir plus/minus dasabuvir plus/minus ribavirin for treatment of HCV genotype 1 and genotype 4 infection was effective and generally well tolerated in clinical practice.
A study, conducted in South Korea, in Hepatology found that monotherapy with tenofovir disoproxil fumarate was efficacious and safe for up to 144 weeks in heavily pretreated patients with multidrug-resistant HBV infection.
Overt and occult HBV infection of children was more serious in underdeveloped northwest regions of China, a study in the Journal of Viral Hepatitis found, suggesting that HBV neonatal immunization and catch-up programs should be strengthened and supplemented.
A study in Hepatology found that long-term entecavir monotherapy is highly effective in preventing HBV reactivation after liver transplantation for chronic HBV, with a durable HBV surface antigen seroclearance rate of 92%, undetectable HBV DNA rate of 100% at 8 years, and excellent long-term survival of 85% at 9 years.
An Italian study in the Journal of Viral Hepatitis found that treatment with direct-acting antivirals was effective and well tolerated in people who inject drugs, although cirrhotic subjects with Model For End-Stage Liver Disease scores greater than 10 and albumin levels below 3 g/dL showed a higher risk of developing serious adverse events and treatment failure.
Direct-acting antiviral–based treatments for severe posttransplant HCV recurrence, comprising fibrosing cholestatic hepatitis, significantly improves liver function even without viral clearance and permits excellent long-term survival, according to a study in the Journal of Viral Hepatitis.
[email protected]
On Twitter @richpizzi
If you work on the front lines of medical care, treating patients with hepatitis, you may not have time to review all the hepatitis research that enters the medical literature every month. Here’s a quick look at some notable news items and journal articles published over the past month, covering the major hepatitis viruses.
Preliver transplant treatment with a highly effective, all-oral direct-acting antiviral agent regimen provides the best health outcomes and is the most cost-effective strategy for the treatment of patients with hepatitis C virus with hepatocellular carcinoma or decompensated cirrhosis who are waitlisted for liver transplant, a study in Hepatology revealed.
A recent study in the Journal of Viral Hepatitis found that patients with chronic HCV and compensated or decompensated cirrhosis who achieve sustained viral response can have clinically meaningful reductions in hepatic venous pressure gradient at long-term follow-up.
The hepatic expressions of cannabinoid receptor 1 and cannabinoid receptor 2 play important roles during the progression of fibrosis induced by chronic hepatitis B virus, according to a study in the International Journal of Infectious Diseases.
A study in the Journal of Viral Hepatitis found that the Pooled Cohort atherosclerotic cardiovascular disease risk equation overestimated the risk of cardiovascular disease among lower-risk patients and underestimated risk among higher-risk patients in both HCV-infected and uninfected groups.
A multinational study in Hepatology found that hemoglobin levels and international normalized ratio values were similar in patients with inherited bleeding disorders and HCV infection who received elbasvir/grazoprevir and placebo.
The number of HBV patients in the United States requiring liver transplantation remained stable, according to a recent study in the Journal of Viral Hepatitis, but the proportion of HBV patients with hepatocellular carcinoma continues to rise.
A research letter in the Morbidity and Mortality Weekly Report reported the transmission of HCV from the inappropriate reuse of saline flush syringes for multiple patients in an acute care hospital in Texas.
A large German study in the Journal of Viral Hepatitis found that ombitasvir/paritaprevir/ritonavir plus/minus dasabuvir plus/minus ribavirin for treatment of HCV genotype 1 and genotype 4 infection was effective and generally well tolerated in clinical practice.
A study, conducted in South Korea, in Hepatology found that monotherapy with tenofovir disoproxil fumarate was efficacious and safe for up to 144 weeks in heavily pretreated patients with multidrug-resistant HBV infection.
Overt and occult HBV infection of children was more serious in underdeveloped northwest regions of China, a study in the Journal of Viral Hepatitis found, suggesting that HBV neonatal immunization and catch-up programs should be strengthened and supplemented.
A study in Hepatology found that long-term entecavir monotherapy is highly effective in preventing HBV reactivation after liver transplantation for chronic HBV, with a durable HBV surface antigen seroclearance rate of 92%, undetectable HBV DNA rate of 100% at 8 years, and excellent long-term survival of 85% at 9 years.
An Italian study in the Journal of Viral Hepatitis found that treatment with direct-acting antivirals was effective and well tolerated in people who inject drugs, although cirrhotic subjects with Model For End-Stage Liver Disease scores greater than 10 and albumin levels below 3 g/dL showed a higher risk of developing serious adverse events and treatment failure.
Direct-acting antiviral–based treatments for severe posttransplant HCV recurrence, comprising fibrosing cholestatic hepatitis, significantly improves liver function even without viral clearance and permits excellent long-term survival, according to a study in the Journal of Viral Hepatitis.
[email protected]
On Twitter @richpizzi
If you work on the front lines of medical care, treating patients with hepatitis, you may not have time to review all the hepatitis research that enters the medical literature every month. Here’s a quick look at some notable news items and journal articles published over the past month, covering the major hepatitis viruses.
Preliver transplant treatment with a highly effective, all-oral direct-acting antiviral agent regimen provides the best health outcomes and is the most cost-effective strategy for the treatment of patients with hepatitis C virus with hepatocellular carcinoma or decompensated cirrhosis who are waitlisted for liver transplant, a study in Hepatology revealed.
A recent study in the Journal of Viral Hepatitis found that patients with chronic HCV and compensated or decompensated cirrhosis who achieve sustained viral response can have clinically meaningful reductions in hepatic venous pressure gradient at long-term follow-up.
The hepatic expressions of cannabinoid receptor 1 and cannabinoid receptor 2 play important roles during the progression of fibrosis induced by chronic hepatitis B virus, according to a study in the International Journal of Infectious Diseases.
A study in the Journal of Viral Hepatitis found that the Pooled Cohort atherosclerotic cardiovascular disease risk equation overestimated the risk of cardiovascular disease among lower-risk patients and underestimated risk among higher-risk patients in both HCV-infected and uninfected groups.
A multinational study in Hepatology found that hemoglobin levels and international normalized ratio values were similar in patients with inherited bleeding disorders and HCV infection who received elbasvir/grazoprevir and placebo.
The number of HBV patients in the United States requiring liver transplantation remained stable, according to a recent study in the Journal of Viral Hepatitis, but the proportion of HBV patients with hepatocellular carcinoma continues to rise.
A research letter in the Morbidity and Mortality Weekly Report reported the transmission of HCV from the inappropriate reuse of saline flush syringes for multiple patients in an acute care hospital in Texas.
A large German study in the Journal of Viral Hepatitis found that ombitasvir/paritaprevir/ritonavir plus/minus dasabuvir plus/minus ribavirin for treatment of HCV genotype 1 and genotype 4 infection was effective and generally well tolerated in clinical practice.
A study, conducted in South Korea, in Hepatology found that monotherapy with tenofovir disoproxil fumarate was efficacious and safe for up to 144 weeks in heavily pretreated patients with multidrug-resistant HBV infection.
Overt and occult HBV infection of children was more serious in underdeveloped northwest regions of China, a study in the Journal of Viral Hepatitis found, suggesting that HBV neonatal immunization and catch-up programs should be strengthened and supplemented.
A study in Hepatology found that long-term entecavir monotherapy is highly effective in preventing HBV reactivation after liver transplantation for chronic HBV, with a durable HBV surface antigen seroclearance rate of 92%, undetectable HBV DNA rate of 100% at 8 years, and excellent long-term survival of 85% at 9 years.
An Italian study in the Journal of Viral Hepatitis found that treatment with direct-acting antivirals was effective and well tolerated in people who inject drugs, although cirrhotic subjects with Model For End-Stage Liver Disease scores greater than 10 and albumin levels below 3 g/dL showed a higher risk of developing serious adverse events and treatment failure.
Direct-acting antiviral–based treatments for severe posttransplant HCV recurrence, comprising fibrosing cholestatic hepatitis, significantly improves liver function even without viral clearance and permits excellent long-term survival, according to a study in the Journal of Viral Hepatitis.
[email protected]
On Twitter @richpizzi
FDA approves new treatment for episodic cluster headaches in adults
The Food and Drug Administration announced April 18 the approval of the gammaCore device to treat pain associated with episodic cluster headache in adult patients.
The agency based its approval of the noninvasive vagus nerve stimulator device on subgroup analyses of episodic cluster headache patients in the ACT1 and ACT2 trials, which were double-blind, placebo-controlled, randomized studies.
In the ACT1 trial of 85 patients, 34.2% experienced a reduction in pain (defined as the percentage of patients who reported mild or no pain 15 minutes after treatment initiation with gammaCore), compared with 10.6% of patients treated with placebo (P = .008). Of 27 patients in the ACT2 trial, 47.5% of patients using the device were pain free at 15 minutes after the onset of pain from cluster headache, with no use of rescue medication through the 30-minute treatment period, which was significantly greater than for placebo (6.2%; P = .003).
“Cluster headache is a rare, debilitating, and difficult to treat disorder with few effective acute therapies,” Stephen Silberstein, MD, director of the Headache Center at Jefferson University, Philadelphia, said in a statement from the manufacturer, electroCore. “The FDA release of gammaCore is an important advance in the treatment of the pain associated with cluster headache. It is a way for patients to treat their symptoms as often as they need to use the device. It does not have the side effects or dose limitations of commonly prescribed treatments or the need for invasive implantation procedures, which can be inconvenient, costly, and high-risk.”
The gammaCore device works by transmitting a mild electrical stimulation to the vagus nerve through the skin, resulting in a reduction of pain. Currently, gammaCore is in use only outside of the United States, including in the European Union. Commercial availability of gammaCore in the United States is expected to begin early in the third quarter of 2017, the company said.
The Food and Drug Administration announced April 18 the approval of the gammaCore device to treat pain associated with episodic cluster headache in adult patients.
The agency based its approval of the noninvasive vagus nerve stimulator device on subgroup analyses of episodic cluster headache patients in the ACT1 and ACT2 trials, which were double-blind, placebo-controlled, randomized studies.
In the ACT1 trial of 85 patients, 34.2% experienced a reduction in pain (defined as the percentage of patients who reported mild or no pain 15 minutes after treatment initiation with gammaCore), compared with 10.6% of patients treated with placebo (P = .008). Of 27 patients in the ACT2 trial, 47.5% of patients using the device were pain free at 15 minutes after the onset of pain from cluster headache, with no use of rescue medication through the 30-minute treatment period, which was significantly greater than for placebo (6.2%; P = .003).
“Cluster headache is a rare, debilitating, and difficult to treat disorder with few effective acute therapies,” Stephen Silberstein, MD, director of the Headache Center at Jefferson University, Philadelphia, said in a statement from the manufacturer, electroCore. “The FDA release of gammaCore is an important advance in the treatment of the pain associated with cluster headache. It is a way for patients to treat their symptoms as often as they need to use the device. It does not have the side effects or dose limitations of commonly prescribed treatments or the need for invasive implantation procedures, which can be inconvenient, costly, and high-risk.”
The gammaCore device works by transmitting a mild electrical stimulation to the vagus nerve through the skin, resulting in a reduction of pain. Currently, gammaCore is in use only outside of the United States, including in the European Union. Commercial availability of gammaCore in the United States is expected to begin early in the third quarter of 2017, the company said.
The Food and Drug Administration announced April 18 the approval of the gammaCore device to treat pain associated with episodic cluster headache in adult patients.
The agency based its approval of the noninvasive vagus nerve stimulator device on subgroup analyses of episodic cluster headache patients in the ACT1 and ACT2 trials, which were double-blind, placebo-controlled, randomized studies.
In the ACT1 trial of 85 patients, 34.2% experienced a reduction in pain (defined as the percentage of patients who reported mild or no pain 15 minutes after treatment initiation with gammaCore), compared with 10.6% of patients treated with placebo (P = .008). Of 27 patients in the ACT2 trial, 47.5% of patients using the device were pain free at 15 minutes after the onset of pain from cluster headache, with no use of rescue medication through the 30-minute treatment period, which was significantly greater than for placebo (6.2%; P = .003).
“Cluster headache is a rare, debilitating, and difficult to treat disorder with few effective acute therapies,” Stephen Silberstein, MD, director of the Headache Center at Jefferson University, Philadelphia, said in a statement from the manufacturer, electroCore. “The FDA release of gammaCore is an important advance in the treatment of the pain associated with cluster headache. It is a way for patients to treat their symptoms as often as they need to use the device. It does not have the side effects or dose limitations of commonly prescribed treatments or the need for invasive implantation procedures, which can be inconvenient, costly, and high-risk.”
The gammaCore device works by transmitting a mild electrical stimulation to the vagus nerve through the skin, resulting in a reduction of pain. Currently, gammaCore is in use only outside of the United States, including in the European Union. Commercial availability of gammaCore in the United States is expected to begin early in the third quarter of 2017, the company said.
Infantile hemangiomas: Calculating dose for propranolol is tricky
Use of Hemangeol was associated with fewer dosing errors than use of generic propranolol hydrochloride oral solutions in treating infantile hemangiomas, according to an online questionnaire survey.
Anastasia O. Kurta, DO, of Saint Louis University and her associates emailed a questionnaire to 531 physicians who were members of the Society for Pediatric Dermatology and physicians known to treat infantile hemangiomas. Most of the 220 physicians who responded were pediatric dermatologists. Of those, 90% had prescribed generic propranolol available in concentrations of 4 mg/mL and 8 mg/mL, and 58.6% had prescribed Hemangeol, the Food and Drug Administration-approved formulation of propranolol hydrochloride available in a concentration of 4.28 mg/mL.
“A dosing chart accompanies propranolol 4.28 mg/mL [Hemangeol] using mL/kg doses, which eliminates conversion from milligrams to milliliters and could potentially explain the lower reported dose calculation error reported with propranolol 4.28 mg/mL,” Dr. Kurta and her associates said. “The risk of dispensing errors is increased for medications that are commercially available in different concentrations. Liquid medications prescribed for pediatric patients require additional computation for weight-based dosing and conversion, increasing the possibility of miscalculation.”
Daisy Dai, PhD, is employed by Pierre Fabre Pharmaceuticals and Elaine C. Siegfried, PhD, is a consultant for the company. Dr. Kurta and Eric S. Ambrecht, PhD, have no relevant financial disclosures.
Read more at J Am Acad Dermatol. 2017 May;76(5):999-1000.
Dr. Kurta reported no relevant financial disclosures.
Use of Hemangeol was associated with fewer dosing errors than use of generic propranolol hydrochloride oral solutions in treating infantile hemangiomas, according to an online questionnaire survey.
Anastasia O. Kurta, DO, of Saint Louis University and her associates emailed a questionnaire to 531 physicians who were members of the Society for Pediatric Dermatology and physicians known to treat infantile hemangiomas. Most of the 220 physicians who responded were pediatric dermatologists. Of those, 90% had prescribed generic propranolol available in concentrations of 4 mg/mL and 8 mg/mL, and 58.6% had prescribed Hemangeol, the Food and Drug Administration-approved formulation of propranolol hydrochloride available in a concentration of 4.28 mg/mL.
“A dosing chart accompanies propranolol 4.28 mg/mL [Hemangeol] using mL/kg doses, which eliminates conversion from milligrams to milliliters and could potentially explain the lower reported dose calculation error reported with propranolol 4.28 mg/mL,” Dr. Kurta and her associates said. “The risk of dispensing errors is increased for medications that are commercially available in different concentrations. Liquid medications prescribed for pediatric patients require additional computation for weight-based dosing and conversion, increasing the possibility of miscalculation.”
Daisy Dai, PhD, is employed by Pierre Fabre Pharmaceuticals and Elaine C. Siegfried, PhD, is a consultant for the company. Dr. Kurta and Eric S. Ambrecht, PhD, have no relevant financial disclosures.
Read more at J Am Acad Dermatol. 2017 May;76(5):999-1000.
Dr. Kurta reported no relevant financial disclosures.
Use of Hemangeol was associated with fewer dosing errors than use of generic propranolol hydrochloride oral solutions in treating infantile hemangiomas, according to an online questionnaire survey.
Anastasia O. Kurta, DO, of Saint Louis University and her associates emailed a questionnaire to 531 physicians who were members of the Society for Pediatric Dermatology and physicians known to treat infantile hemangiomas. Most of the 220 physicians who responded were pediatric dermatologists. Of those, 90% had prescribed generic propranolol available in concentrations of 4 mg/mL and 8 mg/mL, and 58.6% had prescribed Hemangeol, the Food and Drug Administration-approved formulation of propranolol hydrochloride available in a concentration of 4.28 mg/mL.
“A dosing chart accompanies propranolol 4.28 mg/mL [Hemangeol] using mL/kg doses, which eliminates conversion from milligrams to milliliters and could potentially explain the lower reported dose calculation error reported with propranolol 4.28 mg/mL,” Dr. Kurta and her associates said. “The risk of dispensing errors is increased for medications that are commercially available in different concentrations. Liquid medications prescribed for pediatric patients require additional computation for weight-based dosing and conversion, increasing the possibility of miscalculation.”
Daisy Dai, PhD, is employed by Pierre Fabre Pharmaceuticals and Elaine C. Siegfried, PhD, is a consultant for the company. Dr. Kurta and Eric S. Ambrecht, PhD, have no relevant financial disclosures.
Read more at J Am Acad Dermatol. 2017 May;76(5):999-1000.
Dr. Kurta reported no relevant financial disclosures.
FROM THE JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Three-strategy combo reduces pancreatoduodenectomy fistula risk
MIAMI BEACH – Pancreaticojejunostomy reconstruction, use of stents, and avoidance of prophylactic octreotide, especially in combination, could reduce the fistula rate associated with pancreatoduodenectomy.
Failure of the anastomosis is “of greatest concern” to surgeons performing a pancreatoduodenectomy, said Brett L. Ecker, MD, a surgical resident at the University of Pennsylvania, Philadelphia.
“There is no shortage of high-quality data to help guide the use of [fistula reduction] strategies,” he added. However, “the utility of these strategies in patients most vulnerable to fistula … has rarely been particularly explored.”
Dr. Ecker and his colleagues conducted a study with 62 surgeons at 17 institutions to compare various fistula mitigation strategies in this higher-risk population. They assessed surgical reconstruction, dunking, tissue patches, intraperitoneal drains, stents, prophylactic octreotide, and use of tissue sealants.
“Ultimately, we want to know the best way to deal with this high-stakes situation, and whether outcomes might be optimized by bundling these proactive strategies,” Dr. Ecker explained.
“We found the combination of externalized stents and PJ [pancreaticojejunostomy] reconstruction with the omission of prophylactic octreotide was associated with significant improvements in fistula that exceeded the benefit of any individual mitigation approach or any other combination of strategies,” he said at the annual meeting of the Americas Hepato-Pancreato-Biliary Association.
“The mitigation of risk in real-life practice is often the result of multiple moving parts,” Dr. Ecker said. “The best outcomes [may result from] the synergistic effects of multiple strategies.”
Of the approximately 10% of patients with a Fistula Risk Score of 7-10, 152 ended up with clinically relevant postoperative pancreatic fistula (CR-POPF). “An FRS score of 7 or higher is associated with worse outcomes, including a fistula rate approaching 30%,” Dr. Ecker said. Grade B or C fistula based on International Study Group on Pancreatic Surgery criteria were considered clinically relevant. All patients had surgery from 2003 to 2016 in the retrospective, multinational study.
“This represents the only series of high-risk cases where current international standards were used to define both the risk and the outcome,” he noted.
“Almost all [of the 522] patients had a soft gland and a small duct, a median of 2 mm,” Dr. Ecker added. “High-risk pathology was common, in 86%.”
Surgeons contributing to the series were at high-volume centers and had performed more than 200 Whipple procedures in their careers. “Both institutional and surgeon volume were associated with improved fistula outcomes,” Dr. Ecker said. “We found that intraperitoneal drains were not associated with improved fistula outcomes, but that is limited by the fact that drains were rarely omitted in these cases.”
Four strategies compared
The investigators compared the outcomes of four fistula strategies among the patients considered high risk prior to surgery. When they combined pancreaticogastrostomy, prophylactic octreotide, and no stent, the CR-POPF rate was 47%. “This was associated with an alarming fistula rate approaching 50%,” Dr. Ecker said.
When surgeons combined pancreaticojejunostomy, octreotide, and no stent, the CR-POPF rate declined to 34%. Furthermore, pancreaticojejunostomy without octreotide or a stent yielded a 26% CR-POPF rate.
Ultimately, the most effective strategy to avoid clinically relevant fistula was pancreaticojejunostomy with an external stent and no octreotide.
“The use of PJ reconstruction with an external stent and omission of octreotide was associated with a fistula rate of about 13%, which was a greater than 50% risk reduction from the overall cohort,” Dr. Ecker said.
The researchers also performed propensity score matching to reduce bias associated with surgeon or patient factors. They matched 167 participants in the study with 155 controls. Dr. Ecker said, “Still, we observed that patients managed this way had significantly lower fistula rates.”
“This is an excellent paper and an important topic,” said study discussant Michael L. Kendrick, MD, a general surgeon at the Mayo Clinic in Rochester, Minn.
“At our institution, we’ve used the same Fistula Risk Score and found it very helpful for a mitigation strategy in a separate protocol, and we found that reduced our leak rates as well,” Dr. Kendrick noted.
Dr. Ecker and Dr. Kendrick had no relevant disclosures.
MIAMI BEACH – Pancreaticojejunostomy reconstruction, use of stents, and avoidance of prophylactic octreotide, especially in combination, could reduce the fistula rate associated with pancreatoduodenectomy.
Failure of the anastomosis is “of greatest concern” to surgeons performing a pancreatoduodenectomy, said Brett L. Ecker, MD, a surgical resident at the University of Pennsylvania, Philadelphia.
“There is no shortage of high-quality data to help guide the use of [fistula reduction] strategies,” he added. However, “the utility of these strategies in patients most vulnerable to fistula … has rarely been particularly explored.”
Dr. Ecker and his colleagues conducted a study with 62 surgeons at 17 institutions to compare various fistula mitigation strategies in this higher-risk population. They assessed surgical reconstruction, dunking, tissue patches, intraperitoneal drains, stents, prophylactic octreotide, and use of tissue sealants.
“Ultimately, we want to know the best way to deal with this high-stakes situation, and whether outcomes might be optimized by bundling these proactive strategies,” Dr. Ecker explained.
“We found the combination of externalized stents and PJ [pancreaticojejunostomy] reconstruction with the omission of prophylactic octreotide was associated with significant improvements in fistula that exceeded the benefit of any individual mitigation approach or any other combination of strategies,” he said at the annual meeting of the Americas Hepato-Pancreato-Biliary Association.
“The mitigation of risk in real-life practice is often the result of multiple moving parts,” Dr. Ecker said. “The best outcomes [may result from] the synergistic effects of multiple strategies.”
Of the approximately 10% of patients with a Fistula Risk Score of 7-10, 152 ended up with clinically relevant postoperative pancreatic fistula (CR-POPF). “An FRS score of 7 or higher is associated with worse outcomes, including a fistula rate approaching 30%,” Dr. Ecker said. Grade B or C fistula based on International Study Group on Pancreatic Surgery criteria were considered clinically relevant. All patients had surgery from 2003 to 2016 in the retrospective, multinational study.
“This represents the only series of high-risk cases where current international standards were used to define both the risk and the outcome,” he noted.
“Almost all [of the 522] patients had a soft gland and a small duct, a median of 2 mm,” Dr. Ecker added. “High-risk pathology was common, in 86%.”
Surgeons contributing to the series were at high-volume centers and had performed more than 200 Whipple procedures in their careers. “Both institutional and surgeon volume were associated with improved fistula outcomes,” Dr. Ecker said. “We found that intraperitoneal drains were not associated with improved fistula outcomes, but that is limited by the fact that drains were rarely omitted in these cases.”
Four strategies compared
The investigators compared the outcomes of four fistula strategies among the patients considered high risk prior to surgery. When they combined pancreaticogastrostomy, prophylactic octreotide, and no stent, the CR-POPF rate was 47%. “This was associated with an alarming fistula rate approaching 50%,” Dr. Ecker said.
When surgeons combined pancreaticojejunostomy, octreotide, and no stent, the CR-POPF rate declined to 34%. Furthermore, pancreaticojejunostomy without octreotide or a stent yielded a 26% CR-POPF rate.
Ultimately, the most effective strategy to avoid clinically relevant fistula was pancreaticojejunostomy with an external stent and no octreotide.
“The use of PJ reconstruction with an external stent and omission of octreotide was associated with a fistula rate of about 13%, which was a greater than 50% risk reduction from the overall cohort,” Dr. Ecker said.
The researchers also performed propensity score matching to reduce bias associated with surgeon or patient factors. They matched 167 participants in the study with 155 controls. Dr. Ecker said, “Still, we observed that patients managed this way had significantly lower fistula rates.”
“This is an excellent paper and an important topic,” said study discussant Michael L. Kendrick, MD, a general surgeon at the Mayo Clinic in Rochester, Minn.
“At our institution, we’ve used the same Fistula Risk Score and found it very helpful for a mitigation strategy in a separate protocol, and we found that reduced our leak rates as well,” Dr. Kendrick noted.
Dr. Ecker and Dr. Kendrick had no relevant disclosures.
MIAMI BEACH – Pancreaticojejunostomy reconstruction, use of stents, and avoidance of prophylactic octreotide, especially in combination, could reduce the fistula rate associated with pancreatoduodenectomy.
Failure of the anastomosis is “of greatest concern” to surgeons performing a pancreatoduodenectomy, said Brett L. Ecker, MD, a surgical resident at the University of Pennsylvania, Philadelphia.
“There is no shortage of high-quality data to help guide the use of [fistula reduction] strategies,” he added. However, “the utility of these strategies in patients most vulnerable to fistula … has rarely been particularly explored.”
Dr. Ecker and his colleagues conducted a study with 62 surgeons at 17 institutions to compare various fistula mitigation strategies in this higher-risk population. They assessed surgical reconstruction, dunking, tissue patches, intraperitoneal drains, stents, prophylactic octreotide, and use of tissue sealants.
“Ultimately, we want to know the best way to deal with this high-stakes situation, and whether outcomes might be optimized by bundling these proactive strategies,” Dr. Ecker explained.
“We found the combination of externalized stents and PJ [pancreaticojejunostomy] reconstruction with the omission of prophylactic octreotide was associated with significant improvements in fistula that exceeded the benefit of any individual mitigation approach or any other combination of strategies,” he said at the annual meeting of the Americas Hepato-Pancreato-Biliary Association.
“The mitigation of risk in real-life practice is often the result of multiple moving parts,” Dr. Ecker said. “The best outcomes [may result from] the synergistic effects of multiple strategies.”
Of the approximately 10% of patients with a Fistula Risk Score of 7-10, 152 ended up with clinically relevant postoperative pancreatic fistula (CR-POPF). “An FRS score of 7 or higher is associated with worse outcomes, including a fistula rate approaching 30%,” Dr. Ecker said. Grade B or C fistula based on International Study Group on Pancreatic Surgery criteria were considered clinically relevant. All patients had surgery from 2003 to 2016 in the retrospective, multinational study.
“This represents the only series of high-risk cases where current international standards were used to define both the risk and the outcome,” he noted.
“Almost all [of the 522] patients had a soft gland and a small duct, a median of 2 mm,” Dr. Ecker added. “High-risk pathology was common, in 86%.”
Surgeons contributing to the series were at high-volume centers and had performed more than 200 Whipple procedures in their careers. “Both institutional and surgeon volume were associated with improved fistula outcomes,” Dr. Ecker said. “We found that intraperitoneal drains were not associated with improved fistula outcomes, but that is limited by the fact that drains were rarely omitted in these cases.”
Four strategies compared
The investigators compared the outcomes of four fistula strategies among the patients considered high risk prior to surgery. When they combined pancreaticogastrostomy, prophylactic octreotide, and no stent, the CR-POPF rate was 47%. “This was associated with an alarming fistula rate approaching 50%,” Dr. Ecker said.
When surgeons combined pancreaticojejunostomy, octreotide, and no stent, the CR-POPF rate declined to 34%. Furthermore, pancreaticojejunostomy without octreotide or a stent yielded a 26% CR-POPF rate.
Ultimately, the most effective strategy to avoid clinically relevant fistula was pancreaticojejunostomy with an external stent and no octreotide.
“The use of PJ reconstruction with an external stent and omission of octreotide was associated with a fistula rate of about 13%, which was a greater than 50% risk reduction from the overall cohort,” Dr. Ecker said.
The researchers also performed propensity score matching to reduce bias associated with surgeon or patient factors. They matched 167 participants in the study with 155 controls. Dr. Ecker said, “Still, we observed that patients managed this way had significantly lower fistula rates.”
“This is an excellent paper and an important topic,” said study discussant Michael L. Kendrick, MD, a general surgeon at the Mayo Clinic in Rochester, Minn.
“At our institution, we’ve used the same Fistula Risk Score and found it very helpful for a mitigation strategy in a separate protocol, and we found that reduced our leak rates as well,” Dr. Kendrick noted.
Dr. Ecker and Dr. Kendrick had no relevant disclosures.
AT AHPBA 2017
Key clinical point: Reconstruction, use of stents, and avoidance of octreotide, especially in combination, could reduce the fistula rate associated with pancreatoduodenectomy.
Major finding: The incidence of fistula decreased from 33% to 13% by combining the three strategies.
Data source: Multicenter retrospective study from 2003 to 2016 with 522 patients undergoing pancreatoduodenectomy.
Disclosures: Dr. Ecker and Dr. Kendrick had no relevant disclosures.
The psychiatric care system of the future
Yogi Berra once said, “It’s tough to make predictions, especially about the future.” It is particularly difficult to talk about the future of psychiatric care and the profession of psychiatry given the current state of affairs and the dysfunction of the mental health services system in America today.
The current system is broken. Needs are not being met. Care is underfunded and uncoordinated. Patients fall through the cracks and are criminalized or homeless. And although there are some early signs of reform, such as the push for integration of psychiatry in medical care systems, it is unclear with the potential repeal of the Affordable Care Act and the undoing of parity whether the situation for our patients and the profession might get even worse.
In the year 2067, most physicians will be employees of one out of four major health care nonprofit corporations that are vertically or horizontally integrated systems of care. All Americans will be enrolled through a government-financed universal single payer plan of care, as employer-based health insurance will have disappeared for the last 25 years. Americans will choose which of the four health systems they wish to join during an annual open season and be able to select their primary and specialty care physicians. Many of the services provided will be in the home or workplace through broad and interactive computing and telemedicine capacity and high-tech centers. Hospitals will provide sophisticated gene therapy, organ transplantation, and biomedical engineering. Approximately 30% of the gross national product will be spent on health care.
Americans will live to an average age of 125 years, but it would not be unusual to find some individuals living to age 150. These Americans will have had many of their organs replaced by either genetically programmed animal organs or harvested organs from special banks. However, the brain is the only irreplaceable organ, and psychiatrists will be prominently involved in the interface of brain and behavior as they have been for the past 200 years.
In the year 2067, an expanded specialty of psychiatric physicians will be certified in one of four major categories of practice. Those certifications will be in neuroscience, medical psychiatry, psychotherapy, and social psychiatry.
The neuroscience psychiatrists will combine an MD with a PhD, and will be the most highly technical and specialized and the most highly compensated psychiatrists. They will be the clinician scientists. The neuroscience psychiatrist will be an expert on the human genome, sophisticated brain imaging and mapping, and the differential use of a variety of neurochemicals, as well as the application of technology such as magnetic fields for the treatment of mental illness and direct intervention into the brain with psychosurgery.
The medical psychiatrists will most resemble the early 21st century psychiatrists with subspecialties in geriatrics, adult, child and adolescent, and substance use. The medical psychiatrists will be integrated with other medical colleagues in many ambulatory as well as residential settings. Geriatrics will be the specialty for the treatment of the very old working with the neuroscience psychiatrist in the treatment of dementias and similarly, the child psychiatrist will work with the neuroscience psychiatrists in early preventive interventions at the intrauterine level with genetic abnormalities being corrected before birth. The medical psychiatrist will be a very popular area for all physicians, with more than 20% of all medical graduates specializing in medical psychiatry.
The psychotherapy psychiatrists will combine the MD degree with psychology education, religion, and the humanities. This psychotherapist will work one to one and in group settings on the age-old problems of individuation, separation, grief, loss, insight, and self-actualization.
The social psychiatrists will combine the MD degree with a degree in sociology or criminology and/or a law degree. They will focus on the social control issues of the day. Forensic prisons will be an area of government-sponsored treatment and will dominate the criminal justice system with interventions in an effort to reduce criminal behavior.
Managed care will not exist 50 years from now. It will be perceived as a regrettable experiment of the late 20th century ending in the first part of the 21st century. With the enactment of a universal single payer system of care, the high-cost intrusive middle management of carve-out behavioral health care companies will become moot.
Human progress comes in many forms. By the year 2067, psychiatry will have made significant advances that will make the prior 200 years of psychiatric care seem crude, quaint, and absurd.
Dr. Sharfstein, a past president of the American Psychiatric Association, is president emeritus of the Sheppard Pratt Health System, Baltimore. This essay is based on a presentation he made in February 2017 at the annual meeting of the American College of Psychiatrists in Scottsdale, Ariz.
Yogi Berra once said, “It’s tough to make predictions, especially about the future.” It is particularly difficult to talk about the future of psychiatric care and the profession of psychiatry given the current state of affairs and the dysfunction of the mental health services system in America today.
The current system is broken. Needs are not being met. Care is underfunded and uncoordinated. Patients fall through the cracks and are criminalized or homeless. And although there are some early signs of reform, such as the push for integration of psychiatry in medical care systems, it is unclear with the potential repeal of the Affordable Care Act and the undoing of parity whether the situation for our patients and the profession might get even worse.
In the year 2067, most physicians will be employees of one out of four major health care nonprofit corporations that are vertically or horizontally integrated systems of care. All Americans will be enrolled through a government-financed universal single payer plan of care, as employer-based health insurance will have disappeared for the last 25 years. Americans will choose which of the four health systems they wish to join during an annual open season and be able to select their primary and specialty care physicians. Many of the services provided will be in the home or workplace through broad and interactive computing and telemedicine capacity and high-tech centers. Hospitals will provide sophisticated gene therapy, organ transplantation, and biomedical engineering. Approximately 30% of the gross national product will be spent on health care.
Americans will live to an average age of 125 years, but it would not be unusual to find some individuals living to age 150. These Americans will have had many of their organs replaced by either genetically programmed animal organs or harvested organs from special banks. However, the brain is the only irreplaceable organ, and psychiatrists will be prominently involved in the interface of brain and behavior as they have been for the past 200 years.
In the year 2067, an expanded specialty of psychiatric physicians will be certified in one of four major categories of practice. Those certifications will be in neuroscience, medical psychiatry, psychotherapy, and social psychiatry.
The neuroscience psychiatrists will combine an MD with a PhD, and will be the most highly technical and specialized and the most highly compensated psychiatrists. They will be the clinician scientists. The neuroscience psychiatrist will be an expert on the human genome, sophisticated brain imaging and mapping, and the differential use of a variety of neurochemicals, as well as the application of technology such as magnetic fields for the treatment of mental illness and direct intervention into the brain with psychosurgery.
The medical psychiatrists will most resemble the early 21st century psychiatrists with subspecialties in geriatrics, adult, child and adolescent, and substance use. The medical psychiatrists will be integrated with other medical colleagues in many ambulatory as well as residential settings. Geriatrics will be the specialty for the treatment of the very old working with the neuroscience psychiatrist in the treatment of dementias and similarly, the child psychiatrist will work with the neuroscience psychiatrists in early preventive interventions at the intrauterine level with genetic abnormalities being corrected before birth. The medical psychiatrist will be a very popular area for all physicians, with more than 20% of all medical graduates specializing in medical psychiatry.
The psychotherapy psychiatrists will combine the MD degree with psychology education, religion, and the humanities. This psychotherapist will work one to one and in group settings on the age-old problems of individuation, separation, grief, loss, insight, and self-actualization.
The social psychiatrists will combine the MD degree with a degree in sociology or criminology and/or a law degree. They will focus on the social control issues of the day. Forensic prisons will be an area of government-sponsored treatment and will dominate the criminal justice system with interventions in an effort to reduce criminal behavior.
Managed care will not exist 50 years from now. It will be perceived as a regrettable experiment of the late 20th century ending in the first part of the 21st century. With the enactment of a universal single payer system of care, the high-cost intrusive middle management of carve-out behavioral health care companies will become moot.
Human progress comes in many forms. By the year 2067, psychiatry will have made significant advances that will make the prior 200 years of psychiatric care seem crude, quaint, and absurd.
Dr. Sharfstein, a past president of the American Psychiatric Association, is president emeritus of the Sheppard Pratt Health System, Baltimore. This essay is based on a presentation he made in February 2017 at the annual meeting of the American College of Psychiatrists in Scottsdale, Ariz.
Yogi Berra once said, “It’s tough to make predictions, especially about the future.” It is particularly difficult to talk about the future of psychiatric care and the profession of psychiatry given the current state of affairs and the dysfunction of the mental health services system in America today.
The current system is broken. Needs are not being met. Care is underfunded and uncoordinated. Patients fall through the cracks and are criminalized or homeless. And although there are some early signs of reform, such as the push for integration of psychiatry in medical care systems, it is unclear with the potential repeal of the Affordable Care Act and the undoing of parity whether the situation for our patients and the profession might get even worse.
In the year 2067, most physicians will be employees of one out of four major health care nonprofit corporations that are vertically or horizontally integrated systems of care. All Americans will be enrolled through a government-financed universal single payer plan of care, as employer-based health insurance will have disappeared for the last 25 years. Americans will choose which of the four health systems they wish to join during an annual open season and be able to select their primary and specialty care physicians. Many of the services provided will be in the home or workplace through broad and interactive computing and telemedicine capacity and high-tech centers. Hospitals will provide sophisticated gene therapy, organ transplantation, and biomedical engineering. Approximately 30% of the gross national product will be spent on health care.
Americans will live to an average age of 125 years, but it would not be unusual to find some individuals living to age 150. These Americans will have had many of their organs replaced by either genetically programmed animal organs or harvested organs from special banks. However, the brain is the only irreplaceable organ, and psychiatrists will be prominently involved in the interface of brain and behavior as they have been for the past 200 years.
In the year 2067, an expanded specialty of psychiatric physicians will be certified in one of four major categories of practice. Those certifications will be in neuroscience, medical psychiatry, psychotherapy, and social psychiatry.
The neuroscience psychiatrists will combine an MD with a PhD, and will be the most highly technical and specialized and the most highly compensated psychiatrists. They will be the clinician scientists. The neuroscience psychiatrist will be an expert on the human genome, sophisticated brain imaging and mapping, and the differential use of a variety of neurochemicals, as well as the application of technology such as magnetic fields for the treatment of mental illness and direct intervention into the brain with psychosurgery.
The medical psychiatrists will most resemble the early 21st century psychiatrists with subspecialties in geriatrics, adult, child and adolescent, and substance use. The medical psychiatrists will be integrated with other medical colleagues in many ambulatory as well as residential settings. Geriatrics will be the specialty for the treatment of the very old working with the neuroscience psychiatrist in the treatment of dementias and similarly, the child psychiatrist will work with the neuroscience psychiatrists in early preventive interventions at the intrauterine level with genetic abnormalities being corrected before birth. The medical psychiatrist will be a very popular area for all physicians, with more than 20% of all medical graduates specializing in medical psychiatry.
The psychotherapy psychiatrists will combine the MD degree with psychology education, religion, and the humanities. This psychotherapist will work one to one and in group settings on the age-old problems of individuation, separation, grief, loss, insight, and self-actualization.
The social psychiatrists will combine the MD degree with a degree in sociology or criminology and/or a law degree. They will focus on the social control issues of the day. Forensic prisons will be an area of government-sponsored treatment and will dominate the criminal justice system with interventions in an effort to reduce criminal behavior.
Managed care will not exist 50 years from now. It will be perceived as a regrettable experiment of the late 20th century ending in the first part of the 21st century. With the enactment of a universal single payer system of care, the high-cost intrusive middle management of carve-out behavioral health care companies will become moot.
Human progress comes in many forms. By the year 2067, psychiatry will have made significant advances that will make the prior 200 years of psychiatric care seem crude, quaint, and absurd.
Dr. Sharfstein, a past president of the American Psychiatric Association, is president emeritus of the Sheppard Pratt Health System, Baltimore. This essay is based on a presentation he made in February 2017 at the annual meeting of the American College of Psychiatrists in Scottsdale, Ariz.
Waldenström macroglobulinemia panel advises on IgM paraproteinemic neuropathies
With optimal approaches still evolving for the diagnosis and management of peripheral neuropathies associated with Waldenström macroglobulinemia and other IgM paraproteinemias, new consensus recommendations from a multidisciplinary panel were recently published in the British Journal of Haematology.
Up to half of patients with IgM monoclonal gammopathies develop peripheral neuropathy, according to the 11-member panel (Br J Haematol. 2017 Mar;176[5]:728-42). The panel began deliberations at the eighth International Workshop on Waldenström Macroglobulinemia in London and was led by Shirley D’Sa, MD, of the Waldenström Clinic, Cancer Division, University College London Hospitals NHS Foundation Trust.
• Diagnostic evaluation: “The indications for invasive investigations such as cerebrospinal fluid analysis, nerve conduction tests, and sensory nerve biopsies are unclear,” according to the panelists.
When clinical examination identifies a neuropathy, neurophysiologic testing can ascertain its nature and inform additional work-up. Cerebrospinal fluid examination is not mandatory in cases of demyelinating neuropathy, but it is indicated when clinical evaluation is inconclusive and malignancy or CNS invasion is suspected.
Nerve biopsy carries substantial risk and is rarely indicated. It may be warranted when a comprehensive systemic work-up has not identified a cause and clinicians still suspect amyloid, vasculitis, or direct cellular invasion; in atypical cases not responding to treatment; or when the neuropathy is progressive and debilitating.
When it comes to imaging, “MRI of the neuraxis should be performed prior to lumbar puncture to avoid false positive meningeal enhancement,” they advised. “Prior discussion of likely sites of involvement with an experienced neuroradiologist will ensure that the correct sequences of the correct anatomical area are performed with appropriate gadolinium enhancement.”
• Clinical phenotypes and their treatment: IgM-associated neuropathies vary with respect to specific antibodies present and the likelihood that they are causally associated with the neuropathy, Dr. D’Sa and her colleagues noted. They provided a decision tree to help guide the work-up to determine the specific etiology.
“The presence of a neuropathy alone is not a justification for treatment, but steady progression with accumulating disability should prompt action,” they maintained.
Patients with antibody-negative peripheral neuropathy associated with IgM monoclonal gammopathies of undetermined significance who have mild disease and no hematologic reason for treatment can be managed with surveillance, according to the panelists.
However, immunosuppressive or immunomodulatory treatment should be considered when there is substantial or progressive disability associated with demyelination.
Patients with anti-MAG (myelin-associated glycoprotein) demyelinating neuropathy may benefit from rituximab (Rituxan). In those with more advanced disease, clinicians should consider immunosuppressive or immunomodulatory treatment instead.
Surveillance is also an option for Waldenström macroglobulinemia–associated peripheral neuropathy that is progressing slowly. When used, treatment should be tailored to severity of both systemic and neurologic disease.
• Treatment response assessment: “The optimum way to measure clinical response to treatment unknown,” Dr. D’Sa and her fellow panelists noted. A variety of measures of muscle strength, sensory function, and disability are used.
“The I-RODS [Inflammatory Rasch-Built Overall Disability Scale] more often captures clinically meaningful changes over time, with a greater magnitude of change, compared with the INCAT-ONLS [Inflammatory Neuropathy Cause and Treatment–Overall Neuropathy Limitation Scale] disability scale and its use is therefore suggested in future trials involving patients with inflammatory neuropathies,” they wrote.
• Model of care: Management of patients with IgM-associated neuropathies requires multidisciplinary care with good collaboration to optimize patient outcomes, the consensus panel said.
“A suggested model of care is a combined neurological and hematological clinic, in which patients are seen jointly by a specialist neurologist and hematologist and a decision can be made about the sequence of investigations, interventions, and the formulation of a treatment plan,” they proposed. “Appropriate and timely referral to physical, occupational, and orthotic professionals is recommended in order to maximize safety and function.”
• Future perspectives: “There is much to be done to improve outcomes for patients with IgM and [Waldenström macroglobulinemia]-associated peripheral neuropathies,” the panelists concluded.
Key areas of focus are “early recognition of the problem, appropriate causal attribution achieved through sensitive diagnostics that are not overly invasive, timely therapeutic intervention with effective and nonneurotoxic therapies, achievement of an appropriate degree of clonal reduction for optimum clinical outcomes, and the use of reproducible and readily applicable tools to measure outcomes.”
Dr. D’Sa disclosed that she receives honoraria from Janssen.
With optimal approaches still evolving for the diagnosis and management of peripheral neuropathies associated with Waldenström macroglobulinemia and other IgM paraproteinemias, new consensus recommendations from a multidisciplinary panel were recently published in the British Journal of Haematology.
Up to half of patients with IgM monoclonal gammopathies develop peripheral neuropathy, according to the 11-member panel (Br J Haematol. 2017 Mar;176[5]:728-42). The panel began deliberations at the eighth International Workshop on Waldenström Macroglobulinemia in London and was led by Shirley D’Sa, MD, of the Waldenström Clinic, Cancer Division, University College London Hospitals NHS Foundation Trust.
• Diagnostic evaluation: “The indications for invasive investigations such as cerebrospinal fluid analysis, nerve conduction tests, and sensory nerve biopsies are unclear,” according to the panelists.
When clinical examination identifies a neuropathy, neurophysiologic testing can ascertain its nature and inform additional work-up. Cerebrospinal fluid examination is not mandatory in cases of demyelinating neuropathy, but it is indicated when clinical evaluation is inconclusive and malignancy or CNS invasion is suspected.
Nerve biopsy carries substantial risk and is rarely indicated. It may be warranted when a comprehensive systemic work-up has not identified a cause and clinicians still suspect amyloid, vasculitis, or direct cellular invasion; in atypical cases not responding to treatment; or when the neuropathy is progressive and debilitating.
When it comes to imaging, “MRI of the neuraxis should be performed prior to lumbar puncture to avoid false positive meningeal enhancement,” they advised. “Prior discussion of likely sites of involvement with an experienced neuroradiologist will ensure that the correct sequences of the correct anatomical area are performed with appropriate gadolinium enhancement.”
• Clinical phenotypes and their treatment: IgM-associated neuropathies vary with respect to specific antibodies present and the likelihood that they are causally associated with the neuropathy, Dr. D’Sa and her colleagues noted. They provided a decision tree to help guide the work-up to determine the specific etiology.
“The presence of a neuropathy alone is not a justification for treatment, but steady progression with accumulating disability should prompt action,” they maintained.
Patients with antibody-negative peripheral neuropathy associated with IgM monoclonal gammopathies of undetermined significance who have mild disease and no hematologic reason for treatment can be managed with surveillance, according to the panelists.
However, immunosuppressive or immunomodulatory treatment should be considered when there is substantial or progressive disability associated with demyelination.
Patients with anti-MAG (myelin-associated glycoprotein) demyelinating neuropathy may benefit from rituximab (Rituxan). In those with more advanced disease, clinicians should consider immunosuppressive or immunomodulatory treatment instead.
Surveillance is also an option for Waldenström macroglobulinemia–associated peripheral neuropathy that is progressing slowly. When used, treatment should be tailored to severity of both systemic and neurologic disease.
• Treatment response assessment: “The optimum way to measure clinical response to treatment unknown,” Dr. D’Sa and her fellow panelists noted. A variety of measures of muscle strength, sensory function, and disability are used.
“The I-RODS [Inflammatory Rasch-Built Overall Disability Scale] more often captures clinically meaningful changes over time, with a greater magnitude of change, compared with the INCAT-ONLS [Inflammatory Neuropathy Cause and Treatment–Overall Neuropathy Limitation Scale] disability scale and its use is therefore suggested in future trials involving patients with inflammatory neuropathies,” they wrote.
• Model of care: Management of patients with IgM-associated neuropathies requires multidisciplinary care with good collaboration to optimize patient outcomes, the consensus panel said.
“A suggested model of care is a combined neurological and hematological clinic, in which patients are seen jointly by a specialist neurologist and hematologist and a decision can be made about the sequence of investigations, interventions, and the formulation of a treatment plan,” they proposed. “Appropriate and timely referral to physical, occupational, and orthotic professionals is recommended in order to maximize safety and function.”
• Future perspectives: “There is much to be done to improve outcomes for patients with IgM and [Waldenström macroglobulinemia]-associated peripheral neuropathies,” the panelists concluded.
Key areas of focus are “early recognition of the problem, appropriate causal attribution achieved through sensitive diagnostics that are not overly invasive, timely therapeutic intervention with effective and nonneurotoxic therapies, achievement of an appropriate degree of clonal reduction for optimum clinical outcomes, and the use of reproducible and readily applicable tools to measure outcomes.”
Dr. D’Sa disclosed that she receives honoraria from Janssen.
With optimal approaches still evolving for the diagnosis and management of peripheral neuropathies associated with Waldenström macroglobulinemia and other IgM paraproteinemias, new consensus recommendations from a multidisciplinary panel were recently published in the British Journal of Haematology.
Up to half of patients with IgM monoclonal gammopathies develop peripheral neuropathy, according to the 11-member panel (Br J Haematol. 2017 Mar;176[5]:728-42). The panel began deliberations at the eighth International Workshop on Waldenström Macroglobulinemia in London and was led by Shirley D’Sa, MD, of the Waldenström Clinic, Cancer Division, University College London Hospitals NHS Foundation Trust.
• Diagnostic evaluation: “The indications for invasive investigations such as cerebrospinal fluid analysis, nerve conduction tests, and sensory nerve biopsies are unclear,” according to the panelists.
When clinical examination identifies a neuropathy, neurophysiologic testing can ascertain its nature and inform additional work-up. Cerebrospinal fluid examination is not mandatory in cases of demyelinating neuropathy, but it is indicated when clinical evaluation is inconclusive and malignancy or CNS invasion is suspected.
Nerve biopsy carries substantial risk and is rarely indicated. It may be warranted when a comprehensive systemic work-up has not identified a cause and clinicians still suspect amyloid, vasculitis, or direct cellular invasion; in atypical cases not responding to treatment; or when the neuropathy is progressive and debilitating.
When it comes to imaging, “MRI of the neuraxis should be performed prior to lumbar puncture to avoid false positive meningeal enhancement,” they advised. “Prior discussion of likely sites of involvement with an experienced neuroradiologist will ensure that the correct sequences of the correct anatomical area are performed with appropriate gadolinium enhancement.”
• Clinical phenotypes and their treatment: IgM-associated neuropathies vary with respect to specific antibodies present and the likelihood that they are causally associated with the neuropathy, Dr. D’Sa and her colleagues noted. They provided a decision tree to help guide the work-up to determine the specific etiology.
“The presence of a neuropathy alone is not a justification for treatment, but steady progression with accumulating disability should prompt action,” they maintained.
Patients with antibody-negative peripheral neuropathy associated with IgM monoclonal gammopathies of undetermined significance who have mild disease and no hematologic reason for treatment can be managed with surveillance, according to the panelists.
However, immunosuppressive or immunomodulatory treatment should be considered when there is substantial or progressive disability associated with demyelination.
Patients with anti-MAG (myelin-associated glycoprotein) demyelinating neuropathy may benefit from rituximab (Rituxan). In those with more advanced disease, clinicians should consider immunosuppressive or immunomodulatory treatment instead.
Surveillance is also an option for Waldenström macroglobulinemia–associated peripheral neuropathy that is progressing slowly. When used, treatment should be tailored to severity of both systemic and neurologic disease.
• Treatment response assessment: “The optimum way to measure clinical response to treatment unknown,” Dr. D’Sa and her fellow panelists noted. A variety of measures of muscle strength, sensory function, and disability are used.
“The I-RODS [Inflammatory Rasch-Built Overall Disability Scale] more often captures clinically meaningful changes over time, with a greater magnitude of change, compared with the INCAT-ONLS [Inflammatory Neuropathy Cause and Treatment–Overall Neuropathy Limitation Scale] disability scale and its use is therefore suggested in future trials involving patients with inflammatory neuropathies,” they wrote.
• Model of care: Management of patients with IgM-associated neuropathies requires multidisciplinary care with good collaboration to optimize patient outcomes, the consensus panel said.
“A suggested model of care is a combined neurological and hematological clinic, in which patients are seen jointly by a specialist neurologist and hematologist and a decision can be made about the sequence of investigations, interventions, and the formulation of a treatment plan,” they proposed. “Appropriate and timely referral to physical, occupational, and orthotic professionals is recommended in order to maximize safety and function.”
• Future perspectives: “There is much to be done to improve outcomes for patients with IgM and [Waldenström macroglobulinemia]-associated peripheral neuropathies,” the panelists concluded.
Key areas of focus are “early recognition of the problem, appropriate causal attribution achieved through sensitive diagnostics that are not overly invasive, timely therapeutic intervention with effective and nonneurotoxic therapies, achievement of an appropriate degree of clonal reduction for optimum clinical outcomes, and the use of reproducible and readily applicable tools to measure outcomes.”
Dr. D’Sa disclosed that she receives honoraria from Janssen.
FROM THE BRITISH JOURNAL OF HAEMATOLOGY
Key clinical point:
Major finding: The indications for invasive testing and definitive answers about when and how to treat peripheral neuropathies due to Waldenström macroglobulinemia and other IgM paraproteinemias are unclear.
Data source: Recommendations from the eighth International Workshop on Waldenström Macroglobulinemia (IWWM-8) consensus panel.
Disclosures: Dr. D’Sa disclosed that she receives honoraria from Janssen.
SHM receives Eisenberg Award as part of I-PASS Study Group
The Society of Hospital Medicine is part of a patient safety research group that received the prestigious 2016 John M. Eisenberg Award for Innovation in Patient Safety and Quality presented annually by The Joint Commission and the National Quality Forum, two leading organizations that set standards in patient care as part of the I-PASS Study Group.
I-PASS comprises a suite of educational materials and interventions dedicated to improving patient safety by reducing miscommunication during patient handoffs that can lead to harmful medical errors. The team in SHM’s Center for Quality Improvement has been instrumental in supporting the I-PASS Study Group, which represents more than 50 hospitals from across North America.
“The Eisenberg Award for Innovation represents the highest patient safety and quality award in the country, and we are honored to be recognized for our role in this important program,” said Jenna Goldstein, director of SHM’s Center for Quality Improvement. “Our team’s participation in developing and sustaining the SHM I-PASS mentored implementation demonstrates our commitment to ensure safe and high-quality care for hospitalized patients.”
SHM previously won the 2011 Eisenberg Award at the national level for its mentored implementation program model. Through its mentored implementation framework and project management, SHM has supported the I-PASS program across the country at 32 hospitals of varying types, including pediatric and adult hospitals, academic medical centers, and community-based hospitals. SHM has offered both an I-PASS mentored implementation program, in which a physician mentor coaches hospital team members on evidence-based best practices in process improvement and culture change for safe patient handoffs, and an implementation guide, which contains strategies and tools needed to lead the quality improvement effort in the hospital.
In a large multicenter study published in the New England Journal of Medicine, implementation of I-PASS was associated with a 30% reduction in medical errors that harm patients. An estimated 80% of the most serious medical errors can be linked to communication failures, particularly during patient handoffs.
In addition to its work with I-PASS, SHM’s Center for Quality Improvement plays a prominent role in developing tools that empower clinicians to lead quality improvement efforts in their institutions.
Brett Radler is SHM’s communications specialist.
The Society of Hospital Medicine is part of a patient safety research group that received the prestigious 2016 John M. Eisenberg Award for Innovation in Patient Safety and Quality presented annually by The Joint Commission and the National Quality Forum, two leading organizations that set standards in patient care as part of the I-PASS Study Group.
I-PASS comprises a suite of educational materials and interventions dedicated to improving patient safety by reducing miscommunication during patient handoffs that can lead to harmful medical errors. The team in SHM’s Center for Quality Improvement has been instrumental in supporting the I-PASS Study Group, which represents more than 50 hospitals from across North America.
“The Eisenberg Award for Innovation represents the highest patient safety and quality award in the country, and we are honored to be recognized for our role in this important program,” said Jenna Goldstein, director of SHM’s Center for Quality Improvement. “Our team’s participation in developing and sustaining the SHM I-PASS mentored implementation demonstrates our commitment to ensure safe and high-quality care for hospitalized patients.”
SHM previously won the 2011 Eisenberg Award at the national level for its mentored implementation program model. Through its mentored implementation framework and project management, SHM has supported the I-PASS program across the country at 32 hospitals of varying types, including pediatric and adult hospitals, academic medical centers, and community-based hospitals. SHM has offered both an I-PASS mentored implementation program, in which a physician mentor coaches hospital team members on evidence-based best practices in process improvement and culture change for safe patient handoffs, and an implementation guide, which contains strategies and tools needed to lead the quality improvement effort in the hospital.
In a large multicenter study published in the New England Journal of Medicine, implementation of I-PASS was associated with a 30% reduction in medical errors that harm patients. An estimated 80% of the most serious medical errors can be linked to communication failures, particularly during patient handoffs.
In addition to its work with I-PASS, SHM’s Center for Quality Improvement plays a prominent role in developing tools that empower clinicians to lead quality improvement efforts in their institutions.
Brett Radler is SHM’s communications specialist.
The Society of Hospital Medicine is part of a patient safety research group that received the prestigious 2016 John M. Eisenberg Award for Innovation in Patient Safety and Quality presented annually by The Joint Commission and the National Quality Forum, two leading organizations that set standards in patient care as part of the I-PASS Study Group.
I-PASS comprises a suite of educational materials and interventions dedicated to improving patient safety by reducing miscommunication during patient handoffs that can lead to harmful medical errors. The team in SHM’s Center for Quality Improvement has been instrumental in supporting the I-PASS Study Group, which represents more than 50 hospitals from across North America.
“The Eisenberg Award for Innovation represents the highest patient safety and quality award in the country, and we are honored to be recognized for our role in this important program,” said Jenna Goldstein, director of SHM’s Center for Quality Improvement. “Our team’s participation in developing and sustaining the SHM I-PASS mentored implementation demonstrates our commitment to ensure safe and high-quality care for hospitalized patients.”
SHM previously won the 2011 Eisenberg Award at the national level for its mentored implementation program model. Through its mentored implementation framework and project management, SHM has supported the I-PASS program across the country at 32 hospitals of varying types, including pediatric and adult hospitals, academic medical centers, and community-based hospitals. SHM has offered both an I-PASS mentored implementation program, in which a physician mentor coaches hospital team members on evidence-based best practices in process improvement and culture change for safe patient handoffs, and an implementation guide, which contains strategies and tools needed to lead the quality improvement effort in the hospital.
In a large multicenter study published in the New England Journal of Medicine, implementation of I-PASS was associated with a 30% reduction in medical errors that harm patients. An estimated 80% of the most serious medical errors can be linked to communication failures, particularly during patient handoffs.
In addition to its work with I-PASS, SHM’s Center for Quality Improvement plays a prominent role in developing tools that empower clinicians to lead quality improvement efforts in their institutions.
Brett Radler is SHM’s communications specialist.