News Release

Effective Clinical Practice, Sept/Oct 2001 Highlights

Peer-Reviewed Publication

American College of Physicians

Effective Clinical Practice, the journal for quality improvement in health care delivery systems, seeks to answer how much, how often, and how best to deliver clinical care. ECP is published by ACP-ASIM, the nation’s largest medical specialty society, and the Alliance of Community Health Plans, which is dedicated to helping participating plans improve the health of their members and their communities. These highlights do not substitute for articles as sources of information. Please request articles by calling 215-351-2655, or by sending an E-mail to Llteer@mail.acponline.org

Cardiologists performing peripheral angioplasties have impact on utilization

A growing number of cardiologists are performing peripheral angioplasty (surgical alteration of an artery) and stent placement (positioning a scaffold-type support) in areas away from the heart, procedures traditionally done by radiologists and surgeons. Researchers studied the 37,000 procedures performed on Medicare patients in 1996. Rates of peripheral angioplasty varied widely, and were highest in regions where cardiologists perform the majority of these procedures (“Cardiologists Performing Peripheral Angioplasties: Impact on Utilization,” p. 191). An editorial on page 221 explores “Increases in Peripheral Interventional Procedures by Cardiologists -- Are Patients or Providers Being Served?”

Nurse staffing in the intensive care unit affects quality of care after surgery

Postsurgical patients in hospital ICUs with nurse-to-patient ratios of 1:1 or 1:2 had fewer serious complications than patients in ICUs with fewer nurses per patient. Patients had abdominal surgery to repair aortic aneurysms. Mortality did not differ between the two groups. The study is based on data from seven Maryland hospitals (“Intensive Care Unit Nurse Staffing and the Risk for Complications after Abdominal Aortic Surgery,” p. 199). An editorial on page 223 asks, “More Nurses, Better Patient Outcomes: Why Isn’t It Obvious?”

Physicians give reasons for not following so-called 'best practices'

Physicians may disregard medical guidelines in light of individual patient considerations. In a descriptive study in which 85 internists voluntarily tracked their care of type II diabetes patients, 24 percent of “best practice” tests and exams were not performed. Physicians commented that some patients had more pressing medical problems, or the guideline did not apply (such as an eye exam in a blind patient). Physician oversight; patient non-adherence (missed appointments, for example) and systems issues (lapses in communication, inadequate insurance) also affected doctors’ ability to comply with guidelines (“Physician Explanations for Failing to Comply with ‘Best Practices’,” p. 207). (Separate news release issued.)

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