NJ c-section raties

At Hackensack University Medical Center, 42% of first-time mothers with low-risk deliveries had a C-section. This worse than the national target of 23.9% and places Hackensack University Medical Center in CR’s bottom Rating category for avoiding C-sections. 

Read more about Consumer Reports c-section Ratings at http://bddy.me/1XygSdm. Photo by @ICAN

source: Facebook, April 14, 2016

C. Diff: Deadly Infection on the Rise in U.S. Hospitals

Consumer Reports' new Ratings show many teaching hospitals fail to prevent this deadly disease

By Hallie Levine
Last updated: March 04, 2016
consumerreports.org

A life-threatening bacterial infection is gaining ground in America’s hospitals, according to a new report from the Centers for Disease Control and Prevention. And a Consumer Reports analysis finds that even some of the nation’s largest and most prestigious medical institutions are having a hard time getting it under control.

The infection, called C. diff (Clostridium difficile) sickened 101,074 hospital patients in 2014, the most recent data available, according to a March report from the CDC. Other research shows that overall about 450,000 people a year, inside and out of hospitals, are sickened by the infection, and it contributes to the death of about 29,000 people.

"New data show that far too many patients are getting infected with dangerous bacteria in healthcare settings,” said CDC director Tom Frieden, M.D. “Doctors and healthcare facilities have the power to protect patients—no one should get sick while trying to get well," he said.

While several serious hospital-acquired infections, such as those caused by central-line catheters, have declined in recent years, C. diff. rates increased by 4 percent between 2013 and 2014, according to the CDC.

And Consumer Reports’ updated Ratings of more than 3,200 hospitals across the country show that many are doing a poor job of reining in the infection. Overall, about a third of them received a low Rating in combating the infection. That means they have C. diff infection rates that are worse than the national benchmark.

That includes 24 of the nation’s largest teaching hospitals, including familiar ones such as Baylor University Medical Center in Dallas, the Cleveland Clinic in Cleveland, Cedars-Sinai Medical Center in Los Angeles, Johns Hopkins Hospital in Baltimore, and Mount Sinai Hospital in New York City. “Teaching hospitals are supposed to be places where we identify the best practices and put them to work,” said Lisa McGiffert, director of Consumer Reports' Safe Patient Project. “But even they seem to be struggling against this infection,” she said.

While about 28 percent of hospitals nationwide earned one of our top two scores in preventing the infection, only four of them were large teaching hospitals: Harris Health System in Houston, Maine Medical Center in Portland, Maimonedes Medical Center in Brooklyn, N.Y., and Mount Sinai St. Luke’s - Mount Sinai West in New York City.

(See the chart below for a complete list of low-scoring large teaching hospitals. And check our free hospital Ratings to see how your local hospitals score on infection prevention for five different types of infections and other key safety measures.)

How C. Diff Spreads

There are two important reasons why C. diff is hard to control in U.S. hospitals.  

First is the misuse of antibiotics in hospitals, said Erik Dubberke, M.D., associate professor of medicine in the Division of Infectious Diseases at Washington University in St. Louis and a spokesman for the Infectious Diseases Society of America. “Those drugs are obviously lifesaving when used appropriately, but they can also make you vulnerable to C. diff,” he said. That’s because those drugs can kill off the “good” bacteria that normally grow in your stomach, allowing bad bacteria, including C. diff, to spread.

About half of all hospitalized patients receive antibiotics during their stay—even though up to 50 percent of such prescriptions are unnecessary or inappropriate, according to the CDC. Particularly worrisome is when patients are given powerful “broad-spectrum” antibiotics, such as ciprofloxacin (Cipro and generic) and levofloxacin (Levaquin and generic), which are meant to act against a variety of disease-causing bacteria at once, instead of drugs that target specific bacteria. That increases the chance of developing C. diff, because those drugs are more likely to kill off the body’s good bacteria along with the bad.

The second reason is poor hygiene. C. diff, which is found in fecal matter, is easily passed from person to person on the hands of healthcare workers—and can survive on door knobs, bed rails, and other surfaces for weeks.

Proper hygiene—including washing hands and, especially, wearing gloves—can cut the spread of the disease. But less than a third of healthcare workers in intensive care units always wash their hands, according to a 2014 University of Iowa study. And a Consumer Reports survey of 1,200 recently hospitalized people found that only about half always saw their doctor or nurse wash their hands.

“Doctors and nurses get busy, and they sometimes simply forget to rewash their hands every time they walk into a new patient’s room,” said Louise-Marie Dembry, M.D., professor of medicine and epidemiology at Yale University and president of the Society for Healthcare Epidemiology of America.

What Hospitals Say

Representatives of some of the low-scoring teaching hospitals in our Ratings say that institutions like theirs face special challenges in combating C. diff.

For example, they may see sicker patients than non-teaching hospitals, said Craig Civale, a spokesman for Baylor University Medical Center. “As a major academic hospital in an urban setting, BUMC routinely admits very complex patients with multiple conditions,” he said. A spokeswoman for Cedars-Sinai Medical Center offered a similar explanation for its hospital's C. diff infection rate, and also notes that it sees an unusually large number of older patients, who are at increased risk of the infection.

Another factor may simply be that teaching hospitals detect more cases of the disease than do other hospitals, because they test and report more carefully, said Lisa Maragakis, M.D., senior director of health care epidemiology and infection control for the Johns Hopkins Health System.

Still, hospital officials acknowledge that C. diff. is a serious problem, and that they are responding by changing their practices. “The results reported by Consumer Reports are disappointing to us,” said a spokeswoman for Mount Sinai Hospital in a statement. Mount Sinai also said that it has recently established a task force to look into the hospital’s infection rates, and is investigating “evidence-based practices targeted to reduce all healthcare-associated infections.”

At Baylor, the hospital is developing new protocols to ensure that antibiotics are prescribed appropriately, Civale said. Johns Hopkins is taking similar steps, and is also instituting “rigorous hand hygiene and environmental cleaning initiatives,” Maragakis said. In addition to to those steps, Cedars-Sinai now tests all patients with diarrhea for C. diff, a spokeswoman for the hospital said. And in a statement to Consumer Reports, the Cleveland Clinic noted that the hospital is “committed to continuous improvement in quality and safety.”

What You Can Do

If you (or family members or friends) are in the hospital, here’s what you can do to reduce your risk of developing a C. diff infection:

• Make sure you really need that antibiotic. If your doctor wants to give you an antibiotic, ask why. If he suspects an infection, he should do a rapid culture, if possible, to quickly pinpoint the possible bacteria so that he can prescribe the most effective antibiotic at the lowest dose. 
• Watch out for heartburn drugs. Hospital patients are sometimes prescribed heartburn drugs called proton-pump inhibitors such as omeprazole (Prilosec and generic) and esomeprazole (Nexium and generic) to ease stomach pain. But those medications can also increase the risk of C. diff infections taking hold in your stomach. So if your doctor suggests you take one of those drugs while in the hospital, ask why. 
• Insist on hand-washing and gloves. Ask everyone who walks into your room whether they’ve washed their hands—if they’re doing it at your sink, make sure they scrub for 40 to 60 seconds. Also check that they are wearing gloves. Rubbing on alcohol-based hand sanitizer is not strong enough to destroy C. diff, Dembry said. 
• Ask about the hospital’s protective measure: Hospitals should order a C. diff test for any patient who has diarrhea (three loose stools within 24 hours), said the CDC. Anyone with diagnosed C. diff should be put in a single room, and healthcare providers should wear gloves and gowns when treating that patient.

Consumer Report's Hospital Ratings Receive National Attention

Consumer Reports released their most recent analysis of hospital infection data last week showing that many well-known teaching hospitals are performing poorly in CR's Ratings and putting patients at risk. (Their hospital Ratings are now free to all consumers.) CR released the story in conjunction with a CDC press conference about antibiotic resistance, which included Tom Frieden, M.D., CDC director, and Peter Pronovost, M.D., from Johns Hopkins Hospital. CR's timely and relevant content was referenced in the first question from the media when an NBC News reporter asked about Johns Hopkins' low score in preventing the hospital-acquired infection, C. diff. This story is part of CR's ongoing hospital safety coverage.

Prestigious Healthcare Experts Join OpenNotes Movement

John is an amazing doctor. I had the pleasure of working with John during his tenure at Consumer Reports Health Ratings Center. He made a difference for consumers while at CR and he will definitely continue to make a huge difference in the OpenNotes movement. As the article states “He is a prestigious healthcare expert” but more importantly, he is a darn good man! 

Reprinted from Boston CityBizList / February 24, 2016


National health care leaders, John Santa, MD, MPH, Homer Chin, MD, MS, and Amy Fellows, MPH, have joined the OpenNotes team. The three bring decades of expertise in information technology and population health to the expanding OpenNotes movement.

OpenNotes is a national initiative that urges health care institutions and clinicians to offer patients ready access to notes written by providers after a medical visit. Evidence shows that this type of transparency in health care leads to more active patient engagement, with patients reporting far more control of their own health and healthcare.

In the three years since the results of an initial OpenNotes study were published, the number of patients with ready access to their notes has grown from 20,000 to more than five million. The goal now is to expand open access to notes so that this new practice becomes the national standard of care.

"These three, outstanding individuals bring to OpenNotes considerable healthcare industry and IT expertise, along with vital clinical and consumer perspectives," said Tom Delbanco, MD, co-founder of OpenNotes and Koplow–Tullis Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center.

John Santa, MD, MPH, Director of Dissemination for OpenNotes, will take a vital leadership role in bringing the OpenNotes movement to clinical sites throughout the country.

Santa has more than 40 years of experience in clinical medicine and administration, having worked in leadership positions for hospitals, physician groups, insurers, state government, and consumer organizations. Drawing on his expertise in national rollouts of healthcare initiatives, he initiated the Northwest OpenNotes Consortium, whose members now offer more than a million patients access to their notes.

Before joining OpenNotes, Santa was Medical Director for the Drug Effectiveness Review Project, one of the country's most robust comparative effectiveness programs, as well as the Director of the Health Ratings Center at Consumer Reports from 2008 to 2014. The Ratings Center focuses on explicit approaches for evaluating and comparing health services, products, institutions, and practitioners. He is a board member and Treasurer of the National Physicians Alliance and a resident of Oregon.

"Transparency was my top priority in clinical practice and at Consumer Reports. I am thrilled to be part of a movement that brings that to millions of individual patients," said Santa. "If you're healthy, clinician notes are interesting, educating, and help you set priorities. But, if you're sick and want to be a full-fledged member of your own health care team, easy access to clinician notes is a game changer."

Homer Chin, MD, MS, will lead efforts to integrate Health Information Technology further with OpenNotes. He has extensive knowledge of medical informatics and electronic health systems and will work closely with electronic health record vendors, helping them to develop sophisticated methods for supporting OpenNotes.

Chin is an Affiliate Professor in the Department of Medical Informatics and Outcomes Research at the Oregon Health and Science University and a member of the board of OCHIN, a not-for-profit organization that provides information and management services to safety-net clinics in support of the medically underserved.

Chin was previously the Associate Medical Director for Medical Informatics at Kaiser Permanente Northwest, where he pioneered efforts to implement an award-winning comprehensive computer-based outpatient record.

"With the advent of the electronic health record it becomes much easier to share notes among providers, and as a logical extension, with patients. In light of the many benefits of doing so, it is time that we engage and empower patients by providing them easy access to their own medical information," said Chin. "We also have opportunities to work with EHR developers to enhance the patient experience and make it easier for them to interact with notes."

Amy Fellows, MPH, joins OpenNotes to focus on Community Health Programs, with particular attention to individuals who are medically underserved. She brings considerable experience in working to introduce electronic health records to the increasing number of vulnerable populations served by the OpenNotes movement.

Fellows is the Executive Director of We Can Do Better, a non-profit organization dedicated to creating opportunities for education and engagement, bringing people together who share the values of better health care and health for all. Under Fellow's leadership, We Can Do Better convened the Northwest OpenNotes Consortium, which currently includes all nine major health systems in the Portland, Oregon metro area. The group continues to expand, adding practices of all sizes, but has already allowed more than one million patients access to their medical notes through patient portals.

"OpenNotes is proving invaluable for helping patients take charge of their health," said Fellows. "I'm proud to be part of this movement whose goal is to help all patients and families take a more active role in their personal health care."

About OpenNotes

OpenNotes is a national movement that invites patients, families and clinicians to come together and improve communication through shared clinicians' notes and fully transparent medical records. Based at Beth Israel Deaconess Medical Center in Boston, OpenNotes is supported by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, Cambia Health Foundation and the Peterson Center on Healthcare. To learn more, visit www.opennotes.org.

- See more at: http://boston.citybizlist.com/article/336563/prestigious-healthcare-experts-join-opennotes-movement#sthash.1IzAt6ep.dpuf