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Follow-up care reduces costs in high-risk infants
A program of comprehensive neonatal follow-up care after hospital discharge for inner-city high-risk infants reduces life-threatening illnesses and appears to reduce medical costs by more than $3,000 per infant as well, according to a study published in the Journal of the American Medical Association. Researchers at the University of Texas Southwestern Medical Center at Dallas found that when high-risk infants received comprehensive follow-up care, 47% fewer of them died or developed life-threatening illnesses that required admission for pediatric intensive care. High-risk infants were defined as those weighing less than 1,000 g at birth or those weighing 1,001 g to 1,500 g who required mechanical ventilation.
Comprehensive follow-up care for high-risk infants was defined as 24-hour access to highly experienced caregivers and five-day-a-week follow-up care, which included well-baby care, treatment for acute and chronic illnesses, and routine follow-up care. Routine follow-up care was available two days per week and included well-baby care and chronic illness management. For all care between discharge and one year, the estimated average cost per infant was $6,265 for comprehensive care and $9,913 for routine care.
(See: Broyles RS, Tyson JE, Heyne ET, et al. Comprehensive follow-up care and life-threatening illnesses among high-risk infants: A randomized controlled trial. JAMA 2000; 284:2,070-2,076.)
GOLD standard for COPD released
The National Heart, Lung and Blood Institute in Bethesda, MD, and the World Health Organi-zation in Geneva recently released new international guidelines for diagnosing, managing, and preventing chronic obstructive pulmonary disease (COPD). The guidelines were a cooperative effort called the Global Initiative for Chronic Obstructive Lung Disease (GOLD), commonly referred to as the GOLD Guidelines. Among other recommendations, the guidelines emphasize the use of bronchodilators for symptom management in COPD. They state:
- Inhaled bronchodilator maintenance therapy has been shown to improve health status significantly.
- Long-acting bronchodilators are more convenient than alternative treatments.
"The guidelines represent the latest thinking about COPD management and contain important information for both physicians and patients," notes Stephen Rennard, MD, professor of medicine at the University of Nebraska Medical Center in Omaha and a member of the expert panel that helped developed the guidelines. "There is clearly a need for better education about this disease and the best ways to manage it. My hope is that the guidelines will help raise awareness and improve the quality of care and the quality of life for people living with COPD."
More information on the guidelines is available on www.goldcopd.com.
Better education may reduce back surgery rates
Back surgery rates in the United States are rising rapidly, according to the Agency for Healthcare Research and Quality in Rockville, MD. A recent study in Medical Care finds that an interactive video helps patients make better decisions about whether or not to undergo elective back surgery. Researchers randomly assigned 171 patients with a range of back problems including herniated disks and spinal stenosis into two groups. One group saw an interactive video and received an educational booklet about surgery for their condition, the second group received the booklet alone.
Symptom and function outcomes at three months and 12 months were similar for the two groups, but the overall surgery rate was 22% lower in the video group. Patients with herniated disks in the video group who learned that their problem usually improves with nonsurgical care had a surgical rate of 32% compared to 47% for the booklet-only group.
Patients with spinal stenosis in the video group who learned their condition would probably stay the same for years without surgery had higher surgery rates than the booklet-only group — 39% compared to 29%. The video had little effect on patient satisfaction, but patients in the video group felt better informed than patients in the booklet-only group, researchers note.
(See: Deyo RA, Cherkin DC, Weinstein J, et al. Involving patients in clinical decisions: Impact of an interactive video program on use of back surgery. Medical Care 2000; 38:959-969.)
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