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Newscast: Lead Story - Hospitalization of the
Poor Much Higher for Asthma, Diabetes, Other Preventable Diseases
(opening music)
Rand: This is Healthcare 411 for the week of July 15, 2009.
Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare
Research and Quality, part of the U.S. Department of Health and Human Services.
I’m Debra James.
Rand: And I’m Rand Gardner.
Debra: This week on Healthcare 411:
Rand: AHRQ data about the hospitalization rates for lower-income
Americans.
Debra: And in research news, bariatric surgery: A new study finds
post-surgical and other complications are on the decline.
Rand: And tips for consumers for navigating the health care system. This
week we’ll explore end-of-life treatment decisions. How to talk about your
wishes with your family and make decisions about your care. All this coming up
on Healthcare 411.
[Begin PSA: Questions to Ask Before Surgery]
Narrator: Every year more than 15 million Americans have surgery. Most
operations are not emergencies, which means that you’ll have time to learn about
your operation and make certain it’s the best treatment for you. And you’ll have
time to work with your surgeon to help make the surgery as safe as possible. Be
active in your health care to ensure you receive quality care. To find out more
about important questions to ask before surgery, visit
ahrq.gov/consumer. A
message from the U.S. Agency for Healthcare Research and Quality.
[End PSA]
Debra: Now, the numbers.
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Debra: Low-income Americans are more likely than people in higher income
groups to be hospitalized for chronic health conditions. And experts say some of
these hospitalizations can be prevented through higher-quality outpatient care.
That’s according to recent AHRQ data that shows hospitalizations for the poor
are about 75 percent higher for asthma and almost 90 percent higher for
diabetes. Researchers say that despite national efforts to eliminate health care
disparities, low-income Americans continue to have higher hospital admission
rates for these types of chronic health conditions. AHRQ research also shows
patients from the poorest communities are more likely to be admitted to the
hospital for other medical issues, such as severe blood infections, stroke, and
depression.
Rand: Weight-loss surgery, known as bariatric surgery is becoming an
increasingly popular alternative to treating obesity. But the procedure has long
been known to have potentially serious complications. Now, a new study from AHRQ
has found that the average rate of post-surgical and other complications in
patients who have bariatric surgery declined 21 percent between 2002 and 2006.
The study also found that payments to hospitals dropped by up to 13 percent for
bariatric surgery patients during the same time period. Here to talk about the
new study and its findings is coauthor and AHRQ Senior Economist Dr. Didem
Bernard. Dr. Bernard, thanks for joining us.
Dr. Bernard: Thanks for having me.
Rand: Dr. Bernard, this study really sheds some new light on bariatric
surgery. Tell us a little about the study itself and what some of your findings
were.
Dr. Bernard: Our study found that the 180-day complication rate among
patients who had bariatric surgery dropped from approximately 42 percent to
roughly 33 percent. Much of this was driven by a drop in infections that happen
after surgery, which plummeted 58 percent. Fewer complications meant that fewer
patients had to go back to the hospital, and that meant less money spent.
Rand: What data did you examine in the study and what did it tell you?
Dr. Bernard: We compared complication rates among more than 9,500
patients under age 65 who had obesity surgery at 652 hospitals between 2001 and
2002 and between 2005 and 2006. The complication rate fell in spite of an
increase in the percentage of older and sicker patients having the surgery. For
example, the proportion of patients over age 50 operated on by bariatric
surgeons increased from 28 percent to 44 percent during the period, and the
patients had more than twice the number of other chronic conditions, such as
high blood pressure or sleep apnea, than patients who had the surgery earlier.
Rand: Your study also found that certain costs involving the surgery went
down. Can you give us some examples?
Dr. Bernard: As a whole, hospital payments just for bariatric surgery
fell from more than $29,000 to roughly $27,000. Hospital payments for the most
expensive patients - those who had to go back to the hospital because of
complications - also decreased from about $80,000 to almost $70,000.
Rand: And overall, what are the reasons for these improvements?
Dr. Bernard: All surgeries involve risks, but with newer technologies and
techniques - and when surgeons and hospitals gain experience - the risks can
decrease. We’re seeing reduced complications in bariatric surgery due to a
combination of factors. First, there has been an increased use of laparoscopy,
which is a technique that allows physicians to operate through smaller
incisions, making it less risky for the patient. Second, we’ve had an increased
use of less invasive procedures. For instance, surgeons are more likely to put a
band around the stomach rather than to cut the stomach. Third, surgeons are
becoming more experienced in performing bariatric surgery. So all of these
factors have contributed to reduced complications for patients.
Rand: Dr. Bernard, thank you so much for joining us.
Dr. Bernard: My pleasure.
Rand: The AHRQ study, entitled "Recent Improvements in Bariatric Surgery
Outcomes," was published in the May 2009 issue of Medical Care. Up next, health
care advice for navigating the health care system.
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Debra: How many times have you told your children to "talk it out" to
resolve issues or gain clarity on problems? That’s sage advice later in life,
too, when the end of life is no longer impossible to imagine. It’s natural to
avoid thinking about - much less talking about - end-of-life treatment
decisions. As a result, most of us have not made our wishes about these
important decisions clear with our loved ones and health care providers. And
most of us don’t have an advance directive, which is a legal document that
allows us to convey our decisions about end-of-life care ahead of time. Here to
talk with us more about this is AHRQ Director Dr. Carolyn Clancy. Welcome, Dr.
Clancy.
Dr. Clancy: Thank you.
Debra: It seems as though there is never really a good time for most of
us to talk about death and dying, even though death is a natural part of life.
Dr. Clancy: Yes, that’s true. According to research by AHRQ, less than
half of severely or terminally ill patients, for example, have an advance
directive. As many of three-quarters of doctors whose patients have one are not
aware that it exists, and only 12 percent of patients who have one of them
received input from their doctor. Fortunately, more Baby Boomers appear to be
willing to talk about this, probably because of their involvement in their
parents’ end-of-life medical decisions.
Debra: Ideally, when should discussions of this nature take place?
Dr. Clancy: They should take place long before care is needed.
End-of-life planning involves thought and effort, such as completing the advance
directive. But one of the most important parts of advanced planning is talking
about your wishes - both with family members and your doctor. When this doesn’t
happen early enough, we end up having to try and make decisions for loved ones
based on what we and the doctors think they would want. Doing this for someone
who can’t express their wishes can be a gut-wrenching experience.
Debra: I imagine that patients feel much better off when these decisions
are made in advance?
Dr. Clancy: AHRQ-funded studies have shown that conversations about
advance care planning with doctors increased satisfaction among patients age 65
years and older. Patients who talked with their families or physicians about
their preferences for end-of-life care have less fear and anxiety, feel they
have more ability to influence and direct their medical care, believe their
physicians have a better understanding of their wishes and have a greater
understanding and comfort level than they had before the discussion.
Debra: Can your doctor help you begin the process of developing an
advance directive?
Dr. Clancy: Depending on your age and medical condition, your doctor may
be helpful in starting your decision-making process. But you can rely on several
good resources to help you. Once you’ve considered the options and have had
discussions, you need to put your desires in writing in proper documents. Be
sure to give copies to your family members and to your doctor.
Debra: What are some examples of advance directives that should be
considered in this process?
Dr. Clancy: There is a living will, which describes the kinds of medical
treatments you would want, or not want, should you become incapacitated. It also
gives instructions for future care in cases when you cannot make those
decisions. A durable power of attorney allows the patient to designate someone
who will be in charge of health care decisions. And finally, a
Do-Not-Resuscitate order, or DNR, outlines what measures should or should not be
taken on your behalf in events such as cardiac or respiratory arrest. Talking
about our concerns and worries - and then taking steps to address them - remains
solid advice throughout life. This holds true, even as we anticipate its end.
I’m Dr. Carolyn Clancy and that’s my advice on how to navigate the health care
system.
Debra: For more information about end-of-life treatment options and
decisions, visit "Advance Care Planning: Preferences for Care and the End of
Life," at:
http://www.ahrq.gov/research/endliferia/endria.htm.
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Debra: That’s it for this week. For more information on these and other
health-related stories and topics, go to
healthcare411.ahrq.gov.
Rand: Healthcare 411 is produced by AHRQ, the Agency for Healthcare
Research and Quality, part of the U.S. Department of Health and Human Services.
For Debra James, I’m Rand Gardner. Please join us for the next edition of
Healthcare 411.
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