by Dan Osterweil, MD, FACP, CMD

I am very happy to report that the word is spreading through our State... INTERACT works!

More adopters have ventured to incorporate elements of the quality improvement system. In a recent survey of a convenient sample of 12 Nursing facilities in Northern California, we learned that 5 have fully have adopted INTERACT,  4 partially and the rest were trying to learn more about it. These adopters seem to come from chains and had a vested interest in improving performance due to market forces as well as a conviction that quality is good for business.

Health care is changing as payment models shift from quantity to quality; with these changes comes the need for the health care community to join forces. Specifically, hospitals are looking to partner with nursing homes because they play an integral role in transferring patients across the continuum of care. This collaboration can have a direct effect on hospital readmission rates, which will become even more important as penalties are scheduled to rise in the future. The Centers for Medicare & Medicaid Services recently announced the latest penalties for hospital readmissions, with more than 250 California hospitals assessed penalties. (1)

Numerous studies in recent years have raised concerns about the health hazards of serious hypoglycemia in persons with diabetes, particularly elderly diabetics with significant co-morbidities and cardiovascular disease. For this reason the ADA now recommends individualized A1C goals and AGS in this year’s draft Diabetes Care CPG recommends A1C of < 8.0 for most of our older patients.

Despite these concerns, the literature also documents that serious nocturnal hypoglycemia is very common and frequently not recognized by the patient or the caregiver including licensed nurse in the acute hospital setting.  The below abstract from a study published in Diabetic Medicine on June 29th further makes the association of a lack of sacks h.s. as a risk factor for hypoglycemia.  Is this a problem in your facilities?

Helping keep medical malpractice premiums under control in California for almost four decades, MICRA (the Medical Injury Compensation Relief Act) is under attack again from the trial attorneys.  Legislation has been introduced in the California legislature that would increase the cap on non-economic damages (e.g., pain and suffering) in medical malpractice actions from $250,000 to somewhere around $1.2 million, with further increases built in based on inflation.  In addition, the legislation would require physicians to have random testing for alcohol and drugs of abuse (but only when seeing patients in acute care hospitals), and would call for immediate suspension of the physician’s medical license if alcohol (any amount, apparently) were found in his or her body fluids.  There are other seemingly ill-advised provisions to the legislation, and it appears improbable that this legislative effort will succeed in its current form.