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Biotech / Medical : Millennium Pharmaceuticals, Inc. (MLNM) -- Ignore unavailable to you. Want to Upgrade?

To: Icebrg who wrote (2036)	3/9/2004 9:03:43 AM
From: Icebrg	Read Replies (2) \| Respond to of 3044

Report: Following guidelines saves lives Hospital Quality Initiative BY JIM SHAMP : The Herald-Sun jshamp@heraldsun.com Mar 8, 2004 : 11:24 pm ET DURHAM -- Scientists wading through piles of research papers have established guidelines that tell doctors and hospitals how they should treat heart attack patients. Now Duke University Medical Center researchers are reminding their peers why it's important. On Sunday, Duke doctors presented a study to the American College of Cardiology in New Orleans that showed many small community hospitals fail to transfer heart attack patients soon enough, possibly improving a hospital's income but hampering a patient's outcome. A separate Duke study presented Monday to the same scientific gathering added statistics that prove the lifesaving value of hospitals' adherence to national treatment guidelines. For both studies, the researchers waded through CRUSADE, a database of 64,775 patients at more than 400 U.S. hospitals. They sought to determine how those hospitals followed nine established methods for providing quality in-hospital and discharge care. The top 100 were deemed "leading," the bottom 25 percent "lagging." The research showed a mortality rate of 4.17 percent at the leading hospitals, compared to 6.33 percent at the lagging hospitals. "This difference has a lot of punch," said Eric Peterson, a cardiologist at the Duke Clinical Research Institute, who led the study. "It validates that we can look at these few metrics and clearly correlate them to a likelihood of surviving." The gaps between the two groups ranged from narrow differences for initial aspirin use (96 percent vs. 85 percent) to wide for the use of clot-busting drugs known as GP IIb/IIIa inhibitors (50 percent vs. 17 percent). On average, leading hospitals were slightly larger, at 388 beds vs. 321 beds for laggers. Leaders also tended to be academic institutions -- 34 percent vs. 21 percent. Not surprisingly, the leaders also were more likely to offer high-tech cardiac catheterization and coronary artery bypass surgery. Both the American College of Cardiology and the American Heart Association have issued the guidelines, or "best practices," for treating patients who show up at a hospital with heart attack symptoms. Those symptoms can include chest pain, irregular ECG readings and/or blood tests showing increases in certain chemicals that may indicate heart cell death. The guidelines call for doctors to give suspected heart attack patients anti-clotting drugs -- heparin, glycoprotein IIb/IIIa inhibitors or beta-blockers -- within the first 24 hours of admission. Doctors also are supposed to send patients home with such drugs as aspirin, beta-blockers, ACE inhibitors or statins. CRUSADE, coordinated by DCRI, involves a national registry of data that is updated every three months by the 400-plus participating hospitals. However, the information from individual hospitals about how they are adhering to the guidelines is kept under wraps. So consumers have no way of knowing whether their local hospital is among the "leaders" or the "laggers." "While the data generated by the CRUSADE initiative highlights weaknesses in the process of delivering health care, it clearly shows the areas that need improvement," Peterson said. "The goal of the program is to stimulate hospitals to re-evaluate their care processes." That's also the goal of the federal Centers for Medicaid and Medicare Services (CMS), which is expanding a national effort to get hospitals to voluntarily report to the public, via the CMS Web site, how well they adhere to some of the "best practices" guidelines. CMS also plans to offer higher Medicare reimbursements to participating hospitals that log good "report cards." That could translate into hundreds of thousands of extra dollars every year for larger institutions such as Duke. "I think we can see that our numbers from these studies not only fit into improved survival," Peterson said, "but they also fit into this whole CMS idea to pay for quality." CRUSADE is funded by Millennium Pharmaceuticals of Cambridge, Mass., and Schering Corp. of Kenilworth, N.J. In addition, Bristol-Meyers Squibb/Sanofi Pharmaceuticals Partnership of New York provided an unrestricted grant in support of CRUSADE. Other members of the Duke team were Matthew Roe, Barbara Lytle, Kristin Newby and Elizabeth Fraulo, who were joined by Brian Gibler and Magnus Ohman of UNC. herald-sun.com