Effective clinical practice, Nov/Dec 2001 highlights

December 20, 2001

1.) Is it Worthwhile to Screen High-Risk Patients for Diabetes?

Screening patients at high risk for diabetes may not be a wise health care expenditure, a new study says. Researchers targeted high-risk patients from three Minnesota clinics for glucose screening. Only 176 of the 469 targeted patients completed the two-step screening program. Screening identified only five new cases of diabetes at a cost of $4,064 per case detected. Thus, screening had a low yield and high cost ("Screening for Diabetes Mellitus in High-Risk Patients: Cost, Yield, and Acceptability," p. 271). An editorial says studies have not yet identified the net benefit of early diabetes diagnosis, or the best screening strategy for the disease ("Finding Undiagnosed Type 2 Diabetes: Is It Worth The Effort?" p. 281).

2.) What's Delaying Patient Discharges? It Depends on Whom You Ask

Nurses at one academic medical center said attending physicians and housestaff were too busy in the mornings to write discharge orders. Attending physicians and housestaff at the same medical center said discharge delays were caused by inadequate staffing, paperwork, or incomplete tests. According to researchers who surveyed the two groups, this hospital could probably reduce discharge delays if it addressed its communication gaps and re-examined its traditional morning routines ("Caregiver Perceptions of the Reasons for Delayed Hospital Discharge," p. 250).

3.) Quality Intervention for Depression Did Not Work in "Real World" Test

A system that encouraged physicians to order one of five new management options for their patients with depression did not work. In this study of a Continuous Quality Improvement (CQI) intervention, patient management options were based on effective new strategies for depression. However, physicians in nine clinics rarely used the system. Patients with depression experienced neither improved care nor improved symptoms after the study ("A CQI Intervention To Change the Care of Depression: A Controlled Study," p. 239). An editorial says a system change is needed to close the gap between the type of care patients can get and the care they do receive ("Quality Improvement Can't Be Optional," p. 278).
-end-


American College of Physicians

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