Results. Part 3
The principal reasons for admission for COPD or asthma are either exacerbation of the underlying condition or pneumonia (Merrill, Stranges, and Steiner 2008; Stranges, Merrill, and Steiner 2008). Aggressive pharmacological management of COPD and asthma has helped reduce hospitalizations or ED visits by 31-56 percent (Akazawa et al. 2008), and in their study Flores and Abrev (2005) reported that 15-54 percent of asthma-related hospitalizations in children could have been prevented through better education of the family, closer outpatient follow-up by PCPs, and avoiding known disease triggers.
Umscheid et al. (2008) used 2002 estimates of hospital-acquired infections (HAI) and determined the range of HAI risk reductions from U.S. studies (Ranji et al. 2007). They report that 18-82 percent of blood-stream infections, 46-55 percent of ventilator-associated pneumonia, 17-69 percent of urinary tract infections, and 26-54 percent of surgical site infections are preventable. Healy et al. (2002) analyzed complications in hospitalized surgical patients and reported that between 39 and 61 percent of major complications (wound infections, pneumonia, urinary tract infections, arrhythmias, respiratory failure, gastrointestinal complications, and deep vein thrombosis) and about an equal percent of minor complications could have been avoided. The National Pressure Ulcer Advisory Panel reported in 2001 that pressure ulcer prevention programs had reported 50 percent or greater reductions in facility-acquired pressure ulcers (Cuddigan, Berlowitz, and Ayello 2001). Similarly, appropriate prophylaxis could reduce the risk of venous thromboembolism by 45 percent in acutely ill medical patients (Leizorowicz et al. 2004), and a recent study found a 50 percent reduction in thromboembolic events with extended pharmacologic prophylaxis (Hull et al. 2007). Adequate evidence-based treatment protocols in preventing contrast nephropathy and adequate drug dosing have demonstrated a risk reduction between 52 and 90 percent in the incidence of acute renal failure in patients in the intensive care unit (Singri, Ahya, and Levin 2003). Additionally, a study of the use of a hospital electronic medical system with prompts for nursing care protocols demonstrated that infection rates dropped 88 percent, bedsores were reduced, and compliance to guidelines for care of patients on ventilator increased by 77 percent (Landro 2009). Canadian generic viagra
Overall, our review of the literature suggests that current PAC rates might be reduced by about 50 percent for CHF and CAD, 40 percent for diabetes, 60 percent for COPD and asthma, and 75 percent for hypertension, as compared with the current rates. These potential reductions are significantly higher than what we used in our estimations of both (1) cost savings if providers in states with high average PAC rates were to decrease them to second decile levels, and (2) our analysis of the prototypical practice. However, there is no evidence that the results achieved in these settings could be replicated widely across the U.S. delivery system.