A trade group that represents more than 400 integrated health systems and medical groups that employ 130,000 physicians is launching an initiative to dramatically improve the quality of hypertension care.

More than 120 health care organizations, including Mayo Clinic, Kaiser Permanente and Cleveland Clinic, have signed on for the Measure Up, Pressure Down campaign. The project was started by the American Medical Group Foundation, the nonprofit research and education arm of the American Medical Group Assn. The foundation hopes that at least three-quarters of AMGA members will take part in the campaign, whose goal is for each organization to achieve an 80% rate of blood-pressure control among its patients with uncomplicated hypertension by 2016.

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Rates of serious bleeding among patients taking warfarin are much higher than those found in clinical trials of the drug and are even greater during the first month of use, according to a five-year study of 125,195 seniors with atrial fibrillation.

The findings complicate an already difficult decision-making process for patients with atrial fibrillation and highlight the importance of careful management of warfarin, especially during the first month of use, experts said. Warfarin is a generic anticoagulant that is marketed under brand names such as Coumadin and Jantoven.

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A quality improvement project involving seven prominent hospitals around the country cut the rate of colorectal surgical site infections by 32%, the hospitals said in November. One in seven patients who undergoes a colorectal procedure experiences a surgical site infection. These infections extend patients’ hospital stays and sometimes contribute to their deaths.

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Another wrinkle has emerged in the developing medical literature on patient ratings of care. Hispanic immigrant patients who have limited English proficiency and in other ways demonstrate a lack of assimilation into American culture give doctors higher satisfaction grades than patients who are white or black, or than Hispanics who have lived in the U.S. longer.

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Physicians who take after-hours calls from patients often face a difficult decision: Which symptoms can wait for an office visit, and which ones require a trip to the emergency department? Now doctors find these decisions complicated by a troubling, rising trend: Will a trip to the ED mean an upfront charge for a patient if the problem is deemed nonemergent?

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Honolulu Physicians and other workers who have direct contact with patients in long-term-care settings should be required to get the influenza immunization annually, said the American Medical Association House of Delegates. Workers who have medical contraindications or religious objections should be exempt from the vaccine requirement, said the policy adopted at the Association’s Interim Meeting.

“Many health care organizations now have mandatory immunization,” said internist Eric Tangalos, MD, a delegate from Rochester, Minn., who spoke on behalf of the American Medical Directors Assn., which proposed the policy. “It saves lives, saves money and keeps people on the job. And with regard to [this resolution], we’re talking about protecting the most frail, most vulnerable population of patients.”

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