Less than half of U.S. states require hospitals to report surgical site infections, and only a fraction of these states have publicly posted the information for patients to use in deciding where to seek care, said a study published online March 2 in theJournal for Healthcare Quality.

Twenty-one states require reporting of infections acquired during surgical procedures such as coronary artery bypass grafts and hip and knee replacements. Only 14 of these states have so far posted any of the information publicly. Moreover, states differ on data collection procedures and risk-adjustment standards.

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Many state and local government agencies and health systems are not ready to coordinate the response to a disaster that overwhelms available medical resources and requires a shift in standards of care, said an Institute of Medicine report released in March.

In the event of a catastrophe such as pandemic flu that results in a shortage of ventilators, hard choices will have to be made about who gets the high-tech breathing help. Ethical and legal “crisis standards of care” should be triggered by predefined indicators of disaster, yet few states have taken action to implement such a process, said the IOM report.

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Recent outbreaks of vaccine-preventable diseases and a growing immunization opt-out rate are pushing physician organizations in California and Vermont to seek greater restrictions on exemptions from school-entry immunization requirements.

Every state allows exemptions for children with medical contraindications verified by a physician, and all but two states let parents with religious objections skip immunizing their children.

An additional 20 states allow exemptions based on parents’ philosophical or personal beliefs. Requirements for securing personal-belief exemptions vary by state but are often as easy as signing a form.

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The mortality rate for obese patients who regularly take sleeping pills is nine times higher than the death risk for similar patients who do not use the drugs, said a study presented at an American Heart Assn. scientific meeting in March.

Researchers examined the medical records of more than 34,000 patients treated in the Geisinger Health System in Pennsylvania. After controlling for sex, age, smoking status, alcohol use, marital status and ethnicity, the obese patients who took hypnotic medicines regularly — at least 132 pills annually — were 9.3 times likelier to die than patients with similar health who did not. Even obese patients who took 18 pills or fewer annually had a death rate eight times higher.

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Pharmaceutical companies have slashed their sales rep force by about 30% from a high of 105,000 five years ago, according to industry figures. And as the number of detailers has fallen, so, too, has another hallmark of pharmaceutical marketing: drug samples.

Drugmaker spending on the samples that drug reps leave behind in physician offices has gone down by 25% since 2007, said Cegedim Strategic Data, a global pharmaceutical market-research firm that surveys a rotating panel of 2,300 U.S. physicians to generate its industrywide estimates. In 2007, drugmakers spent nearly $8.4 billion on samples. That figure fell to about $6.3 billion in 2011, the most recent data available.

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Peter A. Goodwin, MD, a family physician who lobbied for passage of Oregon’s Death with Dignity Act, died March 11 after ingesting medication prescribed to him by a doctor under the law. He was 82.

Dr. Goodwin was diagnosed with the progressive neurogenerative disease corticobasal degeneration in 2006. He said in a recent online video that three physicians gave him a prognosis of less than six months.

“I’ve always accepted the idea that if push came to shove, and if I qualified for the [Death with Dignity Act], that I’d use the law,” Dr. Goodwin said in the video.

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Seven years after the federal government started publicly reporting hospitals’ performance on quality measures, evidence suggests that this transparency effort has not improved patient outcomes measurably.

The latest discouraging finding is in a study in the March issue of Health Affairs that analyzes death rates among Medicare patients with heart attack, heart failure and pneumonia in the five years before the launch of the government’s Hospital Compare website and in the three years afterward. Although individual hospitals’ compliance with quality metrics for these conditions was reported publicly, the effort reduced the odds of a heart failure patient dying within 30 days by only 3%. Heart attack and pneumonia patients saw no improvement in death rates, the study concluded.

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Many patients struggle to understand written health materials, as well as their physicians’ spoken instructions. Doctors can help their patients get the message.

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A coalition of health care organizations is highlighting how collecting patients’ demographic data, expanding cultural competency training and diversifying health leadership can help reduce care disparities.

For example, New York-Presbyterian Hospital started an initiative to improve care for patients in the largely Hispanic neighborhoods of Washington Heights and Inwood in New York City. The effort included a four-hour training program for health professionals to help address patients’ cultural, language and literacy needs.

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Community health centers that implement the most sophisticated elements of the medical home concept may not achieve superior quality outcomes compared with centers that meet basic medical home criteria, said a study published online Feb. 13 in Health Affairs.

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The proportion of newborn boys circumcised in U.S. community hospitals is at its lowest level, 54.5%, since the federal government starting tracking the statistic in 1993.

The rate has fallen from its peak of 62.7% in 1999, when the American Academy of Pediatrics adopted a neutral position on the procedure.

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A majority of physicians told a patient that his or her prognosis was more positive than the medical facts warranted within the previous year. More than a third say it is sometimes OK to shield significant medical errors from affected patients or hide financial relationships with pharmaceutical companies and device makers from patients.

These are just a few of the areas in which at least some physicians say that always telling patients the whole story is not the right way to go, according to a nationwide survey of nearly 2,000 doctors across seven specialties in the February issue of Health Affairs.

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A note on the white boards in hospital patients’ rooms saying, “I like clean hands,” can result in higher rates of hand-washing among health professionals, but a sign in the staff lounge urging hand-hygiene compliance probably will not make a difference.

These are among the findings of a rapid intervention-testing process used at seven hospitals in the Sentara Healthcare system, headquartered in Norfolk, Va., that pushed the hand-hygiene compliance rate to 92.5%. The nationwide hand-washing rate has hovered around 50%, depending on the study and measurement used.

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