Two studies published in January highlight the challenges blacks face in accessing equitable, quality health care.

In one study, primary care physicians found to have unconscious bias against blacks received lower marks from their African-American patients on measures of trust and communication skills. Another study found that racial segregation exacerbates disparities in lung cancer mortality.

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Patients who give their physicians low grades are likelier to have lapses in drug adherence, said a study of nearly 10,000 Northern California patients with diabetes.

Thirty-nine percent of patients who said they never or only sometimes have confidence in their primary care physicians skipped their cardiometabolic medicines at least 20% of the time, the study said. That is a nonadherence rate 11 percentage points higher than for patients who said they usually or always trust their doctors.

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About 80 times each week, U.S. patients undergoing surgery experience mistakes that safety advocates say never should happen.

The types of errors being made: Surgical instruments such as sponges are unintentionally left behind in the patient; a wrong procedure is performed; a wrong surgical site is operated upon; and surgery is done on the wrong patient altogether.

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Hospitals are reporting more patient safety problems related to electronic health records, yet it appears that only a fraction of the mix-ups are leading to patient harm, according to a recent study of more than 3,000 incidents in Pennsylvania.

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At a Rush University Medical Center continuing education course in Chicago last fall, a room of more than 80 physicians and other health professionals did something they rarely do during days packed with rushed patient encounters and consultations with colleagues — they sat together in silence for a solid 35 minutes.

In neat rows of chairs, the doctors, nurses, social workers, psychologists and other health professionals sat straight-backed with their hands on their knees and their eyes open, gazing into the middle distance. Throats were cleared, coughs pierced the stillness, and an elevated train rumbled just outside the conference room’s picture windows.

“The effort in this practice is remembering to come back — back to your posture, back to your breathing, over and over again,” said Mitchell M. Levy, MD. He led the exercise, known as mindfulness meditation, with a quiet yet commanding tone of voice.

“Whatever thought or feeling arises, just bring it here,” he said. “Let it be here in this space.”

This sort of meditative exercise is only one element of what Dr. Levy and the course participants covered during two days in October 2012, and the well-attended course is just one sign of the rising interest among physicians, medical schools and hospitals in using mindfulness practices to help alleviate doctors’ stress and reconnect them with their patients and their calling in medicine.

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When the employer-backed Leapfrog Group handed out grades of A, B or C on patient safety to individual hospitals in June, 5% of hospitals scored low enough to receive D’s or F’s but were marked as “grade pending.” The hospitals had better shape up by the end of the year, Leapfrog said, or they will get a D or F.

Now the group has kept its promise, handing out the low marks to 146 U.S. hospitals, including highly regarded facilities such as Cleveland Clinic and the Ronald Reagan UCLA Medical Center in Los Angeles.

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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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Honolulu Appropriate professional standards and regulation will help ensure that recent advances made in the use of genomic-based technologies benefit more patients, according to policies adopted at the American Medical Association Interim Meeting.

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