1. Health care and the vote

What health care issues may drive voters to the polls this coming Tuesday? An NEJM special report on the 2018 midterms claims that health care is an extremely important issue driving Congressional votes among 40% of likely voters. Among Republicans, 75% say that lowering health care costs is important in who they'll vote for in Congress, while 82% of Democrats report that protecting coverage for preexisting conditions is an extremely important issue. As for the impact of races for state governor and legislators, a new analysis finds that, depending on election outcomes, more than 2.4 million patients in states that haven't expanded Medicaid (Florida, Georgia, Kansas, Maine, South Dakota and Wisconsin) could gain Medicaid coverage. Further, expanding Medicaid is on the ballot in Idaho, Nebraska and Utah. In other state initiatives. Californians will decide whether to cap the profits of dialysis centers, while voters in Massachusetts will vote on whether to limit the number of patients that individual RNs in hospitals can treat. Read more in NEJM.

2. The high price of hospital-acquired conditions

A research brief issued by IBM Watson Health delivers this grim news: In 2016, 14 hospital-acquired conditions (HACs) led to nearly 49,000 adverse events, more than 3,200 deaths and more than $2 billion in unnecessary hospital costs. Further, patients who experienced those avoidable conditions (which include falls, CAUTIs, and stage 3 and 4 pressure ulcers, among others) spend on average more than eight days longer in the hospital than other patients, with HACs increasing patients' mortality risk by more than 70%. That report comes at the same time that results published in NEJM of two surveys, one done in 2011 and the other in 2015, indicate that the number of health care-associated infections fell between those two years, particularly surgical-site and urinary tract infections. Read more in Modern Healthcare.

3. Rifaximin may tamp down C. diff recurrence

British researchers report that chasing successful C. diff treatment with rifaximin may prevent recurrence. In their pilot study, about 150 patients whose C. diff had been resolved were randomized to either rifaximin 400 mg three times a day for two weeks, then reduced to 200 mg three times a day for another two weeks, or identical placebo. The use of rifaximin cut the recurrence rate in half, with 29.5% of patients taking placebo having a recurrence within 12 weeks vs. 15.9% in the rifaximin group. The study authors noted that they'd failed to reach their recruitment target, and they called for larger trials. But they also pointed out that their results were consistent with an earlier, smaller trial, which also found that rifaximin reduced C. diff recurrence by 50%. Read more in Gut.

4. Close to 10% of young family physicians are hospitalists

Bad news for primary care, good news for hospital medicine: A 2016 survey of family physicians who were only three years out of residency has found that about 9% report being a hospitalist, with no outpatient practice. Further, family physicians who identified as hospitalists were more likely than their non-hospitalist peers to report working longer hours (64.2 hours vs. 53.6 hours), being better paid (earning a median of $250,000 vs. $185,000) and being more satisfied with their careers. Those attributes, according to the authors publishing the survey results, "may attract more family physicians to hospital medicine." More than 2,000 young physicians responded to the survey, and male family physicians were almost twice as likely to self-report being hospitalists as females (11.9% vs. 6.6%). Read more in the Journal of the American Board of Family Medicine.

5. What's hospitalists' role in emergency preparedness?

A new review article points out that hospitalists are often left out of both the planning for and management of disaster preparedness in hospitals, with ED doctors and surgeons typically taking on those responsibilities instead. But the authors argue that hospitalists should play vital roles in preparing hospitals for natural and manmade events. When disasters strike, hospitalists can help offload patients in the ED, comanage trauma patients coming out of surgery, work with case management and social workers to move patients to other health care settings, and manage hospital evacuations and transfers. The authors propose a framework for hospitalist leadership in disaster planning and management, and they recommend using repeated drills to test clinician responses to different scenarios. In other news, the OIG reports that many more hospitals now compared to just a few years ago say they are prepared for an infectious disease outbreak. In 2014, 71% of hospitals said they were unprepared to receive Ebola patients, a percentage that fell to 14% in 2017. Read more in the Journal of Hospital Medicine.

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