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General interest items edited by Janice Flahiff

NLM Director’s Comments Transcript Care Benefits from EHRs: 10/28/2013

English: MedlinePlus logo

English: MedlinePlus logo (Photo credit: Wikipedia)

 

From the 28 October 2013 Director’s Comments Blog

 

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I’m Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.

Here is what’s new this week in MedlinePlus.listen

Emergency room use and hospitalization rates for diabetes patients declined after a large California medical provider introduced an electronic health records system, finds a five year study recently published in the Journal of the American Medical Association.

The study of 170,000 Kaiser Permanente Northern California diabetes patients (from 2004-2009) found an average of 501 emergency department visits per 1000 patients declined to 490 after Kaiser’s clinics began to use an electronic health records system (EHR) for outpatient treatment.

The study found an average of 252 hospitalizations per 1000 diabetes patients declined to 238 per 1000 after Kaiser Permanente’s clinics used the health care provider’s EHR. The specific hospitalizations for ambulatory care-sensitive conditions also fell from a mean of 67 per 1000 to about 60 per 1000 diabetes patients after the use of an EHR for diabetes outpatient treatment.

The comparative, overall declines in emergency department visits and aforementioned hospitalizations among Kaiser Permanente’s diabetes patients were statistically significant, or did not occur by chance. There was no overall difference in the frequency of patient visits to a physician’s office after Kaiser’s clinics began to use the health system’s EHR.

The study’s nine authors estimate Kaiser’s cost savings from reduced emergency department and hospitalizations were about $158,478 per 1000 patients each year. Overall, they write (and we quote): ‘the estimated reductions in emergency department (ED) visits and hospitalizations that we identified for patients with diabetes may have potential to affect ED and hospitalization costs’ (end of quote).

The authors acknowledge future research needs to provide a more comprehensive assessment of the cost savings after the implementation of an EHR. They add the findings are limited to diabetes patients within one large health care provider (within one U.S. state) and may not be generalizable to other states and different medical systems. For example, the authors explain the reductions in emergency department use and reduced hospitalizations were not uniform among all of the 17 Kaiser Permanente clinics where the five year study was conducted.

On the other hand, the authors note the study is the most comprehensive to date about the impact of outpatient EHR use on adverse health outcomes. The authors explain they assessed diabetes patients in order to observe the impact of EHR use on an outpatient basis among adults with a chronic (or ongoing) medical condition over time.

The authors conclude (and we quote): ‘We extend the evidence of EHR-related improvements in care delivery by further describing statistically significant modest reductions in downstream adverse health outcomes measured by ED visits and hospitalizations’ (end of quote).

Meanwhile, MedlinePlus.gov’s personal health records health topic page provides information about the physician adoption of EHRs in the ‘statistics’ section. Information about the adoption of EHRs within residential care communities and office-based physicians also is provided within the same section.

A overview that explains how and why EHRs are implemented in medical centers is available in the ‘MedlinePlus Magazine’ section of MedlinePlus.gov’s personal health records health topic page.

A helpful explanation (from the National Institutes of Health) about how to protect the privacy and security of your health information is available in the ‘related issues’ section of MedlinePlus.gov’s personal health records health topic page.

MedlinePlus.gov’s personal health records health topic page also provides links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. You can sign up to receive updates about personal health records (and EHRs) as they become available on MedlinePlus.gov.

To find MedlinePlus.gov’s personal health records health health topic page, type ‘personal health records’ in the search box on MedlinePlus.gov’s home page. Then, click on ‘personal health records (National Library of Medicine).’

 

Before I go, this reminder… MedlinePlus.gov is authoritative. It’s free. We do not accept advertising …and is written to help you.

To find MedlinePlus.gov, just type in ‘MedlinePlus.gov’ in any web browser, such as Firefox, Safari, Netscape, Chrome or Explorer. To find Mobile MedlinePlus.gov, just type ‘Mobile MedlinePlus’ in the same web browsers.

We encourage you to use MedlinePlus and please recommend it to your friends. MedlinePlus is available in English and Spanish. Some medical information is available in 43 other languages.

Your comments about this or any of our podcasts are always welcome. We welcome suggestions about future topics too!

Please email Dr. Lindberg anytime at: NLMDirector@nlm.nih.gov

That’s NLMDirector (one word) @nlm.nih.gov

A written transcript of recent podcasts is available by typing ‘Director’s comments’ in the search box on MedlinePlus.gov’s home page.

The National Library of Medicine is one of 27 institutes and centers within the National Institutes of Health. The National Institutes of Health is part of the U.S. Department of Health and Human Services.

A disclaimer — the information presented in this program should not replace the medical advice of your physician. You should not use this information to diagnose or treat any disease without first consulting with your physician or other health care provider.

It was nice to be with you. I look forward to meeting you here next week.

 

 

 

 

November 3, 2013 Posted by | Consumer Health, health care | , , , , , , , , , | Leave a comment

[Reblog from the Brookings Institute] CHART: Winners and Losers from Obamacare

From the 1 November 2013 item at The Brookings Institution

  • Fred Dews

    Managing Editor of the Brookings Website

November 3, 2013 Posted by | health care | , , , , , | Leave a comment

Pitt Team Treats Gum Disease by Using Homing Beacon to Bring Needed Immune Cells to Inflamed Area

From the 1 November 2013 University of Pittsburgh press release

 
PITTSBURGH, Nov. 1, 2013 – The red, swollen and painful gums and bone destruction of periodontal disease could be effectively treated by beckoning the right kind of immune system cells to the inflamed tissues, according to a new animal study conducted by researchers at the University of Pittsburgh. Their findings, published this week in the early online version of the Proceedings of the National Academy of Sciences, offer a new therapeutic paradigm for a condition that afflicts 78 million people in the U.S. alone.
Periodontal disease currently is treated by keeping oral bacteria in check with daily brushing and flossing as well as regular professional deep cleaning with scaling and root planing, which remove tartar above and below the gum line. In some hard-to-treat cases, antibiotics are given. These strategies of mechanical tartar removal and antimicrobial delivery aim to reduce the amount of oral bacteria on the tooth surface, explained co-author and co-investigator Charles Sfeir, D.D.S., Ph.D., director, Center for Craniofacial Regeneration and associate professor, Departments of Periodontics and Oral Biology, Pitt’s School of Dental Medicine.
“Currently, we try to control the build-up of bacteria so it doesn’t trigger severe inflammation, which could eventually damage the bone and tissue that hold the teeth in place,” Dr. Sfeir said. “But that strategy doesn’t address the real cause of the problem, which is an overreaction of the immune system that causes a needlessly aggressive response to the presence of oral bacteria. There is a real need to design new approaches to treat periodontal disease.”
In the healthy mouth, a balance exists between bacteria and the immune system response to forestall infection without generating inflammation, said senior author Steven Little, Ph.D., associate professor and chair of the Department of Chemical and Petroleum Engineering, Pitt’s Swanson School of Engineering. But in many people, a chronic overload of bacteria sets up the immune system to stay on red alert, causing harm to the oral tissues while it attempts to eradicate germs.
“There is a lot of evidence now that shows these diseased tissues are deficient in a subset of immune cells called regulatory T-cells, which tells attacking immune cells to stand down, stopping the inflammatory response,” Dr. Little said. “We wanted to see what would happen if we brought these regulatory T-cells back to the gums.”
To do so, the researchers developed a system of polymer microspheres to slowly release a chemokine, or signaling protein, called CCL22 that attracts regulatory T-cells, and placed tiny amounts of the paste-like agent between the gums and teeth of animals with periodontal disease. The team found that even though the amount of bacteria was unchanged, the treatment led to improvements of standard measures of periodontal disease, including decreased pocket depth and gum bleeding, reflecting a reduction in inflammation as a result of increased numbers of regulatory T-cells. MicroCT-scanning showed lower rates of bone loss.
“Mummified remains from ancient Egypt show evidence of teeth scraping to remove plaque,” Dr. Little noted. “The tools are better and people are better trained now, but we’ve been doing much the same thing for hundreds of years. Now, this homing beacon for Treg cells, combined with professional cleaning, could give us a new way of preventing the serious consequences of periodontal disease by correcting the immune imbalance that underlies the condition.”
Next steps include developing the immune modulation strategy for human trials. In addition to Drs. Sfeir and Little, the research team included Ph.D. candidate Andrew J. Glowacki,, Sayuri Yoshizawa, D.D.S., Ph.D., Siddharth Jhunjhunwala, Ph.D., all of the University of Pittsburgh; and Andreia E Vieira, Ph.D., and Gustavo P. Garlet, D.D.S., Ph.D., of Sao Paulo University, Brazil.
The project was funded by National Institutes of Health Grants 1R01DE021058-01 A1, 1R56DE021058-01, the Wallace H. Coulter Foundation, the Camille and Henry Dreyfus Foundation, the Arnold and Mabel Beckman Foundation and the Commonwealth of Pennsylvania.

 

November 3, 2013 Posted by | Consumer Health, Medical and Health Research News | , , , , | Leave a comment

Public Health Policies, Practices May Negatively Affect Marginalized Populations

From the 31 October 2013 Science Daily article

Despite the best intentions of those working in public health, some policies and practices inadvertently further disadvantage marginalized populations, according to a commentary by a researcher at St. Michael’s Hospital

Dr. Diego S. Silva, a scientist in the hospital’s Centre for Research on Inner City Health, said there’s an emphasis toward social justice in public health, particularly when it comes to people who are marginalized, disadvantaged or vulnerable.

“For example, despite evidence suggesting that people who are homeless are at greater risk of being infected with influenza and suffer greater morbidity than the general population, many pandemic influenza plans provide impracticable advice or otherwise fail to address their specific needs,” said Dr. Silva.

The commentary appears online today in the Canadian Journal of Public Health.

Read the entire article here

November 3, 2013 Posted by | Public Health | , , , | Leave a comment

[Repost] A Galaxy Within Us: Our Gut Microbiota and How It Can Be Programmed by Food

From the1 November 2013 ScienceDaily article

Who would have thought that the human body contains over 10 times the amount of bacterial cells as human cells? These bacteria — now collectively called the gut microbiota — number in their trillions and are made up of more than a 1,000 different species most of which are beneficial in some way.

“Research is starting to show that the food we eat has a huge bearing on the composition of this collective and also that the profile of the collection of bacteria can be associated with a person’s health status,” explains Dr Paul Ross, Head of the Teagasc Food Research Programme and Principal Investigator at the Alimentary Pharmabiotic Centre, Teagasc, Food Research Centre, Moorepark.

To the team at the Alimentary Pharmabiotic Centre (APC), an SFI-funded CSET at Teagasc, Food Research Centre, Moorepark and at University College Cork, the study of the human microbiota has the potential to transform much of the thinking around basic human nutrition, gut health and disease prevention: “This has been made possible through developments made in DNA sequencing technology which has allowed the study of complex microbial communities such as the human gut microbiota, the majority of which cannot be cultured on an individual basis,” explains Dr Ross.

Although the composition of the microbiota is highly stable during adulthood, there are times when it can be highly dynamic — such as at the extremes of life, e.g., following birth, during inflammatory bowel conditions, gastrointestinal infection and in the elderly. Despite this stability, the microbiota also displays a high degree of interindividual variation reflecting differences in lifestyle, diet, host genetics, etc.

In a project called ELDERMET, a team of UCC/Teagasc scientists headed by Professor Paul O’Toole has recently profiled the faecal microbiota from elderly people in different residences including community, day-hospital, rehabilitation or long-term residential care locations.

This study found that the microbiota correlated with the residence location. “The results demonstrated that the individual microbiota of people in long-stay care was significantly less diverse than those that resided in the community,” explains Dr Ross. “In addition, these subjects were also clustered by diet by the same residence location and microbiota groupings. Interestingly, the separation of microbiota composition correlated significantly with health parameters in these individuals including measures of frailty, co-morbidity, nutritional status, markers of inflammation and with metabolites in faecal water.”

Taken together these data suggest that diet can programme the gut microbiota — the composition of which correlates with health status. Such a suggestion opens up great potential for the food industry in the design of food ingredients and supplements which may in the future shape the microbiota in a particular direction to correlate with an improved consumer health status. Interestingly, a related study called INFANTMET, funded by the Department of Agriculture, Food and the Marine and led by Professor Catherine Stanton at Teagasc Moorepark, is looking at the development of the gut microbiota in early life as a consequence of breast feeding.

November 3, 2013 Posted by | Nutrition | , , | 1 Comment

[Bread for the World Report] The Push Up Decade: CAADP at 10

Screen Shot 2013-11-03 at 11.59.09 AM

Excerpts from the report

The 2007-2008 food price crisis was a wake-up call for the international community, reigniting the discussion about the need to refocus attention on agricultural development. In sub-Saharan Africa, however, member governments of the African Union (AU) had already been grappling with the issue for several years. In 2001, AU members agreed to establish a process to help spur economic growth and political transformation on the continent. The majority of poor people in Africa— approximately 75 percent—live in rural areas and depend on
agriculture for their livelihood.1 Yet between 1995 and 2003, most African countries spent very little public money on agriculture—well below 1 percent of their Gross Domestic Products (GDP).2

Realizing this contradiction, the AU’s New Partnership for Africa’s Development (NEPAD) launched the Comprehensive Africa Agriculture Development Program (CAADP). African heads of state met in Maputo, Mozambique, in 2003, and agreed in the Maputo Declaration both to begin devoting 10 percent of their national budgets to agriculture by 2008, and to set a goal of achieving an average annual growth rate of 6 percent in the agricultural sector by 2015.3 Nonetheless, donor funding for agriculture was very limited until 2009.

CAADP, an ambitious and comprehensive vision for agricultural reform in Africa, is an example of how initiatives with effective local ownership are making strides toward the U.N. Millennium Development Goals (MDGs).

A good example of what is possible is Tanzania, whose economy has been growing steadily over the past 10 years. On average, the economy expanded by 6.9 percent a year. Five sectors were the source of almost 60 percent of Tanzania’s economic growth between 2008 and 2012:

  • CommunicationGDPalmostdoubledinlessthanfour years, growing on average more than 20 percent a year.
  • Banking and financial services, which has expandedby 11 percent a year since 2008.
  • Retail trade, which increased by almost 40 percentbetween 2008 and 2012.
  • Construction,withaverageannualgrowthof9percentover the same period.
  • Manufacturing, which grew by 8.4 percent annuallyduring the past four years.Agriculture also contributed to Tanzania’s economic growth, but this was a given because it makes up a significant share of GDP, about 25 percent. In fact, during the period 2008-2012, agriculture’s growth rate was consistently below the overall economic growth rate.

Nutrition: Investing in nutrition is extremely cost-effective yet critically underfunded. In fact, of the “10 best buys in development” identified by a group of top economists, five are nutrition interventions.15 But although relatively simple, very affordable interventions to treat malnutrition are available, nutrition remains the “forgotten MDG.” Both overseas development assistance for nutrition, and national budget allocations have been very low.

Since 2009, the United States has worked through its global food security initiative, Feed the Future, to emphasize the urgent need to improve nutrition in the “1,000 Days” window between pregnancy and age 2.16 Because malnutrition in this critical age group causes irreversible physical and cognitive damage, countries with a high proportion of malnourished babies and toddlers pay the price in diminished productivity and economic growth. On the other hand, research shows that $1 invested in nutrition generates as much as $138 in better health and increased productivity.17 In sub-Saharan Africa, an estimated 41 percent of all children younger than 5 are malnourished.18 It is the only world region where the number of child deaths is increasing, and the only one expected to see further increases in food insecurity and absolute poverty.19

In spite of the currently tight budget climate, the United States and other development partners should not back off. Rather, they should press forward to support and help strengthen county-led initiatives such as CAADP. As the African Union prepares for the January 2014 African Union summit, which marks the start of “the Year of Agriculture in Africa,” there is real opportunity for this renewed commitment to have an impact on hunger. On July 1, 2013, African heads of state and government of AU Member States, together with representatives of international organizations, civil society organizations, the private sector, cooperatives, farmers, youths, academia, and other partners unanimously adopted a Declaration to End Hunger in Africa by 2025. This High Level Meeting, Renewed Partnership for a Unified Approach to End Hunger in Africa by 2025 within the CAADP Framework, took place at the initiative of the African Union, FAO, and the Lula Institute along with a broad range of non-state actors.22 With this renewed commitment to end hunger, African countries still have a chance to fulfill their Maputo commitments since that deadline coincides with the MDG deadline, two years away in 2015.

November 3, 2013 Posted by | Nutrition, Public Health | , , , , , | Leave a comment

[Reblog] Forms do not keep patients out of hospitals

A patient having his blood pressure taken by a...

A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)

 

From the 21 October 2013 KevinMD.com article by Kathy Neider, Physician

 

Over one year ago my office implemented an EHR (electronic health record). I’ve not done a note on paper since.

Last week, a Transition of Care (TOC) document was placed on my desk with a sticky note stating: “Dr. Nieder please fill out this form so we can bill a 99496 for your visit with Mrs. Jones yesterday.”

 

I pick up two sheets of paper with multiple questions including:

  • discharge Medications: (list)
  • present Medications: (list)
  • diagnostic tests reviewed/disposition (list)
  • disease/illness education (discussion documentation)
  • home health/community services discussion/referrals: (list)
  • establishment or re-establishment of referral orders for community resources: (list)
  • discussion with other health care providers: (list)
  • assessment and support of treatment regimen adherence: (discussion documentation)
  • appointments coordinated with: (list)
  • education for self-management, independent living and activities of daily living: (discussion documentation)

Please remember, I am now on an EHR. So I am expected to document electronically first then manually fill out forms. I have no discharge summary yet from the hospital.  The medications when she left the hospital state “resume pre-admission meds.” In order for me to list what tests she had I log in to the hospital portal and look them all up. Some of them have been scanned into my EHR, some not. She had a straight forward admission for a small bowel obstruction. She declined to keep the surgeon’s appointment as she was told there was nothing he could do for her.

A TOC visit is paid at a higher rate than other visits if the patient does not return to the hospital in the following 30 days. Hence, we hold the billing until that time. My understanding of the purpose of this new code is to improve coordination of care as a patient transitions from the hospital to home. Coordination would imply that there are other individuals involved and thus there is improved communication between us.

However my staff and I bear the brunt of gathering information (which is what we normally do anyway, so I guess it’s nice because now we get paid for it).

At what point will it become incumbent upon the hospital to send me the necessary information for treating the patient now that he/she is home again? How does it follow that improving care means the primary care doctor fills out even more forms, ultimately reducing the time spent with the patient?

The form will not keep the patient out of the hospital. Communication can keep the patient out of the hospital. True coordination of care might keep the patient out of the hospital. More busy work for the patient’s primary care doctor will not. Since the order of the day is using hospitalists, it is imperative that we improve our communication systems at the time of discharge and before the patient is seen again in the primary care office. Systems must stop thinking that one more form is going to save the patient. Especially another form on my back.

Kathy Nieder is a family physician who blogs at Family Practice 2.0.

 

 

November 3, 2013 Posted by | health care | , , , , , | Leave a comment

   

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