Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] Discount drug pricing: Cutting through the controversy

From the 4 February 2015 article through the Association of Health Care Journalists

pricey-pills1

Independent journalist Lola Butcher reports that debate about the government’s 340B Drug Pricing Program continues to build as the program expands.

“Like all good controversies, this one has enthusiastic advocates and wild-eyed opponents, and it’s easy to get snagged by the passion of the partisans,” she writes in a new tip sheet.

The program, which started in 1992, requires pharmaceutical companies to sell outpatient drugs to eligible health care organizations at significantly reduced prices.

Over the years, the eligibility criteria to participate has expanded repeatedly. Currently, safety-net hospitals, children’s hospitals, critical access hospitals, federal health centers and other organizations are eligible; organizations that fall into those categories must register and enroll in the 340B program.

Butcher, as a 2014 AHCJ Reporting Fellow on Health Care Performance, wrote about the migration of cancer care from physician-owned clinics and community centers to hospital outpatient departments. She found that the 340B program helped fuel that trend.

In this tip sheet for reporters, she explains the program, including the program’s winners and losers, how much money is involved and story ideas.

 

February 5, 2015 Posted by | health care | , | Leave a comment

Does More Care Do More Good?

My sentiments exactly. A few months ago, I collapsed at church. Although I couldn’t stand up well, I knew it was from exhaustion, and not anything needing immediate expensive care. I was talked into going to the hospital by the first responders. Battery of tests showed everything was normal. Thank goodness for insurance, the bill was nearly $2,000.

As Our Parents Age

When we are sick, how much health care is good health care? These days when we call an ambulance, the medics rush in with all sorts of equipment and medications — called advanced life support, which replaces the basic life support that many of us learned in CPR classes.

Doing More for Patients Often Does No Good, a January 12, 2015 article appearing in the New York Times, makes the point that more advanced therapies and medical care do not guarantee higher quality or better outcomes. Written by Aaron E. Carroll, M.D., the piece shares a study in the journal JAMA Internal Medicine that compared the outcomes for patients who had received life support — basic or advanced — before being admitted to the hospital. He also writes about other studies that appear to show how the most advanced emergency care does not necessarily mean longer survival.

Dr. Carroll, a professor…

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February 5, 2015 Posted by | Uncategorized | Leave a comment

[Reblog] Women’s Health Issues: Special Collection on Women’s Heart Health | Full Text Reports…

Women’s Health Issues: Special Collection on Women’s Heart Health | Full Text Reports….

Women’s Health Issues: Special Collection on Women’s Heart Health

February 3, 2015

Special Collection on Women’s Heart Health
Source: Women’s Health Issues

For American Heart Month 2015, the editorial team at Women’s Health Issues has assembled a special collection of research on women’s cardiovascular health published in the journal since mid-2011, following the release of updated American Heart Association guidelines on the prevention of cardiovascular disease in women. The articles address healthcare services for women at risk for cardiovascular disease; social determinants of health; and physical activity in specific populations of women.

These articles will be accessible for free during the month of February 2015 so that they are available to a wider interested audience.

February 5, 2015 Posted by | Consumer Health, Public Health | , | Leave a comment

Add nature, art and religion to life’s best anti-inflammatories

Wondering if people with anti-social tendencies, and those who harm others have less anti-inflammatories…

Add nature, art and religion to life’s best anti-inflammatories 

From the 3 February 2015 UC Berkeley repress release

The awe we feel when we're in nature may help lower our inflammatory response, new study suggests
The awe we feel when we’re in nature may help lower levels of pro-inflammatory proteins, a new study suggests (iStockphoto)

Taking in such spine-tingling wonders as the Grand Canyon, Sistine Chapel ceiling or Schubert’s “Ave Maria” may give a boost to the body’s defense system, according to new research from UC Berkeley.

Researchers have linked positive emotions – especially the awe we feel when touched by the beauty of nature, art and spirituality – with lower levels of pro-inflammatory cytokines, which are proteins that signal the immune system to work harder.

“Our findings demonstrate that positive emotions are associated with the markers of good health,” said Jennifer Stellar, a postdoctoral researcher at the University of Toronto and lead author of the study, which she conducted while at UC Berkeley.

While cytokines are necessary for herding cells to the body’s battlegrounds to fight infection, disease and trauma, sustained high levels of cytokines are associated with poorer health and such disorders as type-2 diabetes, heart disease, arthritis and even Alzheimer’s disease and clinical depression.

It has long been established that a healthy diet and lots of sleep and exercise bolster the body’s defenses against physical and mental illnesses. But the Berkeley study, whose findings were just published in the journal Emotion, is one of the first to look at the role of positive emotions in that arsenal.

 

February 5, 2015 Posted by | Medical and Health Research News | , , , | Leave a comment

Surgical metrics do not provide a clear path to improvement

Surgical metrics do not provide a clear path to improvement 

From the 4 February 2015 Mayo Clinic press release

PHOENIX – While surgical outcomes have improved nationally over time, surgical outcome reporting does not necessarily lead to better outcomes, according to a Mayo Clinic study published this week in the Journal of the American Medical Association.

Systems that capture, analyze, and report surgical outcomes are an increasingly important part of the quality improvement movement in health care in the United States.  Within the U.S., the most widely used surgical outcomes reporting system is the National Surgical Quality Improvement Program (NSQIP), which is coordinated through the American College of Surgeons.

The study analyzed data regarding surgical outcomes — complications, serious complications, and mortality — in over 345,000 patients treated between 2009 and 2013 at academic hospitals throughout the United States.  Of these patients, approximately half were treated at hospitals that participated in the NSQIP.  The study showed that surgical outcomes significantly improved overall in both study groups during the period of analysis.

“In our study we weren’t interested in whether patients had better outcomes in NSQIP vs. non-NSQIP hospitals,” says David Etzioni, M.D., chair of Colorectal Surgery at Mayo Clinic in Arizona and the study author. “We wanted to know whether the outcomes experienced by patients treated at NSQIP hospitals improved, over time, in a way that was different from patients treated at non-NSQIP hospitals.”

The study found no association between hospital-based participation in the NSQIP and improvements in postoperative outcomes over time, suggesting that a surgical outcomes reporting system does not provide a clear mechanism for quality improvement.  According to the research team, the failure of these types of outcomes monitoring systems to produce measurable improvements in outcomes may be related to difficulties in identifying mechanisms that translate reports into changes in how surgical care is provided.

“I think if there is one lesson that we have learned at Mayo Clinic; real quality is achieved through a system — not just a doctor, not just a nurse or other staff,” Dr. Etzioni says. “All of these elements of care have to work together closely to provide patients with the best possible outcomes.”

February 5, 2015 Posted by | health care | , , , , | Leave a comment

[Press release] Care of patients prior to making a diagnosis rarely assessed by quality measures

Care of patients prior to making a diagnosis rarely assessed by quality measures

From the 3 February 2015 press release

An examination of process measures endorsed by the National Quality Forum finds that these measures focus predominantly on management of patients with established diagnoses, and that quality measures for patient presenting symptoms often do not reflect the most common reasons patients seek care, according to a study in the February 3 issue of JAMA.

 

Health care reform efforts, such as accountable care organizations, focus on improving value partly through controlling use of services, including diagnostic tests. Publicly reported quality measures that evaluate care provided prior to arriving at a diagnosis could prevent financial incentives from producing harm. The National Quality Forum (NQF) currently serves as the consensus-based quality-measure-endorsement entity called for in the Affordable Care Act. Endorsed measures are often adopted by the Centers for Medicare & Medicaid Services in payment and public reporting programs, according to background information in the article.

 

Hemal K. Kanzaria, M.D., M.S.H.P.M., of the University of California, Los Angeles, and colleagues examined NQF-endorsed process measures that evaluate the prediagnostic (prior to making a diagnosis) care of patients presenting with signs or symptoms. There were 372 process quality measures listed on the NQF website as of June 4, 2014; from these, 385 codings were determined, by categorizing the process quality measures by a system developed by the Institute of Medicine. Approximately two-thirds (n = 267) targeted disease management and 12 percent (n = 46) targeted evaluation/diagnosis. The remaining were evenly distributed among prevention, screening, and follow-up.

 

Of 313 measures pertaining to evaluation/diagnosis or management, 211 (67 percent) began with an established diagnosis, whereas 14 (4.5 percent) started with a sign/symptom. The sign/symptom-based measures focused on geriatric care (e.g., memory loss, falls, urine leakage) or emergency department care (e.g., chest pain). In contrast, many common reasons for which patients seek care, including fever, cough, headache, shortness of breath, earache, rash, and throat symptoms, were not reflected by the quality measures. The performance of a lab test or medical imaging study was the action required by 59 of 313 (19 percent) endorsed quality measures; many others required actions related to medication prescribing.

February 5, 2015 Posted by | health care | , , , , | Leave a comment

[press release] Reducing Hospital Readmission Rates Will Require Community-Focused Effort

From the Wiley press release (February 2015)

Recent research indicates that most of the variation in hospital readmission rates in the United States is related to geography and other factors over which hospitals have little or no control. Access and quality of care outside of the hospital setting seem to be especially important.

A new editorial that addresses these findings notes that a broader focus on community health systems, not just performance of individual hospitals, may be needed to reduce hospital readmissions.

Because high readmission rates trigger reductions in Medicare reimbursements to hospitals, facilities in socioeconomically disadvantaged and underserved communities may be disproportionately penalized. The editorial is published in Health Services Research.

Access and quality outside the hospital may affect the degree to which the HRRP can achieve its intended outcome, fewer readmissions, but other factors are likely to determine whether the policy is an operational success. For the HRRP, operational success could be defined as whether hospitals respond in a manner consistent with the underlying motivations of improving quality of care and reducing costs. In terms of improving quality, a recent meta-analysis of randomized trials found that interventions designed to prevent readmissions tended be moderately effective (relative risk of 30-day readmission 0.82, 95 percent CI, 0.73–0.91). The studied interventions addressed care both during and after hospitalization, such as through case management, patient education, home visits, and patient self-management support, among other activities. Multifaceted interventions were more common and were 30–40 percent more effective than one-dimensional ones (Leppin et al. 2014), yet they may also be more challenging to implement and more costly. The degree to which hospitals nationwide are implementing quality improvement interventions that target readmissions does not appear to have been described.

February 5, 2015 Posted by | health care | , , , | Leave a comment

   

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