[Reblog] Value-Based Care’s Data Problem

From the 22 May 2015 post at The Healthcare Blog

…

I believe the concept of value-based care is good for healthcare. VBC encourages providers to make changes that put the patient at the center of care, so that different services can be provided across providers in a collaborative way. If all went according to the VBC vision, there would be fewer redundant tests, more emphasis on preventative care, and an effort to keep high-risk patients out of the emergency room. It’s also better for costs, something we desperately need in the US, where healthcare spending per capita is more than twice the OECD average.

But Lisa’s story, at the leading edge of the value-based experiment, is not good at all. ACOs and most other value-based models are new, constantly changing, and unproven. ACOs report on 33 metrics that are supposed to represent the quality of care provided by their networks of providers. While still extremely limited in scope, any more than 33 metrics would have made Lisa’s job impossible. So far, few ACOs have reported any savings. Worse — the metrics are unproven. What if they overemphasize standardized process over patient outcomes? And what if efficiency measures result in neglectful and impersonal care? A lot is riding on Lisa’s testing ground.

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The administrative challenge

By engaging with and learning from people like Lisa, I have begun to understand the problems frontier administrators face — the same problems countless others will face if we don’t address the administrative burden early on. Here are a few of the top headaches being rolled out in the name of value:

Selecting metrics

For ACOs, 33 metrics are tracked today. Inevitably, these will expand and change as accountable care evolves. There are also countless other systems of metrics encouraged by other incentive programs: the Physician Quality Reporting System measures, Meaningful Use metrics, Agency for Healthcare Research and Quality Indicators, the Consumer Assessment of Healthcare Providers and Systems for patient experience metrics, indicators for each specialty (Stroke and Stroke Rehabilitation Physician Performance Measurement Set, Endoscopy and Polyp Surveillance Physician Performance Measurement Set, and the Heart Failure Performance Measurement Set, to name a few). The document outlining protocols for the Physician Quality Reporting System is 18 pages long, with a mouthful of a title to match: “The 2015 Physician Quality Reporting System (PQRS) Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures.” Got that? A new piece of legislation that passed the House of Representatives last week — the “doc fix” bill — is about to revamp many of these requirements once again.

Collecting data

Lisa had to fumble through different electronic systems and paper charts to extract the relevant data for each patient in her panel at dozens of different clinics. In many cases, it was clear that care had been provided (e.g. an unstable patient had been upgraded from a cane to a walker), but the documentation wasn’t there (to fulfill the “Screening for Future Fall Risk” metric, documentation must state whether the patient had no falls, one fall without major injury, two or more falls, or any fall with major injury.) Therefore, even though care was provided to prevent future falls, the documentation did not meet the CMS requirement and no credit was given.

For the next reporting year, Lisa is designing her own reporting mechanisms for clinics and doctors. She says that her first reporting experience “was invaluable in learning ways to improve the reporting for year 2015 and beyond,” and she is putting processes in place to facilitate reporting next year. But each clinic is different: some need a page at the front of their paper chart with check boxes, and some have templates in their electronic health records. Her new processes may improve the situation, but additional tracking could also cut into time doctors spend with patients and add to the squeeze they already feel.

Integrating data

Lisa integrated all the data from each clinic manually, and this is a problem for small institutions who are trying to communicate and coordinate with each other. Right now it takes a long time and is not very scalable. Even at larger institutions with leading electronic health record systems, the data is locked away within proprietary databases, often in incompatible formats. Clinical data is rarely integrated with financial and patient-reported data in the way required to tie outcomes and claims to reimbursements in a value-based model.

Reporting

After all of her data collection, Lisa still had to submit her data to a third part to produce reports, and she will wait many months for the results. The CMS websites are comically complex ; the instruction manual for using the CMS metric reporting interface is 127 pages long.

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Putting patients at the center

If these problems aren’t addressed, we’re in for a long and painful healthcare reform. Administrative costs will continue to rise, along with another generation of frustrated physicians and admins. Moreover, value-based care could be deemed a failure not because it’s a bad idea but because of poor implementation. Instead of putting patients at the center of care, it could breed more bureaucracy and force doctors to spend more time reporting on metrics and less time with patients.

We can address these issues and we must — to give value-based care a chance at moving the US toward more patient-centered, less exorbitant healthcare.

 

[Reblog] When hospitals buy physician practices, patients hit with fees

From the 5 March 2015 post at Covering Health (Association of Health Care Journalists)

WSB-Atlanta recently explored what happens when hospitals buy physician practices, which has been happening all over the Atlanta area.

Prices for patients go up.

The same physicians – in the same offices, with the same treatments – start charging more.

“Everything is exactly the same,” said cancer patient Mike Rosenberg.

Except the bill.

Sometimes it’s an “outpatient facility fee.” And sometimes it’s a “treatment room fee.”

And it’s a lot of money – sometimes thousands of dollars, not covered by insurance.

And even patients who are savvy enough to know about these fees before they get the bill have a lot of trouble finding out about them, as Erica Byfield made clear in her strong 3-minute report.

…

It’s not unique to Atlanta. She quotes a University of California, Berkeley, studythat found that patients generally pay 10 percent more at hospital-owned practices.

…

The ACA does include incentives for “vertical integration,” or having doctors and physicians part of one organization. But it’s not supposed to raise costs. It’s supposed to bring them down by improving efficiency, creating economies and encouraging care coordination. (Some of the fee problems actually stem from Medicare billing practices, not specifically the ACA.)

 

 

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• When Transparency Isn’t Transparent
• Medical Costs Rise as Retirees Winter in Florida
• Physician Groups that demonstrate high quality care receive increases to their Medicare Payments
• Solving the physician shortage requires these 3 things to happen

How can I order Evidence Reports/Technology Assessments (ERTAs) or Comparative Effectiveness Reviews?

 

What are Evidence Based Reports?

EPC Evidence-Based Reports (home page and links to reports)

The Agency for Healthcare Research and Quality (AHRQ), through its EPCs, sponsors the development of various reports to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reports provide comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies. The EPCs review all relevant scientific literature on a wide spectrum of clinical and health services topics. EPCs also produce technical reports on methodological topics and other types of evidence synthesis-related reports.

Where do Technology Assessments come from?

The Technology Assessment (TA) Program at the Agency for Healthcare Research and Quality (AHRQ) provides technology assessments for the Centers for Medicare & Medicaid Services (CMS). These technology assessments are used by CMS to inform its national coverage decisions for the Medicare program as well as provide information to Medicare carriers.
Fact sheets and reports can be found through The Technology Assessment (TA) Program

 

 

How can I order Evidence Reports/Technology Assessments (ERTAs) or Comparative Effectiveness Reviews? [From http://www.ncbi.nlm.nih.gov/books/NBK45610/ (accessed 3 March 2015)]

The Evidence Reports/Technology Assessments (ERTAs) and Comparative Effectiveness Reviews (CERs) are provided to Bookshelf by the Agency for Healthcare Research and Quality (AHRQ). AHRQ has a publications clearinghouse, which can be accessed through this link: http://ahrqpubs.ahrq.gov/OA_HTML/ibeCZzpHome.jsp

 

Related articles

• Open Access: U.S. Dept. of Health and Human Services (HHS) Expands Its Approach to Making Research Results Freely Available For the Public
• Agency for Healthcare Research and Quality Adopts Open Access Mandate
• U.S. Agency for Healthcare Research and Quality (AHRQ) Announces Public Access Policy

[Journal article] What the Agency for Healthcare Research and Quality Forgets to Tell Americans about How to Protect Their Sexual and Reproductive Health

What the Agency for Healthcare Research and Quality Forgets to Tell Americans about How to Protect Their Sexual and Reproductive Health 

From the January/February 2015 journal article abstract

If there is one thing that health care experts seem to agree on, it is the importance of preventive care. Anything that can help the American public to do a better job of understanding, accessing, and affording effective preventive care and thereby helping them to avoid potential threats to their health should be indisputably a good thing for individuals, families, and society.

Recommendations for the public about what preventive care services an individual might need at different points in his or her life can be one important tool in this tool box, and that goes double for recommendations that speak with the imprimatur of the U.S. Department of Health and Human Services (DHHS). So, a series of fact sheets on “staying healthy” from the Agency for Healthcare Research and Quality (AHRQ)—a branch of DHHS devoted to evidence-based improvements to the provision of U.S. health care—should be a welcome and valued resource (Agency for Healthcare Research and Quality (AHRQ), 2014a, Agency for Healthcare Research and Quality (AHRQ), 2014b).

In this light, it is disappointing to find the AHRQ fact sheets falling short of the mark in some critical ways related to their recommendations on sexual and reproductive health care. The four fact sheets—for women of all ages, women at age 50 and older, men of all ages, and men at age 50 and older—contain a wealth of good advice about screenings and preventive medicine that a patient might need. However, they leave out many effective sexual and reproductive health-related preventive services—perhaps most notably any mention of contraceptive services and supplies—that have been endorsed by other agencies in the DHHS and by the medical establishment more broadly, and that have been promoted through the Affordable Care Act’s (ACA) requirements for private health plans to cover preventive services without patient out-of-pocket costs (HealthCare.gov, 2014, Sonfield, 2012). The AHRQ fact sheets compound those oversights by seeming to imply that they embody the sum total of DHHS’s preventive care recommendations, when in reality they seem to be based almost exclusively on the recommendations of a single body, the U.S. Preventive Services Task Force.

Full text of the article here

[Press Release] Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

#172216716 / gettyimages.com

Efforts to improve patient safety result in 1.3 million fewer patient harms, 50,000 lives saved and $12 billion in health spending avoided

From the US Health and Human Services press release

Hospital-acquired conditions decline by 17 percent over a three-year period

A report released by the Department of Health and Human Services today shows an estimated 50,000 fewer patients died in hospitals and approximately $12 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2013.  This progress toward a safer health care system occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events. The efforts were due in part to provisions of the Affordable Care Act such as Medicare payment incentives to improve the quality of care and the HHS Partnership for Patients initiative.  Preliminary estimates show that in total, hospital patients experienced 1.3 million fewer hospital-acquired conditions from 2010 to 2013.  This translates to a 17 percent decline in hospital-acquired conditions over the three-year period.

“Today’s results are welcome news for patients and their families,” said HHS Secretary Sylvia M. Burwell. “These data represent significant progress in improving the quality of care that patients receive while spending our health care dollars more wisely.  HHS will work with partners across the country to continue to build on this progress.”

Today’s data represent demonstrable progress over a three-year period to improve patient safety in the hospital setting, with the most significant gains occurring in 2012 and 2013. According to preliminary estimates, in 2013 alone, almost 35,000 fewer patients died in hospitals, and approximately 800,000 fewer incidents of harm occurred, saving approximately $8 billion.

Hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical site infections, among others.  HHS’ Agency for Healthcare Research and Quality (AHRQ) analyzed the incidence of a number of avoidable hospital-acquired conditions compared to 2010 rates and used as a baseline estimate of deaths and excess health care costs that were developed when the Partnership for Patients was launched. The results update the data showing improvement for 2012 that were released in May.

“Never before have we been able to bring so many hospitals, clinicians and experts together to share in a common goal – improving patient care,” said Rich Umbdenstock, president and CEO of the American Hospital Association. “We have built an ‘infrastructure of improvement’ that will aid hospitals and the health care field for years to come and has spurred the results you see today. We applaud HHS for having the vision to support these efforts and look forward to our continued partnership to keep patients safe and healthy.”

…

Additional Information

• Interim Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted from 2010 to 2013
• May 2014 patient safety results report
• Partnership for Patients Preliminary Evaluation Report

[Research summary] New Research Review Looks at Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain

From the AHRQ Web site

A new research review from AHRQ’s Effective Health Care Program  found that while the evidence on the effectiveness and harms of opioid therapy for chronic pain treatment is limited, there is an increased risk of serious harms based on the opioid dose given. The research review assesses observational studies that suggest that use of long-term opioids for chronic pain is associated with increased risk of abuse, overdose, fractures and heart attack, when compared with patients who are not being prescribed opioids. The review noted that more research is needed to understand the long-term benefits, risk of abuse and related outcomes, and effectiveness of different opioid prescribing methods and strategies. The review is titled, “The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain.” AHRQ has also released a statistical brief from the Healthcare Cost and Utilization Project titled, “Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993-2012.” According to the brief, hospitalization rates for opioid overuse more than doubled from 1993 to 2012 and increased at a faster rate for people age 45 and older. In addition, AHRQ Director Rick Kronick, Ph.D., has published a blog about opioids.

Related articles

• AHRQ: Little Evidence for Opioids in Managing Long-term Chronic Pain
• The Ineffectiveness of Opioids for Chronic Pain
• The Ineffectiveness of Opioids for Chronic Pain
• Risks of Opioids Outweigh Gains for Many Patients
• National study of discontinuation of long-term opioid therapy among veterans
• Heroin overdose deaths increased in many states through 2012
• Risks of opioids outweigh benefits for headache, low back pain, other conditions

[Reblog] Measuring Quality of Care for Older Adults With Serious Illness

From he 22 January 2014 post at HealthAffairsBlog

by Laura Hanson, Anna Schenck, and Helen Burstin

Editor’s Note: This post is the third in a periodic Health Affairs Blog series on palliative care, health policy, and health reform. The series features essays adapted from and drawing on an upcoming volume, Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, in which clinicians, researchers and policy leaders address 16 key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value. 

In the United States, value is the new health care imperative – improving quality while controlling costs.  We spend nearly twice the rate of comparable nations, yet have poorer health outcomes.  In 2010, President Obama signed the Patient Protection and Affordable Care Act (ACA), mandating a new emphasis on paying for value, not volume.

Our greatest opportunity to enhance value in US health care is to improve quality of care for older adults with serious illness – the group who uses the most health care services. Serious illness, in which patients are unlikely to recover, stabilize, or be cured, is life-altering for patients and family caregivers.  It includes advanced, symptomatic stages of diseases such as congestive heart failure, chronic lung disease, cancer, kidney failure, and dementia. Serious illness may also refer to the cumulative consequences of multiple conditions progressing over time, causing functional decline or frailty.

We’ve made important progress in understanding high quality care for this population of patients.  Researchers have asked patients with serious illness and their families how they define high quality care.  Especially in serious illness, patients want control over treatment through shared decision-making.   Even when there is no cure, most patients still want health care that helps them live longer – but only if they can also get help with function, physical comfort, and attention to family, emotional and spiritual needs.

We know what types of health care help patients and families cope with serious illness.  A 2012 report to the Agency for Healthcare Research and Quality finds evidence for three types of care to improve health outcomes:

1. Expert pain and symptom treatment
2. Communication to engage patient preferences for treatment decisions
3. Interdisciplinary palliative care

We’ve developed quality measures to understand how often real-world care lives up to these ideals.

……

 

Read the entire article here

Related articles

• Five Myths of Palliative Care Dispelled
• UN: WHO Boosts Hope on Pain Relief, Palliative Care
• A pioneering palliative care program “walks alongside” Broward Health patients
• Palliative care is about LIVING!
• Rethinking palliative care

[News article] Heart attacks hit poor hardest

Heart attacks hit poor hardest.

From the 8 January 2014 ScienceDaily article

As people get older, their bodies wear down and become less resilient. In old age, it’s common for people to become “clinically frail,” and this “frailty syndrome” is emerging in the field of public health as a powerful predictor of healthcare use and death.

p. 50 of The 2012 National Healthcare Disparities Report
http://www.ahrq.gov/research/findings/nhqrdr/nhdr12/2012nhdr.pdf

Now researchers Vicki Myers and Prof. Yariv Gerber of the Department of Epidemiology and Preventive Medicine at the School of Public Health at Tel Aviv University’s Sackler Faculty of Medicine and colleagues have found that poor people are more than twice as likely as the wealthy to become frail after a heart attack. The findings, published in the International Journal of Cardiology, could help doctors and policymakers improve post-heart-attack care for the poor.

“By defining frailty, which combines many areas of medicine, we can predict which people are at the highest risk after a heart attack,” said Ms. Myers. “And we found a strong connection between frailty and socioeconomic status.”

…

Read entire article here

Related Resource

National Healthcare Disparities Report (NHDR)

• 2012 Web Version | PDF Version [  – .8.74 MB] | State Snapshots
   

  For the tenth year in a row, the Agency for Healthcare Research and Quality (AHRQ) has produced the National Healthcare Quality Report (NHQR) and theNational Healthcare Disparities Report (NHDR). These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care.
  New this year are chapters on care coordination, and health system infrastructure. The reports present, in chart form, the latest available findings on quality of and access to health care.
  The National Healthcare Quality Report tracks the health care system through quality measures, such as the percentage of heart attack patients who received recommended care when they reached the hospital or the percentage of children who received recommended vaccinations.
  The National Healthcare Disparities Report summarizes health care quality and access among various racial, ethnic, and income groups and other priority populations, such as residents of rural areas and people with disabilities.

   

Related articles

• Sunlight ‘protects against heart attack’
• Heart attack damage slashed with microparticle therapy
• Living Sick and Dying Young in Rich America – Leah Sottile – The Atlantic

 

[Reblog] The Alaska-based Nuka system of health care

 

Reblog from the NLM Director’s Comments Transcript,  July 22,2013

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.

The Alaska-based Nuka system of health care is an alternative approach to clinical practice that is drawing attention as a possible model for other states, and perhaps other nations. I was fortunate to participate in a recent meeting in Anchorage that discussed the Southcentral Foundation’s health care transformation efforts – and introduced Nuka to persons from hospitals and clinics across the U.S. and some other countries. 

Nuka is an Alaska Native word that means a strong, living, and large structure. Anchorage’s Southcentral Foundation applies the term Nuka to describe a system of caring for patients (and the community of Alaska Natives Southcentral serves) that prioritizes achieving physical, mental, emotional, and spiritual wellness.

While other health care systems espouse similar wellness goals, Donald Berwick M.D., the recently departed director of the Centers for Medicare and Medicaid Services (CMS) [who attended the meeting], described the Nuka approach as unique and a role model.

What strikes you immediately are Nuka’s and Southcentral’s emphases on a team approach to health care, helping patients improve their quality of life, and a sincere effort to build personal relationships among providers, staff, patients, and the surrounding community.

Incidentally, the Southcentral Foundation calls patients ‘customer owners’ because Southcentral works exclusively for Alaska Natives, who provide extensive advisory roles in the hospital and clinic’s management and policies. The Southcentral Foundation assumed the clinical responsibilities of the Indian Health Service under the Indian Self-determination Act about three decades ago.

Since that time, Southcentral has revitalized what it means to be in a medical clinic for a checkup or routine care. For example, the first Nuka-related surprise occurs when a patient (or visitor) expects to enter a physician’s office for a routine clinic appointment — and instead meets a team of four persons who sit together in an open area.

That’s right – there are no physician’s offices, no nurse’s stations in the clinic. The team who helps you (and whom you are encouraged to know) includes a primary care physician, a doctor’s assistant (who administers some clinical tests during your visit), a nurse (who arranges further care and provides medical instructions), and a person who helps you coordinate future appointments and navigate your way through the medical center. The team’s four members take pride in their ability to work together. Physicians can use a private examination room to treat patients.

If you need to see a specialist, such as a nutritionist, psychologist, or pharmacist, these providers rotate throughout the clinic teams. Other medical specialists, such as cardiologists, are available on referral the same day — within another area of the medical center. Incidentally, the clinical options include Native Alaskan traditional healing, which is available at a person’s request and encouraged as a compliment to western medical treatment.

Have I got your attention? How many clinics linked to a hospital do you know that have a similar approach and level of staff coordination?

Moreover, Nuka’s teams are encouraged to screen patients to enhance their quality of life — in addition to responding to their physical condition. So, Nuka’s screening may include physical fitness, nutrition habits, family and personal relationships, and what is often perceived as social work issues (such as housing quality and access to transportation). In other words, the team is encouraged to react to someone’s needs and boost his or her quality of life parallel to traditional clinical interventions.

Nuka and Southcentral also perceive wellness as individual, family, and community-based. So, the clinics and medical center encourage exercise programs for persons of all ages, and provide community-based counseling to counter ongoing health challenges such as: obesity, alcoholism, drug abuse, abusive family interactions, and learning how to buy and cook nutritious foods.

All of this is based on extensive efforts to train every Southcentral employee how to communicate well with others and how to share stories about one’s personal character and life journey. One of Nuka’s core discoveries is staff members who know each other well function optimally — and understand the importance (and will take the time) to try to know their patients. Southcentral’s employee and patient satisfaction are well above national averages. Southcentral won the prestigious Malcolm Baldridge National Quality Award in 2011.

In a talk during the meeting Dr. Berwick said (and I quote): ‘this is the cutting edge health care system in the U.S.’ (end of quote). Berwick added Southcentral and Nuka were a source of inspiration that influenced CMS’ recent investment in Oregon to encourage a statewide approach to wellness and health care that may serve as a future, national model. Since the Oregon health care experiment has yet to be fully implemented, it is premature to report how well the Southcentral/Nuka model works if adopted within a more diverse patient population in another state.

However, more than 100 participants interested in applying the principles and some specific aspects of Nuka care attended the meeting, including several administrators and physicians from U.S. Veterans Administration medical centers, a multisite federally qualified health clinic in New York City, officers from state departments of health, and a delegation from one of the largest hospitals in Singapore. I was told recent attendees included medical officials from several other nations.

Overall, it was inspiring to watch as medical professionals learned about  and tried to embrace a fresh approach to providing care and rethink their primary responsibilities to patients and surrounding communities.

I should add Katherine Gottlieb, the Southcentral Foundation’s chief executive officer, is a member of NLM’s Board of Regents. I thank her for helping me begin to understand the extent of Southcentral’s transformative efforts – and I hope you enjoyed hearing about it. You can read more about Nuka at: southcentralfoundation.com/nuka/

Meanwhile, a helpful guide to choosing a hospital (provided by CMS) is provided in the ‘overviews’ section of MedlinePlus.gov’s health facilities health topic page. A guide to hospital quality indicators (from the Agency for Healthcare Research and Quality) also is available in the ‘overviews’ section of MedlinePlus.gov’s health facilities health topic page.

MedlinePlus.gov’s health facilities health topic page contains links to the latest pertinent journal research articles, which are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the health facilities health topic page, you can sign up to receive email updates with links to new information as it becomes available on MedlinePlus.

To find MedlinePlus.gov’s health facilities health topic page, just type ‘health facilities’ in the search box at the top of MedlinePlus.gov’s home page. Then, click on ‘Health facilities (National Library of Medicine).’ MedlinePlus.gov also has health topic pages devoted to health checkups and nursing homes.

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.

 

Related articles

• Graham Leicester: NHS and the Nuka option (scotsman.com)

 

Book offers 10 checklists for hospital patients / Links to related resources

As Elizabeth points out, it is important for patients and patient families to advocate for themselves.
Competent professional health care providers will welcome folks who are prepared and take an active role.
Dedicated hospital staff will not feel antagonized. They will work address concerns and questions for the patient’s benefit.

From the 2 February 2012 article at USA Today

Elizabeth Bailey learned what could go wrong in a hospital the hard way: by watching her elderly father endure a long in-patient nightmare.

It’s important to keep your medications organized because drug mix-ups are among the biggest risks you face in a hospital, experts say.

It’s important to keep your medications organized because drug mix-ups are among the biggest risks you face in a hospital, experts say.

Her dad got too much of one medicine, not enough of others and the wrong food (heavy sweets for a diabetic). One day, he went missing for six hours and, on another, he ended up in restraints on a psychiatric ward (he was suffering mental confusion from his mismanaged medications and poorly controlled blood sugar).

“There were mistakes all the time,” says Bailey, who at the time was a music video producer. “I felt like I was on a very poorly run film set.” She realized her family needed a system to handle the chaos.

Six years later, she has turned that system into a book:The Patient’s Checklist: 10 Simple Hospital Checklists to Keep You Safe, Sane & Organized. And she is no longer a video producer: Instead, at age 50, she is a graduate student in health advocacy and a patient representative at a New York City hospital.

Her mantra: “You want to go in hoping for the best, but you have to prepare — I don’t want to say for the worst — but you have to prepare for everything.”

Among her checklists:

•Before-you-go list. One tip: Organize a schedule for friends and family to be with you in the hospital. Especially crucial: having someone with you the night after a surgery (even if you must hire someone).

•What-to-bring list. Included: “economy-sized hand sanitizer.” You should plant that next to your bed so that you can frequently clean your hands — and not-so-subtly remind everyone else to do likewise. That may lower the risk that you will pick up a nasty infection.

•Daily medication log. She provides a chart to keep track of the name, timing and dosage of every drug you get. That’s because drug mix-ups are among the biggest risks you face in a hospital.

•Discharge plan. On that list: Make sure you know how to handle surgical sites, medical equipment and medications at home….

Related Resources

• [4 minute video]How to make your hospital safer and cheaper (PBS, October 22, 2012)

In her recent book, “The Patient’s Checklist: 10 Simple Hospital Checklists to Keep You Safe, Sane and Organized,” Elizabeth Bailey describes the simple steps patients can take to avoid some of the most common (and potentially deadly) medical mistakes in the hospital. The theme throughout: Pay attention, ask questions, and never assume that any hospital is error-free where your care is concerned.

• A safety checklist for patients (Points From Pronovost – Johns Hopkins)

Including these links

• 20 Tips to Help Prevent Medical Errors(Agency for Healthcare Research and Quality)
• Don’t Become the Victim of a Surgical Error (CNN)
• Medical Errors: Tips to Help Prevent Them (American Academy of Family Physicians)
• My Health Notebook (Johns Hopkins Medicine)
• Patient Handbook (Johns Hopkins Hospital)
• Patient Safety Video (Johns Hopkins Hospital)
• Patient Safety Checklists (Campaign Zero: Families for Patient Safety)
• Taking Charge of Your Healthcare (Consumers Advancing Patient Safety)
• Getting Safer Care (AHRQ)

Related articles

• How to Make Your Hospital Stay Safer and Cheaper: A Checklist (pbs.org)
• What the U.S. Could Buy With Wasted Health Care Money (pbs.org)
• Reducing Healthcare Associated Infections And Improving Patient Safety Conference, 22 November 2012, London (medicalnewstoday.com)
• Computerized Checklist Offers Best Preventive Strategy For Deadly Blood Clots (medicalnewstoday.com)
• Seven Factors Driving Up Your Health Care Costs (pbs.org)
• How to Stop Hospitals From Killing Us (listahit.wordpress.com)
• 10 shocking medical mistakes (cnn.com)
• Electronic Checklists Help Prevent Medical Errors (informationweek.com)
• Waste in U.S. Health Care: Your First-Hand Accounts (pbs.org)

Only 10 percent of the U.S. population accounted for nearly two-thirds of all health care costs in 2008, and related statistics

Image via Wikipedia

Old news to many, still worth repeating as we here in the US strive for more equitable access to healthcare for all.
Who pays for healthcare can be very complicated…including issues of justice, fairness, compassion, personal responsibility.
Yes, the debate does get heated often, as there are disagreements about core values and essential beliefs.
Yet I am hopeful that addressing this issue (not sure if it will ever be 100% solved) can serve to further unite us in rethinking community and participating in community. At the risk of sounding trite, we are all in this together, all we have is each other.

AHRQ News and Numbers: Most Health Care Costs Incurred by Few Americans

The press release by the US Agency for Healthcare Research and Quality

Release date: January 12, 2012

Only 10 percent of the U.S. population accounted for nearly two-thirds of all health care costs in 2008, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). The average annual cost for each of these individuals totaled almost $24,000, which includes costs covered by insurance and paid out of pocket. Approximately 45 percent of these individuals remained in this 10 percent of the population in 2009, based on their health expenses that year.

The Federal agency’s analysis of the 10 percent of patients with the highest health care expenses in both 2008 and 2009 also found that:

Nearly 60 percent of these patients were women.
More than 40 percent of patients were age 65 or older, while those age 18 to 29 made up just 3 percent.
More than 80 percent of patients were white, while Asians were the smallest segment at 2 percent.
The data in this AHRQ News and Numbers summary are taken from the Medical Expenditure Panel Survey (MEPS), a detailed source of information on the health services used by Americans, the frequency with which they are used, the cost of those services, and how they are paid. For more information, go to Statistical Brief #354: The Concentration and Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2008-2009.

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New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation Move Beyond The Cycle Of Costly ‘Crisis Care’ [With Related Resources]

Health literacy used to be thought of as a problem individuals had in understanding health information and making health decisions. Now health literacy is beginning to be viewed in more holistic terms. For example, health care providers (from nurses to institutions) now view themselves as having roles in providing relevant understandable information to patients and the public.
What brought about this change in focus? According to the article below, major health policy initiatives at the federal level, including the “Plain Writing Act of 2010, which requires all new publications, forms, and publicly distributed documents from the federal government to be written in a “clear, concise, well-organized” manner.”

A good summary of this change in direction and focus may be found within the article…
New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation Move Beyond The Cycle Of Costly ‘Crisis Care’

Here is an abstract of the article (in the journal Health Affairs, January 12, 2012)

Health literacy is the capacity to understand basic health information and make appropriate health decisions. Tens of millions of Americans have limited health literacy—a fact that poses major challenges for the delivery of high-quality care. Despite its importance, health literacy has until recently been relegated to the sidelines of health care improvement efforts aimed at increasing access, improving quality, and better managing costs. Recent federal policy initiatives, including the Affordable Care Act of 2010, the Department of Health and Human Services’ National Action Plan to Improve Health Literacy, and the Plain Writing Act of 2010, have brought health literacy to a tipping point—that is, poised to make the transition from the margins to the mainstream. If public and private organizations make it a priority to become health literate, the nation’s health literacy can be advanced to the point at which it will play a major role in improving health care and health for all Americans…

In years past, clinicians and researchers alike largely viewed these issues and outcomes in terms of individual patient deficits—that is, a patient’s lack of knowledge and skills regarding health issues. We now recognize that health literacy is a dynamic systems issue,2 reflecting the complexity of both the health information being presented and the health care system being navigated.3 As summarized by the Institute of Medicine, addressing the challenge of health literacy requires system-level changes for both health professionals and organizations…

It is impossible to list all relevant related resources here!
A small sampling..

Health Literacy Library Guides (while aimed at professionals, librarians, etc, some have links to materials for the rest of us)

• [Especially for the rest of us] Medical Information in Plain Language: A Health Literacy Resource Guide(Univ of CT Health Center) , including
  • News about health

• Improving Health Education Literacy (Nebraska Methodist College), especially
  • Evaluating health information on the Web (with a video)

• Health Literacy (Duke University), especially
  • Tools for Patients (Patient Care)

Great places to start for health information on many topics (diseases, conditions, talking with health care professionals, etc)

(More Great Places here)

• MedlinePlus – Over 750 topics on conditions, diseases, and wellness.  Information ondrugs, herbs, and supplements. Links to directories (health care providers, health care facilities, etc) and organizations which provider health information. Surgery videos, informative slideshows, and more.
• Agency for Healthcare Research and Quality – Consumers and Patients
  the latest evidence based information for improving your health, including podcasts and videos
• Familydoctor.org includes health information for the whole family
  Short generalized information on Diseases and Conditions (with A-Z index), Health Information for Seniors, Men, and Women, Healthy Living Topics, pages geared to Parents & Kids, and videos.  Numerous health tools in the left column (as health trackers, health assessments, and a Search by Symptom page.
  
  
• KidsHealth provides information about health, behavior, and development from before birth through the teen years. Material is written by doctors in understandable language at three levels: parents, kids, and teens
  KidsHealth also provides families with perspective, advice, and comfort about a wide range of physical, emotional, and behavioral issues that affect children and teens.

Understanding Health Research

• “Summaries for Patients”  are short summaries of studies and clinical guidelines (how medicine is best practiced) are  published in Annals of Internal Medicine.
  [Go to Summaries for Patients, scroll down a little, the right column has  link to all summaries and a search box ]Summaries about studies describe how researchers did the published study and what they found.
  Summaries about clinical guidelines describe the official recommendations for patient care
• patientINFORM plain language summary Web sites are provided by participating publishers to help patients or their caregivers more fully understand the implications of research and to provide links to the full text of research articles they’ve selected from participating journals. The publishers allow readers following links from patientINFORM material on the health organizations’ sites to access the full text of these articles without a subscription, and they provide patients and caregivers with free or reduced-fee access to other articles in participating journals.
• Cochrane Collaboration provides systematic reviews (thorough summaries) of the strongest evidence available about healthcare interventions (as drugs and medical procedures).  It does not cover all interventions, but those covered were reviewed  in-depth by experts in the medical and library fields.
  • Here is how to find plain language  and audio summaries of Cochrane reviewsGo to the Cochrane Collaboration home page and scroll down to Browse Free Summaries.
    Topics include Breast Cancer, Dementia and Cognitive Improvement, and Complementary Medicine.
    Click on To the Cochrane Library in the upper right corner of the Cochrance Collaboration home page.
    This Cochrane Library search page has a Help page , and an Advanced Search option.
• HealthNewsReview.org – Independent Expert Reviews of News Stories
  The site is dedicated to
  • Improving the accuracy of news stories about medical treatments, tests, products and procedures.
  • Helping consumers evaluate the evidence for and against new ideas in health care.

Health News Review includes

• Select (about 2-3 a day out of hundreds!) reviews of news articles. These reviews are very thorough, including how the article stacks up against criteria as treatment costs, scientific evidence, conflicts of interest
• Toolkit with links to how to understand studies, evaluate claims, etc

• Understanding Medical Research (MedlinePlus) has great links, including
  • Increasing Knowledge — How to Read a Research Paper(Lewy Body Dementia Association)
  • JAMA Patient Page: Basic Science Research(American Medical Association) – PDF
    Also available in Spanish

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Reminder: NLM Gateway Changing

Image via Wikipedia

From NLM Technical Bulletin, November 23, 2011 [posted]

Reminder: NLM Gateway Changing

On December 1, 2011, the Lister Hill National Center for Biomedical Communications (LHNCBC) will complete the transition of the NLM® Gateway to the new LHNCBC pilot project. The new site will retain the Web address of the former NLM Gateway. It will have two databases: Meeting Abstracts and Health Services Research Projects in Progress (HSRProj). HSRProj also remains available via a separate search engine through the portal HSR Information Central.

The Meeting Abstracts database contains abstracts from HIV/AIDS, Health Services Research, and Space Life Sciences meetings and conferences. The final update to the Meeting Abstracts database is the addition of the abstracts from the 2010 18th International AIDS Conference which will be completed in December 2011. After this addition, no new meeting abstract data will be loaded.

For additional information on the transition to the pilot project, see the article NLM Gateway Transitioning to New Pilot Project Site.

========

May 27, 2011 [posted]

NLM Gateway Transitioning to New Pilot Project Site

On December 1, 2011, the NLM® Gateway will transition to a new pilot project from the Lister Hill National Center for Biomedical Communications (LHNCBC). The current version of the NLM Gateway provides search access across multiple databases; however, all but one of these databases is available from other NLM sources, and most users of those databases search them directly and do not use the NLM Gateway. Only one database, Meeting Abstracts, is uniquely located on the Gateway system. Although NLM has invested in and supported the NLM Gateway for eleven years, based on current budget limitations and the results of evaluations of the use of NLM Gateway, the Library has recently decided to discontinue this service, as currently configured, and transition to a new pilot project site.

The new site will focus on two databases: Meeting Abstracts and Health Services Research Projects in Progress (HSRProj). A forthcoming NLM Technical Bulletin will provide more information on this new service from the LHNCBC. Once the new pilot system is available in December, the current Gateway URL will redirect any visitors to the new Web site. The Meeting Abstracts database will still be unique to this site, while HSRProj will continue to be accessible from its home site.

The Meeting Abstracts database contains selected abstracts from meetings and conferences in the subject areas of AIDS, Health Services Research, and Space Life Sciences. The last update to the Meeting Abstracts Database is anticipated to be the addition of the 2010 18th International AIDS Conference, which is expected to be loaded in the fall of 2011. After this addition, the Meeting Abstracts database will still be accessible, but no new data will be loaded.

All of the other resources currently accessed through the NLM Gateway will be available through their individual sites (see Table 1). The home sites for these systems are listed on the NLM Databases & Electronic Resources page. This directory of resources is easily located by clicking on the “All NLM Databases” link in the Databases column on theNLM homepage.

Table 1: The NLM Resources, and homepage URLs, that will no longer be available through the NLM Gateway.

NLM Resources Formerly on the NLM Gateway	URL
Bookshelf	http://www.ncbi.nlm.nih.gov/books
Chemical Carcinogenesis Research Information System (CCRIS)	http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?CCRIS
ClinicalTrials.gov	http://clinicaltrials.gov/
Developmental and Reproductive Toxicology Database (DART)	http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?DARTETIC
Directory of Health Organizations (DIRLINE®)	http://dirline.nlm.nih.gov/
Genetic Toxicology Data Bank (GENE-TOX)	http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?GENETOX
Genetics Home Reference	http://ghr.nlm.nih.gov/
Hazardous Substances Data Bank (HSDB)	http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?HSDB
Household Products Database	http://hpd.nlm.nih.gov/
Images from the History of Medicine	http://www.nlm.nih.gov/hmd/ihm/index.html
Integrated Risk Information System (IRIS)	http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?IRIS
International Toxicity Estimates for Risk (ITER)	http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?iter
MEDLINE®/PubMed®	http://www.ncbi.nlm.nih.gov/pubmed/
MedlinePlus®	http://www.nlm.nih.gov/medlineplus/
NLM Catalog	http://www.ncbi.nlm.nih.gov/nlmcatalog
Online Mendelian Inheritance in Man (OMIM)	http://www.ncbi.nlm.nih.gov/omim
Profiles in Science®	http://profiles.nlm.nih.gov/
TOXLINE® Subset	http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?TOXLINE

If you are accustomed to the NLM Gateway cross file searching function you may want to try using the cross database features provided by TOXNET® and by the NCBI Entrez system.

The search box on the TOXNET homepage offers a cross database search function for the databases in the Toxicology Data Network (see Figures 1 and 2).

Figure 1: TOXNET homepage with “Search All Databases” feature.

Figure 2: TOXNET Search All Databases Results Page.

The NCBI global query feature on the NCBI homepage provides a cross database search feature for all of the Entrez databases (see Figures 3 and 4). Selecting “All Databases” in the search box will return a summary search page identifying possible results across all of the NCBI Entrez databases, including PubMed, PubMed Central, BookShelf, NLM Catalog, and the genetic and protein databases such as Gene, OMIM, BLAST, dbGaP, and others.

You can simply bookmark the Web page http://www.ncbi.nlm.nih.gov/gquery to access the global query search feature. However, going to the NCBI homepage may be the easier way to access this function; the NCBI logo on the top left corner of any Entrez-based system links to the NCBI homepage.

Figure 3: NCBI homepage and “All Databases” option in the search box.

Figure 4: Entrez global query search results page.

By David Gillikin
Bibliographic Services Division

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Medication Safety Booklet in Spanish and English | Health Information Literacy – for health and well being

Medication Safety Booklet in Spanish and English | Health Information Literacy – for health and well being.

 

Posted on November 18, 2011

The following was posted on the BHIC Blog; August 30, 2011.

by Siobhan Champ-Blackwell

Spanish http://1.usa.gov/niu45x
English http://1.usa.gov/jClN3h
AHRQ has released a revised Spanish-language medication safety booklet, “Su medicamento: Infórmese. Evite riesgos” (“Your Medicine: Be Smart. Be Safe.”) to help Spanish-speaking patients learn more about how to take medicines safely. The booklet includes a detachable, wallet-size card that can help patients keep track of medicines they are taking, including vitamins and herbal and other dietary supplements. Print copies are available by sending an e-mail to AHRQPubs@ahrq.hhs.gov.

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PubMed Health – A Growing Resource for Clinical Effectiveness Information

From the November NLM Technical Bulletin article

PubMed Health — A Growing Resource for Clinical Effectiveness Information

PubMed® Health developed further as a resource for clinical effectiveness research with its August and September 2011 releases. Growing from around 200 items based on systematic reviews to over 5,000, PubMed Health has also begun a collection focused on helping people understand systematic reviews and their results. PubMed Health goals are: helping users find the evidence that could answer their questions about effects of health care and helping them understand what they find.

Making Systematic Reviews More Accessible
Systematic reviews that identify and interpret studies on the effects of health care form an essential research basis for informed decision-making. Systematic reviewing has been growing, especially with the advent of The Cochrane Collaboration and the increasing incorporation of this methodology in health technology assessment by public agencies and clinical practice guideline development.

Systematic reviews (including health technology assessments) are often lengthy and highly technical. Their evolution has been accompanied by a growth in knowledge translation activity. Along with traditional abstracts, various forms have been developed to help people use systematic reviews: executive and policymaker summaries, summaries or other forms for patients/consumers and summaries for clinicians.

However, these materials have been scattered widely on content providers’ Web sites without being collected centrally. Many of the systematic reviews undertaken by public health technology assessment agencies have also remained outside the National Library of Medicine® (NLM®) system. The PubMed Health initiative is gathering them together within a single searchable resource.

PubMed Health Content
PubMed Health contains systematic reviews and summaries of systematic reviews undertaken or updated in roughly the last ten years. The time limit is applied to publication date of around eight years, to allow for the time lag from the date of the evidence search. The cut-off currently is 2003.

New content incorporated in these releases include summaries from The Cochrane Collaboration and the National Health Service (NHS) National Institute for Health Research (NIHR) Health Technology Assessment Programme. There are also full text reviews from the U.S. Agency for Healthcare Research and Quality (AHRQ), the Drug Effectiveness Review Project (DERP) at Oregon Health & Science University (OHSU), England’s National Institute for Health and Clinical Excellence (NICE) guidelines program, and the Department of Veterans Affairs’ Evidence-based Synthesis Program. From NHS Choices comes “Behind the Headlines”, its educational service on the science behind the news. These new content providers join PubMed Health original consumer clinical effectiveness content for consumers content provided by AHRQ and the German Institute for Quality and Efficiency in Health Care (IQWiG).

The reviews and review summaries now in PubMed Health account for perhaps one-third of the good quality systematic reviews published by public agencies and journals worldwide. Most of the remainder can be found in PubMed “Clinical Queries” Systematic Reviews search which runs simultaneously with a PubMed Health search; those PubMed results are presented as links on the right-hand portion of the results page (see #3 in Figure 4).

Organization
The re-designed homepage (see Figure 1) includes four key sections:

• Contents: a complete alphabetical listing of all titles, sorted by type of content.
• Behind Headlines: the NHS guide to the science behind health stories in the news.
• New & updated: content added in the last 60 days.
• Featured reviews: high quality reviews on interesting topics are selected and featured here. “Previously featured reviews” are provided in an RSS feed to which people can subscribe.
• Understanding clinical effectiveness: an explanation of clinical effectiveness research along with a section focusing on resources to help people understand systematic reviews and interpret the results.

Figure 1: PubMed Health homepage.

A drop-down box under “Contents” (see Figure 2) shows the categories of information currently included in PubMed Health where these are available:

• For consumers: includes consumer summaries of systematic reviews as well as consumer information based on systematic reviews.
• Executive summaries: executive or policymaker summaries of systematic reviews.
• Clinical guides: clinician summaries of systematic reviews as well as clinical practice guidelines that are based on a fully reported systematic review.
• Full text reviews: systematic reviews with full texts, including PDF versions.
• Medical encyclopedia: medical and drug information for consumers for supplementary background information.

PubMed Health includes content that is currently also cited in PubMed, and PubMed Health will systematically be building in links to these citations. However, there will be some time lag for many items between inclusion in PubMed Health and citation in PubMed. Consumer content from PubMed Health is currently not included in PubMed.

Figure 2: Contents drop-down box.

At the top right-hand corner (see Figure 3), “About PubMed Health” explains the Web site and the National Center Biotechnology Information, NLM, with a full listing of content providers. “Help” includes explanation of basic functions, along with suggested citations for PubMed Health content.

Figure 3: About PubMed Health and Help features.

Searching
The primary search (see #1 in Figure 4) returns clinical effectiveness content by relevance, with the option of viewing all (default) or only specified content types. Relevant medical encyclopedia results are shown at the right (see #2 inFigure 4), with the results of the “Clinical Queries” filter search for systematic reviews in PubMed showing below those (see #3 in Figure 4). “Clinical Queries” returns results chronologically.

Figure 4: Search results.

Additional Features
With medical encyclopedia content, PubMed Health has enhanced the display of anatomical images and given this popular feature a more prominent position. There are links from the medical encyclopedia diseases and conditions pages to MedlinePlus® content.

PubMed Health now features “Add this” sharing for e-mail and social media. Coming in the fall, PubMed Health will begin a Twitter feed, announcing new content providers and features, as well as featured content.

PubMed Health full address: http://www.ncbi.nlm.nih.gov/pubmedhealth/
Shortcut: http://www.pubmed.gov/health
Customer service contact: pmh-help@ncbi.nlm.nih.gov

By Hilda Bastian
National Center for Biotechnology Information

 

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PubMed Health — A Growing Resource for Clinical Effectiveness Information

 

Image via Wikipedia

From the November NLM Technical Bulletin article

PubMed Health — A Growing Resource for Clinical Effectiveness Information

PubMed® Health developed further as a resource for clinical effectiveness research with its August and September 2011 releases. Growing from around 200 items based on systematic reviews to over 5,000, PubMed Health has also begun a collection focused on helping people understand systematic reviews and their results. PubMed Health goals are: helping users find the evidence that could answer their questions about effects of health care and helping them understand what they find.

Making Systematic Reviews More Accessible
Systematic reviews that identify and interpret studies on the effects of health care form an essential research basis for informed decision-making. Systematic reviewing has been growing, especially with the advent of The Cochrane Collaboration and the increasing incorporation of this methodology in health technology assessment by public agencies and clinical practice guideline development.

Systematic reviews (including health technology assessments) are often lengthy and highly technical. Their evolution has been accompanied by a growth in knowledge translation activity. Along with traditional abstracts, various forms have been developed to help people use systematic reviews: executive and policymaker summaries, summaries or other forms for patients/consumers and summaries for clinicians.

However, these materials have been scattered widely on content providers’ Web sites without being collected centrally. Many of the systematic reviews undertaken by public health technology assessment agencies have also remained outside the National Library of Medicine® (NLM®) system. The PubMed Health initiative is gathering them together within a single searchable resource.

PubMed Health Content
PubMed Health contains systematic reviews and summaries of systematic reviews undertaken or updated in roughly the last ten years. The time limit is applied to publication date of around eight years, to allow for the time lag from the date of the evidence search. The cut-off currently is 2003.

New content incorporated in these releases include summaries from The Cochrane Collaboration and the National Health Service (NHS) National Institute for Health Research (NIHR) Health Technology Assessment Programme. There are also full text reviews from the U.S. Agency for Healthcare Research and Quality (AHRQ), the Drug Effectiveness Review Project (DERP) at Oregon Health & Science University (OHSU), England’s National Institute for Health and Clinical Excellence (NICE) guidelines program, and the Department of Veterans Affairs’ Evidence-based Synthesis Program. From NHS Choices comes “Behind the Headlines”, its educational service on the science behind the news. These new content providers join PubMed Health original consumer clinical effectiveness content for consumers content provided by AHRQ and the German Institute for Quality and Efficiency in Health Care (IQWiG).

The reviews and review summaries now in PubMed Health account for perhaps one-third of the good quality systematic reviews published by public agencies and journals worldwide. Most of the remainder can be found in PubMed “Clinical Queries” Systematic Reviews search which runs simultaneously with a PubMed Health search; those PubMed results are presented as links on the right-hand portion of the results page (see #3 in Figure 4).

Organization
The re-designed homepage (see Figure 1) includes four key sections:

• Contents: a complete alphabetical listing of all titles, sorted by type of content.
• Behind Headlines: the NHS guide to the science behind health stories in the news.
• New & updated: content added in the last 60 days.
• Featured reviews: high quality reviews on interesting topics are selected and featured here. “Previously featured reviews” are provided in an RSS feed to which people can subscribe.
• Understanding clinical effectiveness: an explanation of clinical effectiveness research along with a section focusing on resources to help people understand systematic reviews and interpret the results.

Figure 1: PubMed Health homepage.

A drop-down box under “Contents” (see Figure 2) shows the categories of information currently included in PubMed Health where these are available:

• For consumers: includes consumer summaries of systematic reviews as well as consumer information based on systematic reviews.
• Executive summaries: executive or policymaker summaries of systematic reviews.
• Clinical guides: clinician summaries of systematic reviews as well as clinical practice guidelines that are based on a fully reported systematic review.
• Full text reviews: systematic reviews with full texts, including PDF versions.
• Medical encyclopedia: medical and drug information for consumers for supplementary background information.

PubMed Health includes content that is currently also cited in PubMed, and PubMed Health will systematically be building in links to these citations. However, there will be some time lag for many items between inclusion in PubMed Health and citation in PubMed. Consumer content from PubMed Health is currently not included in PubMed.

Figure 2: Contents drop-down box.

At the top right-hand corner (see Figure 3), “About PubMed Health” explains the Web site and the National Center Biotechnology Information, NLM, with a full listing of content providers. “Help” includes explanation of basic functions, along with suggested citations for PubMed Health content.

Figure 3: About PubMed Health and Help features.

Searching
The primary search (see #1 in Figure 4) returns clinical effectiveness content by relevance, with the option of viewing all (default) or only specified content types. Relevant medical encyclopedia results are shown at the right (see #2 inFigure 4), with the results of the “Clinical Queries” filter search for systematic reviews in PubMed showing below those (see #3 in Figure 4). “Clinical Queries” returns results chronologically.

Figure 4: Search results.

Additional Features
With medical encyclopedia content, PubMed Health has enhanced the display of anatomical images and given this popular feature a more prominent position. There are links from the medical encyclopedia diseases and conditions pages to MedlinePlus® content.

PubMed Health now features “Add this” sharing for e-mail and social media. Coming in the fall, PubMed Health will begin a Twitter feed, announcing new content providers and features, as well as featured content.

PubMed Health full address: http://www.ncbi.nlm.nih.gov/pubmedhealth/
Shortcut: http://www.pubmed.gov/health
Customer service contact: pmh-help@ncbi.nlm.nih.gov

By Hilda Bastian
National Center for Biotechnology Information

 

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Patients want to understand the medical literature (with links to resources for patients)

http://medicalcenter.osu.edu/patientcare/library_for_health_information/Pages/index.aspx

From the Science Intelligence blog item

Findings of a recent  study by JISC:

Publishing a lay summary alongside every research article could be the answer to assisting in the wider understanding of health-related information. 

Patients Participate! asked patients, the public, medical research charities and the research community, ‘How can we work together in making sense of scientific literature, to truly open up research findings for everyone who is interested?’ The answer came from patients who explained that they want easy-to-understand, evidence-based information relating to biomedical and health research. 

Some universities now offer researchers training in communicating with lay audiences. (…)

JISC believes that publicly-funded research should be made available for everyone and be easy to find. JISC funded this work to show how making access to scientific literature enables citizen-patients to participate in the research process, therefore providing mutual understanding and better links between scientists, medic, patients and the general public.

http://www.jisc.ac.uk/news/stories/2011/10/participate.aspx

———————————————————————————————–

——————————————-

“Summaries for Patients” and other plain language summaries help patients and others understand medical studies and guidelines

“Summaries for Patients

“Summaries for Patients” are brief, non-technical summaries of studies and clinical guidelines published inAnnals of Internal Medicine. The Summaries aim to explain these published articles to people who are not health care providers.

• Summaries about studies describe how researchers did the published study and what they found.
• Summaries about clinical guidelines describe the official recommendations for patient care developed by official groups such as the US Preventive Services Task Force or the American College of Physicians.

To search for summaries, click on New Search (top of middle column) at “Summaries for Patients”
Once at the New Search Page (http://www.annals.org/search), be sure to check Summaries for Patients , under Limit Results by Section (Articles Published After 1927)

Here are excerpts from a recent Summaries for Patients, Who Reports Having More Pain at the End of Life?

What is the problem and what is known about it so far?

Pain at the end of life is everyone’s great fear, but we still do not know enough about what makes pain worse at the end of life. Studies of pain near death have mostly looked at specific types of patients, such as those with cancer or those who are in a hospice program in which a patient’s comfort and reducing pain is a main focus of care. Other studies have asked family members about their deceased or dying relative’s experience of pain in the last months of life, but these reports are affected by their feelings about the pain of their loved one. In addition, studies have generally not examined patients from national surveys that offer broader understanding of patients’ experience of moderate to clinically significant pain at the end of life.

What did the researchers find?

Among the more than 4700 patients in the study, about 25% had clinically significant pain. However, the proportion experiencing significant pain increased to nearly 50% in the last 4 months before death. One of the most important things that affected the amount of pain was having arthritis. Surprisingly, the reason that a person was dying, such as heart disease or cancer, was not associated with important differences in the amount of pain.

What were the limitations of the study?

No information about treatment for pain was provided, and the study did not follow specific patients over time to see how their pain changed. Some people with arthritis might have had pain from something else that they mistakenly thought was arthritis.

What are the implications of the study?

Physicians and patients are not good at knowing when death is close, so it is important long before the last few months of life to discuss pain and ways to reduce it. Arthritis may be an important cause of pain or death that could be reduced by lifestyle changes long before death.

patientINFORM plain language summary Web sites are provided by participating publishers to help patients or their caregivers more fully understand the implications of research and to provide links to the full text of research articles they’ve selected from participating journals. The publishers allow readers following links from patientINFORM material on the health organizations’ sites to access the full text of these articles without a subscription, and they provide patients and caregivers with free or reduced-fee access to other articles in participating journals.

• American Cancer Society (News Center)
• American Association for the Advancement of Science  (Eureka Alert- Medicine and Health)
• American Diabetes Association (Access: Diabetes Research)
• American Heart Association
• Lupus Foundation of America (Research Summaries)
• National Breast Cancer Coalition
• National Organization for Rare Disorders
• American Society of Hematology Articles for patients from the ASH education book can be accessed via the patient section of ASH’s web site under Other Resources.
• Journal of Rehabilitation Research and DevelopmentFor its nontechnical readers (e.g., veterans, patients, and caregivers), JRRD publishes plain-language summaries in each issue that describe the purpose and explain who may benefit from the research. These summaries are useful tools that keep patients and interested individuals informed of current research and encourage discussion of research between patients and their healthcare providers.

The Cochrane Collaboration

Working together to provide the best evidence for health care

Cochrane Collaboration provides systematic reviews of the strongest evidence available about healthcare interventions (as drugs and medical procedures).  It does not cover all interventions, but those covered were reviewed  in-depth by experts in the medical and library fields.
The main activity of the Collaboration is the preparation of Cochrane reviews that are published electronically in successive issues of The Cochrane Library. These Cochrane reviews investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting.
[Click here to find more information about the use of the evidence to inform decision making in health care ]

Here is how to find plain language  and audio summaries of Cochrane reviews

• Go to the Cochrane Collaboration home page and scroll down to Browse Free Summaries.
  Topics include Breast Cancer, Dementia and Cognitive Improvement, and Complementary Medicine.
• Click on To the Cochrane Library in the upper right corner of the Cochrance Collaboration home page.
  This Cochrane Library search page has a Help page , and an Advanced Search option.
  
  

Related Blog Items 

• How to read a research paper (and also understand medical/health news items)

Cannot find a plain language summary with the above resources?

Consider asking a reference librarian for help at your local public, academic, or hospital library. Many academic and hospital libraries provide at least limited reference service to the public.
Call or email them for information about their services.

You may also contact me at jmflahiff@msncom.  I will do my best to reply within 48 hours.

Government agency working to empower patients and others to improve health care quality

The US Agency for Healthcare Research and Quality is working to empower us through an ad campaign and online materials.

The ad campaign Questions are the Answers includes public service announcements (the videos may  be viewed here)

The Questions are the Answers campaign also features these Web pages

• Reducing Medical Mistakes with questions to ask your health care provider, how to prevent medical errors, and more
• Talking with Your Clinician with tips on how to give and get information, get quality care and more
• Planning for Surgery with questions to ask and tips
• Getting a Prescription with tips on keeping track of meds, how to take medicine safely, and more
• Links to Additional Patient Safety Resources

Related articles

• Your Health Priorities Tool (AHRQ) (jflahiff.wordpress.com)
• I’m happy that patients use the internet  (ScienceRoll)
• IOM Report: Government Should Consider Public Health Implications Of All Major Legislation (jflahiff.wordpress.com)
• Question Authority (centerforhealthmediapolicy.com)

AHRQ Offers Interactive Tool To Analyze National and State Health Care Data

From the AHRQ (Agency for Healthcare Research and Quality) press release

Mining for specific data on health care quality and disparities in the U.S.?  It’s an easy process with AHRQ’s NHQRDRnet online query system, which features data from the 2010 National Healthcare Quality Report and the National Healthcare Disparities Report.  At the State and national level, you’ll find quality-of-care data on clinical conditions ranging from asthma and diabetes to heart disease and cancer.  You can review data by specific age groups as well as by race, ethnicity, income, and education.  Using NHQRDRnet’s search tool, you can locate data tables based on selected words, chapters, or type of table.  Select to access AHRQ’s NHQRDRnet system.

Related Link

• Improving Data Collection to Reduce Health Disparities (Healthcare.gov)

 

[How to] Explore Your Treatment Options

 

The US Agency for Healthcare Research and Qualtiy (AHRQ) publishes a wealth of information for consumers and patients on staying healthy, choosing medical care, understanding diseases and conditions, and comparing medical treatments.

For example, Explore Your Treatment Options gives sound advice on

• Why one should explore treatment options
• Tips on how to start the conversation about treatment options with doctors
• Rating health priorities through a  check list type tool. The questions ask you to rate ease of every day activities, concerns about treatment side effects, and basic questions about treatment time, cost, and effort. Results may be printed to share with your doctor.
• Links to Treatment Guides (cancer, diabetes, heart conditions, and more)

AHRQ Releases Tool to Help Consumers Reduce Medication Errors

From the press release

Three out of four Americans are not following their doctor’s advice when it comes to taking prescription medication, according to U.S. Surgeon General Dr. Regina Benjamin.  AHRQ and the National Council on Patient Information and Education have released a revised guide to help patients learn more about how to take medicines safely.  “Your Medicines: Be Smart. Be Safe” is a booklet that includes a detachable, wallet-sized card that can be personalized to help patients keep track of all medicines they are taking, including vitamins and herbal and other dietary supplements.  Available in English and Spanish, the guide includes questions that patients can ask their doctors about their medications.  Select to access a copy of the guide.  Print copies are available by sending an e-mail to ahrqpubs@ahrq.hhs.gov.