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Patient Engagement: Overused Sound Bite or Transformative Opportunity?

From the 31 March 2015 post at The C Health Blog

Criteria for Stage 3 of meaningful use of EHRs were released recently and there is lots of controversy, as would have been predicted. One set of recommendations that is raising eyebrows is around patient engagement.

The recommendations include three measures of engagement, and providers would have to report on all three of them, but successfully meet thresholds on two.

1. Following on the Stage 2 measure of getting patients to view, download, and transmit their personal health data, the Office of the National Coordinator (ONC) has proposed an increase from five to 25 percent.
2. The second measure requires that more than 35 percent of all patients seen by the provider or discharged from the hospital receive a secure message using the electronic health record’s (EHR) electronic messaging function or in response to a secure message sent by the patient (or the patient’s authorized representative).
3. The third measure calls for more than 15 percent of patients to contribute patient-generated health data or data from a non-clinical setting, to the EHR.

This is all a mouthful, and it’s striking and a bit misguided from two perspectives. First, this requires health care providers to present material to or interact with patients electronically in the name of patient engagement. But it is really mostly about shoveling uninspiring material at our patients that is redolent of highly technical jargon with minimal context, with the belief that it is somehow good for patients to be engaged in this way. The intent is admirable, but the execution flawed. In addition, it is not surprising that many providers have had challenges meeting the Stage 2 requirement that five percent of patients download their medical records. It seems akin to saying that this week’s book club selection is the text for advanced graduate study of quantum mechanics — and then wondering why no one shows up for the meeting.

Some define engagement in terms of how many times consumers or patients interact with informational websites or portals. Both insurers and providers do this. Once again, there is puzzlement over why consumers would choose to spend more time on sites such as BuzzFeed, Facebook and Yahoo, rather than intently study their health benefits or review their lab tests.

At Partners HealthCare Connected Health, our first generation interest in engagement came when we saw, reproducibly, that people who interact with connected health programs have consistently better health outcomes.

This brings up two salient points: The first is how finely we can measure engagement using connected health.

……

[Reblog] Debunking myths designed to hinder price, quality transparency efforts

From the 18 May 2015 post from the Association of Health Care Journalists

When writing about transparency in health care prices and quality, journalists should expose the myths that health care providers promote. That’s the advice Francois de Brantes gave during a session on price and quality transparency at Health Journalism 2015 last month.

…
Providers promote the false ideas that gathering accurate price and quality data is difficult, if not impossible, and that variations in price result from the severity of illness in populations, de Brantes explained. By debunking these myths, journalists would inform policymakers and the public that there are ways to calculate the prices of medical episodes of care accurately, and that price variation can be controlled. “Price varies because of the way physicians practice,” he said.

…

Among those myths:

• Price is a trade secret
• Disclosing prices would impede the ability of health plans, hospitals and physicians to compete effectively
• Revealing prices enables collusion and thus violates antitrust law
• Publishing prices leads to higher health care costs.

…

Both Quincy and Suzanne Delbanco (@SuzanneDelbanco), executive director of the Catalyst for Payment Reform, made the point that price and quality transparency are similar in that both seem simple but are in fact extremely complex topics to cover. Most consumers, for example, are unaware of such quality measures as hospital infection rates and the CAHPS Hospital Survey from the federal Agency for Healthcare Research and Quality, Quincy said.

…

 

 

[Reblog] Value-Based Care

From the 11 March 2015 post by Cindy Nayer at The Health Care Blog

In recent weeks, the market has reacted to a few noteworthy headlines, all involved with or touching upon value-based discretionary actions, and many with the not-so-hidden question: What’s In It for Me or WIIFM?

• CMS announced that by 2016 30% of fees in health care should be paid for through a value-based system, moving away from fee-for-service.
• ACO results have shown ambivalent outcomes.
• Outcomes-based contracts have permeated the Hepatitis C cost-nado (that’s a cost sharknado, the kind that fiercely defies cost controls and takes over all noise about payment reform and patient preferences).
• Reference-based pricing is a good/bad troublemaker in the middle of the value-based travails.

The latest rampages have appeared on two national and highly-regarded blogs: The Health Care Blog [Value-Based Reform] and The Health Affairs Blog [Go Slow on Reference Pricing].

As one of the loudest proponents on value-based designs, I lift the curtain again to show the thinking behind the movement from fee for service to value-based designs. All of these items above discuss the message of payment reform, or system alignment, but they are intensely linked to the patient-consumer ability to make the right choices, choose the right sites for care, and pay the right amount for services rendered to achieve health security.

….

Related articles

• State is model for doctors, hospitals nationwide
• White House Launches ‘Next Generation ACO’ With High-Touch Value-Based Care
• Health Insurers Poised to Profit on Value-Based Care
• A 3-part checklist that gets you ready for the value-based world of healthcare
• The shifting center of care
• CMS Releases Physician Value Modifier Payment Data
• What’s Wrong With Obama’s Rush to Change Doctors’ Medicare Payments
• Aetna Can’t Escape Fee-For-Service Medicine ‘Fast’ Enough
• New Phase of Obamacare: Next Generation Medical Care

[Reblog] Four insurers reveal what they pay for 70 health care services

Four insurers reveal what they pay for 70 health care services | Association of Health Care Journalists.

From the 26 February 2015 article at Covering Health

Health insurers are taking incremental steps to release information on what they pay to health care providers. Each month, they reveal just a bit more.

This week, Aetna, Assurant Health, Humana and UnitedHealthcare released state and local cost information through the nonprofit Health Care Cost Institute (HCCI) on a consumer site called Guroo.com. The data show the costs for about 70 common health conditions and services and are based on claims from more than 40 million insured individuals, HCCI announced.

No other organization has made these data available, HCCI said. In that way, this release is significant. Or, as the Guroo site says of the data: “The biggest collection of cost information is now at your fingertips, so you know what care really costs.”

Well, not exactly. The data show what insurers paid. Or, as Jason Millman pointed out in The Washington Post, “The site doesn’t break down what a consumer pays for services versus what the insurer pays.”

…

The release of cost-transparency data seems to be gaining some momentum. Last month, the North Carolina Department of Health and Human Services published what it said was “the most current price information” from hospitals and ambulatory surgery centers. In so doing, North Carolina joined Maine and Massachusetts as the only states that publish price data on the web, according to last year’s Report Card on State Transparency Laws  from the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute.

Within days of the publication of the state data, Blue Cross Blue Shield of North Carolina published data on what it pays hospitals and physicians. In an earlier blog post we covered those events in North Carolina.

[Reblog] Germs. The pseudoscience of quality improvement

hmmm…position justifications? power plays?

From the 7 December 2014 post by Karen Siebel, MD at the HealthCare Blog

No one wants a hospital-acquired infection—a wound infection, a central line infection, or any other kind.  But today, the level of concern in American hospitals about infection rates has reached a new peak—better termed paranoia than legitimate concern.

The fear of infection is leading to the arbitrary institution of brand new rules. These aren’t based on scientific research involving controlled studies.  As far as I can tell, these new rules are made up by people who are under pressure to create the appearance that action is being taken.

Here’s an example.  An edict just came down in one big-city hospital that all scrub tops must be tucked into scrub pants. The “Association of periOperative Registered Nurses” (AORN) apparently thinks that this is more hygienic because stray skin cells may be less likely to escape, though there is no data proving that surgical infection rates will decrease as a result.  Surgeons, anesthesiologists, and OR nurses are confused, amused, and annoyed in varying degrees.  Some are paying attention to the new rule, and many others are ignoring it.  One OR supervisor stopped an experienced nurse and told to tuck in her scrub top while she was running to get supplies for an emergency aortic repair, raising (in my mind at least) a question of misplaced priorities.

The Joint Commission, of course, loves nothing more than to make up new rules, based sometimes on real data and other times on data about as substantial as fairy dust.

A year or two ago, another new rule surfaced, mandating that physicians’ personal items such as briefcases must be placed in containers or plastic trash bags if they are brought into the operating room.  Apparently someone thinks trash bags are cleaner.

Now one anesthesiology department chairman has taken this concept a step further, decreeing that no personal items at all are to be brought into the operating room–except for cell phones and iPods.  That’s right, iPods, not iPads.  This policy (of course) probably won’t be applied uniformly to high-ranking surgeons or to people like the pacemaker technicians who routinely bring entire suitcases of equipment into the OR with them.

What’s particularly irrational about this rule is that cell phones likely are more contaminated with bacteria than briefcases or purses, even if they’re wiped off frequently.

…

 

Instead of creating more and more rules governing the care of all patients, perhaps we need to focus on the subsets of patients and case types that we already know are at higher risk, and examine what additional steps we need to take on their behalf.

 

…

 

 

[News Article] New AARP report looks at onus on spousal caregivers

From the 24 April 2014 article at Covering Health

A new report from the The United Hospital Fund and AARP Public Policy Institute finds that spouses who act as the primary family caregiver routinely perform complex medical and nursing tasks without adequate in-home support from health care professionals, especially when compared with non-spousal family caregivers.

…

“Wedding vows include the promise to be there “in sickness and in health”, but we should not expect spouses to do things that can make nursing students tremble without offering them instructions and support. They should not have to do this important work at home alone. They need and deserve support from professionals, other family members, and the community,” Reinhard said.

It’s unclear why spouses receive less help, but Reinhard and co-authors Carol Levine and Sarah Samis of the United Hospital Fund theorize that choice, lack of awareness about resources, financial limitations, or fear of losing independence play a role. The report calls for additional research to help tailor interventions that support but do not supplant the primary bond between spouses.

 

Read the entire article here

Related articles

• Report: Almost Half of Family Caregivers Perform Medical Tasks
• Many family caregivers
• Many Family Caregivers Lack Training They Need

Order or Download Your Free Patient Packet – Tips on How to Talk with your Health Care Provider

Order or Download Your Free Patient Packet | NCCAM

From the Web page

Order or Download Your Free Patient Packet

As part of the Time To Talk campaign, NCCAM has developed a packet of helpful materials to help you begin a dialogue with your health care providers. Order your packet online or call 1-888-644-6226 and use reference code D393.

Each packet contains:

• Backgrounder: The backgrounder provides information about the importance of health care providers and their patients talking about complementary health practices.Download PDF

 

• TELL tip sheet: This sheet provides tips for talking with health care providers.Download PDF

• Patient wallet card: This card will help to keep track of all medications, including dietary supplements and other complementary health products, and will be a handy reference during visits to your health care provider.Download PDF

• Get the Facts: Are You Considering Complementary and Alternative Medicine? This fact sheet will assist you in your decision making about using CAM.Download PDF

Order your packet online or call 1-888-644-6226 and use reference code D393.

 

Related Resources

• Patient involvement (including questions to ask your doctor) from US AHRQ (Association for Healthcare Research and Quality)
• Diagnosis and Treatment (including Quick Tips When Talking with your Doctor) from US AHRQ

Related articles

• Complementary Health Practices Information from NCAAM
• The director of NCCAM wants a “nuanced conversation” about “complementary and alternative medicine”
• National Institute on Health article on Benefits of Yoga
• About NCCAM
• NCCAM- Herbs at a Glance
• NCCAM features musical training lecture

Reduce Unnecessary Lab Tests, Decrease Costs by Modifying Software

From the 4 November 2013 ScienceDaily article

When patients undergo diagnostic lab tests as part of the inpatient admission process, they may wonder why or how physicians choose particular tests. Increasingly, medical professionals are using electronic medical systems that provide lists of lab tests from which medical professionals can choose. Now, a University of Missouri researcher and her colleagues have studied how to modify these lists to ensure health professionals order relevant tests and omit unnecessary lab tests, which could result in better care and reduced costs for patients.

“Ordering numerous lab tests can result in unnecessary testing and can cause physical discomfort and financial stress to patients,” said Victoria Shaffer, an assistant professor of health sciences in the MU School of Health Professions. “We found that by changing the way electronic order set lists were designed, we could significantly alter both the number and quality of lab tests ordered by clinicians.”

Shaffer and her research team studied how physicians selected lab tests using three order set list designs on the same electronic medical system. The first order set list design was an opt-in version in which no lab tests were pre-selected; this is the standard method of lab test ordering in electronic health records for most healthcare facilities. A second option was an opt-out version in which physicians had to de-select lab tests they believed were not clinically relevant. In the third design, only a few tests were pre-selected based on recommendations by pediatric experts. On average, clinicians ordered three more tests when using the opt-out version than the opt-in or recommended versions. However, providers ordered more tests recommended by the pediatric experts when using the recommended design than when using the opt-in design.

 

Read entire article here

Related articles

• MU researcher finds way to reduce unnecessary lab tests, decrease patient costs by modifying software (eurekalert.org)
• Majority of ambulatory physicians had capability to exchange prescription and laboratory data in 2011 (hispanicbusiness.com)
• Researchers find way to reduce unnecessary lab tests, decrease patient costs by modifying software (medicalxpress.com)

 

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

English: MedlinePlus logo (Photo credit: Wikipedia)

 

From the 28 October 2013 Director’s Comments Blog

 

Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

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

Here is what’s new this week in MedlinePlus.

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

 

 

 

 

[Reblog] Forms do not keep patients out of hospitals

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

 

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

 

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

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

 

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

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

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

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

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

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

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

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

 

Related articles

• How Can Reinventing Patient Experience Decrease Readmissions? (healthcareitstrategy.com)
• St. Elizabeth Hospital Helps Meet HIMSS Stage 7 Requirements, Improves Patient Care with Hosted Electronic Patient … (prweb.com)
• Electronic Health Records Benefits: An ePatient Story (healthcarereimagined.wordpress.com)
• Managing Unsolicited Health Information in the Electronic Health Record – AHIMA (healthcarereimagined.wordpress.com)
• Meaningful Use, Meaningful Results (medcitynews.com)

 

Improving Health Care through Mobile Medical Devices and Sensors

From the 22 October 2013 Brookings Report

Health care access, affordability, and quality are problems all around the world and large numbers of individuals do not receive the quality care that they need. Mobile technology offers ways to help with these challenges. Through mobile health applications, sensors, medical devices, and remote patient monitoring products, there are avenues through which health care delivery can be improved. These technologies can help lower costs by facilitating the delivery of care, and connecting people to their health care providers. Applications allow both patients and providers to have access to reference materials, lab tests, and medical records using mobile devices.

Complex mobile health applications help in areas such as training for health care workers, the management of chronic disease, and monitoring of critical health indicators. They enable easy to use access to tools like calorie counters, prescription reminders, appointment notices, medical references, and physician or hospital locators. These applications empower patients and health providers proactively to address medical conditions, through near real-time monitoring and treatment, no matter the location of the patient or health provider.

In this paper, part of the Mobile Economy Project, Darrell West looks at specific applications and inventions, and discuss how mobile is transforming health care in the United States and around the world. He argues that mobile health helps frontline health workers and health care providers extend their reach and interactions – enabling them to be more efficient and effective in their provision of medical assistance. And in the conclusion, West recommends several steps that will speed the adoption of mobile technology in health care.

• Policymakers should encourage the use of mobile devices for health care. Moving to electronic systems for service delivery will save money, improve access, and provide higher levels of quality in both developed and developing nations.

• Nearly three-quarters of medical expenditures takes place on a small number of chronic illnesses including cardiovascular disease, cancer, diabetes, and asthma. We should encourage the use of mobile systems that monitor patient symptoms and provide real-time advice on treatment and medication because they have the potential to control costs, reduce errors, and improve patients’ experiences.

• We should work to remove barriers to adoption of mobile applications that aid in chronic disease management and make these tools much more widely available.

• With growing knowledge about diseases, genetics, and pharmaceutical products, the practice of medicine has become far more complicated. Health providers need access to as much accurate data as they can get on how to treat various ailments.

• One of the barriers to cost containment and quality service delivery has been the continued reliance in many locales on paper-based medical systems. In a digital world, one cannot imagine a costlier way to run a health care system.

• On the issue of government regulation, the FDA has finalized its guidance on how mobile applications and regulated mobile medical devices are to be treated in an effort to clarify some of the ambiguities and help further innovation. Having clear rules that encourage desirable behavior is the best way to move forward in mobile health.

Editor’s Note: This paper is released in tandem with the panel discussion: The Modernization of Health Care through Mobile Technology and Medical Monitoring Devices on October 22, 2013.

Related articles

• Frost & Sullivan Examines the Future of On-Demand Mobile Personal Health Records (hispanicbusiness.com)
• Mobile Health Could Save developed countries $400 billion by 2017 (nextbigfuture.com)
• The Explosion In Health Apps, And How They’re Disrupting The Gigantic, Lethargic Health Care Industry (businessinsider.com)
• Better Living Through Mobile: A Patient’s Journey (blogs.sap.com)
• Next-Gen Nanotech Breath Sensor Could Change How We Monitor Health (medgadget.com)
• Leading Healthier Lives Through Mobile Technology (blogs.sap.com)
• Patient care appears to be catching up with mobile technology (kevinmd.com)
• Better Living Through Mobile: A Patient’s Journey (business2community.com)
• Finally, FDA tells mobile health app developers what it plans to regulate [GigaOM] (gigaom.com)
• FDA To Regulate Some Mobile Health Apps (cio-today.com)

 

[Reblog] Gloves and Gowns Don’t Stop Spread of All Infections in Hospitals

Methicillin-resistant Staphylococcus aureus Bacteria (Photo credit: NIAID)

 

From the 5 October 2013 post at Time- Health & Family

 

Bacterial infections can imperil the fragile patients at hospitals‘ intensive care units. And a new study reveals an unlikely spreader: the health care workers who treat them. The standard sterile hospital garb typically thought to prevent infections isn’t helping.

 

Physical barriers are the most effective way to block invisible intruders like the bacteria responsible for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) infections, which are among the most common hospital-acquired pathogens. Such strains, which are resistant to most antibiotic treatments, contribute to more than $4 billion in health care costs for treating the skin lesions, respiratory symptoms and sepsis that the bacteria cause.

It’s hardly been clear that requiring all health care workers to put on gowns and gloves before visiting each patient, then discarding and re-robing before visiting the next patient, would help to reduce the spread of such infections in ICUs. The Centers for Disease Control currently recommends that workers suit up with gowns and gloves before caring for patients with known MRSA or VRE infections, but researchers led by Dr. Anthony Harris at the University of Maryland School of Medicine wanted to see how effective universal gowning and gloving would be in lowering the number of new cases of disease in ICUs.

Read more: http://healthland.time.com/2013/10/05/gloves-and-gowns-dont-stop-spread-of-all-infections-in-hospitals/#ixzz2hgctzzKb

 

Patients Can Emit Small, Influenza-Containing Particles Into the Air During Routine Care

From the 31 January 2013 article at KevinMD.com

[The]majority of influenza virus in the air samples analyzed was found in small particles during non-aerosol-generating activities up to a 6-foot distance from the patient’s head..

Vaccination of health providers remains a fundamental and key part of protecting them from influenza

 

A new study suggests that patients with influenza can emit small virus-containing particles into the surrounding air during routine patient care, potentially exposing health care providers to influenza. Published in The Journal of Infectious Diseases, the findings raise the possibility that current influenza infection control recommendations may not always be adequate to protect providers from influenza during routine patient care in hospitals…

…

The current belief is that influenza virus is spread primarily by large particles traveling up to a maximum of 3 to 6 feet from an infected person. Recommended precautions for health providers focus on preventing transmission by large droplets and following special instructions during aerosol-generating procedures. In this study, Dr. Bischoff and his team discovered that the majority of influenza virus in the air samples analyzed was found in small particles during non-aerosol-generating activities up to a 6-foot distance from the patient’s head, and that concentrations of virus decreased with distance. The study addressed only the presence of influenza-containing particles near patients during routine care, not the actual transmission of influenza infection to others.

Fitted respirators are currently required for health care providers during aerosol-generating procedures with patients. During routine, non-aerosol-generating patient care, the current precautions recommend that providers wear a non-fitted face mask. Based on their findings, Dr. Bischoff and investigators are concerned that providers may still be exposed to infectious dosages of influenza virus up to 6 feet from patients with small wide-spreading particles potentially exceeding the current suggested exposure zones.

These findings suggest that current infection control recommendations may need to be reevaluated, the study authors concluded. The detection of “super-emitters” raises concerns about how individuals with high viral load may impact the spread of influenza, they noted. “Our study offers new evidence of the natural emission of influenza and may provide a better understanding of how to best protect health care providers during routine care activities,” the study authors wrote. However, studies of influenza virus transmission will be necessary before the role of super-emitters can be firmly established, they noted…

Whatever protective equipment or infection control practices are used for preventing influenza transmission, vaccination of health providers remains a fundamental and key part of protecting them from influenza, noted Dr. William Schaffner, professor medicine and chair of the department of preventive medicine at Vanderbilt University School of Medicine in Nashville, Tenn., who was not involved with the study. “Influenza vaccination, although not perfect, is the best tool we have to protect health care workers — and their patients — from influenza illness.

 

Related articles

• Health care providers may be at greater risk of flu exposure (eurekalert.org)
• Stand Back: Flu Virus Travels 6 Feet (livescience.com)
• People with flu can release small, flu-filled particles into air: Study (sunnewsnetwork.ca)
• 2012-13 Influenza vaccine effectiveness: a preliminary estimate (bio230fall2010.wordpress.com)

 

Simple intervention helps doctors communicate better when prescribing medications (5 basic facts to convey)

English: medications (Photo credit: Wikipedia)

 

The EurkAlert article is here.

 

If the prescribing health care practitioner forgets, here they are

 

• the medication’s name
• its purpose
• the directions for its use
• the duration of use
• the potential side effects

 

Related articles

• Doctors Prescribe, Pharmacists Dispense, Patients Suffer (medicine.com.my)
• Better care from doctors who are culturally aware (eurekalert.org)
• Pharmacists to prescribe medication (stuff.co.nz)

 

More information does not equal better care

 Chalmette, LA, December 16, 2005 – A patient describes his symptoms with a nurse at the Primary Care Clinic in St. Bernard Parish. The facility located in a triple-wide office trailer offers free medical care to area residents, staffed by personnel from the U.S. Public Health Agency and FEMA Disaster Medical Assistance Team (DMAT). Robert Kaufmann/FEMA

A wise, sobering post on the limits of medical/health related information.

Technology is increasingly used to collect and store personal health and medical data. While the amount of personal stored data is rising, this does not necessarily translate into better care. For example, the information stored in electronic medical records is only as good as the data entered.  Medical devices (as imaging and gene testing instruments) generate data that may or may not be useful depending on why they were ordered and how they results are interpreted.

The use of the data is also troublesome. As this post states, medical test results are often misused by the diagnostics industry in over testing.  This leads to unneeded treatments which divert money and resources.  Health care providers, especially those in primary care have less time to listen to and counsel patients.

The money spent on unnecessary treatments is a burden not only on individuals, but also health care facilities and government agencies. Health care facilities become caught in a spiral of justifying diagnostic equipment through marketing and at some point they will find it nearly impossible to recoup their investments. Medicare and Medicaid funds are not used wisely to diagnose and treat, resulting in ever more increased costs to the system.

As this post points out, health care providers would be wise to take a deep look at their role and be realistic about their expectations.
The same can be said about those who consult with health care providers.

From the 1 November 2012 article at KevinMD.com

I have found that this concept is hard for non-healthcare people to really grasp – that a less aggressive testing approach knowingly misses disease, but makes no difference in the overall prospects of the patient. It is crucial that the U.S. culture fights the prevailing scare tactics of the diagnostics industry, or we’ll never lower the rate of over testing. Any administrative tricks to lower testing rates will be subverted by both physicians and patients who assume more tests equal better care unless the underlying culture and conventional beliefs are changed.

The change required is deeper than administrative rules. It has to come from a more humble attitude on the part of doctors, patients, employers, and insurers that just because a patient could be labeled as having a disease, there is nothing to be gained by doing anything about it. More information does not equal better care.

Our American culture proclaims, “Just Do It.” To reclaim resources from the healthcare industry and return them to the general economy, we must proclaim, “Don’t just do something for the sake of doing something, stand there.”

 

Related Resources

• US Agency for Healthcare Research and Quality (AHRQ)- Consumers and Patients
  • Choosing Quality Care
  • Comparing Medical Treatments
• Evaluating Health Information (Health Resources for All Edited by Janice Flahiff)

Related articles

• Why Health Care is a Civil Right (jflahiff.wordpress.com)
• Misinformation in electronic medical records has consequences (kevinmd.com)
• Shared Decision Making Leads To A Better Patient Experience And Higher Levels Of Patient Satisfaction (introcomm)
• Supplies and Devices Are Biggest Cause of Hospital Cost Increase(jflahiff.wordpress.com)
• 9-part series on over-diagnosis (HealthNewsReview.org)

As Painkiller Overdoses Mount, Researchers Outline Effective Approaches to Curb Epidemic

 

English: A graphic map showing the rates of accidental prescription drug overdose deaths for the state of Ohio by counties for the years 2004 to 2008. Information obtained from here and here. (Photo credit: Wikipedia)

 

From the 19 September 2012 article at Science News Daily

 

“Good things happen when state prescription drug monitoring programs shift to a proactive strategy,” said Dr. Nathaniel Katz, assistant professor of anesthesia at Tufts University School of Medicine. “Not only can it prevent painkillers from being misused or distributed illegally in the first place, but it can also enable health professionals to identify patients who need help overcoming addiction.”

 

Repairing the tear in health care’s safety net with social media

Excerpt from the post at KevinMD.com (May 5, 2012)

…And while social media is by no means a replacement for in-person care, it should be a viable means for consumers to get safe, trusted health information from medical professionals online that provides enough orientation and preventative guidance that they do not need to visit the ER for routine care.

America needs to reverse the role of the safety net system back to its designated place of original design – with safety net care serving critical need patients without insurance or other economic means who require both proactive and reactive medical care.  We remain optimistic that healthcare reform will address some of these critical issues – and help to deploy more efficient protocols.  In the interim, we are hopeful that consumers and physicians will recognize the role that “information sharing” can play in empowering both patients and doctors to collectively embrace better, more accessible solutions…

Related articles

• What Makes Better Care? The Series. Part 2: Protect Vulnerable People (hcfama.org)
• James V. Pagano M.D. on Affordable Care Act (clarespark.com)
• When It Comes To Healthcare, We Are Not The Customers (vistage.com)

Federal agencies should take advantage of opportunities to promote integration of primary care and public health

From the 28 March 2011 Eureka news alert

WASHINGTON — The traditional separation between primary health care providers and public health professionals is impeding greater success in meeting their shared goal of ensuring the health of populations, says a new report from the Institute of Medicine. Integration of these fields will require national leadership as well as substantial adaptation at the local level, said the committee that wrote the report.

[ The report is free and available at http://www.iom.edu/Reports/2012/Primary-Care-and-Public-Health.aspx

The above link also includes a briefing slides (an overview) and a report brief.]
The report recommends ways that the Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA) could foster integration between primary care and public health through funding, policy levers, and other means. Collaboration presents an opportunity for both primary care and public health to extend their reach and achieve the nation’s population health objectives, the committee noted.

The committee’s recommendations are based on its review of published papers as well as case studies in specific cities — Durham, N.C.; New York City; and San Francisco — where integration efforts have taken place. The review showed that successful integration of primary care and public health requires community engagement to define and tackle local population health needs; leadership that bridges disciplines and jurisdictions and provides support and accountability; shared data and analyses; and sustained focus by partners.

The Patient Protection and Affordable Care Act (ACA) authorizes HRSA and CDC to launch several new programs. The agencies should coordinate these programs and funding streams with other partners at the national, state, and local levels to spur momentum. Promising opportunities include building incentives to promote interactions with local public health departments into HRSA’s funding for community health centers; encouraging hospitals to treat primary care and community health as priorities as they strive to earn federal tax exempt status through demonstrated community benefits; and fostering collaboration among health departments and community health centers to improve the provision of preventive clinical services to Medicaid recipients.

The medical home model and the new accountable care organizations (ACOs) established by ACA also offer opportunities for integration. As more primary care practices move toward the patient-centered medical home model, public health departments could work with these practices and spread the benefits of care coordination to the community, the committee said. As ACOs — groups of hospitals and clinicians that work together to provide primary care and other health care services to Medicare beneficiaries — begin operating, they should reach out to health departments to forge links to community programs and public health services.

Training primary care and public health professionals in aspects of each other’s fields will help promote a more integrated work force, the report adds. HRSA and CDC should work together to develop training grants and teaching tools that can prepare the next generation of health professionals for shared practice. For example, HRSA should use its Title VII and VIII primary care training programs to support curriculum development and training opportunities that involve aspects of public health, and CDC’s Epidemic Intelligence Service officers could assist HRSA-supported community health centers in using public health data to guide the care they provide.

“While integrating fields that have long operated separately may seem like a daunting endeavor, our nation has undertaken many major initiatives, such as building both a national hospital system and an extensive biomedical research infrastructure and significantly expanding high-tech clinical capacity through investments in specialty medicine,” said committee chair Paul J. Wallace, senior vice president and director, Center for Comparative Effectiveness Research, The Lewin Group, Falls Church, Va. “It’s time we did the same for primary care and public health, which together form the foundation of our population’s overall well-being. Each of these foundational elements could be stronger if they were better coordinated and collaborated more closely.”

###
The report was sponsored by the Centers for Disease Control and Prevention, Health Resources and Services Administration, and United Health Foundation. Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides objective, evidence-based advice to policymakers, health professionals, the private sector, and the public. The Institute of Medicine, National Academy of Sciences, National Academy of Engineering, and National Research Council together make up the independent, nonprofit National Academies. For more information, visit http://national-academies.org or http://iom.edu. A committee roster follows.

 

The culture of medicine needs to change

Image via Wikipedia

by SHARON BAHRYCH, PA-C, MPH in the 23 Nov 2011 article at KevinMD.com

’ve been involved in clinical medicine for more than 20 years and during this time I’ve come across numerous situations that created stress, or emotional upheaval within myself, and even times of burnout.  At one point, I came close to permanently leaving my chosen profession.  The culture of medicine is not geared towards allowing health care providers to de-stress, acquire emotional support, or discuss in an encouraging environment various conflictive work scenarios with their colleagues. The end result of this culture of medicine leads providers to either leave their chosen profession, have professional burnout, deal with work conflict and/or become emotionally broken (i.e. having a lack of integrity, honesty, emotional connectedness with others, etc.)

An example of medicine’s culture which needs to be changed and causes conflict is one of its many unwritten rules of professional conduct.  It states that the hospital attending is the only one who is supposed to go in and tell a patient their medical diagnosis and treatment.  Anyone else on the medical team is just supposed to pretend as though they don’t know anything until after the attending has discussed the diagnosis with the patient.  Usually this works out, but it can also lead to a breakdown in patient’s trusting their providers and/or asking team members to lie to patients until the attending has this discussion.  This can lead to dishonesty and a lack of integrity on the part of the providers…..

Related articles

• The culture of medicine needs to change (kevinmd.com)
• Short waits, long consults keep most patients very happy with their physicians (Eureka news alert)
• Intuition saved this patient from a potentially fatal diagnosis (kevinmd.com)
• 6 reasons why doctors won’t call patients (with possible solutions) (jflahiff.wordpress.com)
• Patients have a part to play in their own medical care (kevinmd.com)