[Press release] Penn Medicine Bioethicists Call for Return to Asylums for Long-Term Psychiatric Care
From the 20 January 2015 Penn Medicine press release
JAMA Viewpoint Characterizes Current Model for Treating Mentally Ill as “Ethically Unacceptable and Financially Costly”
PHILADELPHIA — As the United States population has doubled since 1955, the number of inpatient psychiatric beds in the United States has been cut by nearly 95 percent to just 45,000, a wholly inadequate equation when considering that there are currently 10 million U.S. residents with serious mental illness. A new viewpoint in JAMA,written by Dominic Sisti, PhD, Andrea Segal, MS, and Ezekiel Emanuel, MD, PhD, of the department of Medical Ethics and Health Policy in the Perelman School of Medicine at theUniversity of Pennsylvania, looks at the evolution away from inpatient psychiatric beds, evaluates the current system for housing and treating the mentally ill, and then suggests a modern approach to institutionalized mental health care as a solution.
“For the past 60 years or more, social, political and economic forces coalesced to move severely mentally ill patients out of psychiatric hospitals,” write the authors. They say the civil rights movement propelled deinstitutionalization, reports of hospital abuse offended public consciousness, and new drugs gave patients independence. In addition, economics and federal policies accelerated the transformation because outpatient therapy and drug treatment were less expensive than inpatient care, and the federal legislation like the Community Mental Health Centers Act and Medicaid led to states closing or limiting the size of so-called institutions for mental diseases.
However, the authors write, “deinstitutionalization has really been transinstitutionalization.” Some patients with chronic psychiatric diseases were moved to nursing homes or hospitals. Others became homeless, utilizing hospital emergency departments for both care and housing. But “most disturbingly, U.S. jails and prisons have become the nation’s largest mental health care facilities. Half of all inmates have a mental illness or substance abuse disorder; 15 percent of state inmates are diagnosed with a psychotic disorder.” According to the authors, “this results in a vicious cycle whereby mentally ill patients move between crisis hospitalization, homelessness and incarceration.”
Instead, the authors suggest that a better option for the severely and chronically mentally ill, and the most “financially sensible and morally appropriate way forward includes a return to psychiatric asylums that are safe, modern and humane.” They argue that the term ‘aslyum’ should be understood in its original sense — a place of safety, sanctuary and healing.
“Asylums are a necessary, but not sufficient component of a reformed spectrum of psychiatric services,” write the authors. Reforms need to expand the role of these institutions to address a full range of integrated psychiatric treatment services — from providing care to patients who cannot live alone or are a danger to themselves and others, to providing care to patients with milder forms of mental illness who can thrive with high-quality outpatient care. These fully-integrated, patient-centered facilities do exist in the U.S. today, but more are needed to provide 21st century care to patients with chronic, serious mental illness.
[Press release] Equation helps identify global disparities in cancer screening and treatment | EurekAlert! Science News
From the 20 January 2015 press release
Disparities in cancer screening, incidence, treatment, and survival are worsening globally. In a new study on colorectal cancer, researchers found that the
mortality-to-incidence ratio (MIR) can help identify whether a country has a higher mortality than might be expected based on cancer incidence. Countries with lower-than-expected MIRs have strong national health systems characterized by formal colorectal cancer screening programs. Conversely, countries with higher-than-expected MIRs are more likely to lack such screening programs.
The findings suggest that the MIR has potential as an indicator of the long-term success of global cancer surveillance programs. “The MIR appears to be a promising method to help identify global populations at risk for screenable cancers. In this capacity, it is potentially a useful tool for monitoring an important cancer outcome that informs and improves health policy at a national and international level,” said Dr. Vasu Sunkara, lead author of the Cancerstudy. Senior author Dr. James Hébert, who had used the MIR previously at the state and national level within the US, added that the use of the MIR internationally opens new possibilities for testing the relationship between this important indicator of cancer outcome and characteristics of countries’ health care delivery systems.
[News article]NerdWallet Health Study: Medical Debt Crisis Worsening Despite Policy Advances – Health
From the 8 October 2014 article
Despite recent advances in health care policy, American households continue to struggle with medical debt, and it’s only getting worse. Americans are putting more of their take-home pay toward medical costs than ever before.
- NerdWallet Health has found that Americans pay three times more in third-party collections of medical debt each year than they pay for bank and credit card debt combined. In 2014, roughly one in five American adults will be contacted by a debt collection agency about medical bills, but they may be overpaying – NerdWallet found rampant hospital billing errors resulting in overcharges of up to 26%.
- NerdWallet found 63% of American adults indicate they have received medical bills that cost more than they expected. At the same time, 73% of consumers agree they could make better health decisions if they knew the cost of medical care before receiving it.
- Between 2010 and 2013, American households lost $2,300 in median income, but their health care expenses increased by $1,814. Out-of-pocket spending is expected to accelerate to a 5.5% annual growth rate by 2023 – double the growth of real GDP.
In a follow-up to last year’s study that found medical debt is the largest cause of personal bankruptcy, NerdWallet Health investigated the mounting financial obstacles facing the American patient.
From the 14 October 2014 article
he foundation of evidence-based research has eroded and the trend must be reversed so patients and clinicians can make wise shared decisions about their health, say Dartmouth researchers in the journal Circulation: Cardiovascular Quality and Outcomes.
Drs. Glyn Elwyn and Elliott Fisher of The Dartmouth Institute for Health Policy & Clinical Practice are authors of the report in which they highlight five major problems set against a backdrop of “obvious corruption.” There is a dearth of transparent research and a low quality of evidence synthesis. The difficulty of obtaining research funding for comparative effectiveness studies is directly related to the prominence of industry-supported trials: “finance dictates the activity.”
The pharmaceutical industry has influenced medical research in its favor by selective reporting, targeted educational efforts, and incentivizing prescriber behavior that influences how medicine is practiced, the researchers say. The pharmaceutical industry has also spent billions of dollars in direct-to-consumer advertising and has created new disease labels, so-called disease-mongering, and by promoting the use of drugs to address spurious predictions.
Another problem with such studies is publication bias, where results of trials that fail to demonstrate an effect remain unpublished, but trials where the results are demonstrated are quickly published and promoted.
The authors offer possible solutions:
Any journalist who covers nursing homes should check out this month’s special supplement in The Gerontologist, the Gerontological Society of America’s journal. It focuses on the two-decade long effort to change nursing home culture and many of the articles and studies raise important questions about whether enough progress has been shown.
For example, this study finds that nursing homes that are considered culture change adopters show a nearly 15 percent decrease in health-related survey deficiency citations relative to comparable nonadopting homes. This study looks at what is meant by nursing home culture change – the nature and scope of interventions, measurement, adherence and outcomes. Harvard health policy expert David Grabowski and colleagues take a closer look at some of the key innovators in nursing home care and what it might mean for health policy – particularly in light of the Affordable Care Act’s directive to provide more home and community-based care. Other articles look at the THRIVE study, mouth care, workplace practices, Medicaid reimbursement, and more policy implications.
Any of these studies — or several taken together — can serve as a jumping off point for local coverage. Are there nursing homes in your community that are doing things differently? Have any instituted policies or processes that show improvements in care coordination, outcomes, quality, or other key measures? Are there homes that are resisting change? Why? Which one(s) best exemplify person-centered care? How do these changes affect the workforce?
Nursing Home Compare from CMS provides the data behind complaints, violations, quality, and cost, among other metrics. This article in The Philadelphia Inquirer is a great example of interweaving research with personal narrative. Another approach might be to look at trends in the city, state, or region. How are nursing homes marketing themselves to consumers? To referral sources? Have their business models changed?
Experts on all sides have been talking about culture change for more than a decade. And in 2008, a Commonwealth Fund report explored culture change in nursing homes. Has the time finally come, for real?
Unfortunately, the articles referred to are subscription based only.
For information on how to get them for free or low cost, click here.
Transforming Nursing Home Culture: Evidence for Practice and Policy
- What Does the Evidence Really Say About Culture Change in Nursing Homes?
- A “Recipe” for Culture Change? Findings From the THRIVE Survey of Culture Change Adopters
- High-Performance Workplace Practices in Nursing Homes: An Economic Perspective
- Medicaid Capital Reimbursement Policy and Environmental Artifacts of Nursing Home Culture Change
- Building a State Coalition for Nursing Home Excellence
Implications for Policy: The Nursing Home as Least Restrictive Setting
Originally posted on NobodyisFlyingthePlane:
“What we need,” Freudenberg said to me, “is to return to the public sector the right to set health policy and to limit corporations’ freedom to profit at the expense of public health.”
Bittman contributes to the ongoing discussion here at NobodyisFlyingthePlane about how certain industries deflect public discourse from what is best for our citizens to what makes the most profit, no matter the consequences.
The author he quotes poses a series of questions which get at the heart of the matter.
“Shouldn’t science and technology be used to improve human well-being, not to advance business goals that harm health?”
Similarly, we need to be asking not “Do junk food companies have the right to market to children?” but “Do children have the right to a healthy diet?”
Essentially its a PR game. Do we let whole industries spin how the conversation is framed or do we let the…
View original 339 more words
The Association of Health Care Journalists offers a wide range of resources – many of which are available exclusively to members.
AHCJ publications include our newsletter, HealthBeat, as well as several guides to covering specific aspects of health and health care.
Members share ideas and ask questions of fellow members on the AHCJ electronic mailing list. Tip sheets are prepared for our conferences and workshops, often offering sources and information about covering specific stories.
Contest entries are from the Awards for Excellence in Health Care Journalism, recognizing the best health reporting in print, broadcast and online media. We have links to past winners and information culled from questionnaires submitted with the entries about how each story was researched and written.
We include links to some recent reports and studies of interest to our membership, as well as links to Web sites relevant to health care.
Members and other journalists write articles specifically for AHCJ about how they have reported a story, issues that our members are likely to cover and other important topics.
- AHCJ Articles
- Tip Sheets
- Health Data
- Covering Health blog
- Global Health Coverage
- AHCJ Reporting Guides
- AHCJ Publications
- Electronic Discussion List
- Contest Entries
- Latest Reports/Studies
- Health-related Newsletters
- Freelancer’s Corner
- Advanced Search
- Journalists Doubt Obama Administration’s Dedication to Transparency (pogoblog.typepad.com)
- Charles Ornstein: Six Questions About HealthCare.gov’s Future (guernicamag.com)
- There Once was a Responsible Journalist (find links at the bottom) (scottbest.wordpress.com)
- Donor Dilemma receives national recognition (andrewcconte.wordpress.com)
The Guide to Community Preventive Services is a great resource for what methods and interventions work well to improve public health. It is geared towards public health officials, researchers, and policy makers. However, it is also a good aid for anyone looking for the best way(s) to address issues touching family members and friends. The information can be used to promote or advocate for changes in policies and laws at local or national levels. They can be used to positively influence changes for the better in schools, workplaces, public health departments, and more.
A good way to start is through the Topics link at the top of the page. It includes links to issues as asthma, cancer, diabetes, nutrition, obesity, vaccines, and violence. Each topic includes links to more information on the topic and related topics.
Many topics have summaries of recommendations and findings. For example the topic Diabetes includes recommendations for certain disease management programs but insufficient evidence for self management programs in school settings or worksites.
All information on the interventions for a specific topic (as violence, diabetes, alcoholism) is carefully reviewed through a standardized step by step process. systematic reviews. Each reviews includes summarized results of all related evidence. These unbiased evidence-based reviews are also called systematic reviews.
[Click here for a good explanation of the systematic review process]
Each topic in this community guide answer questions such as: c
- What interventions have and have not worked?
- In which populations and settings has the intervention worked or not worked?
- What might the intervention cost? What should I expect for my investment?
- Does the intervention lead to any other benefits or harms?
- What interventions need more research before we know if they work or not?
- Use the community guide for an overview, listing of topics, and subscribing to email updates
- Methods for explanations of systematic and economic reviews
- Resources as
- Behavioural interventions for the prevention of sexually transmitted infections in young people aged 13 – 19 years: a systematic review (testcas.wordpress.com)
- A systematic review of the interconnections between maternal & newborn health – collaboration with researchers at Aga Khan University (ismailimail.wordpress.com)
- Systematic review / synthesis of qualitative evidence – issues (phtwitjc.wordpress.com)
- Systematic review / synthesis of qualitative evidence – issues (healthpolsoc.wordpress.com)
- Systematic review of beliefs, behaviours and influencing factors associated with disclosure of a mental health problem in the workplace (jflahiff.wordpress.com)
- PubMed Health – A Growing Resource for Clinical Effectiveness Information (jflahiff.wordpress.com)
- Patients want to understand the medical literature (with links to resources for patients) (jflahiff.wordpress.com)
- Poorly presented risk statistics could misinform health decisions(jflahiff.wordpress.com)
- What is comparative effectiveness research? (jflahiff.wordpress.com)
- Cochrane Reviews – A Great Source for Sound Medical Evidence (jflahiff.wordpress.com)
This is an interesting blog posting on business models (old) and technologies (new) in health care delivery.
The author writes on why this is not working.
Specifically the author is advocating decentralization of health care delivery to reduce costs and reduce time in treating people at the onset of health problems (before and during treatment).
The author does provide a disclaimer, he is employed by a health care technology company.
Still, an interesting view of what health care industry trends.
- Enough planning, lets have some action (theglobeandmail.com)
- Is the Cost Curve Bending? (lawprofessors.typepad.com)
- Learn How Nurses Can Revolutionize Home Health Technology (prweb.com)
Atul Gawande, associate professor of surgery and public health at Harvard and one of our most prolific contemporary physician-writers, adapts his New Yorker piece [full text of the article The Hotspotters] surveying innovative attempts to lower healthcare costs by better serving those patients with greatest need to a 13 minute PBS FRONTLINE report focused on one such program, the Camden Coalition of Healthcare Providers in Camden, New Jersey, led by Dr. Jeffrey Brenner, that is having unprecedented success.
- FRONTLINE: Doctor Hotspot (full report) (milkandcookies.com)
- The emerging liberal doctor majority (salon.com)
A new report by the Institute of Medicine (IOM) says that strong evidence indicates that policies beyond the health sector have substantial effects on people’s health, and recommends that all levels of U.S. government adopt a structured approach to considering the health effects of any major legislation or regulation.
Good health is not merely the result of good medical care but the result of what we do as a society to create the conditions in which people can be healthy. Public policy can be one of the most effective approaches to protecting and improving the health of the population. Unlike the one-on-one care provided by clinicians, laws, regulations, and other policies can affect the health of millions. This makes “healthy” public policy particularly important in a time of scarce resources, because it can diminish or preclude the need for other, more costly and potentially less efficient interventions.
The IOM report addresses three categories of law and public policy pertinent to health:
1. Laws that establish the structure, function, and authority of government public health agencies at the federal, state, and local levels.
2. Statutes and other policies that are designed to achieve specific health objectives, for example, taxing tobacco products and requiring immunization for school entry.
3. Policies in other areas of government, such as education, transportation, land use planning, and agriculture, that have health effects. In this area, intersectoral strategies are necessary—non-health agencies can contribute to improving health by considering the health implications of their policies. vices as the standard of practice in public health.
The report makes recommendations in these areas
- Laws and policies should be updated to reflect current science, practice, socioeconomic conditions, and goals such as the CDC’s 10 essential public health services***
- Legal and policy tools should be more effectively used, including regulations, taxation, and modification of the environment (as bicycle paths).
- Inclusion of all health policy stakeholders should be encouraged to prevent unintended negative consequences of health policy and legislation. Examples includeThese stakeholders are potential allies in addressing related issues outside of the health sector, as housing, employment, and education arenas.
he Essential Public Health Services provide the fundamental framework for the NPHPSP instruments, by describing the public health activities that should be undertaken in all communities.
The Core Public Health Functions Steering Committee developed the framework for the Essential Services in 1994. This steering committee included representatives from US Public Health Service agencies and other major public health organizations.
The Essential Services provide a working definition of public health and a guiding framework for the responsibilities of local public health systems.
- Monitor health status to identify and solve community health problems.
- Diagnose and investigate health problems and health hazards in the community.
- Inform, educate, and empower people about health issues.
- Mobilize community partnerships and action to identify and solve health problems.
- Develop policies and plans that support individual and community health efforts.
- Enforce laws and regulations that protect health and ensure safety.
- Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
- Assure competent public and personal health care workforce.
- Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
- Research for new insights and innovative solutions to health problems.
- Public Health Toolbox (aa47.wordpress.com)
- Nations First Ever National Prevention Strategy (jflahiff.wordpress.com)
- Public Health in two-tier local government areas: some tips from experience. (ascleses.wordpress.com)
- For the Public’s Health: The Role of Measurement in Action and Accountability (jflahiff.wordpress.com)
- A Seattle doctor speaks out on public health and paid sick leave (seattlehealthyworkforce.org)