Mapping the Quality of Care From Hospitals and Doctors

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From the 28 June 2011 Wall Street blog item by Katherine Hobson

How’s the diabetes treatment in Wisconsin? Or the access to after-hours medical care in California?

The Robert Wood Johnson Foundation has rolled out a new online directory** of 224 health-care quality reports that compare local physicians and hospitals.

The idea is that consumers can get localized, quantitative information on measures such as how often patients in a certain medical practice receive their recommended screening tests or how long mothers typically spend in a given hospital after a cesarean section. The specific measures will vary by report.

Note the emphasis on “quantitative.” These reports, 197 of which cover specific states, all use performance data based on nationally recognized standards on quality and cost. All are freely available. The more subjective picture offered by sites such as RateMDs.com or Yelp aren’t on the map….

…The reports mainly focus on quality; the cost of health-care services is tougher to measure, says Painter. For example, are you looking for the price that would be charged to a patient, the cost breakdown of certain elements of care or something else? Some reports do include cost data; we’ve written separately about sites that tackle the cost issue…

**For example, go to  Comparing Health Care Quality: A National Directory to compare hospital data in Ohio

• Click on the state of Ohio in the interactive map, then click on View these (Ohio) resources
• Click on View Report to the left of  the Ohio Department of Health (one higher in the list)
• Use the options to select counties, hospitals, locations to find out information about one or more hospitals

You can also select one or more quality measures for one or more hospitals (as infection prevention, heart failure, knee
surgery)

Related Resources (from the Comparing section of  the Tulane University Health Management LibGuide***)

• Leapfrog Group Hospital Quality and Safety Survey  compares” hospitals’ performance on the national standards of safety, quality, and efficiency that are most relevant to consumers and purchasers of care”
• The CAHPS Hospital Survey  -Centers for Medicare & Medicaid Services, programs and information.
• Hospital Compare – A quality tool provided by Medicare
• HealthGrades –   A healthcare ratings organization, providing ratings and profiles of hospitals, nursing homes and physicians to consumers, corporations, health plans …

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A more general resource for health information and much, much more

LibGuides are free topic specific guides to Web sites and books by library specialists.

Currently  one can “Search and explore 168,085 guides by 32,658 librarians at 2269 libraries worldwide!”

Library types include academic, public, and K-12.

Have a topic or subject in mind? There is most likely a related library guide in the LibGuide collection.Related articles

• Comparing Health Care Quality: A National Directory (aa47.wordpress.com)

• New HHS Program Incentivizes Hospitals for Quality of Care Not Quantity of Service (extendhealth.wordpress.com)
• PolicyMap will present on retail-based healthcare at the Health Data Initiative (HDI) Forum on June 9! (policymap.com)

Related Articles (for Mapping the Quality of Care from Hospitals and Docs)

• Hospital Referral Program May Not Improve Surgery Outcome (nlm.nih.gov)
• Hospital Compare data may not help surgical patients find hospitals with better outcomes (AHRQ, Oct 2010)
• Referral to high-volume hospitals for operations fails to improve outcomes statewide (eurekalert.org)
• 1 in 3 patients harmed during hospital stay (kboreilly.com)

Pulse: Voices from the heart of medicine (online magazine)

The recently launched online magazine Pulse (currently free through registration) publishes personal accounts of illness and healing.

One can also follow Pulse through Facebook and RSS.

Pulse accepts submissions about giving and receiving health care  from patients and health care professionals. Through the sharing of emotional and practical stories and poems,  the magazine strives to promote compassionate health care.

Here are some excerpts from the article Hospital Librarian, by Pam Kress-Dunn

Some people seem surprised to find a library in a hospital. But it’s here, and so am I. Having been a librarian in lots of different libraries–public, academic, archival–I jumped at this job when it opened up. Little did I know what I was getting into.

Like many medical librarians, I work solo. I do have a volunteer who, despite being decades older than me, works tirelessly during the two days a week she’s here. But I’m the one who does the lit searches, tracks down the articles in medical journals and finds the piece of information the doctor requires before the surgery that’s scheduled for noon.

My predecessor told me about his most harrowing moment: A surgeon needed information–stat!–and it was available only from a journal our library didn’t carry. So he placed an interlibrary loan request, marking it “Urgent: Patient Care.” When the article came through on the fax machine, he read it aloud over the phone to the surgeon, who was standing in the OR as a nurse pressed the receiver to his ear….

…For family members like these, a hospital library is a sanctuary. It can be a relief to escape the medical floors for a while. And librarians may not be doctors or nurses, but we provide an essential kind of caregiving.

Librarians try to intuit what people need–whether it be silence, respite or practical help. From experience, I’ve learned that you never know what people are going through, or what they need. Often, the best I can offer is to keep my concerns to myself.

One day, a woman came in and asked if she could use a computer to send emails informing others about a family member’s health.

“Of course!” I said, showing her how to log on.

Looking cheerful, she began typing away. Then she paused.

“How do you spell ‘hospice’?” she asked.

I spelled the word, my heart sinking, and left her to craft her sad message…..

Improving Health Care Decisions By Putting Research Into Practice

From a 12 May 2011 Medical News Today article

Adding research-centred approaches into the day-to-day life of the doctor’s clinic strengthens clinical decisions, according to a new report by the European Medical Research Councils. The “Implementation of Medical Research in Clinical Practice” report launched at the European School of Management and Technology in Berlin, Germany.

The report examines the quality of clinical research, and how using research in clinical practice can improve treatment. An important theme is tightening the relationship between doctors, patients and researchers, such as involving GPs in clinical trials to get a better idea of how treatments work in a wider range of patients, beyond the controlled environment of a hospital.

“Medical care has improved greatly in the last 50 years, underpinned by progress in clinical research,” said Professor Liselotte Højgaard, chair of the European Medical Research Councils, part of the European Science Foundation (ESF). “But we cannot be complacent. We want new findings to be introduced into clinical practice as speedily and efficiently as possible, so that evidence-based medicine is used in each and every patient treatment.”…

…
Greater international collaboration between countries could help with systematically reviewing treatments, through shared databases on protocols, data, and health technology assessments. The report recommends actively using evidence-based clinical practice guidelines, as well as promoting rigorous reporting for clinical studies. Health technology assessment reports and clinical guidelines are strongly advised for hospitals and primary care facilities, as well as for administrative processes including financing of treatment and technologies. ….

Click here to read the rest of the news article

Related articles

• Do Doctors Resist Reform? The Case of Evidence-Based Medical Practice (larrycuban.wordpress.com)
• IOM recommends standards to achieve reliable clinical practice guidelines (eurekalert.org)

For the Public’s Health: The Role of Measurement in Action and Accountability

Proper health care planning requires the collection and use of  good factual public health statistics. Sadly, according to this report, quality collection and application of health measurements are lacking partly because there is not enough coordination among governmental agencies  and private sector entities.

For the Public’s Health: The Role of Measurement in Action and Accountability assesses the current situation.
From the press release:

“To inform the public health community and all other sectors that contribute to population health, the Robert Wood Johnson Foundation commissioned the IOM to examine three major topics that influence the health of the public-measurement, laws, and funding. In this, the first of three reports, the IOM reviews current approaches for measuring the health of individuals and communities and suggests changes in the processes, tools, and approaches used to gather information about health outcomes and their determinants.”

“The IOM recommends developing an integrated and coordinated system in which all parties—including governmental and private sector partners at all levels—have access to timely and meaningful data to help foster individual and community awareness and action. “

Links to the report, report brief, and report release slides may be found here.

Related Articles

• Two Health Data Tools for Research and Surveillance : Health Indicators Warehouse and Catalogue of Surveillance Systems (jflahiff.wordpress.com)

American Customer Satisfaction Index (ASCI) includes health care related agencies, institutions, and companies

From the ACSI About page

ACSI reports scores on a 0-100 scale at the national level and produces indexes for 10 economic sectors, 47 industries (including e-commerce and e-business), more than 225 companies, and over 200 federal or local government services. In addition to the company-level satisfaction scores, ACSI produces scores for the causes and consequences of customer satisfaction and their relationships. The measured companies, industries, and sectors are broadly representative of the U.S. economy serving American households.
View PDF of ACSI’s structure showing National, Sector & Industry Scores »

Here are some good places to start for health related customer satisfaction statistics

• ACSI Scores for U.S. Federal Government 2010 with scores for benefits recipients (as the Veterans Administration (VA) and information providers (as Office on Women’s Health), Department Main Site (as National Institutes of Health)
• April 2011 and Historical ACSI Scores with scores for ambulatory care (by types of health care organizations, as hospitals)

(Obama Administration) Partnerships for Patients: Better Care, Lower Costs

From the HealthCare.gov Web page

Doctors, nurses and other health care providers in America work incredibly hard every day to deliver the best care possible to their patients.  Unfortunately, an alarming number of patients are harmed by medical mistakes in the health care system and far too many die prematurely as a result.

The Obama Administration has launched the Partnership for Patients: Better Care, Lower Costs, a new public-private partnership that will help improve the quality, safety and affordability of health care for all Americans.  The Partnership for Patients brings together leaders of major hospitals, employers, health plans, physicians, nurses, and patient advocates along with State and Federal governments in a shared effort to make hospital care safer, more reliable, and less costly.  The Partnership will help save 60,000 lives by stopping millions of preventable injuries and complications in patient care over the next three years and has the potential to save up to $35 billion, including up to $10 billion for Medicare.  Over the next ten years, it could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings.  Already, more than 500 hospitals, as well as physicians and nurses groups, consumer groups, and employers, have pledged their commitment to the new initiative.

The two goals of this new partnership are:

• Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010.  Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years.

• Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010.  Achieving this goal would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge….

…To see which organizations have already joined the Partnership, visitpartnershippledge.HealthCare.gov. …

…For more information about the Partnership for Patients, visitwww.HealthCare.gov/center/programs/partnership.  For more information about the Community-based Care Transitions Program funding opportunity visit: www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1239313.

Related Articles

• Ohio Campaign for Better Care Launches “Healthy Hospital” Initiative, Vows Vigorous Work to Improve Hospital Care for Vulnerable Older Patients (prnewswire.com)
• HHS in Campaign to Cut Hospital Errors (abcnews.go.com)
• Improving Care for People with Medicare (whitehouse.gov)
• Coalition Applauds Congressional Champions for Protecting Access to Medicare Benefits (prnewswire.com)

Health and Well-Being in the Home A Global Analysis of Needs, Expectations, and Priorities for Home Health Care Technology

Health and Well-Being in the Home A Global Analysis of Needs, Expectations, and Priorities for Home Health Care Technology

From the Rand Corporation summary

n both industrialized and transitioning countries, population aging and better survivability have led to a rapid increase of the prevalence of chronic disease and disability. As a result, there is growing concern about the financial sustainability of health care systems, which is compounded by capacity constraints and workforce shortages. Advanced home health care solutions promise to mitigate these pressures by shifting care from costly institutional settings to patients’ homes and allowing patients to self-manage their conditions. A global study of the needs, priorities, and expectations of key stakeholders regarding home health care in six countries (China, France, Germany, Singapore, the United Kingdom, and the United States) revealed that, despite their potential, such technologies face a number of barriers to adoption. Restrictive coverage and existing incentives for in-person home care create obstacles, as does limited patient readiness because of insufficient health literacy. Concerns about audience-appropriate product design and support and limited data on effectiveness and efficiency also impede uptake. Realizing the promise of telecare requires a concerted stakeholder effort, including creation of a conducive policy environment, design of convincing products, and development and dissemination of persuasive evidence.

IU Personalized Medicine Institute to develop targeted and individualized treatments

IU Personalized Medicine Institute to develop targeted and individualized treatments

David Flockhart, M.D., Ph.D. Director, Indiana Institute for Personalized Medicine

 

 

From the February 9 2011 Eureka news alert

Indiana University has announced a major commitment to research in one of health care’s most promising fields with the creation of the Indiana Institute for Personalized Medicine.

The institute’s members will be drawn from the IU schools of medicine, informatics and nursing, with $11.25 million in funding provided by the School of Medicine, the school’s Department of Medicine, Indiana University-Purdue University Indianapolis, the Indiana Physician Scientist Initiative and the Indiana University Melvin and Bren Simon Cancer. The Indiana Physician Scientist Initiative is funded by a $60 million grant from the Lilly Endowment.

Building on modern research techniques that have made it possible to decipher the genetic code, detect slight genetic differences between patients and determine how those affect the way the body metabolizes drugs, physicians are beginning to be able to select more appropriate treatments for individual patients. Research to make such tools broadly available remains in the early but promising stages, institute leaders said.

“Much of the future of health care is in personalized medicine, meaning more precise targeting of the right medication to the right patient at the right time,” said David Flockhart, M.D., Ph.D., who has been named director of the institute.

“We believe it should lead to cost benefits – it clearly will be better for patients,” said Dr. Flockhart, Harry and Edith Gladstein Professor of Cancer Epidemiology and Genetics and director of the Division of Clinical Pharmacology.

“The Indiana Institute for Personalized Medicine is a not only a logical extension of our academic mission but is also part of our strategic plan to be a global leader in translational medicine,” said David S. Wilkes, M.D., executive associate dean for research affairs at the IU School of Medicine.

Some of the earliest examples of personalized medicine have come in the field of cancer treatment. Oncologists now can test a breast cancer patient’s tumor to determine not only whether it is the type that is stimulated to grow by the hormone estrogen, but whether it is a subtype that can be treated with hormone therapy or another type that requires chemotherapy. Cardiology, pediatrics and obstetrics also will be important areas of focus for the institute, said Dr. Flockhart.

“To identify more precisely which drugs are likely to be more effective — or less effective and more toxic — will have a substantial impact on optimizing health care delivery and rationally curbing costs. In no discipline is this more keenly needed than in cancer care where drugs can be extremely costly and toxic,” said Patrick J. Loehrer Sr., M.D., director of the IU Simon Cancer Center.

IU scientists have been working on related research for at least a decade, but creating an institute “allows you to really jump start research and raise the level participation of an institution in both the laboratory and in the clinic, in a broad range of research interests,” Dr. Flockhart said.

For example, Janet Carpenter, Ph.D., R.N., professor in the School of Nursing and a member of the institute, sees personalized medicine playing a key role in improving the treatment of menopause.

“About 6,000 American women enter menopause every day yet personalized medicine has not been well-integrated into their health care,” she said. “The institute will play a very important role in ensuring that women receive the most appropriate and effective menopausal symptom management therapies.”

Mathew Palakal, Ph.D., associate dean for graduate studies and research at the School of Informatics noted that “research in personalized medicine spans a broad spectrum from systems biology to nanomedicine to gene therapy. Our research in such areas as systems biology, biological network analysis and proteomics, along with our graduate programs in health informatics and bioinformatics, will enable informatics and the School of Informatics to play a significant role in the success of the institute.”

“This science will enable physicians to prescribe the right medicines at the right dosages and intervals to maximize efficacy and prevent unwanted toxicity. It should be a very exciting next 10 years of research,” said D. Wade Clapp, M.D., chairman of the Department of Pediatrics…..

 

 

ACP Announces High-Value, Cost-Conscious Care Initiative

ACP Announces High-Value, Cost-Conscious Care Initiative

Excerpts

ACP’s High-Value, Cost-Conscious Care initiative, announced in April 2010, is a broad program that connects two important priorities for the College: helping our physicians to provide the best possible care to their patients, and simultaneously reducing unnecessary costs to the health care system. The initiative includes clinical, public policy, and educational components.

Clinical

ACP launched the clinical component of the initiative with the publication of “High-Value, Cost-Conscious Health Care: Concepts for Clinicians to Evaluate the Benefits, Harms, and Costs of Medical Interventions” in the February 1, 2011, issue of Annals of Internal Medicine. In the paper, ACP explains the purpose of the initiative: to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, and to slow the unsustainable rate of health care costs while preserving high-value, high-quality care….

…

Public Policy

ACP’s High-Value, Cost-Conscious Care initiative continues the College’s position formulated in our 2009 policy paper “Controlling Health Care Costs While Promoting the Best Possible Health Outcomes.” In January 2011, ACP released “How Can Our Nation Conserve and Distribute Health Care Resources Effectively and Efficiently?” In the paper, ACP makes the case that there is an urgent need for the country to have a discussion on how to conserve and allocate limited resources in a uniquely American way that puts the principal responsibility on patients and physicians making informed choices based on evidence.

Education

The next edition of ACP’s Medical Self-Assessment Program (MKSAP) will have a focus on optimal diagnostic and treatment strategies, based upon considerations of value, effectiveness, and avoidance of overuse and misuse.

Additional components of the initiative include patient education materials and possibly curricula for medical students and residents.

New Chapters for Effective Health Care Program’s Methods Guide for Comparative Effectiveness Reviews

New Chapters for Effective Health Care Program’s Methods Guide for Comparative Effectiveness Reviews

The Agency for Healthcare Research and Quality (AHRQ) ’s Effective Health Care Program has released two new chapters of the Methods Guide for Effectiveness and Comparative Effectiveness Reviews:

·         “Finding Evidence for Comparing Medical Interventions”

·         “Assessing the Applicability of Studies When Comparing Medical Interventions”

To learn more about the Methods Guide for Effectiveness and Comparative Effectiveness Reviews and to access other chapters in this guide.

Enabling Personalized Medicine through Health Information Technology: Advancing the Integration of Information

Enabling Personalized Medicine through Health Information Technology: Advancing the Integration of Information

From the Brookings Institute Executive Summary

With federal officials pursuing the goal of a personal human genome map under $1,000 in five years (White House, 2010), it is possible to envision a future where treatments are tailored to individuals’ genetic structures, prescriptions are analyzed in advance for likely effectiveness, and researchers study clinical data in real-time to learn what works. Implementation of these regimens creates a situation where treatments are better targeted, health systems save money by identifying therapies not likely to be effective for particular people, and researchers have a better understanding of comparative effectiveness (President’s Council of Advisors on Science and Technology, 2010).

Yet despite these benefits, consumer and system-wide gains remain limited by an outmoded policy regime.  Federal regulations were developed years before recent advances in gene sequencing, electronic health records, and information technology.  With scientific innovation running far ahead of public policy, physicians, researchers, and patients are not receiving the full advantage of latest developments.  Current policies should leverage new advances in genomics and personalized medicine in order to individualize diagnosis and treatment.  Similarly, policies creating incentives for the adoption of health information technology should ensure that the invested infrastructure is one that supports new-care paradigms as opposed to automating yesterday’s health care practices.

To determine what needs to be done, a number of key leaders from government, academia, non-profit organizations, and business were interviewed about ways to promote a better use of health information technology to enable personalized medicine.  The interviews focused on policy and operational issues surrounding interoperability, standards, data sharing protocols, privacy, predictive modeling, and rapid learning feedback models.

This paper outlines the challenges of enabling personalized medicine, as well as the policy and operational changes that would facilitate connectivity, integration, reimbursement reform, and analysis of information.   Our health system requires a seamless and rapid flow of digital information, including genomic, clinical outcome, and claims data.  Research derived from clinical care must feed back into assessment in order to advance care quality for consumers.  There currently are discrete data on diagnosis, treatment, medical claims, and health outcomes that exist in parts of the system, but it is hard to determine what works and how treatments differ across subgroups.  Changes in reimbursement practices would better align incentives with effective health care practices……

A related commentary…

A commentary featured in the January 19 issue of The Journal of the American Medical Association (JAMA) from AHRQ Health IT grant recipient, Alex Krist, M.D. calls for the design of a patient-centered health information system that goes beyond the Personal Health Record.  Krist explains that in order for technology to be used, a system should be designed to help patients access health information, interpret data from multiple sources and serve as a tool to facilitate action.  Select to access the abstract.
(For suggestions on how to get this article for free or at low cost, click here)

Related articles

• ‘Digital Divide’ Appears To Exist In Adoption Of Online Personal Health Records

March 28, 2011 4:00:00 PM EDT Share

Despite increasing Internet availability, the ‘digital divide’ (disparities in access to technology) appears to exist among primary care patients adopting an online personal health record, according to a report in the March 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. “The personal health record (PHR) is an Internet-based set of tools that allows people to access and coordinate their lifelong health information,” the authors write as background information in the article..

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Electronic medical records not always linked to better care in hospitals, study finds

From the December 23, 2010 Eureka News Alert

Use of electronic health records by hospitals across the United States has had only a limited effect on improving the quality of medical care, according to a new RAND Corporation study.

Studying a wide mix of hospitals nationally, researchers found that hospitals with basic electronic health records demonstrated a significantly higher increase in quality of care for patients being treated for heart failure.

However, similar gains were not noted among hospitals that upgraded to advanced electronic health records, and hospitals with electronic health records did not have higher quality care among patients treated for heart attack or pneumonia.

The findings, published online by the American Journal of Managed Care, are part of a growing body of evidence suggesting that new methods should be developed to measure the impact of health information technology on the quality of hospital care…..

 

 

HHS issues new strategic framework on multiple chronic conditions

From the December 14 2010 US Health and Human Services news release

The U.S. Department of Health and Human Services today issued its new Strategic Framework on Multiple Chronic Conditions― an innovative private-public sector collaboration to coordinate responses to a growing challenge.

More than a quarter of all Americans ― and two out of three older Americans ― have multiple chronic conditions, and treatment for these individuals accounts for 66 percent of the country’s health care budget. These numbers are expected to rise as the number of older Americans increases.

The health care system is largely designed to treat one disease or condition at a time, but many Americans have more than one ― and often several ― chronic conditions. For example, just 9.3 percent of adults with diabetes have only diabetes, according to the Medical Expenditure Panel Survey from the Agency for Healthcare Research and Quality (AHRQ). And as the number of chronic conditions one has increases, so, too, do the risks of complications, including adverse drug events, unnecessary hospitalizations and confusion caused by conflicting medical advice.

The new strategic framework ― coordinated by HHS and involving input from agencies within the department and multiple private sector stakeholders ― expects to reduce the risks of complications and improve the overall health status of individuals with multiple chronic conditions by  fostering change within the system; providing more information and better tools to help health professionals  ― as well as patients ― learn how to better coordinate and manage care; and by facilitating research to improve oversight and care.

“Individuals with multiple chronic conditions deserve a system that works for them,” said Assistant Secretary for Health Howard K. Koh, MD, MPH. “This new framework provides an important roadmap to help us improve the health status of every American with chronic health conditions.”

The management of multiple chronic conditions has major cost implications for both the country and individuals. Increased spending on chronic diseases is a key factor driving the overall growth in spending in the Medicare program. And individuals with multiple chronic conditions also face increased out-of-pocket costs for their care, including higher costs for prescriptions and support services.

“Given the number of Medicare and Medicaid beneficiaries with multiple chronic conditions, focusing on the integration and coordination of care for this population is critical to achieve better care and health for beneficiaries, and lower costs through greater efficiency and quality,” said Centers for Medicare and Medicaid Services Administrator Donald Berwick, MD.

The Affordable Care Act, with its emphasis on prevention, provides HHS with exciting new opportunities to keep chronic conditions from occurring in the first place and to improve the quality of life for patients who have them.

“We need to learn rapidly how to provide high quality, safe care to individuals with multiple chronic conditions.  AHRQ’s investments assess alternative strategies for prevention and management of chronic illness, including behavioral conditions, in persons with varying combinations of chronic illnesses,” said AHRQ Director Carolyn M. Clancy, MD.

HHS has taken action in recent months to improve the health of individuals with multiple chronic conditions. Some examples include:

• Administration on Aging (AoA)/ Centers for Medicare and Medicaid Services Administrator (CMS)

AoA and CMS jointly announced $67 million in grants to support outreach activities that encourage prevention and wellness, options counseling and assistance programs, and care transition programs to improve health outcomes in older Americans.

• Agency for Healthcare Research and Quality (AHRQ)

AHRQ awarded more than $18 million dollars (American Recovery and Reinvestment Act) in two categories of grant awards to understand how to optimize care of patients with multiple chronic conditions.

• Assistant Secretary for Planning and Evaluation (ASPE)

As part of an existing $40 million ASPE contract, the National Quality Forum is undertaking a project to develop and endorse a performance measurement framework for patients with multiple chronic conditions.

• Centers for Disease Control and Prevention (CDC)

CDC is supporting a new project ― Living Well with Chronic Disease: Public Health Action to Reduce Disability and Improve Functioning and Quality of Life ― in which the Institute of Medicine will convene a committee of independent experts to examine the burden of multiple chronic conditions and the implications for population-based public health action.

• Centers for Medicare and Medicaid Services (CMS)

CMS has provided recent guidance to State Medicaid directors on a new optional benefit available Jan. 1, 2011, through the Affordable Care Act, to provide health homes for enrollees with at least two chronic conditions, or for those with one chronic condition who are at risk for another.

• Food and Drug Administration/ Assistant Secretary for Planning and Evaluation (FDA/ASPE)

FDA and ASPE launched a study to examine the extent to which individuals with multiple chronic conditions are being included or excluded from clinical trials for new therapeutic products.

• Indian Health Service (IHS)

IHS has expanded its Improving Patient Care Program to nearly 100 sites across the tribal and urban Indian health system to assist in improving the quality of health care for patients with MCC.

• National Institutes of Health (NIH)

NIH has committed $42.8 million for a study to determine whether efforts to attain a lower blood pressure range in an older adult population will reduce other chronic conditions.

• Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA awarded $34 million in new funding to support the Primary and Behavioral Health Care Integration Program, which seeks to promote the integration of care with people with co-occurring conditions.

For more information about the new HHS Strategy on Multiple Chronic Conditions, go to:http://www.hhs.gov/ash/initiatives/mcc/

 

 

Trust for America’s Health

Trust for America’s Health is a “non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority”.”By focusing on PREVENTION, PROTECTION, and COMMUNITIES, TFAH is leading the fight to make disease prevention a national priority, from Capitol Hill to Main Street. We know what works. Now we need to build the resolve to get it done.”

Trust for America’s Health includes the following

• How Healthy Is Your State? (home page link) where you can select a state from the drop-down menu. Statistics include adult health indicators (as cancer and asthma), child and adolescent health facts (as pre-term labor), obesity and diabetes rates, and program spending
  
• Current Report topics include the flu, liver diseases, preventative health care, how public dollars are spent on health care, and keeping America’s food supply safe
• Advice is given on Advocacy issues, including writing representatives and joining grassroot organizations
• The Resource Library provides links to organization and other Web sites in topics as Health Reform Legislation, Health Disparities, Environmental Health, and Food Safety

Uncertainty a huge source of anxiety in patients

From a December 3 Reuters Health news item by Fran Lowry

CHICAGO, ILLINOIS (Reuters Health) – Uncertainty about a diagnosis causes more anxiety and can be more stressful than actually knowing that you have a serious illness, researchers reported here at the 2010 annual meeting of the Radiological Society of North America.

“Once people have the diagnosis, they gain some understanding and control, but without it, all they have is anxiety, and they do not know how to handle it,” Dr. Elvira V. Lang, from Harvard Medical School, Boston, told Reuters Health. “It is important for physicians and others who work in the health care field to realize this and find ways to alleviate this anxiety and stress. Not only will they help patients, they will also be helping their institutions to provide more cost effective care.”…

…

We were very surprised to see that the women having breast biopsy were significantly more anxious than the women who came for treatment for malignant cancer and those who came for fibroids,” Lang said in an interview.

Health care professionals tend not to be aware that diagnostic tests can be stressful, she added.

The researchers recognize that for a woman awaiting breast biopsy, the fear of being diagnosed with cancer and uncertainty about what the outcome will be can create higher anxiety levels than even those experienced by patients undergoing a “much riskier and invasive treatment of a known cancer.”

“People in health care and also family members may judge what is minor or major by how much risk is involved. But that is not what the patient is experiencing. That is why we want to alert them,” Lang said.

There are simple ways to diffuse this anxiety prior to procedures, she added. “People want to make patients feel better but they use language that is not helpful. For instance, they will say ‘oh, it’s not going to be that bad’, or ‘it’s just going to be a little sting’, but using such vocabulary only increases anxiety and pain.”

Training health care providers to use the right language with patients about to undergo diagnostic procedures will not only reduce their anxiety levels, it will also save the health care system money, Lang added.

“Sometimes patients are so anxious they can’t complete a test….

 

 

Despite Efforts, Study Finds No Decline in Medical Errors

But experts say some safety initiatives may take time to bring results

From a November 24, 2010 Health Day news item

WEDNESDAY, Nov. 24 (HealthDay News) — Despite intensive efforts to improve patient safety, a six-year study at 10 North Carolina hospitals showed no decline in so-called patient “harms,” which included medical errors and unavoidable mistakes.

Sorting through patients’ medical records from more than 2,300 randomly selected hospital admissions, teams of reviewers found 588 instances of patient harm, which included events such as hospital-acquired infections, surgical errors and medication dosage mistakes.

While most harms were minor and temporary, 50 were life-threatening, 17 resulted in permanent problems and 14 people died, said the researchers, who selected North Carolina hospitals because the state has shown a strong commitment to patient safety. The admissions records spanned the period from January 2002 to December 2007.

Study author Dr. Christopher Landrigan said the results likely reflect what’s happening nationwide. A 1999 Institute of Medicine report publicizing high medical error rates spurred many U.S. hospitals to implement safety-promoting changes, but no uniform set of guidelines exists to direct facilities which changes to tackle, he said.

“What has been done right is that regulatory agencies have begun prioritizing patient safety,” said Landrigan, an assistant professor of pediatrics and medicine at Harvard Medical School. “But these efforts have largely been a patchwork of unconnected efforts and so far have not been as strong as they can be.”

Slightly more than half of the errors were avoidable, Landrigan said. They were detected by investigators who scanned patients’ charts for “trigger” events that suggested mistakes had occurred, such as a prescription for an anti-opioid drug that could remedy a morphine overdose.

The study, published in the Nov. 25 issue of the New England Journal of Medicine [free full text article], is important because health-care professionals “really haven’t had a good sense of what’s going on with safety over time,” said Dr. David Bates, a professor of health policy and management at the Harvard School of Public Health, where he co-directs the program in clinical effectiveness.

“It’s very useful to have robust estimates of the frequency of harm over time in a relatively large sample,” said Bates, who also serves as medical director of clinical and quality analysis for Partners Healthcare System in Massachusetts and is associate editor of the Journal of Patient Safety.

Like Landrigan, Dr. Jeffrey Rothschild of Brigham and Women’s Hospital in Boston believes patient safety has likely improved since the study concluded three years ago.

“But lots of opportunities for improvement are still out there,” said Rothschild, also an assistant professor of medicine at Harvard Medical School. “One of the challenges is gaining a really good handle on the extent of the problem.”

The researchers, who were from Brigham and Women’s Hospital, Stanford University Medical School and the Institute for Healthcare Improvement, pointed out that several practices proven to improve patient safety take much time and money to implement.

These practices include work-hour limits for medical staff as well as the use of electronic medical records and computerized work-order entries for prescriptions and procedures.

“It takes awhile for these improvements to happen,” Landrigan said. “My suspicion is, if we go five years hence, we’re going to see these improvements over time.”

Related Web Sites

• Patient Safety (Medlineplus)
• Patient Safety: Ten Things You Can Do to Be a Safe Patient(Centers for Disease Control and Prevention)
• Speak Up (Joint Commission) links to information on preventing errors in your health care, preventing medical test mistakes, avoiding mistakes in surgery, knowing your rights, and much more
• Where Medical Errors Occur and How to Avoid Them (AHRQ video)
• Getting Safer Care (AHRQ Web page with links)

 

 

 

Access to Health Care (CDC Vital Signs Web page)

The recent CDC (US Centers for Disease Control and Prevention)  page Access to Health Care provides general information about health insurance coverage.

Here is the summary

New 2010 estimates show that the number of Americans without health insurance is growing, affecting middle-income Americans as well as those living in poverty. About 50 million adults 18–64 years old had no health insurance for at least some of the past 12 months. People in all income brackets have been affected, not just adults living in poverty, according to a 2009 survey. In the past few years, the number of adults aged 18–64 who went without health insurance for at least part of the past 12 months increased by an average of 1.1 million per year. About half of those additional adults were middle-income.* Adults without consistent health insurance are more likely to skip medical care because of cost concerns, which can lead to poorer health, higher long-term health care costs, and early death.

*About $43,000–$65,000 household income for a household of four

This Web page includes the following links

• Learn about your role in expanding access to health care, with tips for employers, health care providers, and everyone
• Latest Findings with a summary of current health insurance coverage statistics
• Who’s at Risk with a chart on the relationship between disability and health care insurance coverage
• What can be done with tips for employers, health care providers, and everyone

NLM announces MedlinePlus Connect

From a posting by  GMRLIST – email list for the National Network of Libraries of Medicine-Greater Midwest Region (NN/LM-GMR) members. Written by Samanthi Hewakapuge, MA, MLS, Consumer Health Coordinator

Today NLM [US National Libraries of Medicine) announces MedlinePlus Connect (http://medlineplus.gov/connect), a free service that allows electronic health records (EHR) systems to link users to MedlinePlus (http://medlineplus.gov), an authoritative up-to-date health information resource for patients, families and health care providers. MedlinePlus provides information about conditions and disorders, medications, and health and wellness.

MedlinePlus Connect accepts requests for information on diagnoses (problem codes) and medications. NLM mapped MedlinePlus health topics to two standard diagnostic coding systems used in EHRs: ICD-9-CM and SNOMED CT CORE Problem List Subset.

When an EHR submits a request to MedlinePlus Connect, the service returns the closest matching health topic as a response.  MedlinePlus Connect also links EHR systems to drug information written especially for patients. For medication codes, MedlinePlus Connect accepts RXCUIs and NDCs. The API for using this service conforms to the HL7 Context-Aware Knowledge Retrieval (Infobutton) Knowledge Request URL-Based Implementation specification.

MedlinePlus responds to problem code requests in either English or Spanish. Currently, it supports requests for drug information in English only.  NLM is working on adding laboratory test responses to MedlinePlus Connect. We will also support an XML-based Web service at a future date.

You can find more background and technical information at http://medlineplus.gov/connect. If you are an EHR owner or developer interested in staying up-to-date on technical developments with MedlinePlus Connect, or talking to other organizations that are using it, join the free email list athttp://www.nlm.nih.gov/medlineplus/connect/emaillist.html. To send questions or feedback, use the MedlinePlus Contact Us link athttp://apps.nlm.nih.gov/medlineplus/contact/index.cfm.

 

Views on health disparities fueled largely by political ideology

Harry Perlstadt, a Michigan State University sociologist, contends party ideology is more important than party affiliation when it comes to public perception of health disparities.

 

From a November 9 Michigan State University press release

EAST LANSING, Mich. — When it comes to public perception about health disparities in the United States, political ideology plays a surprisingly large role – more so even than party affiliation, according to new research by a Michigan State University sociologist.

“As far as our beliefs about unequal access to health care, whether we are conservative or liberal seems to be much more important than whether we are Republican or Democrat,” said Harry Perlstadt, professor of sociology.

Perlstadt’s study is the first to scientifically examine political and ideological beliefs on the issue of health disparities. He will present his findings today at the American Public Health Association’s 138th annual meeting in Denver….

…….He commissioned a telephone survey with MSU’s Institute for Public Policy and Social Research that gathered information on the respondents and asked a series of questions regarding their beliefs about health disparities. The questions included, “How often do you think the health care system treats people unfairly based on whether they have health insurance?” and “How often does a person’s race or ethnic background affect whether they can get routine medical care when they need it?”

Perlstadt analyzed the survey data and found that race, age, sex, income and whether a respondent lived in an urban or rural community all influenced their beliefs on health disparities. Political party and ideology also affected their beliefs – only not quite as Perlstadt had predicted.

The Case for a National Patient Library (Analysis and Commentary)

Recent article describes the benefits of providing consumer patient information in many areas of health care.

Interesting to note that, according to recent postings at Medlib-L (a listserv for medical librarians), there is no mention of roles for librarians.

Full text of this article is by subscription only, however it may be freely available at your local public or academic library.
Call ahead and ask for a reference librarian.

The abstract from the journal Health Affairs (v. 29, no. 10 [2010]: 1914-1919)

A national patient library that stored and communicated findings from research on the comparative effectiveness of health services could be a valuable resource for patients and clinicians. It could assist in improving the quality of health care and helpreduce inappropriate costs. Public confidence in a national patient library would require that its activities be insulated from government as well as from professional, provider, payer, and commercial groups and advocacy organizations. This article describes why such a library is possible and desirable, what it would do for whom, how it could be governed and financed, and how it could overcome initial challenges.

AHRQ State Snapshots Expanded to Include New Data on Health Insurance Coverage

The Agency for Healthcare Research and Quality’s annual release of state-by-state quality data has been expanded to include new data on health insurance, including data on health care quality categorized by source of payment, including private insurance, Medicare, Medicaid and those without insurance. The 2009 State Snapshots released by AHRQ today are available athttp://statesnapshots.ahrq.gov/.

HealthCare.gov provides online health insurance information

HealthCare.gov is a federal government Website managed by the U.S. Department of Health & Human Services.

It has the goal to provide information so that one can “Take health care into your own hands”.

Web pages provide guidance in finding public and private health insurance,  learning about prevention, comparing care quality, and understanding the new law.  

Email, Twitter, and YouTube options for updates are included.

Bar Codes Help Reduce Medication Administration Errors

Bar codes used with electronic health records greatly reduce the administrating of the “wrong drugs” which can harm patients.

When bar codes are used with eMAR (electronic medical administration records), it is greatly ensured that the correct medication is administered in the correct dose at the correct time to the correct patient. ” The study is published in the May 6 issue of the New England Journal of Medicine.

 This study (press release here) was partially funded by the US Agency for Healthcare Research and Quality (AHRQ).

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AHRQ is the lead federal agency mission in improving the quality, safety, efficiency, and effectiveness of health care for all Americans. Information from AHRQ’s research helps people make more informed decisions and improve the quality of health care services.

Information for Consumers and Patients  includes publications, videos, and podcasts in the following areas:
**Staying Healthy
**Choosing Quality Care
**Getting Safer Care
**Understanding Diseases and Conditions
**Comparing Medical Treatments

Other broad topics include:
**Clinical Information areas as Evidence Based Practice, Technology Assessment, and National Guideline Clearinghouse™. 
**Quality and Patient Safety areas as Health Information Technology, National Quality Measures Clearinghouse™ , and WebM&M: Morbidity & Mortality Rounds.

**Data & Surveys areas as Available Data Sources from AHRQ, and Health Care Costs and Utilization Project.