Health and Medical News and Resources

General interest items edited by Janice Flahiff

Analysis Of Interventions In 5 Diseases Offers Guidelines To Help Close The Gap

 

Racial/Ethnic Disparities in Self-Rated Health Status among Adults with and Without Disabilities — United States, 2004–2006. MMWR 2008:57(39);1069-1073.

 

Chart: General Health Status among US Adults*, by Race or Ethnicity

From the 19th July 2012 article at Medical News Today

Major disparities exist along racial and ethnic lines in the United States for various medical conditions, but guidance is scarce about how to reduce these gaps. Now, a new “roadmap” has been unveiled to give organizations expert guidance on how to improve health equity in their own patient populations.

Finding Answers, a national program based at the University of Chicago and funded by the Robert Wood Johnson Foundation, seeks evidence-based solutions to reduce racial and ethnic health disparities. Its new roadmap, outlined as part of a symposium of six papers published in the Journal of General Internal Medicine (JGIM), builds upon seven years of administering grants, reviewing literature, and providing technical assistance to reduce health disparities.

The roadmap’s architects hope it can provide direction on creating effective and sustainable interventions as the health disparities field shifts from measuring the problem to taking action. ..

…The paper highlights the initial need for recognizing disparities and commitment to their reduction, and suggests that programs to reduce disparities should be integrated into broader quality improvement efforts at clinics, hospitals and other health systems.

“In the past, people did disparities work or quality work, but the two wouldn’t touch one another,” Chin said. “We’re merging the quality improvement field and the disparities field.”

The roadmap also contains advice on designing interventions to address disparities, drawing upon systemic reviews of disparities research in various diseases. Five such reviews – on HIV,colorectal cancer, cervical cancerprostate cancer and asthma – accompany the roadmap article in the JGIM symposium.

Researchers identified characteristics of successful interventions across the five new articles and previously published reviews of cardiovascular disease, diabetesdepression and breast cancer. Effective projects were found to utilize team approaches to care, patient navigation, cultural tailoring, collaboration with non-health care partners such as families or community members, and interactive skill-based training.

The reviews also identified potential targets for reducing health disparities that have yet to be examined..

..While offering general guidelines for best practices, the authors point out that the specifics of any organization’s effort to reduce disparities must be custom-fit to the patient population and community. …

References for this article

The paper, “A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care,” was published on July 13 by the Journal of General Internal Medicine. Five systematic reviews of disparities interventions in HIV, colorectal cancer, cervical cancer, prostate cancer and asthma accompany the main article. The articles are open access, and can be read here:http://www.springerlink.com/content/0884-8734/27/8/
The publications were funded by Finding Answers: Disparities Research for Change, a Robert Wood Johnson Foundation program, with direction and technical assistance from the University of Chicago. More information about Finding Answers and the Roadmap to Reduce Disparities can be found athttp://www.solvingdisparities.org.
University of Chicago Medical Center

 

 

July 19, 2012 Posted by | Public Health | , , , , , , , | Leave a comment

Nursing Research Focuses On Health Trajectory Research

From the 8 June 2011 Medical News Today article

Health care research typically focuses on final outcomes such as cure or death overlooking the fact that health and illness are dynamic states that evolve and change over time. A special collection of articles on health trajectory research is now available in a supplement to Nursing Research***, official journal of the Eastern Nursing Research Society and the Western Institute of Nursing. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The special supplement presents a series of original studies and commentaries on the development of nursing intervention science focused on the “promotion, maintenance, and restoration of health over time.” It reflects a growing interest in studying the ways that health care interventions can affect health trajectories at different stages of life…

…Several types of health trajectories can be affected by nursing interventions. Developmental trajectories refer to normal physiologic changes such as puberty, menopause, or aging or even life transitions such as marriage or retirement. Acute illness trajectories have to do with illnesses that tend to resolve or improve over time, while chronic illness trajectories are associated with illnesses that aren’t curable, but can still have positive health outcomes. Other categories include disability trajectories and end-of-life or dying trajectories. “Having a better understanding of these various health trajectories and how they can be shaped through interventions will help clinicians provide better care for individuals and families at all stages of their lives,” Drs. Wyman and Henly write.

Articles in the special issue present the nursing science perspective on health trajectory research and important theoretical considerations in studying health and illness over time including advances in statistical modeling that support this area of research. The supplement also includes a series of original studies illustrating the health trajectory perspective in health and illness; in community, hospital, and laboratory settings; and across time scales ranging from seconds to years. Topics include:

— Changes in functioning of the parasympathetic nervous system related to feeding in newborns after surgery for major congenital heart abnormalities.

— Changes in patterns of condom use by sexually active teens participating in a pregnancy-prevention program.

— Changes in anxiety related to mechanical ventilation in critically ill patients.

— Changes in patterns of pain (claudication) during treadmill testing in patients with peripheral artery disease.

— Changes in gastrointestinal symptoms in incontinent patients being treated with fiber supplements.

— Changes in burden and depression in caregivers of spouses with dementia as they transition to nursing care.

 

***For suggestions on how to get these articles for free or at low cost, click here

June 14, 2011 Posted by | Medical and Health Research News, Professional Health Care Resources | , , | Leave a comment

Elsevier/MEDai enhances real-time clinical surveillance system for hospitals

a hospital room (Denmark, 2005)

Image via Wikipedia

Elsevier/MEDai enhances real-time clinical surveillance system for hospitals

From the February 15, 2011 Eureka news alert

(Elsevier) Elsevier/MEDai, a leading provider of advanced clinical analytic health-care solutions, announced today the launch of the latest version of Pinpoint Review, its real-time, clinical surveillance system for hospitals. The new version will feature an expanded set of clinical watch triggers, expanded core measure alerts and three new predictions: ICU Admission Prediction, Length of Stay Prediction and Mortality Prediction.

ORLANDO, FL – 14 February, 2011 – Elsevier / MEDai, a leading provider of advanced clinical analytic healthcare solutions, announced today the launch of the latest version of Pinpoint Review®, its real-time, clinical surveillance system for hospitals. The new version will feature an expanded set of clinical watch triggers, expanded core measure alerts and three new predictions: ICU Admission Prediction, Length of Stay Prediction and Mortality Prediction.

“Hospitals are facing an enormous amount of pressure to provide better, safer care with fewer complications while managing costs,” said Swati Abbott, President of Elsevier / MEDai. “Elsevier / MEDai has enhanced its predictive analytics product to continuously give hospitals and clinicians the most up-to-date tools they need to lower mortality rates and healthcare costs, provide a higher quality of care, increase patient safety and maintain regulatory compliance.”

Pinpoint Review generates predictions for acute-care patients, focusing on the likelihood of a patient developing a complication, contracting a healthcare-acquired infection or being readmitted within 30 days of discharge, while patients are still in the hospital and there is time to adjust care to avoid a negative outcome.

With the expansion of Pinpoint Review’s new predictions, care givers are able to enhance their efforts in proactive care management. Pinpoint Review unlocks the power of clinical and administrative hospital data by utilizing predictive technologies to turn data into actionable information. Empowering today’s hospitals with the ability to predict whether or not a patient will be admitted to the ICU or higher intensity care unit, a predicted length of hospital stay or patient expiration goes a long way in driving down the cost of care and brings a proactive approach to quality improvement.

Pinpoint Review addresses the increasing pressure on hospitals from entities such as the Agency for Healthcare Research and Quality and the Joint Commission on Accreditation of Healthcare Organizations to deliver a higher quality of care and fewer medical errors. Pinpoint Review alerts care providers to patients at risk for developing several of the conditions that the Centers for Medicare and Medicaid Services (CMS) no longer reimburse.

February 15, 2011 Posted by | Medical and Health Research News | , , , , , , , , , , , , , , | Leave a comment

Hospital spending may pay off for some conditions

Hospital spending may pay off for some conditions

 

a hospital room (Denmark, 2005)

Image via Wikipedia, in public domain

 

 

 

 

 

 

Image via Wikipedia

 

 

 

 

 

 

 

From the January 31, 2011 Reuters news item by Genevra Pittman

NEW YORK (Reuters Health) — Hospitals that spend more money treating patients with acute illnesses may be better at keeping those patients alive, suggests a new study.

The finding is in line with recent research, but it challenges an assumption held by many policymakers that hospitals can be forced to spend less without significant consequences for patient health.

“The traditional literature on spending is that quality isn’t higher (in hospitals that spend more),” said Mary Beth Landrum, who studies health care policy at Harvard Medical School and did not participate in the research. But, “when you start looking at specific groups of patients, you may actually find that there is some benefit for some of the increased spending,” she told Reuters Health.

The current study included people treated for heart attack, heart failure, stroke, hip fracture, pneumonia and serious stomach bleeding. Researchers led by Dr. John Romley of the University of Southern California looked at records for more than 2.5 million of these patients admitted to California hospitals during the years 1999 through 2008.

Romley’s team calculated how likely the patients were to survive their hospital stay, then compared those numbers to how much money the hospitals typically spent to treat the conditions in question.

For each of the six conditions, they found the highest-spending hospitals spent more than three times as much as the lowest-spenders.

Those hospitals ranking in the bottom-fifth for expenditures on heart failure and hip fracture, for instance, averaged $5,100 caring for a heart failure patient and $8,000 treating a hip fracture. The top-fifth-spending hospitals for the same conditions averaged $19,000 on a heart failure patient and $29,000 on one with hip fracture.

For each of the conditions examined higher spending was also linked to higher patient survival.

Patients treated at the highest-spending hospitals for heart failure, for example, had a 25 percent smaller chance of dying while they were there than patients treated at lowest-spending hospitals.

During the second half of the study (2004 to 2008) the mortality differences seen with high or low spending on hip fracture patients were extremely small, but overall the researchers say the numbers show money does seem to make a difference in survival.

If all patients in the study who were treated at the lowest-spending hospitals had instead been treated at the highest-spending facilities, the authors calculated that about 18,000 fewer people would have died during the first half of the study, and 14,000 fewer during the second half.

What exactly high-spending hospitals are doing to save lives is not completely clear.

Previous research suggests hospitals that spend more money don’t have fewer complications during care — they may just be more prepared to notice and address complications quickly, said Dr. Amber Barnato, who studies end-of-life care at the University of Pittsburgh and was not involved in the current study.

“There must be something about paying close attention, which might mean more staff, more eyes on the patients,” Barnato told Reuters Health. In addition, she said, “there might be a greater willingness to do intensive things to rescue someone, like put them on a breathing machine (or) put them in the (intensive care unit).”

The findings, published in the Annals of Internal Medicine,*** are in line with a few recent studies, including one showing that hospitals where heart failure is treated frequently give better care but also spend more money per patient than hospitals that treat the condition less frequently.

Together such studies challenge the assumption that much of hospital spending is inefficient and that hospitals could perform just as well with smaller budgets, researchers say.

That debate has been an important part of the controversy surrounding new health care reform legislation, which will cut back Medicare spending on hospitals, Romley noted.

“If the results are real … that would suggest these reductions across the board in hospital spending might lead to worse outcomes for some patients,” Romley told Reuters Health. That doesn’t mean cuts wouldn’t still be cost-effective, if money elsewhere could better improve public health. But, he added, “it is important to understand the trade-offs.”

The new findings need to become part of the national debate on how best to allocate money to protect the health of the general population — but they don’t change the fact that health care funding isn’t in unlimited supply, Barnato said.

Even if patients with serious illnesses such as the ones examined in the current study do make it out of the hospital alive, many die within a year, and some of the money used on end-of-life care might save more lives if it was used to address preventable childhood diseases or obesity, for example, she said.

“A hospital that spends more money can have slightly better quality or safety,” Barnato explained, “and that spending might still not result in better population health.”

SOURCE: http://bit.ly/an7XRm Annals of Internal Medicine, online January 31, 2011.

 

***For suggestions on how to get this article for free or at low cost, click here

 

 

 

February 2, 2011 Posted by | Medical and Health Research News | , , , , , , | Leave a comment

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.


February 1, 2011 Posted by | Uncategorized | , , , , , , | Leave a comment

   

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