New Thinking: Medical Hot Spots (Lowering Medical Costs by Giving Neediest Patients Better Care)

From the 2 August 2011 blog posting at Medical-Lee Speaking

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.

Related articles

• FRONTLINE: Doctor Hotspot (full report) (milkandcookies.com)
• The emerging liberal doctor majority (salon.com)

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

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

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

Related Link

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

 

National Prevention Strategy: America’s Plan for Better Health and Wellness

National Prevention Strategy: America’s Plan for Better Health and Wellness

From the press release:

The National Prevention Strategy includes actions that public and private partners can take to help Americans stay healthy and fit and improve our nation’s prosperity. The strategy outlines four strategic directions that, together, are fundamental to improving the nation’s health.  Those four strategic directions are:

• Building Healthy and Safe Community Environments:  Prevention of disease starts in our communities and at home; not just in the doctor’s office.
• Expanding Quality Preventive Services in Both Clinical and Community Settings: When people receive preventive care, such as immunizations and cancer screenings, they have better health and lower health care costs.
• Empowering People to Make Healthy Choices:  When people have access to actionable and easy-to-understand information and resources, they are empowered to make healthier choices.
• Eliminating Health Disparities: By eliminating disparities in achieving and maintaining health, we can help improve quality of life for all Americans.

Related articles

• National Prevention Strategy: America’s Plan for Better Health and Wellness (nlm.nih.gov)
• HHS Announces Plan to Reduce Health Disparities (nlm.nih.gov)

Number Of Deaths In The US Can Be Linked To Social Factors

From the 16 June 2011 Medical News Today site

Published in the American Journal of Public Health, a new study *** calculates the number of deaths attributable to social factors in the United States, finding a broader way to conceptualize the causes of mortality.

Researchers estimated the number of deaths in the United States attributable to social factors, using a systematic review of the available literature combined with vital statistics data. They conducted a MEDLINE search for all English-language articles published between 1980 and 2007 with estimates of the relation between social factors and adult all-cause mortality. After calculating for the relative risk estimates of mortality, researchers obtained estimates for each social factor. Individual social factors included education, poverty, health insurance status, employment status and jobstress, social support, racism or discrimination, housing conditions and early childhood stressors. Area-level social factors included area-level poverty, income inequality, deteriorating built environment, racial segregation, crime and violence, social capital and availability of open or green spaces.

They found that approximately 245,000 deaths in the United States in 2000 were attributable to low education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual-level poverty, 119,000 to income inequality and 39,000 to area-level poverty. …

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

Indiana U. study points to health disparities in physical fitness

From a 4 Jun 2011 Eureka news alert

 

An Indiana University study examining disparities in physical fitness levels between older adults who are patients of safety net community health centers (CHC) and those who are members of a medically affiliated fitness center is producing stunning results.

NiCole Keith, associate professor in the Department of Physical Education at Indiana University-Purdue University Indianapolis, said she expected the study to show similar physical fitness levels between the two groups. The findings, however, show that the fitness center participants performed significantly better on each of the measures when compared to the CHC particpants.

The community health centers serve vulnerable populations, including those without health insurance; the medically affiliated fitness centers serve a more affluent population. Otherwise, the age and health literacy of study participants in both groups were the same.

Further, the members of the medically affiliated fitness center were not exercising at the facility every week, much less every day. Generally, these fitness center members had sedentary jobs. Patients at the CHC who were employed spent a lot of time on their feet and moving about….

…

The overriding difference between the two groups of study participants is access to opportunities to exercise, Keith said. For patients at the CHC, there is generally no place for them to exercise. The cost of joining a fitness center is prohibitive for these patients, she added.

What is of great concern, Keith said, is that low levels of physical fitness are strongly related to negative health outcomes, including increased morbidity and mortality. The distinct differences among physical fitness levels between CHC patients and members of the medically affiliated fitness center demonstrate the clear need to identify low-cost and accessible means for vulnerable populations to improve their physical fitness levels, she said….

Lifelong gap in health between rich and poor set by age 20

 

 

Study by McGill geography professor finds that as people age, the differnce in the health-related quality of life between rich and poor remains constant

From a 8 June 2011 Eureka news alert

 

“We can’t buy our way out of ageing,” says Nancy Ross, a McGill geography professor. “As we get older we start to have vision problems, maybe some hearing loss, maybe lose some mobility – ageing is a kind of a social equalizer.”

Ross is the lead author of a new study about how socio-economic and educational status affects Canadians’ health-related quality of life over the course of a lifetime.

“My research looks at how poverty and social disadvantage affect your health status. Our work was about using social circumstances as a lens to look at how people’s quality of life changes as they age.”

The good news, according to Ross, is that there is no sign of an accelerated ageing process for those who are lower on the social ladder. “The trajectories for declining health as people age look fairly similar across the social spectrum. That surprised me. I thought that there would be a bit more of a difference across social groups.”

But the bad news is that Canadians who are less educated and have a lower income start out less healthy than their wealthier and better-educated compatriots, and remain so over the course of their lives. “What we found, basically, is that people who are more educated and with higher incomes have a better health-related quality of life over their whole lifespan, and that these health “tracks” stay pretty parallel over time.

“The message there is that if you start out with a health-related quality of life deficit through early life experience and a poor educational background, it’s never made up for later on,” says Ross. “Poorer Canadians are in poorer health and they have lower life expectancy than their more affluent counterparts, and by age 20 the pattern for health-related quality of life as people age is already fixed.”

“We might speculate that universal health insurance and other social policies directed to adults and seniors have played a role in preventing accelerated decline in health-related quality of life of the poorer and less educated Canadians. That said, we would need some comparative research in other countries to test this more fully,” she adds. “But this study suggests the need for policies aimed at making sure kids and teens are given the chances early in life to even out socio-economic inequalities that will affect their health as they age.”

 

Solving the Online (Youth Health Information) Health Equity Problem

Mobile Phone Use 2006, http://commons.wikipedia.org/wiki/File:Mobile_phone_use_world2.PNG

Pediatrician and public health expert Dr. Kishan Kariippanon believes that while computers and mobile phones are overall giving youth greater access to health information, they are creating health disparities.

For example, youth today are increasingly using the Internet to find information about their symptoms before doctor appointments.

Dr.  Kariippanon proposes five ways to reduce this health disparity gap at his blog posting Youth, Healthcare & Online Communication 

1. Create health information in video and audio format accessible via mobile phone in small bite sizes, i.e.Miwatj Health videos

2. Data and statistical information should be provided in visual format i.e. Hans Rosling’s Gapminder 
3. Health information needs to appeal to young people through contemporary design, innovative websites and the use of social networking sites i.e. http://www.tuneinnotout.com, Fully Sick Rapper (TB).

4. Youth drop in centres need to be redesigned to incorporate the creation of health resources for youth by youth in their core business, i.e. Studio 34

5. Youth organizations and drop in centres need to promote a service component in their youth programs that will allow young people to connect with each other through joint community development projects.

Reference

1. Gwen Van Servellen, Communication Skills for the Health Care Professional, Concepts, Practice and Evidence. 2nd Edition 2009.

Related articles

• Federal Health IT Strategic Plan Comment: Creating a Patient-Centered Health Information Ecosystem (projecthealthdesign.typepad.com)
• Reports on Health Care Disparities at the State Level Available (jflahiff.wordpress.com)
• Non-profits Excel at Using Twitter to Spread Health Info (healthcaremarcom.wordpress.com)
• Community Connect to Research: Linking You to the World of Health Information and Research (hcfama.org)
• Patients using Facebook for health information (kevinmd.com)
• Electronic Patient Consent System Planned (informationweek.com)
• AHRQ Healthcare 411 podcasts (jflahiff.wordpress.com)
• HHS Announces Plan To Reduce Health Disparities (jflahiff.wordpress.com)
• No thanks, ‘Organized Wisdom’: I say NO to datamining, scraping & pharma funded health information:reminds me of Wellsphere-I dumped that too (bipolarsoupkitchen-stephany.blogspot.com)

HHS Announces Plan To Reduce Health Disparities

From the April 11 2011 Medical News Today article

The U.S. Department of Health and Human Services launched two strategic plans aimed at reducing health disparities.

The HHS Action Plan to Reduce Racial and Ethnic Health Disparities outlines goals and actions HHS will take to reduce health disparities among racial and ethnic minorities.

HHS also released the National Stakeholder Strategy for Achieving Health Equity, a common set of goals and objectives for public and private sector initiatives and partnerships to help racial and ethnic minorities and other underserved groups reach their full health potential. The strategy, a product of the National Partnership for Action (NPA), incorporates ideas, suggestions and comments from thousands of individuals and organizations across the country. The NPA was coordinated by the HHS Office of Minority Health.

 

Related Articles

• Webcast: HHS Action Plan for Reducing Health Disparities (aa47.wordpress.com)
• Health and Human Services: ‘LGBT people have been denied the compassionate services they deserve. That is now changing’ (miamiherald.typepad.com)

Reports on Health Care Disparities at the State Level Available

Reports on Health Care Disparities at the State Level Available

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

AHRQ has released two reports from its Healthcare Cost and Utilization Project that provide information on approaches to using race/ethnicity data for reducing disparities in the quality of health and health care.  The data is from the 2010 National Health Quality Report and National Healthcare Disparities Report.

The following reports focusing provide information on approaches to using race/ethnicity data for reducing disparities in the quality of health and health care.

• State Documentation of Racial and Ethnic Health Disparities to Inform Stategic Action (PDF file, 647 KB; HTML)
• State Uses of Hospital Discharge Databases to Reduce Racial and Ethnic Disparities (PDF file, 205 KB)

 

Also…

2010 National Healthcare Quality & Disparities Reports

For the eighth year in a row, the Agency for Healthcare Research and Quality (AHRQ) has produced

the National Healthcare Quality Report (NHQR) [Full Report (PDF File, 4.4 MB) PDF Help] and

the National Healthcare Disparities Report (NHDR [Full Report (PDF File, 4.3 MB) PDF Help{).

These reports measure trends in effectiveness of care, patient safety, timeliness of care, patient centeredness, and efficiency of care. New this year are chapters on care coordination, health system infrastructure. The reports present, in chart form, the latest available findings on quality of and access to health care.

 

Related Articles

• Health Care Quality Still Improving Slowly, but Disparities and Gaps in Access to Care Persist (jflahiff.wordpress.com)
• “2010 National Healthcare Quality & Disparities Reports” and related posts (nnlm.gov)
• Patient Safety Awareness Week 4: National Quality and Disparities Reports Show Need For Improvement (hcfama.org)
• Kaiser’s Monthly Update on Health Disparities – Kaiser Family Foundation (policyabcs.wordpress.com)
• Health Care Quality Still Improving Slowly, but Disparities and Gaps in Access to Care Persist (nlm.nih.gov)
• Health Disparities Still a Huge Problem (lseegert.wordpress.com)

Health Care Quality Still Improving Slowly, but Disparities and Gaps in Access to Care Persist

Health Care Quality Still Improving Slowly, but Disparities and Gaps in Access to Care Persist

From the Agency for Healthcare Research and Quality (AHRQ) Press Release

ress Release Date: February 28, 2011

Improvements in health care quality continue to progress at a slow rate—about 2.3 percent a year; however, disparities based on race and ethnicity, socioeconomic status and other factors persist at unacceptably high levels, according to the 2010 National Healthcare Quality Report and National Healthcare Disparities Report issued today by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ).The reports, which are mandated by Congress, show trends by measuring health care quality for the Nation using a group of credible core measures. The data are based on more than 200 health care measures categorized in several areas of quality: effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure, and access.

“All Americans should have access to high-quality, appropriate and safe health care that helps them achieve the best possible health, and these reports show that we are making very slow progress toward that goal,” said AHRQ Director Carolyn M. Clancy, M.D. “We need to ramp up our overall efforts to improve quality and focus specific attention on areas that need the greatest improvement.”

Gains in health care quality were seen in a number of areas, with the highest rates of improvement in measures related to treatment of acute illnesses or injuries. For example, the proportion of heart attack patients who underwent procedures to unblock heart arteries within 90 minutes improved from 42 percent in 2005 to 81 percent in 2008.

Other very modest gains were seen in rates of screening for preventive services and child and adult immunization; however, measures of lifestyle modifications such as preventing or reducing obesity, smoking cessation and substance abuse saw no improvement.

The reports indicate that few disparities in quality of care are getting smaller, and almost no disparities in access to care are getting smaller. Overall, blacks, American Indians and Alaska Natives received worse care than whites for about 40 percent of core measures. Asians received worse care than whites for about 20 percent of core measures. And Hispanics received worse care than whites for about 60 percent of core measures. Poor people received worse care than high-income people for about 80 percent of core measures.

Of the 22 measures of access to health care services tracked in the reports, about 60 percent did not show improvement, and 40 percent worsened. On average, Americans report barriers to care one-fifth of the time, ranging from 3 percent of people saying they were unable to get or had to delay getting prescription medications to 60 percent of people saying their usual provider did not have office hours on weekends or nights. Among disparities in core access measures, only one—the gap between Asians and whites in the percentage of adults who reported having a specific source of ongoing care—showed a reduction.

Each year since 2003, AHRQ has reported on the progress and opportunities for improving health care quality and reducing health care disparities. The National Healthcare Quality Report focuses on national trends in the quality of health care provided to the American people, while the National Healthcare Disparities Report focuses on prevailing disparities in health care delivery as it relates to racial and socioeconomic factors in priority populations.

The quality and disparities reports are available online at http://www.ahrq.gov/qual/qrdr10.htm, by calling 1-800-358-9295 or by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

For more information, please contact AHRQ Public Affairs: (301) 427-1892 or (301) 427-1855.

Use Twitter to get AHRQ news updates: http://www.twitter.com/ahrqnews/

 

 

 

Webinar: Black American Health: Law as a Social Determinant of Health

Webinar: Black American Health: Law as a Social Determinant of Health

Information and registration for this free webinar may be found at https://www2.gotomeeting.com/register/363063002

Excerpt

 

Social determinants of health are the key factors in the health status gap between blacks and whites. Social determinants of health are the social, economic and political forces under which people live that affect their health.  Social determinants include wealth/income, education, physical environment, health care, housing, employment, stress and racism/discrimination. In fact, for blacks racism is a key factor. Accumulating evidence strongly suggests that exposure to racial discrimination, and the related economic adversity and social disadvantages, may be a chronic source of trauma in Black communities  that negatively influences mental and physical health outcomes.  These effects may be exacerbated for Black children  who may be impacted by exposure to racial discrimination directly and indirectly via the negative influence of racial discrimination on parent and community support and functioning.  Using a life-course framework, we will examine how exposure to racial discrimination in childhood can shape child and adult health, particularly the likelihood of chronic disease in adulthood. The law is a factor in every social determinant of  health and particularly in racial discrimination.  The webinar will discuss the role of laws and legal structures as a strategy for reducing health disparities. **Racial Inequality: A Risk Factor for Health Disparities in African American Communities”. Dr. Kathy Sanders-Phillips **Law as a Social Determinant of Health Dr. Vernellia Randall The Webinars are organized by Professor Vernellia R. Randall at The University of Dayton (randall@udayton.edu).

 

Homeless people without enough to eat are more likely to be hospitalized

Homeless people without enough to eat are more likely to be hospitalized
Mass. General study is first to document association between food, use of health services

From the February 3, 2011 Eureka news release

Homeless people who do not get enough to eat use hospitals and emergency rooms at very high rates, according to a new study. One in four respondents to a nationwide survey reported not getting enough to eat, a proportion six times higher than in the general population, and more than two thirds of those had recently gone without eating for a whole day. The report will appear in the Journal of General Internal Medicine and has been released online.***

“The study is the first to highlight the association between food insufficiency and health care use in a national sample of homeless adults,” says lead author Travis P. Baggett, MD, MPH, of the Massachusetts General Hospital (MGH) General Medicine Division. “Our results suggest a need to better understand and address the social determinants of health and health-care-seeking behavior,”

Baggett and a team of investigators at MGH and the Boston Health Care for the Homeless Program analyzed survey data from 966 adult respondents to the 2003 nationwide Health Care for the Homeless User Survey. They found that homeless people who did not have enough to eat had a higher risk of being hospitalized in a medical or psychiatric unit than did those with enough to eat and also were more likely to be frequent users of emergency rooms. Neither relationship could be explained by individual differences in illness. Nearly half of the hungry homeless had been hospitalized in the preceding year and close to one-third had used an emergency room four or more times in the same year.

Baggett explains the study was sparked by his clinical experience caring for homeless individuals. “Homeless patients with inadequate food may have difficulty managing their health conditions or taking their medications. They may postpone routine health care until the need is urgent and may even use emergency rooms as a source of food. Whether expanding food services for the very poor would ameliorate this problem is uncertain, but it begs further study.” Baggett is an instructor in Medicine at Harvard Medical School.

 

For suggestions on how to get a free or low cost copy of this article, click here.

 

 

Healthy People 2020 sets health promotion, disease prevention agenda for the nation

From the Healthy People about page

Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:

• Encourage collaborations across sectors.
• Guide individuals toward making informed health decisions.
• Measure the impact of prevention activities.

Healthy People 2020 strives to:

• Identify nationwide health improvement priorities.
• Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress.
• Provide measurable objectives and goals that are applicable at the national, State, and local levels.
• Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge.
• Identify critical research, evaluation, and data collection needs.

The 40+  2020 topics and objectives include

• Adolescent health
• Diabetes
• Educational and Community-based Health
• Environmental Health
• Food Safety
• Heart Disease and Stroke
• Lesbian, Gay, Bisexual, and Transgender Health
• Medical Product Safety
• Occupational Safety and Health
• Public Health Infrastructure
• Social Determinants of Health
• Vision

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.