December 2008
Monthly Health News
President-elect Obama nominates Tom Daschle to serve as the new Health and Human Secretary
President-elect Barack Obama has nominated former Senator Tom Daschle (D-S.D.) to be the next Secretary of Health and Human Services. Both sides of the aisle praise the selection, citing his Senate experience and his reputation for listening to all sides and building coalitions to find solutions to difficult problems. Daschle, an adviser to the law firm of Alston and Bird in Washington, has also been appointed to lead a healthcare policy working group by the Obama-Biden presidential transition team. Daschle is considered to be well versed in healthcare issues. In 2008 he published the book “Critical: What We Can Do about the Healthcare Crisis.” In addition he has published several healthcare related articles.
11/19/2008 Healthcare IT News
HCITNewsDaschle
The Joint Commission releases guiding principles for the “hospital of the future”
Recognizing the continued importance of hospital-based care, the Joint Commission has released a white paper, “Healthcare at the Crossroads: Guiding Principles for the Development of the Hospital of the Future.” In its white paper, the Joint Commission used the recommendations of an expert panel to chart steps hospitals should take in the areas of economic vitality, technology adoption, patient-centered care, staffing, and design to better meet the needs of patients amid the unfolding challenges of older and more acutely ill patients, changing reimbursement models, and a declining workforce.
11/20/2008 The Joint Commission
TheJointCommissionFutureHospital
Mayo Clinic breaks the 90 minute door-to-balloon time barrier
When a patient arrives at the hospital emergency department (ED) with chest pain, the clock starts ticking. An electrocardiogram (ECG) is done. If the patient’s ECG shows elevation of the ST wave and the patient is considered to be experiencing an ST-elevation myocardial infarction (STEMI)—also known as a heart attack—the time spent getting the patient to the cardiac catheterization lab for a primary percutaneous coronary intervention (PCI) balloon angioplasty is critical.
In 2004 the Mayo Clinic had a mean time of 97 minutes for getting a STEMI patient to his or her PCI balloon angioplasty. After implementing a STEMI protocol the mean time dropped to 69 minutes. From the time of arrival at the ED to when a patient receives his or her ECG is less than 10 minutes. The total time in the ED is less than 45 minutes. The remainder of the time is preparing the patient and initiating the procedure. The American Hospital Association and the American College of Cardiology guidelines recommend a door-to-balloon time of 90 minutes. 10/28/2008
Source: Nestler DM, Haro LH, Stead LG, et al. Achieving door-to-balloon times of 90 minutes or less for ST-elevation myocardial infarction. American College of Emergency Physicians Scientific Assembly 2008; October 28, 2008. Chicago IL. Abstract 298.
http://www.theheart.org/article/print.do?primaryKey=915223
The Agency for Healthcare Research and Quality designates 10 patient-safety organizations
The Agency for Healthcare Research and Quality (AHRQ) designated its first 10 patient-safety organizations (PSOs). The 10 designees will collect and report information about medical errors. The companies and associations that will operate the PSOs are:
- California Hospital Association & California Association of Hospitals and Health Systems
- ECRI Institute
- Florida Patient Safety Corp.
- Quality Health Strategies
- Human Performance Technology Group
- Institute for Safe Medication Practices
- Missouri Center for Patient Safety
- Peminic
- Harbor Medical, and
- University HealthSystem Consortium.
The final rule that determines how the PSOs will collect and share patient safety data is expected by the end of December this year. That rule will be the implementation of the Patient Safety and Quality Improvement Act of 2005, through which the federal government hopes to create a network of PSOs that will analyze patient-safety incidents and establish best practices and other quality improvements.
11/4/2008 Modern Healthcare
ModHCPSO (subscription may be required)
American Medical Informatics Association releases electronic health record competencies for healthcare workers
The American Medical Informatics Association (AMIA) in conjunction with the American Health Information Management Association (AHIMA) has created core competencies for all healthcare workers who use electronic health records (EHRs). The core competencies in the free tool include five domains: health information literacy, informatics skills, privacy and confidentiality, data technical security and basic computer literacy skills. The joint AMIA-AHIMA report breaks down knowledge and skill sets within each of the domains. The goal of the tool is to develop shared responsibility between information technology professionals and the workforce end users. 11/5/2008 AMIA
http://amia.vmtllc.com/files/shared/Workforce_2008.pdf
National Quality Forum adds a new standards toolkit, bringing the total to 500 standards
The National Quality Forum (NQF) recently added 10 new standards for hospital emergency department care, 17 perinatal-care measures, eight outpatient-imaging efficiency measures, and two hospital readmission measures to the group's national voluntary consensus standards program. The standards are intended to improve accountability, efficiency and appropriateness, and quality across the various areas of care. With the addition of the new standards, the NQF has about 500 standards.
10/31/2008 Modern Healthcare
ModHCNQFStandards (Subscription may be required)
Two stories are included under this topic – one is about nurse avatars and the other is about patient avatars used in medical education. Special thanks to Dr. Tim Bickmore for the following e-interview on nurse avatars conducted after the November American Medical Informatics Association conference.
Medical simulation takes new leaps with patient “avatars” virtually visiting medical students and nurse avatars providing discharge planning to hospital patients
At the American Medical Informatics Association (AMIA) conference, a Northeastern University and MIT researcher, Dr. Tim Bickmore, presented his findings of using interactive nurse avatars to provide discharge education in a research study at Boston Medical Center. (An avatar is a computer user's representation of person in the form of a three-dimensional model used in computer games or electronic simulation programs.)
Tim Bickmore and his team used nurse avatars to present the patient’s customized discharge education plan, which included information about the patient’s diagnosis as well as detailed information of the patient’s customized medication list. The 19 patients who participated in the pilot study were aged 25-75, with half classified as having inadequate health literacy. The nursing staff brought in a flat screen monitor, positioned it over the patient’s bedside table, started the program, and left the room. The time the patient spent with the nurse avatar for their discharge education was 40 minutes on average (ranging from 7 to 79 minutes). Each time the nurse avatar presented the customized discharge education information the patient needed to respond by using their finger to select a response via a screen with touch-screen options.
The results were amazing! The patients had no problems using the avatar, reported high levels of satisfaction, and felt the avatar helped them get ready to leave the hospital. In addition, a startling 74% of the patients preferred the nurse avatar to a real nurse! The reason they gave was that if they asked the nurse to repeat the information more than once because they did not understand it, they felt stupid. With the nurse avatar, they liked going back over the material as many times as necessary until they understood it. A clinical trial of the nurse avatar with 750 patients is now underway.
Beginning next fall, University of Central Florida College of Medicine students may get calls in the middle of the night from a "virtual patient” avatar. The avatars will also visit the medical students in virtual clinics. The computer-generated patient avatar speaks like a real person and complains of symptoms that will test the students on the clinical application of the education modules they have recently completed. Student responses to their virtual patients will be scored and graded according to predefined care algorithms. The avatars assigned to the medical students will interact with them over their 4 years of school. To make the avatars even more realistic, the avatars will also have family member avatars who will make additional demands on the medical students.
10/31/08 University of Central Florida Press release
UCFMedicalAvatars
“Biotic Man” physiologically-based pharmacokinetic software to speed new drug development
Using computational models to measure a drug’s response, physiologically-based pharmacokinetic (PBPK) software is expected to hasten the development of new drugs. The Department of Defense is funding a two-year Biotic Man project. Researchers are modifying PBPK to simulate the response of new antibiotics or antiviral medications to combat specific diseases and public health threats, including biological attacks.
11/20/2008 Health Data Management
HealthDataMgmtBioticMan
Web surfing is now being used as an early warning system to detect flu outbreaks
What happens when millions of people across the country use Google as their Internet search engine to inquire about flu symptoms? These actions have spawned a new early warning and detection system call Google Flu Trends. Tests of the new Web tool from the company’s philanthropic unit suggest that it may be able to detect regional outbreaks of the flu one week to 10 days before they are reported by the Centers for Disease Control and Prevention (CDC).
11/11/2008 New York Times (subscription may be required)
NYTGoogleFlu
High levels of nurse staffing are tied to higher patient satisfaction scores
In a study published in the New England Journal of Medicine, researchers at the Harvard School of Public Health found that patients who received care in hospitals with a high ratio of nurses to patient-days reported better experiences. They also found large regional variations in patients' experiences with their care, with Birmingham, Alabama, performing better than other regions and the New York City area lagging behind. Patients were satisfied when they received high-quality clinical care in the four conditions measured: acute myocardial infarction, congestive heart failure, pneumonia, and prevention of surgical complications. However, hospitals are failing when it comes to managing pain, communicating about medications, and coordinating discharges. The Commonwealth Fund sponsored the Harvard research study.
10/30/2008 N Engl J Med 359:1921, October 30, 2008
http://content.nejm.org/cgi/content/full/359/18/1921 (free, no subscription required)
When buying health insurance policies women pay up to almost 50% more for coverage
With politicians touting various health insurance plans, some of which propose tax credits or other assistance, women could find themselves in a tough spot. Women typically earn approximately 30% percent less than men, and with this tremendous disparity, women can pay hundreds of dollars more. Insurance industry spokespeople justify the higher costs because women take better care of themselves – seeing doctors more often – plus women of childbearing age may have babies.
For example, under Humana’s Portrait plan with a $2,500 deductible, a 30-year-old woman pays 31% more than a man of the same age in Denver or Chicago and 32% more in Tallahassee, FL. In Columbus, Ohio, a 30-year-old woman pays 49% more than a man of the same age for Anthem’s Blue Access Economy plan. The woman’s monthly premium is $92.87, while a man pays $62.30. At age 40, the gap is somewhat smaller, with Anthem charging women 38% more than men for that policy.
And it is not only private plans that cost more for women. Most state insurance pools for high-risk individuals, also use gender as a factor in setting rates. For example, in Dallas or Houston, women ages 25 to 29 pay 39% more than men of the same age when they buy coverage from the Texas Health Insurance Risk Pool. It is interesting to note that the Agency for Healthcare Research and Quality (AHRQ) has declared that men typically underutilize healthcare to the point of causing potential harm to their health. Considering this a critical problem, AHRQ has launched a campaign to educate men to take better care of themselves by visiting healthcare providers at a rate that closely approximates women’s use of primary care providers.
10/30/2008 New York Times
http://www.nytimes.com/2008/10/30/us/30insure.html
Chronically ill patients in the U.S. are more likely to go without needed healthcare than patients in some other nations
According to a new study from the Commonwealth Fund, chronically ill adults in the U.S. were at greater risk of foregoing care than patients from seven other countries. Adults in the U.S. opted to go without needed healthcare because of costs and because of the fear of experiencing inefficient, poorly organized care or errors. The 2008 Commonwealth Fund International Health Policy Survey interviewed 7,500 adults with chronic conditions who had recent healthcare experiences in eight countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. The study focused on access, coordination, safety, and care management experiences.
The countries participating in the survey represent a diverse mix of insurance designs and primary care systems. Among the eight countries, the U.S. stood out as having the most expensive system ($7,000 per capita compared to under $3,500 in the other countries as of 2006), for having gaps in coverage, and for high cost sharing in which most plans require out-of-pocket payment, even for patients with insurance. Forty-one percent of U.S. patients reported that they spent more than $1,000 out of pocket in the past year.
The other seven countries have systems with comprehensive minimum benefits and universal coverage. Canada, the Netherlands, and the United Kingdom have no cost sharing for primary care. France's insurance system protects patients with specific chronic illnesses from coinsurance. Germany limits cost sharing to 1% of income for the chronically ill and 2% for all households. One finding that pertains to all countries is a need for better care coordination.
11/13/2008 Heath Affairs 28, no. 1 (2009): w1-w16
HealthAffairsChronicCare (subscription required)
Personal health records could save $21 billion annually
According to a report from the Center for Information Technology Leadership (CITL), personal health records (PHR) could save payers and providers $21 billion annually. The CITL research provides a cost-benefit analysis of various infrastructure, administrative, and clinical PHR functions, such as sharing complete medication lists and test results between patients and care providers, appointment scheduling, medication renewals, patient completion of pre-encounter questionnaires, electronic physician visits, congestive heart failure remote monitoring, and smoking cessation management. The projected cost of obtaining interoperable PHRs for 80% of Americans is $3.7 billion, while annual maintenance is estimated to be $1.9 billion. A positive return on investment for a single implementation of an interoperable PHR is estimated to require 52,000 users.
11/13/2008 Center for Information Technology Leadership
http://www.citl.org/research/PHR.asp
The American Health Information Community advisory panel calls it quits
The American Health Information Community, which was Health and Human Services (HHS) Secretary Mike Leavitt’s health information advisory panel, held its last meeting in November. Founded in 2005, the group had the goal of promoting the use of health information technologies. At the last meeting, two researchers presented their healthcare information (IT) adoption research of a survey of 3,037 acute care hospitals conducted between February and September 2008. The survey revealed that only 1.7% of hospitals surveyed had fully implemented across all units of their hospitals a “comprehensive” electronic health record (EHR). Despite this dismal adoption results, the researchers were optimistic since most hospitals were at least on the IT path.
The survey found relatively high full-implementation rates for one or two EHR functions, such as patient demographics at 78%, radiology reports at 77%, and laboratory reports at 76%. Full implementation rates for individual computer-based provider order entry (CPOE) functions were relatively low, with laboratory test ordering at 22% of hospitals surveyed and medication orders at 18%.
The successor to the AHIC is a private corporation that aims to take over some of the functions of its government predecessor.
11/13/2008 Modern Healthcare
ModHCAHIC (subscription may be required.)
Primary care provider shortages in Massachusetts cause recognition of nurse practitioners as full fledged primary care providers
When Massachusetts became the first state in the nation to ensure healthcare insurance coverage for all its citizens, the state faced a crisis in providing primary care providers. Recent legislation changed this. For the first time, all health insurers in Massachusetts are required by law to recognize nurse practitioners as primary care providers, allowing consumers to choose nurse practitioners to coordinate and direct their care. The Massachusetts Medical Society recently reported that more than half of all patients presenting to a primary care practice, and who see a nurse practitioner, make a deliberate choice to do so. Massachusetts joins 24 other states that recognize nurse practitioners as primary care providers.
11/10/2008 Massachusetts Coalition of Nurse Practitioners press release
MCNPpress release
Thanks to Anita Flora for passing this along.
A simple blood test can predict those at risk for heart disease and stroke
A simple $20 blood test that detects inflammation by measuring a substance in the blood called C-reactive protein (CRP) could identify individuals who are at risk for heart disease or stroke. A recent study touted the use of statin medications to drive down the level of CRP. In the study of nearly 18,000 volunteers in 26 countries, researchers found that a cholesterol-lowering statin medication dropped the risk of those flagged by the test by about half -- even if their cholesterol was normal. The study results showed that the control group, versus those that took a placebo, were 54% less likely to have a heart attack and 48% less likely to have a stroke.
Using the results of the study close to 7 million people nationwide would qualify for treatment at a cost of about $116 a month (or $9.7 billion a year), adding nearly $10 billion a year to the nation's medical bill. However, there are far less expensive and potentially more effective alternatives to statins. In his book, The Cholesterol Conspiracy (2nd edition 2007), Ladd McNamara, MD, recommends an alternative to statins, saying that vitamins, minerals, antioxidants, and omega-3 essential fatty acids have all been shown to decrease CRP, homocysteine, and lipid peroxides levels, and in some cases restore endothelial function -- without any toxic side effects associated with statin medications.
11/09/22008 The Denver Post
http://www.usatoday.com/news/health/2008-11-10-crestor-cost_N.htm and
11/10/2008 USA Today http://www.usatoday.com/news/health/2008-11-10-crestor-cost_N.htm
New strain of drug resistant bacteria, Acinetobacter baumannii, becomes more prevalent
A gram negative bacteria, Acinetobacter baumannii (A. baumannii), is becoming more prevalent and may account for up to 30% of drug-resistant hospital-acquired (nosocomial) infections. Although the bacteria, which is found in soil and water, offers little risk to healthy individuals it can be hazardous to those with compromised immune systems. Indeed, when associated with a blood stream infection, the mortality rate of A. baumannii is 34%, which is second only to the mortality rate of Pseudomonas aeruginos at 43%.
The antibiotic class of Polymyxins appears to have the best treatment success. However, the best strategy to avoid this bacterial infection is prevention. Since the bacteria can live on the surface of equipment for up to six months, the authors recommend strict infection control methods including strict environmental cleaning, effective sterilization of reusable medical equipment, attention to proper hand hygiene practices, and use of contact precautions.
11/19/2008 The Lancet Infectious Diseases, Vol. 8, Issue 12, Pages 751 - 762, December 2008
LancetA.baumannii (subscription required)
Thanks to Christine Bottagaro for passing this one along.
Napping – it does the body good!
Cognitive neuroscientists are shifting away from an emphasis on sleep duration to placing more importance on the quality of sleep. It is called sleep intensity. Researchers are studying how sleep helps the brain process memories, such that knowledge is retained. Of special importance is "slow-wave sleep," which is a period of very deep sleep that comes earlier in the sleep cycle than the better-known REM sleep, or dreaming time.
Dr. William Fishbein, a cognitive neuroscientist at the City University of New York, decided to test the value of naps. He and his associate taught 20 English-speaking college students a series of Chinese words spelled with two characters, such as sister, mother, maid, and so forth. Half of the students were hooked up to monitors and allowed to take a 90-minute nap. After the nap, the nappers had better retention and recall than their non-napping peers. The researchers contend that even a 12-minute nap can boost memory.
11/24/2008 PhysOrg.com
http://www.physorg.com/news146761238.html
Also from Christine, another great article.
“Nocebo” – the term for feeling that you are experiencing ill effects of medication after reading the label
You are a good consumer. You know you need to understand what medications you are taking, why you are taking them, when and how to take them, and the effect they are intended to have. But, have you ever read the label listing all the potential side effects you may experience, such as headaches, difficulty concentrating, fatigue, nausea, diarrhea, dry skin, irritability, and suddenly realized that you have one or more of the symptoms?
If so, you are not alone. The technical term is the nocebo effect. That is, it is the opposite of the placebo effect. One women in a controlled study for breast cancer who was being treated with a chemotherapy placebo, which contained no medication, lost her hair because she considered it to be a side effect. For others, the nocebo effect can be fatal. In one classic example, women enrolled in the multi-decade Framingham Heart Study who thought they were at risk for heart attacks were 3.7 times as likely to die of coronary conditions as women who didn't have such fears -- regardless of whether they smoked or had other risk factors.
Nocebo research has been limited. However, in a test that occurred in the 1960s hospital patients who were given harmless sugar water and were told it would make them vomit found that 80% of them did. According to Richard Kradin, a physician and psychoanalyst at Massachusetts General Hospital in Boston, and author of "The Placebo Response and the Power of Unconscious Healing," estimates that about 25% of patients who get completely inert placebos in clinical trials complain of side effects—typically headaches, drowsiness, and dizziness. One possible explanation researchers give for the nocebo phenomenon is that an individual may be experiencing stress. Symptoms such as rapid heartbeat, dry mouth, nausea, and diarrhea are often associated with stress. Worries over one’s health can cause stress.
11/18/2008
WSJNocebo (subscription may be required)
Vilification of high-fructose corn syrup by health-conscious consumers sparks high-profile ad campaign
As a response to consumers who are reading ingredient labels and bypassing products made with high fructose corn syrup, the Corn Refiners Association has panicked and has launched a media blitz claiming that it is perfectly safe. The ad campaign insists that high-fructose corn syrup is just like honey, which is made by enzymes in a bee's abdomen -- as opposed to the enzymes and acids in centrifuges, ion exchange columns, and liquid chromatographers used to make high-fructose corn syrup. According to Christopher Wanjek, a columnist for LiveScience, “High-fructose corn syrup could be all-natural, if cornstarch happened to fall into a vat of alpha-amylase, soak there for a while, then trickle into another vat of glucoamylase, get strained to remove the Aspergillus fungus likely growing on top, and then find its way into some industrial-grade D-xylose isomerase.”
The best advice to confused consumers comes from the American Medical Association, which recommends that consumers limit the amount of any type of added caloric sweeteners (both table sugar and high-fructose corn syrup) to no more than 32 grams per day. This is good advice, although it means limiting the overall consumption of sweets. Indeed, with the average carbonated beverage having about 40 grams of high-fructose corn syrup, one soda would put a person over the sweet limit for the day. Artificial sweeteners should be avoided (for instance, aspartame causes neurologically-related effects and sorbitol causes abdominal bloating, abdominal pain, diarrhea, and irritable bowel syndrome).
10/21/2008 LiveScience
Live Science High Fructose Corn Syrup
