Baptist Health has become the first stand-alone health-care provider to sign on as a founding partner in Shaping Our Appalachian Region, an initiative to improve the economy of Eastern Kentucky.
Baptist will work with SOAR to develop and implement health and education initiatives for residents of Appalachian Kentucky and has committed $150,000 to the initiative over the next three years, the organizations said in a press release.
�Baptist Health understands Eastern Kentucky because we have a proven and time-honored commitment to the health and well-being of our people,� Stephen C. Hanson, chief executive officer of Baptist Health, said in the press release. �Our participation in SOAR reflects this pledge. Besides Richmond, we�ve also got hospitals in Corbin and Lexington, along with outpatient facilities, doctors� offices and other services all over Eastern Kentucky, the rest of the commonwealth and indeed throughout the region."
The University of Kentucky was the first founding sponsor of SOAR, pledging $300,000 over the next three years and winning the right to use the UK HealthCare brand on SOAR materials as well as the university's general logo.
Gov. Steve Beshear and Congressman Hal Rogers formed SOAR in the fall of 2013 to create strategic plans to improve Eastern Kentucky's economy and quality of life.
�Our primary objective is creating and maintaining jobs across eastern Kentucky, and in order to do that, we need a healthy and well-educated workforce,� Beshear said in the release. �I�m pleased that Baptist Health understands the key connections among our efforts and the critical role that health will play in the future of this region."
Each year, more than 120 million prescriptions are written around the world for thiazide drugs, which lower salt to treat high blood pressure. High blood pressure affects 28 percent of Kentucky adults, according to the state Department for Public Health. Thiazide drugs often save lives but are ineffective in some patients and only work for a time in others. A study by University of Maryland School of Medicine researchers has found a key reason for the failure.
Thiazides prevent salt from moving through the kidney, causing it to expel salt and water. However, the researchers found that the kidney seems to know "that it's losing too much salt and activates mechanisms to retain salt in other ways," said Paul Welling, a professor of physiology at the University of Maryland.
The researchers studied an animal model designed to prevent salt retention, which imitated the thiazides' effects. They discovered almost 400 genes that alter their activity to assist regulation of the kidney's salt control. Eventually, it might be possible to make drugs that affect the body's mechanisms that control how the body interacts with thiazides.
Welling and his colleagues also may have discovered a "biomarker" that could allow doctors to easily find out in which patients thiazides will not work. When the kidney is working against the thiazides, a certain molecule increases in the urine. "Now that we know more about these novel pathways and processes, we can begin to find new ways to help patients with high blood pressure," said Dean E. Albert Reece, vice president for medical affairs at the University of Maryland.
A study at Duke University suggests that repeated exposure to alcohol during adolescence causes long-lasting changes in the part of the brain that controls learning and memory. The study, published in the journal Alcoholism: Clinical & Experimental Research, helped explain how exposure to alcohol before the brain has fully developed can cause cellular and synaptic abnormalities and negatively affect behavior. Kentucky is ranked 9th in the nation for the percentage of children who drank alcohol before age 13 (25.1 percent), according to the state Department for Public Health.
"In the eyes of the law, once people reach the age of 18, they are considered adult, but the brain continues to mature and refine all the way into the mid-20s," said lead author Mary-Louise Risher, a post-doctoral researcher in Duke's Department of Psychiatry and Behavioral Sciences. "It's important for young people to know that when they drink heavily during this period of development, there could be changes occurring that have a lasting impact on memory and other cognitive functions.
Studies had shown that animals exposed to alcohol at an early age do not perform as well in memory tasks as those not exposed to it. The new study, which involved exposing young rodents to alcohol and waiting for them to grow into adulthood, found that the exposure also affects the hippocampus, the area of the brain that controls memory and learning. The researchers measured a cellular mechanism called long-term potentiation, which involves the strengthening of brain synapses being used to learn new tasks or bring up memories. Ideally, LTP should be high, especially in young people. The researchers found that the adult rodents exposed to the alcohol during adolescence had higher levels of LTP, which may seem to be a positive outcome but is actually not.
"If you produce too much LTP in one of these circuits, there is a period of time where you can't produce any more," said senior author Scott Swartzwelder, a Duke professor. "The circuit is saturated, and the animal stops learning. For learning to be efficient, your brain needs a delicate balance of excitation and inhibition�too much in either direction, and the circuits do not work optimally."
The researchers also observed a structural change in individual nerve cells: those exposed to alcohol at a young age have brain cells that appear immature, even in adulthood. "It's quite possible that alcohol disrupts the maturation process, which can affect these cognitive functions later on," Risher said. She also noted that the immature appearance of the cells might be associated with behavioral immaturity.
There is little remaining doubt in the scientific/medical community that high levels of LDL, so-called "bad cholesterol", cause heart disease. Yet in some alternative health circles, the debate continues. A new study adds substantially to the evidence that LDL plays a causal role in heart disease.
Pollyanna statements about healthcare IT such as the following are still appearing, and are growing increasingly tiresome. They are, at best, demonstrations of people with a fiduciary duty to have known better making fools of themselves.
... Before ARRA, most surveys concluded that cost was the No. 1 barrier to EHR adoption. But as soon as it appeared that the cost barrier might finally be overcome, individuals with a deeper-seated "anti-EHR" bent emerged. Their numbers are small, but their shocking claims -- that EHRs kill people, that massive privacy violations are taking place, that shady conspiracies are operating --make stimulating copy for the media. Those experienced with EHRs might laugh these stories off, but risk-averse newcomers to health IT, both health care providers and policymakers are easily affected by fear mongering.(Mark Leavitt, former head CCHIT, http://www.ihealthbeat.org/perspectives/2009/health-it-under-arra-its-not-the-money-its-the-message.aspx)
"Wedon't think there's a great deal of data to substantiate that there are major safety problems with the majority of electronic health records systems in use today," said Charlie Jarvis, executive committee vice chair of the EHR Assn., a trade group that represents 46 organizations that supply most of the EMR systems implemented in medical practices. "These products are safe, dependable, time-tested and display a lot of the safety features we think are necessary to prevent problems going forward." (Charles Jarvis, erstwhile NextGen VP and holder of prestigious (and mysterious) "American Medical Informatics Certification for Health Information Technology", http://hcrenewal.blogspot.com/2011/11/two-opposing-views-of-ehr-1.html)
The most recent example highlighted on this blog is:
As Minnesota�s health commissioner, I work to improve the health of all Minnesotans. As a physician, I�m dedicated to providing the best care possible to patients. Secure electronic health records help achieve both goals by enhancing the safety, effectiveness, and efficiency of our health care system. With that in mind, I have been concerned to see some recent pushback on Minnesota�s requirement that all health care providers use electronic health records (EHR) by 2015 ... All Minnesota patients, whether they visit a small clinic, need mental health treatment, or receive care from multiple providers, stand to benefit from EHRs and the improved care coordination they make possible. (Minnesota's Heath Commissioner Dr. Edward Ehlinger, http://www.minnpost.com/community-voices/2015/04/electronic-health-records-advance-quality-care-all-minnesotans.)
Here is the tragic reality.
Recommended for reading, and for feeding to the press and to our elected officials:
The most dangerous of these biases is the "subjunctivisation bias". It results in clinical disruption, mishaps, injury and death:
Subjunctivisation bias: Much of the policy rhetoric on new technologies rests not on what they have been shown to achieve in practicebut on optimistic guesses about what they would, could, or may achieveif their ongoing development goes as planned; if the technologies are implemented as intended; and in the absence of technical, regulatory or operational barriers.4 This is what Dourish and Bell call the �proximate future�: a time, just around the corner, of �calm computing� when all technologies will be plug-and-play and glitch-free.
171 IT mishaps sufficient to cause harm reported voluntarily by 36 hospitals in 9 weeks; 8 injuries; mishaps likely contributed to 3 deaths as well. Projected to a nationwide annual figure, the result is likely many thousands of times greater (see http://hcrenewal.blogspot.com/2013/02/peering-underneath-icebergs-water-level.html).
This letter speaks for itself on exceptionally well-justified clinician dissatisfaction and alarm at the risks and disruptions posed by this technology in its current form and with present roles (e.g., the experimental use of clinicians as cheap data entry clerks).
Late, but better than never. Most of what's in this alert has appeared on this blog since 2004. Footnote 1 (ECRI Institute PSO Deep Dive, the report linked above) is somewhat bizarrely used as a justification of the statement "EHRs have demonstrated the ability to reduce adverse events." I do also note at the linked http://www.jointcommission.org/safe_health_it.aspx these statements:
Poorly designed or implemented health IT can contribute to patient harm
Health IT-related patient safety events can go undetected
As health IT adoption becomes more widespread, the potential for health IT-related patient harm may increase
These could have come directly from my writings dating back over a decade here. (Perhaps they did.)
FOIA response: "We do not have any information that supports or refutes claims that a broader adoption of EHRs can save lives." (But let us spend hundreds of billions of dollars and put patients at risk to find out...)
CMS: "we do not have any information that supports or refutes claims that a broader adoption of EHRs can save lives. [Click to enlarge.]
In conclusion:
Next time you encounter pollyanna/head-in-the-sand statements about health IT that ignore the risks, throw this primer the way of the authors and audience of such statements.
Consumers now have access to a website that ranks 3,500 hospitals around the country on patients' experiences to help them choose a hospital and better understand the quality of care participating hospitals offer, according to a Centers for Medicare and Medicaid Services press release.
The 12 star ratings on Hospital Compare are based on 11 of the publicly reported measures from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey, and a summary rating for the survey. The survey asks patients questions about nine topics:communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment, and transition of care. This survey information is self-reported by patients and will be updated quarterly.
�The patient experience star ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality,� Dr. Patrick Conway, acting principal deputy administrator for the CMS, said in the release.
Consumers already have access to Medicare star systems to rate nursing homes, dialysis centers, private Medicare Advantage insurance plans and certain situations for physicians and group practices, but are they using it?
Not much, according to a recent Kaiser Family Foundation poll. It found that only 31 percent of those polled had seen any information comparing doctors, hospitals, and health insurance plans in the past 12 months. When asked specifically if they had seen information comparing prices or quality across plans and providers, fewer than 1 in 5 people said they had seen such information, and fewer than one in 10 reported using such information.
CMS said the website helps meet goals of the Patient Protection and Affordable Care Act, which calls for transparent, easily understood and widely available public reporting. The agency also reminds consumers that the site is just one tool to help them make a decision abut which hospital to use, and encourages them to talk to their health-care providers about hospital quality, and to use "multiple factors" when deciding about a hospital, such as clinical outcomes and other publicly reported data that is on the website.
In Kentucky, strokes cause about 5 percent of deaths, and the state had the 11th highest stroke mortality rate in 2009, according to data from the Kentucky Cabinet for Health and Family Services. Fewer than 40 percent of severe stroke victims regain functional independence if they get only the standard drug intervention, but a study has found that also removing the clot both helps restore blood flow to the brain and can lead to more favorable long term outcomes.
"The outcomes are the difference between patients being able to care for themselves after stroke and being dependent," said Demetrius Lopes, surgical director of the comprehensive stroke center at Rush University Medical Center.
The traditional treatment for ischemic stroke�a stroke that involves clots in vessels bringing blood to the brain�is intravenous tissue plasminogen activator (tPA), a medication to dissolve the clot. However, doctors can also perform thrombectomy, a minimally invasive procedure to remove the clot that is allowed only in clinical trials.
In the study, patients with severe ischemic strokes were split into two groups. One group received only tPA, while the other group received tPA as well as thrombectomy. After 90 days, those who received both treatments had less disability and had a functional independence rate of 60 percent, compared to 35.5 percent of those who received only tPA. Also, patients who received thrombectomy had better blood flow rates in the brain.
"Ethically, we can't deny patients a treatment when we have such strong evidence it's better for them," Lopes said. Now thrombectomy is a standard treatment for severe strokes at Rush and some other locations. The study is published in the online edition of the New England Journalof Medicine.
After a great experience at the ENDURrace 5K, we were back a week later to enjoy the second race in this 2-race series. Here's how we did at the ENDURrace 8K:
At the front of the race, Dave and Aaron had an outstanding battle for 3rd place. Dave ended up taking it, just seconds off his PB, running 29:46. This was good enough for 3rd OA and 1st in his AG.
Aaron was very close behind with a PB (and all-time fastest race) of 29:53. This brought him in 4th OA and 1st in his AG.
Holger came in next for the team. Less than one week removed from Boston, he still managed a new 8K PB of 32:12, good enough to crack the top 10 and place 2nd in his AG.
Derek Hergott was in next with an outstanding 36:14, placing just inside the top 25, and 4th in his AG.
Paul showed that his fitness continues to improve. Coming off a great TYS10K, he ran an excellent 36:53.
Kyle MacKenzie, the youngest H+P-er out there, was in next for the team with an outstanding result of 38:47. He won his AG, and he also won the parent/child division with his dad!
Jessica came in next with an outstanding time of 41:13.
Cari Rastas Howard was in next for the team with an outstanding 42:10 personal best.
Tracey had a very strong 4th place AG finish with a time of 42:45.
Thanks again for another great event RunWaterloo! And thanks to Julie for all the great photography.
Holger came in first for the team with a very solid 3:09:09. He later celebrated by putting on his medal, letting loose and partying, as shown below:
Jordan was in next for the team with a time of 3:09:49. An ultimate frisbee injury severely reduced his mileage during the key training blocks leading into this race, but he still was able to cross train his way to a very respectable time. Congrats!
Jess was in next with a PB of 3:15:48!
Right after Jess was our masters female All-Star, Val Hobson. She had a very strong finish of 3:16:49, good enough for 25th place in her AG that included just under 1900 women who qualified!
Andrea was in next for the team. Battling through some injury adversity in the final weeks leading up to the race, she still ran an outstanding time of 3:19:17.
Our Manulife Crew (Jeff Collins, Erica Hall and Laura Hewitson) all had strong races and great finishes in their first marathons. Jeff ran a very solid 4:16, Erica came in at 4:25 and Laura finished in 4:47.
There are still some idealistic physicians who enter primary care practice as a calling.
The usual informal definition of primary care is care which is continuous, coordinated, comprehensive and compassionate. The official definition used by the American Academy of Family Physicians (AAFP) is:
Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (the 'undifferentiated' patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis.
Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (e.g., office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and managed by a personal physician often collaborating with other health professionals, and utilizing consultation or referral as appropriate.Primary care provides patient advocacy in the health care system to accomplish cost-effective care by coordination of health care services. Primary care promotes effective communication with patients and encourages the role of the patient as a partner in health care.
Private Equity Firms are Buying Out Primary Care Practices
However, an article this week in Modern Healthcare described how primary care in the US is getting a rude surprise. Apparently, primary care practices are now "in play," (using the terminology for the classic 1987 movie Wall Street, in which Gordon Gekko declared that greed is good).
The argument was that there is
a small but growing number of investments that private-equity firms are making in primary-care physician practices that are ahead of the curve in offering new care delivery and payment models. Investors see an opportunity in being early participants in value-based care, even as the business case is still unclear given mixed results in Medicare's payment and delivery reform demonstrations so far.
But the niche is well-suited for private-equity firms, which feed on uncertainty, said Todd Spaanstra, a partner at Crowe Horwath, an accounting and consulting firm.
This is not about quality of care, it is about the idea that business people think that "value-based care" and "risk-based contracting" are the current rages, and so there is money to be made investing in entities that seem to fit in with these fashions.
said Slava Girzhel, managing director at KeyBanc Capital Markets. 'There's a lot of discussion about private-equity investing in risk-based models, and I do think we'll see more of that.'
Continuous, coordinated, comprehensive and compassionate care may suffer when the time horizons are not that long, and the owners of the practice are ultimately looking to sell it.
The long-term opportunity for private-equity firms is the ability to sell these managed-care-savvy medical groups to insurers or health systems, which may pay a premium for the care-coordination expertise and data analytics these practices offer.
Also,
The typical private-equity investment timetable is short�about five years. At that point, the firm would probably look to sell the practice, ideally to an insurance company or a health system, said Dan Hosler, a principal at private-equity firm Sterling Partners.
Furthermore, why private equity may be interested in primary care now, continuing interest will depend on the numbers, not on the benefits to patients
'This is an area where there are winners and losers,' said Dr. Andrei Gonzales, director for value-based reimbursement initiatives at McKesson Health Solutions. 'It's everyone trying to get a slice of the pie that's getting smaller.'
What Happens When the Barbarians are at the Gate
Conspicuously absent from this article was discussion of aspects of the private equity modus operandi which are even more at odds with primary care values than the short time horizon noted above. We previously warned about the perils of private equity employing physicians (look here.) The main points were:
- Private equity is just the new name for leveraged buyout firms (the type of firm described the book, Barbarians at the Gate.)
- Therefore, when they buy out firms (e.g., the primary care practices discussed above), they use borrowed money.
- But they leverage in two senses. Once firms are bought, the private equity owners makes the firms take out further loans, and the money from them may go back to the owners, usually in the form of a special dividend, to pay down the debt originally incurred by the private equity owners. This leaves the bought out firms heavily in debt, but frees the private equity firm from its original debt. If the firm is eventually sold, the new buyers take over the debt. In a worst case scenario, however, the bought out firm goes bankrupt, the private equity's firm stock in it becomes worthless, but the private equity firm need not be responsible for its financial obligations.
- If the private equity firm desires more money while it still owns the acquired firm, it may sell parts of it off.
- To make the finances of the acquired firm look more attractive to the next buyer, the private equity firms often undertakes short term cost cutting measures that may involve layoffs, increased workload on remaining workers, etc.
Other dark aspects of private equity are discussed on the Naked Capitalism blog here.
Summary
Primary care physicians thinking about selling their practices to private equity ought to think at least twice before doing so, assuming the physicians are serious about upholding the values of primary care. Private equity firms are in it for the money, and in the relatively short term. Private equity firms are unlikely to care about the mission of primary distinct from the ability of primary care practices to make the firms richer. Therefore, practices owned by private equity may well not provide the best possible care for their patients. In any case, the physicians working for such practices may be answering to owners who are very explicitly only in it for the money. They will have become corporate physicians, possibly in the most pessimistic sense of the term.
In general, Dr Arnold Relman reminded us that physicians used to shun the commercial practice of medicine (look here). Physicians and other health professionals who sign on as full-time employees of large corporate entities have to realize that they are now beholden to managers and executives who may be hostile to their professional values, and who are subject to perverse incentives that support such hostility, including the potential for huge executive compensation. It is not clear why physicians seem to be willing to sign contracts that underline their new subservience to their corporate overlords, and likely trap them within confidentiality clauses that make blowing the whistle likely to lead to extreme unpleasantness.
Things are likely to be even worse for corporate physicians who are employed by firms owned by private equity. Because of the way private equity operates, primary care practices owned by such firms are liable to be very unstable. At best, they are liable to be sold to totally new owners in a relatively short time frame, and those owners are likely to be those who will pay the highest price, not necessarily those who will provide the best stewardship for the practices.
Furthermore, primary care practices owned by private equity are likely to end up heavily indebted and subject to strict cost cutting measures that may decrease care quality, decrease access, increase patients' out of pocket costs, and demoralize providers. Practices acquired by private equity may be broken up and sold as separate pieces. Should the debt be too high, and the cost cutting not be sufficient, such practices could end up bankrupt and possible completely defunct.
Do not say I did not warn you.
Physicians need to realize that to fulfill their oaths to put patients first, they have to reduce the influence of rich and powerful organizations with other agendas, like health care corporations, and especially corporations owned by private equity. The metastasis of private equity into primary care should make us all rethink the notion that direct health care should ever be provided, or that medicine ought to be practiced by for-profit corporations. I submit that we will not be able to have good quality, accessible health care at an affordable price until we restore physicians as independent, ethical health care professionals, and until we restore small, independent, community responsible, non-profit hospitals as the locus for inpatient care.
UPDATE, May 20: The council passed the ban with one member opposing it. Gary Mills said, �I don�t think it�s the government�s right to intrude on businesses owned by individuals. If the public doesn�t like it, they won�t come. . . . This is too intrusive by the government.� Two non-smoking business owners expressed similar sentiments.
The Middlesboro City Council has approved on first reading an ordinance that would ban smoking in public, enclosed spaces. "It remains unclear if the ban would apply to the use of e-cigarettes and vaping products," William Tribell reports for the Middlesboro Daily News.
The ordinance was prompted in part by a March presentation and petition from a group of Middlesboro Elementary School students involved in Destination Imagination, "a volunteer-led, educational nonprofit organization whose purpose is to inspire and equip students to become the next generation of leaders," Tribell writes. "The team was awarded the DaVinci Award for Outstanding Creativity for their efforts and will now compete at the world competition May 20 in Knoxville."
The students drafted the ordinance after researching those in other cities, Tribell reports: "In their presentation to the city council, the team said that 33 percent of Bell County�s population smoke, and they discussed the health effects it has on the community at large."
"The council voted unanimously in favor of the ban ordinance, and it will go up for a second-reading vote at their meeting on May 19," Tribell reports.
It constains all the usual baloney (being kind here) about this technology:
It starts with this:
As Minnesota�s health commissioner, I work to improve the health of all Minnesotans. As a physician, I�m dedicated to providing the best care possible to patients. Secure electronic health records help achieve both goals by enhancing the safety, effectiveness, and efficiency of our health care system. With that in mind, I have been concerned to see some recent pushback on Minnesota�s requirement that all health care providers use electronic health records (EHR) by 2015 ... All Minnesota patients, whether they visit a small clinic, need mental health treatment, or receive care from multiple providers, stand to benefit from EHRs and the improved care coordination they make possible.
"Pushback", he writes?
The implication seems clear - 'fear mongering' by Luddite clinicians is responsible. See my March 2012 post "Doctors and EHRs: Reframing the 'Modernists v. Luddites' Canard to The Accurate 'Ardent Technophiles vs. Pragmatists' Reality" at http://hcrenewal.blogspot.com/2012/03/doctors-and-ehrs-reframing-modernists-v.html on that antediluvian, tired old issue.
Note also the terminology "stand to benefit" - a typical weasel phrase just in case things don't work out as intended.
Not mentioned are the harms.
Rather than plow through yet another puff piece by someone either misinformed or just way behind the current medical literature on this experimental technology, I provide the letter I wrote to Dr. Ehlinger and several other Minnesota cabinet members, including Commissioner Kevin Lindsey of the Dept. of Human Rights, Commissioner Lucinda Jesson of the Dept. of Human Services, and Chair Adam Duininck, Chair of the Metropolitan Council:
I don't mean to sound insulting, but it is earned on your part. My mother is deceased in 2011 as a result of an EHR error.
When did you plan on informing the citizens of your state about the risks of bad health IT?
Not giving your citizens opportunity for informed consent regarding the use of these medical devices in their care seems a violation of human rights. The most impacted are the disadvantaged, who go to organizations with lesser budgets to make the IT work safely, I add.
Consultant/Independent Expert Witness in Healthcare Informatics (May 2010-present)
Adjunct faculty in Healthcare Informatics and IT (Sept. 2007-present) Assistant Professor of Healthcare Informatics and IT, and Director, Institute for Healthcare Informatics (2005-7) Drexel University College of Computing and Informatics (formerly College of Information Science and Technology) 3141 Chestnut St., Philadelphia, PA 19104-2875
An entrepreneurial physician in Southern Kentucky has developed a way to deliver school health services that could have a broader impact on communities.
Cumberland Family Medical, based in Burkesville, has clinics at the five schools in Russell County and now has a deal to do likewise with the four in adjoining Adair County.
Dr. Eric Loy, who owns the clinic, "said that the agreement could have an important impact on the community both short term, by helping create a healthier and more focused student body; and long term, by creating a culture where people get acclimated to seeing doctors and nurses for physicals and regular checkups on a consistent basis," Wes Feese reports for The Adair Progress.
�We have a chance to change the culture of health care in Kentucky,� Loy told the Adair County Board of Education, which voted to spend $80,000 next year on the clinics. That is "roughly the same cost the district currently pays for school nurses," Feese reports. "If the trial run next year is successful, both parties will have options to continue the agreement."
"Cumberland Family Medical will pay two-thirds of the nurse expense and will bill the insurance of the patient," Toni Humphress reports for the Adair County Community Voice.
School Supt. Alan Reed complimented the dedication and service of the county�s school nurses but said costs to employ them were �soaring,� Feese reports. Reed said of Loy's plan, �This is kind of a novel approach, and from all we�ve seen, we really like it. It cuts down on time and any barriers for a kid getting health care.�
Loy agreed, saying, �A lot of times that�s the barrier, that it�s hard [for parents] to miss work.�
School principals said sick students may have to sit in an office or lobby all day because working parents are unavailable to come pick the students up and take them to a doctor. "Director of Pupil Personnel Robbie Harmon said that this move could have a bigger long-term impact on the community than any project he�s worked on in his time in the school system."
Loy's in-school clinics are manned by a full-time nurse practitioner who travels between schools, and is overseen by a physician. "Loy said that all forms of insurance would be accepted, and that all children would be seen and treated, regardless of their ability to pay," Feese reports. "He also said that the clinics could help out with insurance enrollment."
Adair County had one of the state's highest percentages of people without health insurance until the federal-state Medicaid program was expanded under federal health reform. The uninsured rate has dropped dramatically, but some families are still without health coverage.
Health departments in Christian, Hopkins and Madison counties will start a program called Giving Infants and Families Tobacco Free Starts, with a $140,000 grant to the state health department from the Anthem Foundation.
The GIFTS program was created to help decrease the number of women who smoke during pregnancy and reduce exposure to secondhand smoke for the pregnant woman and her infant, a state news release said. Smoking before and during pregnancy is the single most preventable cause of illness and death among mothers and infants, according to the federal Centers for Disease Control and Prevention.
�Tobacco use is a serious problem in Kentucky, but it is an even more serious issue for women who smoke during pregnancy,� said Dr. Ruth Shepherd, director of the state health department's Division of Maternal and Child Health. �Smoking during pregnancy and infant exposure to secondhand smoke create numerous risks for babies, including pre-maturity and low birth weight, and risks for developing certain conditions like asthma.�
Smoking rates among pregnant Kentucky women dropped from 26.3 percent in 2004 to 21.9 percent in 2013, but that is still among the highest rates in the U.S. In 2013, 13.3 percent of Kentucky births to smoking mothers were premature, compared to 10.2 percent of births to mothers who did not smoke. Even more striking were these numbers: 13.6 percent of babies born to smokers had low birth weight, compared to only 7.5 percent of those born to non-smokers.
The GIFTS program includes a screening tool for assessing tobacco dependence; screening for depression, social support and domestic violence; individualized counseling and support; referral to a service that helps smokers quit; and educational materials, including relapse prevention and the risks of secondhand smoke exposure in the home.
�Reducing the amount of tobacco use and secondhand smoke exposure is not only crucial for improving the health of our state,� state Health Commissioner Stephanie Mayfield said in the news release. �We are thrilled to receive this grant from the Anthem Foundation and look forward to building on the success of GIFTS and working toward reaching our state�s health goals.�
The sudden increase in use of electronic cigarettes has prompted questions about whether they actually help people quit smoking. A study published online in the American Journal of Public Health found that individuals who use e-cigarettes are actually less likely to quit smoking than those who do not. In Kentucky, 24 percent of adults and 41 percent of those aged 18 to 29 reported using e-cigarettes, according to a Kentucky Health Issues Poll.
The study, conducted by researchers from the University of California San Diego School of Medicine, discovered that smokers who use e-cigs are 59 percent less likely reduce cigarette use and 59 percent less likely to stop smoking altogether, compared to smokers who have not used e-cigs.
"Based on the idea that smokers use e-cigarettes to quit smoking, we hypothesized that smokers who used these products would be more successful in quitting," said Wael Al-Delaimy, professor and chief of the Division of Global Public Health in UC-San Diego's Department of Family Medicine and Public Health. He said the research showed the hypothesis was false, and more studies are required to find out why these people can't stop smoking. "One hypothesis is that smokers are receiving an increase in nicotine dose by using e-cigarettes," he said.
E-cigs don't contain tobacco, but smoking them releases ultra-fine particles and volatile organic compounds such as heavy metals. The study also found that women and those who smoke daily are more likely to have tried e-cigarettes.
One of the most common pieces of advice in the health-nutrition world is that we should focus our carbohydrate intake on slowly-digesting carbohydrates, because they make us feel more full than rapidly-digesting carbohydrates. Rapidly-digesting carbohydrates, such as potatoes, stand accused of causing us to overeat, resulting in obesity, diabetes, and many other chronic ailments. Is this true? Read more �
Portable infusion pump used to deliver Parkinson's drug
The University of Kentucky unveiled a new treatment for people with advanced symptoms of Parkinson's disease at a news conference April 21 and invited one of the first patients to participate in the clinical trial to share how this treatment has improved his function and productivity.
The new, trademarked, treatment, Duopa, provides a continuous 16 hour dose of levodopa, which is the "gold standard" drug to treat Parkinson's disease ,using a special gel preparation, is put directly into the small intestine by a portable infusion pump. It was developed by AbbVie Inc. and approved by the U.S. Food and Drug Administration in January.
"This treatment extends our ability to manage the signs and symptoms" of Parkinson's, said Dr. John Slevin, professor of neurology and vice chair of research at UK's Kentucky Neuroscience Institute. Slevin alsoworked with international investigators to test this treatment and is the lead author of the study, which is published in the Journal of Parkinson's Disease.
Parkinson's is a chronic and progressive disease of the nervous system that is characterized by motor symptoms such as tremors,slowness, stiffness and impaired balance and coordination. It can also cause non-motor symptoms such as sensory deficits, cognitive difficulties and sleep problems.
The cause of Parkinson's is unknown and there is no cure, but it is known that the disease process involves the death of nerve cells in the brain that produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination.
Slevin said that there are many challenges in treating the symptoms of Parkinson's as it progresses. In addition to the continued loss of nerves in the brain, he said levodopa looses its effectiveness over time and the dose level begins to fluctuate. He also noted that over time patients will get a side-effect from the drug called dyskinesia, or involuntary muscle movement.
Another challenge, which he said prompted the development of this treatment, is that the muscles that control digestion are also affected by the disease, which creates an inconsistency in the blood level of levadopa that can be turned into dopamine in the brain.
This new treatment alleviates this challenge by placing the drug directly where it is absorbed in the intestine, allowing "The blood level, and thereby brain level (to remain) constant and that reduces the probability of having intermittent dyskinesia," Slevin said.
Marion Cox
"We are extremely pleased with the results," Slevin said in a press release. "Patients with advanced Parkinson's disease treated via this new method demonstrated marked improvement in symptom fluxuations and reduced dyskinesia."
Marion Cox, a 70-year-old Georgetown farmer and former real estate developer, who has had Parkinson's for 16 years, participated in the clinical trial for three years and said that this treatment has given him a "new lease on life."
"It was the best thing that ever happened to me. The improvements have been that great," Cox said. Later saying, "I can do anything I want to do. I can horseback ride. I've got a team of horses that I drive. I've got lots of farm equipment, excavating equipment that I drive. Before I went on the trial I was still doing those things, but unbelievably slow."
Dr. Michael Karpf, Becky Cox, Marion Cox, Dr. John Slevin
Dr. Michael Karpf, UK's vice president for health, said he was proud to be part of a major health center committed to doing clinical trials: "What UK HealthCare has to do is to not (just) practice the standards of care, we have to move the standards of care forward." Cox will be the first patient in Kentucky to receive Duopa after FDA approval.
Becky Cox, Marion's wife of 25 years, said the treatment "saved him from an early retirement." She noted that before Duopa, he had been taking an "unmanageable" number of pills to treat his symptoms, but now, after he hooks up to the pump in the morning, "It is a set it and forget it kind of thing. ... He is off and running like he always used to be, so that has been a great blessing."
Because this treatment involves an invasive procedure and because most people with Parkinson's disease respond well to oral medication initially, Slevin said this treatment is meant for those with advanced Parkinson's symptoms. He also said the cost for this treatment is still being determined, but it was already approved by Medicare. He noted that the next step will be to train other medical centers in how to deliver this treatment.
The National Parkinson Foundationwebsite says 1 million people in the U.S. have the disease, with 50,000 and 60,000 new cases diagnosed each year. Kentucky has 14,000 people with it, Tony Bucalo, Parkinson's neuroscience account executive at AbbVie, said after the news conference.
The 2015 TYS10K marked the absolute fastest and most PB-riddled performance by H+P. Ever.
It was a massive success from both a team and individual standpoint. We are so appreciative to the Canada Running Series for providing us with this outstanding opportunity to run fast, and for all the other teams and competitors that gave our athletes runners to chase along the way. Here's how we did:
The H+P Men's team was the top team with an average time of 33:08. Top 5 came from Adam Hortian, Brendan Hancock, RunnerRob, Greg Dyce and Ahmed Ahmed.
The H+P Mix team also got in on the action, placing 4th with an average time of 40:00. Top 5 came form Erik V, Simon, Jonathan, Justin and Lucas.
The team had a great time at the 2015 RunWaterloo ENDURrace! Despite having a very large contingent at other team races this weekend, H+P still put together a very solid roster and hit some major personal bests. Here's how we did:
To laugh or to cry? - now it seems that hospital CIOs think they "own" patient engagement.
An article in Medscape summarized a presentation at the Healthcare Information and Management Systems Society (HIMSS) Annual meeting that provided a surprising insight into how some hospital managers think. The survey focused on the concept of patient engagement:
In separate surveys, researchers polled a national sample of 125 chief information officers, 359 primary care physicians, and 2567 patients who visited their doctor in the previous 90 days. Questions centered on beliefs about engagement, the perceived roles of the stakeholders, and barriers.
The patients seemed to have a sensible idea about their own engagement,
From the patient perspective, getting help from a provider they trust is most important, said Mazi Rasulnia, PhD, from M Consulting LLC, who is cofounder of Pack Health, a patient-activation company in Birmingham, Alabama.
What they expect most, according to the survey, is a provider who listens to them and helps them understand treatment options before they make a decision.
'Patients want questions answered around the specificity of their own health, not just what generally happens with 'patients like you' or from a population standpoint,' Dr Rasulnia said.
'What they don't really care for or expect is for providers to 'give me a website so I can access my medical information'.' That, and asking patients about their personal life, ranked lowest on patients' lists of expectations.
They want providers to help them navigate not only their disease, but also the health system. Providing access is important, but that alone won't help patients engage, he explained.
The article did not provide much information about the physicians' responses, but did suggest
When physicians talk about patient engagement, they tend to think in terms of the doctor�patient relationship,...
So in general, the doctors and patients were on the same page, but
doctors believe patients need to take more responsibility for their outcomes, and patients say they can't because their doctors, who are responsible for engaging them, don't spend enough time with them.
Setting aside the causes and approaches to the problem of insufficient time during patient encounters, the chief information officers (CIOs), had a radically different idea,
when healthcare executives talk about the patient engagement envisioned under the Affordable Care Act, they think in terms of transactions,...
Furthermore,
Chief information officers believe they are responsible because patient engagement involves technology,...
Also,
The chief information officers surveyed 'clearly saw themselves as the owners of patient engagement,' said Lorren Pettit, MBA, vice president of market research for HIMSS Analytics, who reported on the systems perspective.
When chief information officers were asked who is most accountable for patient engagement in their organizations, 46.4% said they were, but 14.4% thought nurses were accountable for patient engagement, not physicians or patients.
Comment - on the Hubris of Generic Managers
I have to assume that the article, presentation, or the survey were hopelessly garbled. If not, what on earth were the chief information officers thinking?
Chief information officers think they are the "owners of patient engagement?" While "patient engagement" does not seem to be a well-defined term (look here), and seems like an example of bureaucrat speak or politically correctness, it surely seems to be related to communication between patients and health care professionals. It surely does not seem to be directly about information technology. At best, the health care information technology CIOs manage could support patient engagement. Furthermore, the explanation apparently offered by the CIOs, that patient engagement involves technology, is not helpful because at this time, all of medicine and health care to some extent "involves technology."
So why would CIOs claim to "own" patient engagement? Maybe they are simply clueless about what patient engagement really involves. CIOs rarely interact with patients. Most CIOs have no direct health care experience, and are not trained as doctors or nurses. For example, a recent list of "100 Hospital and Health System CIOs to Know" included only 10 with health professional degrees (seven MDs, three RNs).
Why then, not simply admit that the issue is out of their area of expertise, rather than claiming "ownership." My best guess is this is the bravado, or arrogance of generic managers.
In 1988, Alain Enthoven advocated in Theory and Practice of Managed Competition in Health Care Finance, a book published in the Netherlands, that to decrease health care costs it would be necessary to break up the "physicians' guild" and replace leadership by clinicians with leadership by managers (see 2006 post here). Thus from 1983 to 2000, the number of managers working in the US health care system grew 726%, while the number of physicians grew 39%, so the manager/physician ratio went from roughly one to six to one to one (see 2005 post here). As we noted here, the growth continued, so there are now 10 managers for every US physician.
The managers who first took over health care may have had some health care background. Now it seems that health care managers are decreasingly likely to have any health care background, and increasingly likely to be from the world of finance. Meanwhile, for a long time, business schools and the like seem to have teaching managers that they have a God given right to manage every organization and every aspect of society, regardless how little they know about what the particular context, business, calling, etc involves. Presumably this is based on a faith or ideology that modern management tools are universally applicable and nigh onto supernatural in their powers. Of course, there is not much evidence to support this, especially in health care.
We have discussed other examples of bizarre proclamations by generic managers and their supporters that seem to corroborate their belief in such divine powers. Most recently, there was the multimillionaire hospital system CEO who proclaimed new artificial intelligence technology could replace doctors in short order (look here). Top hospital managers are regularly lauded as "brilliant," or "extraordinary," often in terms of their managerial skills (look here), but at times because of their supposed ownership of all aspects of patient care, e.g., (look here)
They literally are on call 24/7, 365 days a year and they are running an institution where lives are at stake....
If hospital CEOs, who spend lots of time in offices, at meetings, and raising money, really see themselves as perpetually on call, and directly responsible for patients' lives, then maybe it's not surprising that their CIOs think they own patient engagment.
So in summary this latest survey shows the continued hubris of the generic manager, and hence their continued unsuitability to run health care organizations. It is time for health care professionals to take back health care from generic managers. True health care reform would restore leadership by people who understand the health care context, uphold health professionals' values, are willing to be held accountable, and put patients' and the public's health ahead of self-interest.
