Princess Health andMost Kentucky hospitals did average or better in new patient satisfaction ratings; seven got top rating and six got bottom rating.Princessiccia

Princess Health andMost Kentucky hospitals did average or better in new patient satisfaction ratings; seven got top rating and six got bottom rating.Princessiccia

hosptials Medicare rankings

Gusty 21:19 Add Comment

Most of the Kentucky hospitals that were rated on a newly released five-star scale for patient satisfaction got three and four stars. Seven of them got a five-star rating and six got a two-star rating, the lowest rating given to any of the Kentucky hospitals that were evaluated.

The star ratings can be found on Medicare's Hospital Compare website and are based on a patient satisfaction survey given to randomly selected patients, not just those on Medicare, at nearly 3,500 Medicare-certified acute care hospitals across the country. The ratings are based on patient admissions between July 2013 and June 2014. Hospitals were not included if they did not have enough surveys completed during that period.

The survey, also known as Hospital Consumer Assessment of Healthcare Providers and Systems Survey, includes questions about patient satisfaction related to how their doctors, nurses and hospital staff communicated with them, how well their pain was addressed during their hospital stay, how well they were prepared to go home, cleanliness of the hospital and if they would recommend the hospital to others.

Kaiser Health News analyzed the data from the Centers for Medicare & Medicaid Services and found that 76 Kentucky hospitals were included in the patient satisfaction star ratings and 17 Kentucky hospitals were not. Kaiser found that the average for all of the rated hospitals in Kentucky was 3.4 stars, one-third, or 25, got four stars; half, or 38, got three.

HealthWatch USA, a non-profit organization that promotes health care transparency and patient advocacy based in Somerset, further analyzed the data and named the hospitals in each state by its star rating.

The seven with five-star ratings are: Clinton County Hospital, Marshall County Hospital, Westlake Regional Hospital, Saint Joseph Martin, Rockcastle County Hospital, Pikeville Medical Center and Russell County Hospital.

The six with two-star ratings are: Georgetown Community Hospital, Harlan ARH Hospital, Hazard ARH Regional Medical Center, Spring View Hospital in Lebanon, University of Louisville Hospital and Lake Cumberland Regional Hospital in Somerset.

The Centers for Medicare and Medicaid Services reminds consumers that these patient satisfaction star ratings are just one tool to help decide which hospital to use, and encourages them to use multiple factors to make this decision, including clinical outcomes, their health-care providers opinion and other publicly reported data.

Princess Health andStudy finds nutritious food costs more in poor, rural areas, suggests that SNAP (food stamp) policies be changed.Princessiccia

Princess Health andStudy finds nutritious food costs more in poor, rural areas, suggests that SNAP (food stamp) policies be changed.Princessiccia

food deserts food stamps nutrition research rural-urban disparities

Gusty 21:12 Add Comment

A study has found that nutritious foods are more expensive in impoverished rural counties than in urban counties, a phenomenon that doesn't help public health officials who teach healthy eating as a proven, effective strategy to prevent chronic diseases to rural Kentuckians.

"The results of this study find that individuals living in rural areas, particularly food desserts, may be at increased risk of negative health effects as a result of more limited access to higher quality foods compared to those living in urban areas," says the report of the University of Kentucky study, "Food Cost Disparities in Rural Communities," published in Health Promotion Practice.

Researchers analyzed the per-serving cost of 92 foods four times over a 10-month period in the primary grocery stores in four Kentucky counties, two rural and two urban. One rural county was considered a food desert, meaning that fresh produce isn't relatively available. The commonly purchased foods in the study were assigned to one of four categories based on their nutritional value.

Not surprisingly, the cheapest foods were those with the least nutritional value, such as canned fruit in heavy syrup, cereals with high-fructose corn syrup, and processed meats.

Foods that are a bit more nutritional, but mainly processed convenience foods, were more expensive in rural counties than urban counties.

Foods that were considered nutritious, but not the most nutritious, such as white rice, oats, whole-grain bran cereals and frozen fish, cost the most in the rural county with the highest poverty rate.

The cost of the most nutritional items varied by county, with the "most striking finding" being that "the rural food desert had significantly higher per-serving costs among the most nutritious food items, compared to the other three counties," 6 to 8 cents higher per item, the report said.

Within each county, the study did not find much difference in food cost among the foods in each of the four nutrition categories.

However, it did find that highly processed convenience foods in urban counties were more expensive than more nutritional foods, and suggested that those living in urban areas could afford more plant-based foods and fewer processed foods as an "effective strategy to improve overall dietary quality without increasing food budgets."

The study draws attention to the SNAP or food-stamp program, which makes no allowances for food cost differences between regions or counties, and suggests that its model be changed to be more like the Women, Infants and Children program, which uses a portion-based system: Participants buy a set number of ounces or servings of dairy products, whole grains, and fresh produce each month, irrespective of price. This approach "has the potential to adequately meet all participants' nutritional needs, irrespective of differences in food prices," wrote the researchers, Frances Hardin-Fanning and Mary Kay Rayens of the UK College of Nursing.

Princess Health andMay 2nd-3rd Race Weekend.Princessiccia

Princess Health andMay 2nd-3rd Race Weekend.Princessiccia

Gusty 15:00 Add Comment

The team was all over the place this weekend competing in a plethora of different races.  Here's how we did!

Goodlife Marathon

• Kailey Haddock ran her first marathon EVER, running an outstanding 3:22 Boston qualifier and placing 15th OA for females!
• Mike suffered with some serious knee problems during the race, but still managed a solid 3:26!

Goodlife Half Marathon

• Johana had an OUTSTANDING return from Kenya.  He posted a stellar 1:08 half marathon and won the race.
• Brendan, who had almost no long runs in training, could not refuse a free entry!  He still posted a solid 1:20 and placed 15th OA.

Mississauga Marathon

• Colin Calvert posted a very strong 3:18.

Mississauga Half Marathon

• RunnerRob, using this as a primer race, stuck to the plan and ran 1:20, good enough for 14th OA.
• Nick Burt ran a solid new PB of 1:26
• Graham also came in with a new PB of 1:29.
• Tracey, one of our masters all-stars, posted an outstanding 1:41!

Mudpuppy 5K

Lots of H+Pers lit up the Mudpuppy Chase!  Here's how we did:

• Luke Ehgoetz ran an outstanding PB of - 7th OA and 3rd in AG
• Steve Schmidt pushed a very solid PB of 19:31- 15th OA and 1st in AG
• Brian Wetzler came in at  - 20:58- 2nd in AG
• Ed Shrigley was just off his PB at 24:41 - 3rd in AG
• Candice Shrigley ran one of her best times ever, 24:45 - 1st in AG

Mudpuppy 3K

• Olivia Hergott ran an OUTSTANDING 19:46
• Samara Hergott was just behind her with a very speedy 19:57

Mudpuppy 600m 

• Miles Hergott pushed a very hard pace, and finished the course in 3:55!

Bear Mountain 50K

• Dave Rutherford tackled the very tough and technical course in a respectable 6:08 and 4th in his AG.

Rock the Ridge 50M

• Vicki had an outstanding performance, running 7:39, placing 2nd out of females, 7th OA, and recording the second fastest time by a female EVER!

In Ohio, our ultimate Mileage Man (Steve Parke) was ripping it up all weekend.  He won yet another 24 hour event, setting a new course record of 127 miles.

In Vermont, Chris Goldsworthy was back in action running a half marathon- his first race since the LA full earlier this year.  He ran 1:25, placing 8th OA and 2nd in his AG.

What a great two days.  Onwards to the next race weekend!

#cantwontstop

Princess Health and Innovations form the Safra Center Ending iCorruption Conference. Princessiccia

Princess Health and Innovations form the Safra Center Ending iCorruption Conference. Princessiccia

conflicts of interest health care corruption hospital systems pharmaceuticals regulatory capture

Gusty 12:23 Add Comment

I had the pleasure of attending the Ending iCorruption Conference, the capstone conference for the Edmond J Safra Research Lab on Institutional Corruption, held at the Harvard Law School on May 1-2, 2015.  The conference included much material relevant to health care corruption and related topics, and provided some innovative approaches that could be used to address these issues.  I list these below, with citations or links when available.  At some point in the future, all conference proceedings should be available on video from the Safra Center.

Uncovering Data on Conflicts of Interest

Unearth: Using PubMed to Uncover Conflicts of Interest Affecting Clinical Research

Unearth is a browser extension now available for Google Chrome, and soon to become available for other browsers, e.g., Firefox.  It works on PubMed searches, scraping funding and conflict of interest data from the body of articles and adding them to abstracts.  We have often discussed such conflicts of interest, and their relationship to manipulation of clinical research.  Unearth could make such conflicts more salient, making it easier to discriminate unconflicted from conflicted research.  (See this post on the Bill of Health blog.)  This application was developed during the Safra Center Hacking iCorruption Event.

Open Think Tanks: Uncovering Think Tank Funding

Think tanks often publish findings on and make recommendations about health care.  However, think tanks are often opaque, and any institutional conflicts of interest they have may not be easily apparent.  Open Think Tanks currently shows donations from government entities outside the US to US based think tanks.  Enhancements to include various kinds of private donations are likely in the future. This application was also developed during the Hacking iCorruption Event.

Finding Unconflicted Academics

As we have discussed, the majority of medical academics have conflicts of interest, which may affect their research, teaching and patient care.  Yet these conflicts are not always disclosed.  Furthermore, finding experts without conflicts is not easy.  ProfessorCert is a website that allows academics who have no conflicts of interest to register as such.  The website was developed by the Academic Independence Project. 

Improving Integrity

Putting Consumers in the FDA and Other Regulatory Agencies

We have frequently discussed regulatory capture, how government health care regulatory agencies, like the US Food and Drug Administration (FDA),  often seem to end up more concerned about the financial health of those they are supposed to regulate than patients' and the public's health.   Harvard Prof Daniel Carpenter, collaborator in Safra Center research,  talked about the problem of  "cultural capture" of regulatory agencies, in which the regulators' thinking is influenced by outside vested interests.  He proposed that regulatory agencies need to put consumers, or presumably other stakeholders like unconflicted health care professionals, "into the room."  

Putting Ethicists in the C- Suite

We have frequently criticized the leadership of hospitals and hospital systems.  In particular, we have discussed instances in which these leaders seem to have gone directly against the mission of their own organizations, which we termed mission hostile management. Safra Lab Network Fellow James Corbett, now Senior Vice President for Centura Health, proposed that ethicists who also understand the language of finance and management be present among the top leadership of hospital systems.  

Licensing Executives

As noted above, a major theme of the Health Care Renewal blog is the shortcomings of the leadership of large health care organizations.  Top leaders often have business training, but may be ill-informed about health care, and ignorant or unsupportive of  or even hostile to its values.  Wellesley College Professor Emerita Ann Congleton's 2014 article in the Journal of Business Ethics, entitled Beyond business ethics: an agenda for the trustworthy teachers and practitioners of business, proposed requiring that corporate executives, including executives of health care corporations, be licensed in order to lead their organizations.  I proposed licensing of leaders of large health care organizations as early as 2008 (here).    

Pharmaceutical Research Uninfluenced by the Pharmaceutical Industry

Because clinical research meant to evaluate drugs or devices sponsored by  manufacturers of the relevant products has shown to be frequently manipulated, or even suppressed, many people have suggested banning such sponsorship and direct influence of such manufacturers.  (For example, see the book and blog, both entitled "Hooked," written by Dr Howard Brody, and see Health Care Renewal blog posts, e.g., here.)
Safra Center Network Fellow and Rowan University Professor Donald Light's book in press, Good Pharma, basically offers proof of the concept that high quality clinical research on pharmaceuticals can be accomplished without industry money or influence, albeit in Italy, at the Mario Negri Institute. 

Summary

The project on institutional corruption at the Safra Center produced a burst of innovation meant to address this pervasive project, and thus provided much of value to those who want to challenge health care corruption.  I hope this innovation will turn out to be truly disruptive.  It is regretful that this project has come to an end.  We can only hope others pick up the banner.  

Princess Health andMost women are unaware of female-specific stroke symptoms and risks, according to a national survey by Ohio State.Princessiccia

Princess Health andMost women are unaware of female-specific stroke symptoms and risks, according to a national survey by Ohio State.Princessiccia

research stroke survey women's health

Gusty 14:23 Add Comment

Most women are unaware of the symptoms and risks of stroke for females, according to a national survey by the Ohio State University's Wexner Medical Center. The survey found that just 11 percent of the 1,000 respondents knew that pregnancy, lupus, migraine headaches and oral contraception or hormone replacement therapy are female-specific stroke risks.

Also, only 10 percent of those surveyed knew that hiccups and atypical chest pain with or followed by typical stroke symptoms are early warning signs. According to the National Stroke Association, stroke is the third leading cause of death for women, and Diana Greene-Chandos, a neurologist and director of the neuroscience critical care at Ohio State's Wexner Medical Center, said, "We have a ways to go when it comes to educating women about stroke and their unique risk factors."

Other symptoms unique to women include dizziness that is not class vertigo, headaches, atypical chest pain and/or numbness of the body, especially if one side is more numb than the other. Early recognition and treatment are key for strokes.

"Women do not think they are going to have a stroke," said Greene-Chandos. "They think of it as a man's disease." The reality is that 60 percent of stroke deaths occur in females and 40 percent for males. Every year, 137,000 Americans die from a stroke. Smoking, failing to exercise and having high blood pressure are risk factors for both men and women. To take an assessment created by Ohio State's stroke experts to determine risk of stroke, click here.

Princess Health andTeen use of electronic cigarettes has tripled in one year.Princessiccia

Princess Health andTeen use of electronic cigarettes has tripled in one year.Princessiccia

e-cigarettes research smoking

Gusty 16:33 Add Comment

By Melissa Patrick
Kentucky Health News

The number of middle- and high-school students using electronic cigarettes tripled from 2013 to 2014, surpassing the current use of all teen use of tobacco products, including conventional cigarettes, according to the federal Centers for Disease Control and Prevention.

Data from CDC/CDC National Youth
Tobacco Survey; Image: NPR

The findings came from CDC's 2014 National Youth Tobacco Survey,which found that e-cigarette use by high-school students increased to 13.4 percent in 2014 from 4.5 percent in 2013, and to 3.9 percent in 2014 from 1.1 percent in 2013 for middle-school students. That amounts to 2 million high school students and 450,000 middle school students smoking e-cigarettes.

The report also found that the use of traditional cigarettes remained the same for middle-school students at 7.7 percent, but fell among high-schoolers to 9.2 percent in 2014 from 12.7 percent in 2013, the "lowest level in years," CDC said in a press release.

�We want parents to know that nicotine is dangerous for kids at any age, whether it�s an e-cigarette, hookah, cigarette or cigar,� CDC Director Tom Frieden said. �Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use.�

There is great debate about how safe e-cigarettes are. Most public-health officials have called for them to be controlled by government regulations, including advertising regulations, and say more controlled studies need to be done to determine their safety.

And while many proponents of e-cigarettes say the devices may be helpful in helping some smokers give up traditional cigarettes and are safer than traditional cigarettes, a recent study published in the American Journal of Public Health says that using electronic cigarettes doesn't help smokers quit, and Brady Dennis of The Washington Post reports that another study, published in the journal Tobacco Control, found that the chemicals used to flavor e-cigarettes could prove unsafe when inhaled over time.

The U.S. Food and Drug Administration has yet to issue new regulations for e-cigarettes, despite its announced plans to do so last April. Meanwhile, Kentucky enacted a law last year banning the sale of "alternative nicotine products" such as e-cigarettes to minors, and local Kentucky smoking bans have slowly been adding e-cigs to their local ordinances. Several Kentucky schools have also added language to their school policies to include e-cigarettes in their smoking bans, with one school official in Webster County recently saying e-cigarettes are "high on every school system's radar right now."

But not everyone sees this increase in teen use of e-cigarette use as a cause for alarm.

�The CDC should really be jumping for joy at the fact that smoking rates are declining. This is a huge success,� Michael Siegel, a professor and tobacco-control specialist at Boston University�s School of Public Health, told Dennis. �Instead, they are using this as another opportunity to demonize e-cigarettes.�

Siegel said that while minors shouldn't have access to any tobacco products, the CDC numbers also suggest that e-cigarettes are not serving as a gateway to traditional cigarettes and might be diverting them away from them, Dennis reports.

Gregory Conley of the American Vaping Association told NPR that the data, which show a decrease in tobacco smoking by teens as they have increased experimentation with vaping "should be part of the discussion."

Princess Health andKynect has an app for smartphones .Princessiccia

Princess Health andKynect has an app for smartphones .Princessiccia

health insurance Kynect technology

Gusty 09:49 Add Comment

Kentucky's state health benefits exchange, Kynect, is offering a free mobile app that will provide "on-the-go" access to the health-insurance marketplace.

The  smartphone app will allow you to log in to your account, browse plans, report changes in your circumstances, take photos of required verification documents and upload those photos directly to your account.

It can also help determine if you qualify for low-cost or free health coverage, get information about your coverage options, find out enrollment dates and learn how certain life events can qualify you to enroll now.

It allows you to log in to your Kentucky Online Gateway Account, look at the status of your health care plan or application, get more information about your current health care plan, access alerts, notifications or messages related to your account and view and update contact information.

And if you have further questions, it can connect you to an insurance agent or nearby "Kynector."

The app is available for download in the iTunes Store for Apple devices or in the Google Play Store for Android users.