October issue of Health Affairs now online

This issue is packed with a number of articles on health reform and comparative effectiveness research.  Click here to access the TOC (sub. req.).

Medical garbage or waste or both?

From the New York Times article:

The health care industry has a garbage problem.

It’s not just that hospitals, doctors’ offices, clinics and other health facilities generate several billion pounds of garbage each year: buried in that mountain of trash are untold numbers of unused disposable medical devices as well as used but recyclable supplies and equipment, from excess syringes and gauze to surgical instruments.

The problem, fueled by a shift toward the use of disposables that made it simple to keep treatment practices sterile, has been an open secret for years, but getting the health care industry to change its habits has not been easy.

Click here to access the NYT article.

Important PSAs from AAD

Click here to access.

Secondhand smoke and mental health (or lack thereof)

 From the New York Times article:

 Nonsmokers exposed to secondhand smoke were 1.5 times as likely to suffer from symptoms of psychological distress as unexposed nonsmokers, the study found, and the risk increases the greater their exposure to passive smoking.

Click here to access the NYT article. Click here to access the Archives of General Psychiatry article (free text).

The difficulty with C. difficile

From the infectioncontroltoday.com article:

Clostridium difficile infections (CDIs) are quickly becoming a significant issue in healthcare based upon recent studies. Preliminary data collected from nursing homes and highlighted in a Supplementary Pennsylvania Patient Safety Advisory shows that almost 40 percent of gastrointestinal infections reported are CDIs.

"Our first look at infection data submitted from Pennsylvania nursing homes confirms what prior studies have found in hospitals -- C. diff infections are a real problem in healthcare institutions," Mike Doering, executive director of the Pennsylvania Patient Safety Authority said. "Elderly patients are particularly at risk because of their age and their use of hospitals and nursing homes where the infection can spread more easily."

Click here to read this article.

From the Washington Post article:

As one superbug seems to be fading as a threat in hospitals, another is on the rise, a new study suggests.

A dangerous, drug-resistant staph infection called MRSA is often seen as the biggest germ threat to patients in hospitals and other health care facilities. But infections from Clostridium difficile - known as C-diff - are surpassing MRSA infections, the study of 28 hospitals in the Southeast found.

Click here to access the WP article.

Med students and residents under report needle sticks

From the New York Times article:

Surgical students are frequently stuck by needles, but many students don’t bother reporting the injuries, a new study found.

Researchers from Johns Hopkins University surveyed 699 recent medical school graduates who had trained to become surgeons at 17 medical centers in the United States. The survey found that 59 percent had been stuck by a needle at some point during medical school, according to the study, in the December issue of Academic Medicine.
...
In the Johns Hopkins survey, about half the victims of a needle stick didn’t report the injury to hospital officials. The most common reason cited for not reporting a needle stick was the amount of time and paperwork required to make a report.

Click here to access the NYT article. Click here to access the Academic Medicine article.

Side-by-Side Comparison of Major Health Care Reform Proposals

The Kaiser Family Foundation's has an interactive side-by-side health reform comparison online tool at their website which allows users to compare "any or all of 12 different plans, including the plans approved by the Senate Health, Education, Labor and Pensions Committee and by the three House committees with responsibilities for health reform (H.R. 3200, America's Affordable Health Choices Act of 2009, also known as the House Tri-Committee bill)," and it is current as of today. Click here to access said tool!

Strokes in children

From the upi.com article:

Strokes in infants and children may be two to four times higher than previously thought, U.S. researchers say.

The study, published in Stroke: Journal of the American Heart Association, finds strokes undercounted due to coding errors ranging from typographical mistakes to coders not accustomed to using stroke codes in children.

Click here to access the upi.com article.

"Framework for Comprehensive Health Care Reform"

is posted at the website of Senator Baucus. Some excerpts:

Health Insurance Exchange. States would establish an exchange in 2010 to provide easier, more efficient comparison of health insurance plan benefits and premium costs. Information about coverage and cost-sharing would be available in a standard format. So-called “mini-medical” plans with limited benefits and low annual caps would not be offered in the exchange.

Ombudsman. In 2010, states would be required to establish an ombudsman office to act as a consumer advocate for those with private coverage in the individual and small group markets. Policyholders whose health insurers have rejected claims and who have exhausted internal appeals would be able to access the ombudsman office for assistance.

Transparency. Beginning in 2010, to ensure transparency and accountability, health plans would be required to report the proportion of premium dollars that are spent on items other than medical care. Also, beginning in 2010, hospitals would be required to list standard charges for all services and Medicare DRGs.
...
Individual Responsibility. Beginning in 2013, all US citizens and legal residents would be required to purchase health insurance or have health coverage from an employer, through a public program (i.e., Medicare, Medicaid, or CHIP), or through some other source that meets the minimum creditable coverage standard. Exemptions from the requirement would be allowed for religious objections consistent with those allowed under Medicare and for undocumented immigrants. Individuals who choose to keep the plan they have today would be deemed to have satisfied the requirement.
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Employer Responsibility. Employers would not be required to offer health insurance coverage. However, employers with more than 50 full-time employees (30 hours and above) that do not offer health coverage must pay a fee for each employee who receives the tax credit for health insurance through an exchange. The assessment is based on the amount of the tax credit received by the employee(s), but would be capped at an amount equal to $400 multiplied by the total number of employees at the firm (regardless of how many receive a credit in the exchange). Employees participating in a welfare-to-work program, children in foster care and workers with a disability are exempted from this calculation.
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Interstate Sale of Insurance. Starting in 2015, states may form “health care choice compacts” to allow for the purchase of non-group health insurance across state lines. Such compacts may exist between two or more states. Once compacts have been formed, insurers would be allowed to sell policies in any state participating in the compact. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued.

State Health Insurance Exchanges. State-based “exchanges” will be established to facilitate enrollment for individuals and separately for small group (through a SHOP exchange modeled after S. 979, the “Small Business Health Options Program Act”). The exchange will provide a standardized enrollment application, a standard format for describing insurance options and marketing, call center support and customer service. The exchanges must be self-sustaining after the first year.

Click here to access the posted document.

Build it and they will use it (imaging that is)

From the New York Times article:

Federal rules allow physicians to profit from the use of machines they own or lease. But Dr. Harlan M. Krumholz, a cardiologist at Yale and an author of the paper, said financial incentives were only part of the reason the number of tests had risen so fast.

“I think the central driver is more about culture than anything else,” Dr. Krumholz said. “People use imaging instead of examining the patient; they use imaging instead of talking to the patient.

“Patients should be asking the question: ‘Do I really need this test? Is the information in this test going to help in the decision-making process?’ ”

In many cases, there is little evidence that the routine use of scans helps physicians make better decisions, especially in cases where the treatments that follow are also of questionable efficacy.

Click here to access the NYT article. Click here to access the NEJM article on this study (sub. req.). Risk/benefits, folks!

On the right road?

From the Forbes article:

Patrick Soon-Shiong, a self-made billionaire through injectable and breakthrough nanoparticle anticancer technology drug development, is now focusing his philanthropic efforts on creating a national highway for health care.
...
The idea is to create a health grid that empowers the patient and the provider. This should be a public utility, basically what I call a U.S. public health grid.

Click here to read more.

Macy Foundation on "Developing a Strong Primary Care Workforce"

From the publication:

The United States does not have enough health professionals in primary care to meet the anticipated demand. To have any hope of meeting that demand, major changes in the education and reimbursement for primary care professionals will be required. Any effort at healthcare reform must place healthcare workforce issues front and center.

In April 2009, the Josiah Macy, Jr. Foundation convened a meeting in Washington, DC, to discuss the nation’s healthcare workforce. Individuals representing four organizations with expertise in primary care and prevention were in attendance. These professionals work in the trenches of primary care, representing groups that recruit high school and college students into the health professions, nudge medical education toward a greater appreciation of primary care, and guide training for physicians, nurse practitioners, physician assistants, and others on the front lines of healthcare delivery. Their insights are compelling.

To read this publication (which is a summary of the meeting), click here.

The vomiting bug?

From the BBC News article:

A spokeswoman for the Health Protection Agency said: "There are several vaccines for norovirus in development but all are probably several years away from being in general use.

"In the meantime, until one is produced that is effective and safe we recommend strict adherence to the outbreak control measures that exist to stop the virus spreading in hospitals and cruise ships.

"On an individual level, if someone has a norovirus infection they are advised to stay at home and practise good hand hygiene using soap and water to stop the virus from spreading to other members of the household."

Click here to access the BBC News article.

Parental stress plus pollution factors in childhood asthma

From the Time article:

Studying a combination of factors can help explain why some kids are more likely to develop asthma than others, says Rob McConnell, lead author of the study published in the Proceedings of the National Academy of Sciences. "Childhood asthma is a complex disease, and probably has many contributing causes," he says. "This study provides another clue to what might be causing it."

The results also shed light on how risk factors such as stress can increase the vulnerability of the respiratory system to environmental pollution or allergens.

Click here to access.

WHO issues Patient Care Checklist (H1N1)

From WHO's website:

The WHO New Influenza A(H1N1) Clinical Checklist is intended for use by hospital staff treating a patient with a medically suspected or confirmed case of New Influenza A(H1N1). This checklist combines two aspects of care: i) clinical management of the individual patient and ii) infection control measures to limit the spread of New influenza A(H1N1).

The checklist is not intended to be comprehensive. Additions and modifications to fit local practice and circumstances are encouraged.

Click here to access the checklist.

New restrictions on painkillers?

From the Bloomberg article:

The prescription painkillers Percocet and Vicodin should be banned and use of Tylenol, sold over the counter, should be reduced because the ingredient acetaminophen is linked to liver damage, U.S. advisers said.

Outside advisers to the Food and Drug Administration voted 20-17 today in Adelphi, Maryland, for the ban on Percocet and Vicodin, which also contain a narcotic.

Click here to access. This is going to be so interesting...the pendulum swings.

IOM Report recommends research for 100 health topics

From the National Academies news release:

A committee convened by the IOM developed the list of priority topics at the request of Congress as part of a $1.1 billion effort to improve the quality and efficiency of health care through comparative effectiveness research outlined in the American Recovery and Reinvestment Act of 2009. The committee's report provides independent guidance -- informed by extensive public input -- to Congress and the secretary of the U.S. Department of Health and Human Services on how to spend $400 million on research to compare health services and approaches to care.

Health experts and policymakers anticipate that comparative effectiveness research will yield greater value from America's health care system and better outcomes for patients. Despite spending more on care than any other industrialized nation -- $2.4 trillion in 2008 -- the United States lags behind other countries on many measures of health, such as infant mortality and chronic disease burden.

Click here to access the news release. Click here to access the IOM report (please note the executive summary can be downloaded for free).

Would Zeus approve?

From the New York Times column by Pauline Chen, MD:

In the policy journal Health Affairs, Francois de Brantes, a nationally known advocate of health care quality, and his co-authors propose a new health care reimbursement model that comes with a warranty. Developed with the support of the Commonwealth Fund and the Robert Wood Johnson Foundation, this model, called Prometheus Payment, first offers set fees to providers. The fees cover all recommended services, treatments and procedures for specific conditions but are also “risk-adjusted” for patients who may be older or frail.

Click here to access Doctor Chen's column.

Tobacco-control bill passed by U.S. Senate

From the USA Today article:

The legislation, approved by the House in April, is the most sweeping tobacco-control measure ever passed by Congress. It goes now to President Obama, who has said he will sign it.

Click here to access the article.

It's official -- it's a pandemic

The World Health Organization announced that H1N1 has met the scientific criteria for a flu pandemic. Click here to access the WHO announcement.