Medical errors and residents

Check out the Archives of Internal Medicine article "Medical Errors Involving Trainees":

Results Among 240 cases, errors in judgment (173 of 240 [72%]), teamwork breakdowns (167 of 240 [70%]), and lack of technical competence (139 of 240 [58%]) were the most prevalent contributing factors. Lack of supervision and handoff problems were most prevalent types of teamwork problems, and both were disproportionately more common among errors that involved trainees than those that did not (respectively, 54% vs 7% [P < .001] and 20% vs 12% [P = .009]). The most common task during which failures of technical competence occurred were diagnostic decision making and monitoring of the patient or situation. Trainee errors appeared more complex than nontrainee errors (mean of 3.8 contributing factors vs 2.5 [P < .001]).

Conclusions In addition to problems with handoffs, house staff are particularly vulnerable to medical errors owing to teamwork failures, especially lack of supervision. Graduate medical education reform should focus on strengthening these aspects of training.

Click here to access the article (sub. req.).

Smoky Southern California Sunset

Will health care reform work this time?

Probably not...check out the article by Jonathan Oberlander, Ph.D., "Learning from Failure in Health Care Reform" just published in the New England Journal of Medicine:

...it is easy to forget that Bill Clinton was not the first president to fail at health care reform: he was following in the footsteps of Franklin Roosevelt, Harry Truman, and Richard Nixon. Ultimately, the demise of the Clinton plan says less about the administration’s mistakes than it does about the extraordinary difficulty of adopting comprehensive health care reform in the United States.

Click here to access this free full-text article.

Cultural competency and diabetes

From the Wall Street Journal article:

With minorities accounting for nearly a third of the U.S. population, medical professionals are beginning to bone up on so-called cultural competency, part of an effort to ensure that patients from disparate backgrounds get proper care. Nowhere is the challenge more acute than for those treating diabetics, given the rising incidence of the disease, its prevalence among minority groups and the changes in diet and lifestyle that treatment often entails.

Click here to read the entire article (sub. req.).

Resources for coping with disasters

Click here to access the CDC's resources on coping with disasters.

More on anemia drugs

From the L.A. Times article:

The largest group of U.S. cancer doctors said Monday that Medicare has gone too far in restricting the use of anemia drugs made by Amgen Inc. and Johnson & Johnson and released its own guidelines.

The doctors' recommendations add new warnings about heart risks while saying patients can safely use higher doses than Medicare allows. The guidelines, based on a three-year review of clinical trials, are being published by the American Society of Clinical Oncology, an association of cancer doctors, and the American Society of Hematology, a group of blood experts.

Click here to access the article.

San Diego County Ablaze

John Gastaldo/The San Diego Union-Tribune/Zuma Press

Click here to see additional photos.

Christopher Gist

History fascinates me, especially when it involves one of my ancestors, such is the case with Christopher Gist. From the Ohio History Central website:

Christopher Gist was an explorer, surveyor and accomplished frontiersman. He was born about 1706 in Maryland to Richard and Zipporah Gist.
...
Gist returned to the Ohio Country, this time with George Washington, in the winter of 1753-1754. The Ohio Company sent the two men to the region to negotiate with French military forces. The French had constructed Fort Duquesne near Shannopin's Town to prevent English settlement of the Ohio Country. Negotiations failed, but during the trip Gist saved the young Washington's life on two separate occasions.
...
Gist provided England and its colonists with the first detailed description of southern Ohio and northeastern Kentucky. While Daniel Boone is generally given credit for opening Kentucky to white settlement, Gist preceded the frontiersman by more than fifteen years.

Click here to access the website.

Murphy's law?

From the Pittsburgh Post-Gazette article:

In response to a national report on an increase in staph infections, Pennsylvania's Rep. Tim Murphy, R-Upper St. Clair, yesterday touted a bill that would create a public database showing how many infections are acquired by patients in each of the nation's hospitals.

"A hospital is a place where people go to get better. No one should have to worry about getting sick while they're there," he said.

Click here to access the article.

Health advocates

From the San Francisco Chronicle article:

Margalit Mathan and Peter August found themselves caught in a maze of medical appointments and conflicting professional opinions when their 7-year-old daughter developed serious eye problems related to her juvenile rheumatoid arthritis.

The Berkeley family decided to consult yet another professional. They turned to a health care advocate, an adviser who specializes in helping patients and their families cut through the health care bureaucracy to find the help they need..

Click here to access the article; be certain to read the tips for choosing a health advocate.

HealthGrades 10th Annual Report

Click here to check out the latest information on hospital quality courtesy of HealthGrades.

Forget insurance coverage, will there be enough physicians?

From the HealthLeaders cover story:

Americans alive today have never experienced a real physician shortage. Sure, there have been occasional dips every few years in certain specialties, like when we worried that we may not have enough obstetricians to go around. And after the need for HMO gatekeepers went away, a shortage of primary-care physicians developed and is worsening. But a widespread, sustained doctor drought is American healthcare’s disaster without a preparedness plan.

Click here to access the entire article. It's a good read!

Pfizer and Sermo?

From the Boston.com article:

A year-old online forum where 30,000 doctors swap medical observations has lined up a partnership with Pfizer, Inc. - an alliance that runs counter to the site's founding ideal to give doctors a place to communicate without the drug industry listening in.

Under a collaboration to be announced today with Cambridge-based Sermo Inc., Pfizer will work with the fast-growing Web venture and its participating doctors to agree on terms allowing Pfizer's hundreds of staff doctors to view postings and reply.

Click here to access the entire article.

Sink your teeth into this

From the New York Times article:

For American dentists, times have never been better.

The same cannot be said for Americans’ teeth.

With dentists’ fees rising far faster than inflation and more than 100 million people lacking dental insurance, the percentage of Americans with untreated cavities began rising this decade, reversing a half-century trend of improvement in dental health.

Click here to read the entire article.

ACCME posts new FAQs

Click here to access.

Impact of Minnesota limit on industry gifts

From the New York Times article:

Michael Clements, the owner of a food-catering business in St. Paul, said the new rules had been disastrous for him. His business of taking lunches, paid for by drug makers, to doctors’ offices all but disappeared after the rule change, cutting his overall sales by two-thirds, Mr. Clements said.

...

Food has not entirely disappeared from the marketing efforts of drug makers in Minnesota. The companies still rent out private dining rooms in restaurants and still hire influential doctors to deliver educational talks about drugs during dinner. But instead of doctors, the companies now invite nurses and secretaries to dine, drink and listen.

Click here to read the entire article.

The Clooney incident

From the EOnlineNews article:

More than two dozen employees at Palisades Medical Center have been suspended pending an investigation into whether they leaked details about Clooney's condition to the press when the actor and his girlfriend were treated Sept. 21 after a motorcycle crash, New Jersey's WCBS-TV reported Tuesday.

News of Clooney's accident was speedily followed by reports of the injuries he and Sarah Larson suffered—a fractured rib and road rash for him, a broken foot for her. The couple only spent a few hours at the hospital.

Click here to access the article.

Medtronic in the news again

From the Bloomberg.com article:

Medtronic Inc. was warned by the U.S. Food and Drug Administration that a manual for the company's Satellite spinal device encouraged its use in unapproved ways.

The device is intended to be fused with a bone graft to stabilize and hold together parts of the vertebrae while they heal, the FDA said in a warning letter posted today on the agency's Web site. Medtronic's surgical technique manual described a non-fusion procedure without implantation of a bone graft, according to the letter, dated Oct. 1.

Click here to access.

Early treatment key

From the Bloomberg.com article:

Patients who get treatment within a day of having a minor stroke cut their risk of a second stroke by 80 percent, researchers reported.

Aspirin, blood thinners and other common therapies given within 24 hours may prevent almost 10,000 major attacks a year in the U.K., scientists said today in the medical journal The Lancet. Sending patients to a specialized clinic also reduced the risk of a stroke, a separate study in The Lancet Neurology found.

Click here to access.

Facing the serpent

I just found out that Flower, the alpha female on the TV show Meerkat Manor died! I've only watched the show a couple of times, and not recently, but this news certainly moved me.

Flower bravely entered the burrow to protect her pups from a cobra (she kept them safe) but she lost her life in the process. My father always said that animals are a gift from God and could teach us more than we could ever teach them -- a little rodent from the Kalahari Desert proved him right. Click here to check out Meerkat Manor.

"Talking Leaves"

From the Sequoyah Birthplace Museum website:

They called him Sequoyah. And, this great Cherokee Indian gave his people an enduring gift. He gave them a writing system - so that the greatness of the Cherokee Nation will live forever.
...
Although Sequoyah was exposed to the concept of writing early in his life, he never learned the English alphabet. He began to toy with the idea of literacy for the Cherokee people. Unlike the white soldiers, he and the other Cherokees were not able to write letters home, read military orders, or record events as they occurred. After the war, he began in earnest to create a writing system for the Cherokees.
...
In 1821, after 12 years working on the new language, he and his daughter introduced his syllabary to the Cherokee people. Within a few months thousands of Cherokees became literate.

Sequoyah's white name? -- George Gist. Click here to access the museum website.

Surprising smoking prevalence info from the CDC

Smoking prevalence among people with disabilities is nearly 50 percent higher than among people without disabilities (29.9 percent vs. 19.8 percent), according to a new study from the Centers for Disease Control and Prevention (CDC) in Preventing Chronic Disease. The study found that in 2004, smoking prevalence for people with disabilities is highest in Delaware (39.4 percent) and lowest in Puerto Rico (16.5 percent).

The study found that about 70 percent of people with disabilities who smoke and had visited a doctor in the last year had been advised to quit smoking. However, more than 40 percent of those advised to quit reported not being told about the types of tobacco-cessation treatment available.

Click here to access the CDC press release.

Planned behavior theory

From the psychservices.psychiatryonline.org article "The Theory of Planned Behavior Applied to Continuing Education for Mental Health Professionals":

OBJECTIVE: This study evaluated the effects of a continuing education class that applied the theory of planned behavior to the intentions and behavior of mental health practitioners.
METHODS: In 2006 a total of 94 mental health practitioners were randomly assigned to either a standard continuing education class or one that applied principles of the theory of planned behavior. The class topic was a brief, self-report tool that assesses felt need for employment among people with serious mental illnesses. Participants' intentions to apply the tool were evaluated before and after each class. Participants' implementation of the tool was measured three months after the class.
RESULTS: The class guided by the theory of planned behavior significantly and substantially increased the participants' intentions to use the tool in comparison with the standard class. Significantly more participants in the theory-guided class than in the standard class (74% versus 42%) had applied the tool by the three-month follow-up. Among those who implemented the assessment tool, the participants in the theory of planned behavior class also assessed significantly more of their caseload.
CONCLUSION: The theory of planned behavior can improve and may be well suited to continuing education in psychiatry.

Click here to access this article (sub. req.).

If they were psychic, shouldn't they have known this would happen?

From the Skeptical Inquirer Magazine article:

A continuing-education workshop titled “Coming to Our Senses: Psychic Events in the Lives of Clinicians and Clients” was touted in North Carolina this year by Beth Wechsler, MSW. According to the brochure, the topics to be covered included an account of the nature of ESP (with perspectives from parapsychology and quantum physics, as well as material from Einstein, Edison, and Jung), ESP and medicine, psychics and mediums (and how to detect fakes!), telepathy, precognition, and apparitions.
...
An e-mail addressing the content of the workshop was sent to the associations and boards that had designated PESI as an approved provider. Karen Kanefield, the director of the Continuing Education Sponsor Approval System of the American Psychological Association, responded immediately. She said that the content of the psychic-events workshop does not meet the curriculum-content requirements of the APA and that PESI would be informed that the workshop “is not suitable as continuing education for psychologists.”

Please note the new label. Click here to read the entire article.

BMS to pay $515 million

From the AP article:

Bristol-Myers Squibb Co. and a former subsidiary have agreed to pay more than $515 million to settle federal and state investigations into their drug marketing and pricing practices.

The civil settlement announced Friday resolves a broad array of allegations against Bristol-Myers Squibb, dating from 1994 through 2005.

Among them were a charge that the New York-based pharmaceutical company illegally promoted the sale of Abilify, an anti-psychotic drug, for pediatric use and to treat dementia-related psychoses. Neither use is approved by the U.S. Food and Drug Administration.

Click here to access the article.

Orthopedic companies to pay $311 million

From the Wall Street Journal article:

Four makers of orthopedic devices have entered deferred-prosecution agreements and agreed to pay a total of $311 million to settle criminal and civil probes into allegations they paid kickbacks to surgeons to use their products, prosecutors said.

Click here to access the article (sub. req.).

New AACVPR/ACC/AHA Guidelines

From the Washington Post article:

Experts in cardiac care have issued new "performance measures" meant to boost patient enrollment in cardiac rehabilitation programs.

They say too many heart attack patients aren't getting the benefit of this form of care.

Click here to access the article.

International Severe Adverse Events Consortium

From the Boston Globe article:

A rare collaboration of top pharmaceutical companies, regulators and university researchers has begun attacking one of the toughest problems in medicine: why severe drug side effects strike a small percentage of patients.

Click here to access the article.

Medtronic on the hot seat!

From the New York Times article:

Medtronic, which reached a $40 million settlement last year with the federal government over accusations that the company had paid illegal kickbacks to doctors for using its spinal devices, has continued to pay doctors millions of dollars in consulting fees, according to a lawyer representing a whistle-blower involved in the case.

Senator Charles E. Grassley, Republican of Iowa, has written to Medtronic, asking the company to explain, among other things, any payments made since the period covered by the settlement. The letter is part of a broad inquiry by Mr. Grassley into the financial ties that often exist between doctors and the companies that make medical devices and drugs.

Medtronic defended the continuing payments as legitimate compensation for work the doctors have done. Medtronic said it welcomed the opportunity to speak with Mr. Grassley and his staff.

Click here to read the entire article (reg. req.).

Survey shows heath care is a ministry priority in the U.S.

From the news release:

A groundbreaking survey of more than 6,000 American congregations reveals that churches spend a significant amount of time, energy and money in the ministries of health care.

The Congregational Health Ministry Survey, conducted by the National Council of Churches USA (NCC) with support from the Robert Wood Johnson Foundation, shows that a majority of churches are serving their communities by providing health care ministries. As the number of uninsured Americans reaches 47 million people, congregations are supplying health education and direct health care services. Many are advocating on behalf of public policy issues related to health care.

Click here to access.

Tink and Henry

If you'd like to learn more about Henry, click here.

New dress code for UK physicians

From the Associated Press:

British hospitals are banning neckties, long sleeves and jewelry for doctors — and their traditional white coats — in an effort to stop the spread of deadly hospital-borne infections, according to new rules published Monday.

Hospital dress codes typically urge doctors to look professional, which, for male practitioners, has usually meant wearing a tie. But as concern over hospital-borne infections has intensified, doctors are taking a closer look at their clothing.

Click here to access the article.

The next surgical evolution?

From the Archives of Surgery article "Surgery Without Scars: Report of Transluminal Cholecystectomy in a Human Being":

Hypothesis Natural orifice transluminal endoscopic surgery (NOTES) provides the potential for performance of incisionless operations. This would break the physical barrier between bodily trauma and surgery, representing an epical revolution in surgery. Our group at IRCAD-EITS (Institut de Recherche contre les Cancers de l’Appareil Digestif [Institute of Digestive Cancer Research]–European Institute of TeleSurgery) has been actively involved in the development of NOTES since 2004 with a dedicated project created to develop feasibility and survival studies and new endoscopic technology.

Design NOTES cholecystectomy in a woman via a transvaginal approach.

Setting University hospital.

Patient The patient was a 30-year-old woman with symptomatic cholelithiasis.

Intervention The procedure was carried out by a multidisciplinary team using a standard double-channel flexible videogastroscope and standard endoscopic instruments. The placement of a 2-mm needle port, mandatory to insufflate carbon dioxide and to monitor the pneumoperitoneum, was helpful for further retraction of the gallbladder. At no stage of the procedure was there need for laparoscopic assistance. All of the principles of cholecystectomy were strictly adhered to.

Results The postoperative course was uneventful. The patient had no postoperative pain and no scars, and was discharged on the second postoperative day.

Conclusions Transluminal surgery is feasible and safe. NOTES, a radical shift in the practice and philosophy of interventional treatment, is becoming established and is enormously advantageous to the patient. With its invisible mending and tremendous potential, NOTES might be the next surgical evolution.

Click here to access the article (sub. req.). I think that if I needed my gallbladder out I'd still go laparoscopic.

'Bout time!

I remember when my stepfather had to be returned to the OR after heart surgery and I was surprised when he was charged for the additional OR time, etc. (hey, I was naive then). From the Boston Globe article:

About half of Massachusetts hospitals say they have adopted policies to waive charges for serious medical errors such as wrong-site surgery and harmful medication mistakes, and others say they plan to, amid growing resistance from government and health insurers to paying for poor outcomes.

Thirty-three of 61 hospitals recently reported to a national hospital-quality organization, The Leapfrog Group, that they have voluntarily stopped charging for 28 serious and rare errors, called "never events." But consumer groups, health insurers, legislators, and employers are pushing for more far-reaching and mandatory policies as ways to reduce errors, and hospital executives said they expect to forgo payments in an increasing number of cases, including those in which patients require additional treatment because they contracted an infection in the hospital or fell in their room.

Click here to access the article.

Jessica...

She must be a metaphor for something:

Click here to view the video.

Prescription drug labels

From the Archives of Internal Medicine article, "The Variability and Quality of Medication Container Labels":

Results We evaluated 85 labels after excluding 11 ibuprofen prescriptions that were filled with over-the-counter containers that lacked labels printed at the pharmacy. The pharmacy name or logo was the most prominent item on 71 (84%) of the labels, with a mean font size of 13.6 point. Font sizes were smaller for medication instructions (9.3 point), medication name (8.9 point), and warning and instruction stickers (6.5 point). Color, boldfacing, and highlighting were most often used to identify the pharmacy and items most useful to pharmacists. While the content of the main label was generally consistent, there was substantial variability in the content of instruction and warning stickers from different pharmacies, and independent pharmacies were less likely to use such stickers (P < .001). None of the ibuprofen containers were delivered with Food and Drug Administration–approved medication guides, as required by law.

Conclusions The format of most container labels emphasizes pharmacy characteristics and items frequently used by pharmacists rather than use instructions or medication warnings. The content of warning and instruction stickers is highly variable depending on the pharmacy selected.

Click here to access the article (free full text).

Gee, do you think they'll look at any CME activities?

From the Wall Street Journal article:

Drug maker Cephalon Inc. sent letters to doctors this week warning them that several deaths have been linked to Fentora, its powerful narcotic to treat acute cancer pain.

Fentora and its predecessor, Actiq, are approved by the Food and Drug Administration only for use in cancer patients, but they are often prescribed by physicians "off-label" for such ailments as headaches and back pain.

Cephalon denies marketing the two drugs outside their indication, but its marketing practices are under scrutiny in three separate probes: investigations by the U.S. attorney in Philadelphia and the Connecticut attorney general, and a congressional probe into off-label treatments.

Click here to access (sub. req.).

Latest FDA news on anemia drugs

From the Wall Street Journal article:

A Food and Drug Administration advisory committee stopped short of supporting a clear-cut new limit on kidney-failure patients' use of the blockbuster anemia drugs made by Amgen Inc. and Johnson & Johnson, but members split over what doses of the medications are appropriate.

Click here to access (sub. req.).

PDA and brain-injured veterans

From the News Observer article:

Troops who lose limbs in Iraq are fitted with sophisticated replacements such as computer-controlled legs. Now, some of the thousands who have returned with brain injuries are getting a prosthetic for the mind -- a personal digital assistant that serves as their short-term memory.

"If I couldn't use it, I basically wouldn't be able to function," said Master Sgt. Tony Wisyanski, an 82nd Airborne Division paratrooper based at Fort Bragg.

Wisyanski suffered a brain injury and other wounds Oct. 1, 2006, in Iraq when his Humvee was struck by two rocket-propelled grenades. While he was being treated at a brain-injury center in Virginia, a speech pathologist ordered a PDA for him. Among other things, he programs it to beep an audio alert to remind him about appointments and to record phone numbers.

You'd think at least one of these companies would step up and donate PDAs to these veterans. Click here to access the article.

Hospitalist trends...are you in the know?

From the Washington Post article:

Most hospitalists are internists; 11 percent are pediatricians. By 2010, SHM projects 30,000 hospitalists will be practicing. Medical students may soon choose which side of the hospital divide they want to work on: inpatient or outpatient. For now, it's your physician's choice whether to refer you to a hospitalist or to follow your inpatient care. If you have no primary care physician, a hospitalist will probably manage your hospital stay.

Although patients are often confused about the role of hospitalists, hospitals embrace the new model, nationally subsidizing $50,000 to $60,000 of the average hospitalist's $169,000 salary. Managed-care organizations, such as Kaiser, have established their own hospitalist practices. There is financial incentive to do so: Studies show hospitalists manage care more efficiently and reduce hospital stays. Hospitalists say they think that's because they order tests and procedures more promptly.

Shortening hospital stays is to the patient's advantage as well, said Frederick Finelli, chairman of the D.C. Board of Medicine.

Click here to access the article.

Sharp rise in adverse drug reactions

From the Wall Street Journal article:

The number of serious drug side effects and deaths reported to the U.S. Food and Drug Administration more than doubled over an eight-year period, according to an analysis of adverse-drug events reported to the agency.

As part of the agency's so-called MedWatch reporting system, drug companies, health-care professionals and the public can file reports when they think a drug is connected to a side-effect or fatality. Drug companies are required to file such reports while they are voluntary for health-care professionals.

A study, published in Monday's Archives of Internal Medicine, looked at reports that are considered serious from 1998 to 2005. The study was conducted by researchers at the Institute for Safe Medication Practices in Huntingdon Valley, Pa., and Wake-Forest University School of Medicine in Winston-Salem, N.C.

Click here to access (subscription required).

Federal law for disclosure of gifts/payments to physicians?

From the New York Times article:

Makers of drugs and medical devices would be required to report publicly nearly all payments and gifts to doctors under legislation introduced Thursday in the Senate.

“Right now, the public has no way to know whether a doctor’s been given money that might affect prescribing habits,” said Senator Charles E. Grassley of Iowa, the ranking Republican on the Senate Finance Committee and one of the bill’s authors.

Senator Herb Kohl, Democrat of Wisconsin, said drug and medical device makers had long defended their payments and gifts to doctors as appropriate.

“If that is the case, full disclosure will only serve to prove them right,” Mr. Kohl said.

Ken Johnson, senior vice president at the Pharmaceutical Research and Manufacturers of America, said, “A new law is not necessary when pharmaceutical marketing is already heavily regulated by the Food and Drug Administration.”

The F.D.A. does not regulate the gifts or consulting arrangements drug and device makers routinely provide doctors, and it reviews only a fraction of the scripted marketing talks doctors make on companies’ behalf.

Click here to read the entire article.

Interesting stuff over at the Carlat Psychiatry Blog!

Click here to read the 9/04/07 entry. Be certain to read the comment posted by James M. La Rossa Jr.

Need for CME on Biostats?

From the Science Daily article:

Donna M. Windish, M.D., M.P.H., of the Yale University School of Medicine, New Haven, Conn., and colleagues conducted a multiprogram assessment of residents' biostatistics knowledge and interpretation of research results. The study consisted of a cross-sectional survey of 277 internal medicine residents in 11 residency programs. The survey included a biostatistics/study design multiple-choice knowledge test.

...

"If physicians cannot detect appropriate statistical analyses and accurately understand their results, the risk of incorrect interpretation may lead to erroneous applications of clinical research. Educators should re-evaluate how this information is taught and reinforced in order to adequately prepare trainees for lifelong learning, and further research should examine the effectiveness of specific educational interventions."

Click here to access the article.

Teen smoking

From the Archives of Pediatric & Adolescent Medicine:

Exposure to Smoking Depictions in Movies

Its Association With Established Adolescent Smoking

James D. Sargent, MD; Mike Stoolmiller, PhD; Keilah A. Worth, PhD; Sonya Dal Cin, PhD; Thomas A. Wills, PhD; Frederick X. Gibbons, PhD; Meg Gerrard, PhD; Susanne Tanski, MD

Arch Pediatr Adolesc Med. 2007;161:849-856.

Objective To assess the association between exposure to movie smoking and established adolescent smoking.
...
Conclusion In this national US adolescent sample, exposure to smoking in movies predicted risk of becoming an established smoker, an outcome linked with adult dependent smoking and its associated morbidity and mortality.

Click here to read the entire abstract.

JAMA Medical Education Theme Issue

There are a number of interesting articles in the latest issue of JAMA. Click here to access.

A parachute story

Please read today's entry on Medinnovation.blog: "Know Who is Packing Your Parachute"

The "Swiss cheese effect"

From the HeraldTribune.com article:

Two major advances that have improved health care -- abundant, specialized medications and powerful new technology -- also create new possibility for errors.

"The likelihood of error goes up with the more steps there are," said Frances Griffin, a director of the Institute for Healthcare Improvement.

The nonprofit group, known as IHI, won acclaim for its "100,000 Lives Campaign" in 2005 to reduce medical errors.

To all that, add in that doctors are susceptible to the same "classic human factors," Griffin said: "If we have to rely on memory for something, if we're distracted by something, if we have to do several things at once."

She and Krumholz both cited the "Swiss cheese effect."

The concept arose from studying aviation errors, and in recent years has been applied to health care. The thinking goes: A block of Swiss cheese has a lot of holes. But only rarely do they line up so you can see all the way through. When they do, a mistake makes its way through to the patient.

This article also discusses one physician who is very transparent about a surgical error that he made. Click here to check it out.

What about physician privacy?

From the recent press release:

Consumers’ CHECKBOOK/Center for the Study of Services, a nonprofit consumer research and information organization, has won a Freedom of Information Act lawsuit that will require the U.S. Department of Health and Human Services to release data on every physician claim paid by Medicare. The data to be released will identify physicians but will not make possible identification of patients.

“Consumers, physicians, and the Medicare program itself will benefit greatly when these data are used in measures of physician experience, quality, and efficiency,” said Robert Krughoff, president of CHECKBOOK/CSS.

As a first use of the data, the consumer organization will create a resource, free to the public, on its www.checkbook.org website, that will report the number of various types of major procedures performed by each physician and reimbursed by Medicare, “so a consumer selecting a physician for a knee replacement or prostate surgery or other major procedure will be able easily to check that a physician has an appropriate level of experience,” said Krughoff.
CHECKBOOK/CSS

Might this not result in physicians "cherry picking" their Medicare cases so that they will build good stats?? Click here to access the full press release.

U.S. News & World Report ranks best hospitals

From the most recent issue:

In July, America's Best Hospitals turned 18. From the very first, U.S. News has ranked hospitals in pediatrics, identifying medical centers that excel at helping the sickest young patients. We've heard reassuringly few complaints through the years that one or another of the ranked hospitals might not merit such distinction.

Still, improving the usefulness and relevance of the rankings in this important specialty has been a long-standing goal. Mortality data and other information factored into various adult specialty rankings cannot be obtained for children's hospitals. In pediatrics, therefore, the rankings have always relied solely on a facility's reputation among an annual sampling of board-certified physicians in various pediatric specialties. We've long wanted to move beyond reputation.

Click here to read the entire article.

ACCME issues policy updates

Click here to access.

Washington state's "decade of pain"

From the Healthdecisions.org article:

Ten years ago, the state of Washington began a major push to make sure doctors weren't undertreating pain. The change was revolutionary for people dealing with chronic pain, but it was also a boon for drug dealers and those with addiction problems.

Between 1997 and 2005, the percentage of people using five major painkillers rose 96 percent in Washington state, according to an Associated Press analysis of statistics from the Drug Enforcement Administration.

Oxycodone, commonly known as Oxy Contin, is responsible for most of the increase in this state. Use of oxycodone increased by 500 percent between 1997 and 2005. Use of morphine and hydrocodon, commonly known as Vicodin, also have increased dramatically: morphine by 223 percent and hydrocodon by 166 percent.

I can personally understand the good intentions of this major effort in the state of Washington for adequate treatment of pain. A few years back I was suspected of seeking pain medication (that was before the x-rays came back). Click here to access the article.

Real Age

According to the Real Age test, I'm 13 years younger than my "calendar" age and I'll live to be 90. I know nothing about the scientific accuracy of this test, so you should probably think of it as entertainment. That said, it might get you thinking about your lifestyle choices. Click here to access.

Gist artistry in silver and gold

Okay, this is the last Friday for a while on Gist artists (don't worry, we're growing up some more of them). This week I'm highlighting the artistry of my cousin, Gary, and his sons over at Gist Silversmiths:

Click here to access their website.

On-site ACCME monitors?

Well, it hit the WSJ's Health Blog:

In a recent conversation with the Health Blog, Kopelow said ACCME will likely start sending auditors to CME lectures. “We could have trained monitors observing CME presentations and reporting their findings to us,” to see whether the presentations are straying from the rules, he said. The group hasn’t yet decided whether the monitors would work undercover.

CME providers that step out of line might find themselves facing sanction more quickly and more often. Providers now have several years to clean up their act, and only one provider or so a year loses its accreditation. “The Senate and others have said we don’t … have as heavy a hand as we could. The ACCME is going to talk about that,” Kopelow said.

The way money passes from drug and device companies to CME providers could also change, Kopelow said. Now, a provider applies to a company for funding, and the company decides whether to grant the request.

Click here to access.

New study from the Center for Studying Health System Change

From the news release:

The proportion of physicians in solo and two-physician practices decreased significantly from 40.7 percent in 1996-97 to 32.5 percent in 2004-05, according to a new national study released today by the Center for Studying Health System Change (HSC).

Changes in physician practice setting and organization have important implications for the practice of medicine and the care patients receive. Some experts believe that large, multispecialty practices, which combine primary care physicians and a range of specialists in the same practice, are the organizational structure with the greatest potential to provide consistently high-quality care.

Despite the shift away from the smallest practices, physicians are not moving to multispecialty practices, the study found. The proportion of physicians in multispecialty practices decreased from 30.9 percent to 27.5 percent between 1998-99 and 2004-05.

While growth of multispecialty practices stalled, other significant changes in physician practice settings and organization took place over the last decade—more physicians moved to larger practices and more physicians gave up an ownership stake in their practices. Physicians increasingly are practicing in mid-sized, single-specialty groups of six to 50 physicians (17.6 % of physicians in 2004-05 vs. 13.1 % in 1996-97). At the same time, the proportion of physicians with an ownership stake in their practice declined from 61.6 percent in 1996-97 to 54.4 percent in 2004-05.

Perspective?

It's Friday and you should be looking forward to the weekend! The artist?...my nephew, Erik Gist. You can access Erik's website by clicking here. Be forewarned, it's not for the faint of heart!

Breast implants and higher suicide rate

From the Los Angeles Times article:

The report in the August issue of the Annals of Plastic Surgery was the most recent to detect a higher suicide rate among women who had their breasts enlarged, providing a gloomy counterpoint to other studies that showed women felt better about themselves after getting implants.

While the study did not look at the reasons behind the suicides, senior author Joseph McLaughlin, a professor of medicine at the Vanderbilt University School of Medicine, said he believed that many of the women had psychological problems before getting breast implants and that their condition did not improve afterward.

Duh. Click here to access the article.

ACCME Responds to Senate Committee on Finance Report

Click here to access.

"New Prescriptions for Neglected Diseases"

That's the title of a new article just published in Open Medicine. From the article:

Consider that, between 1975 and 1999, only nine medicines of the 1393 that were developed targeted the most neglected diseases. (This figure rises to 16 if one considers tuberculosis and malaria.3) Of the remaining 1377 medicines developed, only two made the World Health Organization’s Model List of Essential Medicines. All 16 new medicines for neglected diseases did. In the ensuing five years, an additional 163 drugs were brought to market, of which four were for the treatment of malaria and one targeted a neglected disease—the drug miltefosine for treatment of leishmaniasis.

Click here to read the entire article.

Bibliotherapy

From the Wall Street Journal article:

A growing number of therapists are recommending something surprising for depressed and anxious patients: Read a book.

The treatment is called bibliotherapy, and it is gaining force from a spate of research showing that some self-help books can measurably improve mental health. In May alone, the journal Behaviour Research and Therapy published two studies demonstrating the effectiveness of bibliotherapy in patients with depression or other mood disorders. The national health system in Britain this year is prescribing self-help books for tens of thousands of people seeking medical attention for mood disorders.

Decades after the emergence of the self-help book, it remains one of publishing's hottest categories. This year, U.S. revenue for the category will exceed $600 million, a single-digit jump from 2006, says Simba Information, a market research firm in Stamford, Conn.

Click here to access the article (sub. req.).

Meadow Gist, Artist

Check out a painting by Meadow Gist:


Click here to access Meadow's website!

Alcohol and drugs

Came across an interesting website with an online newsletter. Looks like it is the result of a collaboration between Boston University, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. Check it out if you are looking for needs assessment data on alcohol and drug use/abuse. Physicians could probably also use it for self-directed learning! Some articles in the most recent newsletter:

• Unhealthy Alcohol Use and the Preventive Paradox
• Drug Use Disorders: Onset, Mental Health Impairment, and Comorbidity
• Why Don't Primary Care Clinicians Screen Teens for Substance Abuse?
• Coordinated Treatment for Hepatitis C in Injection Drug Users

There are also slide presentations available! Click here to access.

Low health literacy and mortality

From the Archives of Internal Medicine article "Health Literacy and Mortality Among Elderly Persons":

Conclusions Inadequate health literacy, as measured by reading fluency, independently predicts all-cause mortality and cardiovascular death among community-dwelling elderly persons. Reading fluency is a more powerful variable than education for examining the association between socioeconomic status and health.

Click here to access the journal abstract. Click here to access a lay article on this study.

Minnesota hospital suspends patient privacy violators

From the StarTribune.com article:

More than 100 Park Nicollet Clinic employees have been suspended this year for violating federal laws on patient privacy -- mostly by tapping into electronic records of relatives or friends, according to clinic officials.

This week, the clinic notified its 8,300 employees about the suspensions as a reminder of what it calls its "zero tolerance policy" on confidentiality. Already, twice as many employees have been disciplined for privacy violations in 2007 than in all of 2006, officials say. They were suspended without pay for three days.

Click here to access the article.

Physician shortage

From the New York Times article:

The government estimates that more than 35 million Americans live in underserved areas, and it would take 16,000 doctors to immediately fill that need, according to the American Medical Association. And the gap is expected to widen dramatically over the next several years, reaching 24,000 in 2020 by one government estimate. A 2005 study in the journal Health Affairs said it could hit an astonishing 200,000 by then, based on a rising population and an aging work force.

Click here to access the article (reg. req.).

Prescription for change?

Check out this Boston Globe article "Tests of ER trainees find signs of race bias in care"; from the article:

In the new study, trainee doctors in Boston and Atlanta took a 20-minute computer survey designed to detect overt and implicit prejudice. They were also presented with the hypothetical case of a 50-year-old man stricken with sharp chest pain; in some scenarios the man was white, while in others he was black.

"We found that as doctors' unconscious biases against blacks increased, their likelihood of giving [clot-busting] treatment decreased," said the lead author of the study, Dr. Alexander R. Green of Massachusetts General Hospital. "It's not a matter of you being a racist. It's really a matter of the way your brain processes information is influenced by things you've seen, things you've experienced, the way media has presented things."

Specialists predict that the novel study, appearing on the website of the Journal of General Internal Medicine, will result in considerable soul-searching in the medical profession, rethinking of medical school curriculum, and refresher courses for veteran doctors.

Click here to access the article.

A bad bug

From the Archives of Surgery:

Main Outcome Measures The prevalence, case fatality, total mortality rate, and colectomy rate of C difficile colitis.

Results We found that the prevalence, case fatality, total mortality rate, and colectomy rate of C difficile colitis increased from 1993 through 2003. In our regression analysis, the year of diagnosis predicted an increase in prevalence, case fatality, total mortality rate, and colectomy rate after adjusting for potential confounders.

Conclusions The prevalence, case fatality, total mortality rate, and colectomy rate of C difficile colitis significantly increased from 1993 to 2003. These findings provide compelling evidence of the changing epidemiological features of C difficile colitis.

Click here to access the Archives of Surgery (subscription required for full article). Click here to read a Boston Globe article on this bad bug.

Physician impairment?

From the Miami Herald article:

Doctors' problems are usually closely held secrets in the healthcare industry and can persist for years before becoming public with any disciplinary action.

Click here to read more.

Disabilityblog.info

Check out the work of my fellow blogger, Rudy, over at disabilityblog.info. This site is a great news feed on a wide variety of disability topics. Per Rudy, it is:

...intended both for people with disabilities and those who wish to learn about disability issues. The main goal of this web site is to raise disability awareness and understanding. It's a place where people can do research on disability issues. I also wanted it to be a place where people can share experiences and help each other.

CME Providers, bookmark it! Click here to access Rudy's blog. Blessings!

Gap in clot risk knowledge?

From the United Press International:

One out of three U.S. hospital patients is at risk for dangerous blood clots, but far fewer actually receive treatments to prevent the potentially life-threatening condition, according to a study released this week.

"Blood clots are the most common preventable cause of death in hospital patients. It is profound and puzzling: Why is there a preventable issue that people are dying from?" Frederick Anderson, a research professor in the Department of Surgery at the University of Massachusetts Medical School and director of the Center for Outcomes Research, told United Press International.

Deep venous thromboembolism, a blood clot in the deep vein of a leg or arm, can occur when people are immobilized for two or three days, such as after surgery. The condition is treatable but if ignored, may become deadly if the blood clot travels to the lung.

It is estimated that 5 percent to 10 percent of hospital deaths are due to blood clots that travel to the lungs, also called a pulmonary embolism.

Click here to access the article.

The patient's perspective

From the Boston Globe article:

When the ambulance arrived, the self-assured nurse was suddenly on the other side of her profession, depending on hulking EMTs to pound life back into her. She suffered a massive heart attack and it took 12 shocks of a defibrillator to stabilize her.

Eaton recently told her story to a rapt audience of doctors and nurses in a crowded conference room at Winchester Hospital. Over coffee and buzzing beepers, the point was to use Eaton's experience to review "best practices" and how to cope with trauma from a patient's point of view.

Click here to access the article.

Triskaidekaphobia

Say what!? Yep, it means fear of the number 13.

ACCME Annual Report 2006 available

Total hours of instruction:

2006: 712,163
2005: 678,528

Total commercial support:

2006: $1,199,405,519
2005: $1,115,597,071

Exhibit income:

2006: $244,913,684
2005: $235,721,224

Click here to access the report.

Proceduralists

From the Wall Street Journal article:

With a steady decline in the number of doctors trained to perform such skills-intensive medical procedures in recent years, Cedars and other large academic medical centers are looking for ways to fill the gap. They are creating special procedure services and new procedure-training programs for medical residents. Teams of doctors known as proceduralists are now available at some centers with special expertise in tunneling a catheter into a vein, slicing an incision in the neck for an airway, or plunging a needle into a patient's back for a spinal tap.

While not a medical specialty in its own right, procedural medicine is emerging as an important new role for physicians with the manual dexterity and steady nerves to perform risky procedures. And hospitals say they see reduced complication rates when services are performed by physicians who are very well-versed in the procedures.

Click here to read the article (subscription required).

Thirteen horses and diphtheria

I love medical history; from the New York Times article, "Long Ago Against Diphtheria, the Heroes Were Horses":

The Claremont Riding Academy, on the Upper West Side of Manhattan, shut its doors for good a few months ago. As the oldest continuously operated stable in New York City, it reached back to an era when horses were as common as taxis are today, and it prompted thoughts of some of New York’s most heroic horses: the 13 beasts of burden used in 1894 to produce the miracle drug of their day, diphtheria antitoxin.

The horses and their successors were stabled for nearly two decades at the New York College of Veterinary Surgeons, on East 57th Street and Third Avenue. Initially joined by a few sheep, goats and dogs, the horses prevailed because they were larger and better antitoxin factories: when systematically injected with diphtheria toxin, their immune systems were prompted to develop neutralizing antibodies against the germ’s poison. (Most survived the injections with nothing more than a fever and loss of appetite, but over the years quite a few horses succumbed to even tiny doses of toxin.)

Click here to read the entire article.

University of Pittsburgh Medical Center and gifts from indusry

From the www.post-gazette.com article:

The University of Pittsburgh Medical Center has drafted a get-tough policy that would prohibit its physicians and other employees from accepting almost all freebies -- from sample medications to pens and notepads -- from drug and medical device companies.

Industry influence can result in "unacceptable conflicts of interest," the draft says, adding that financial support or gifts, even in modest amounts, "can exert a subtle but measurable impact on recipients' behavior."

Click here to access the article.

Palliative Care

I encourage every CME professional to read the Washington Post article "A New Focus on Easing the Pain"; an excerpt:

A 12-year-old boy, struggling to understand why dialysis could no longer keep his father alive, reflected on how fast he outgrew his sneakers. "I'm the size of a man -- size 11. I don't want my feet to grow any more," he said, unaware, perhaps, of how well his imagery called up his preparation to step into his father's shoes as the man of the family.

Click here to access.

Health Data Tools and Statistics

Have you ever wished there was one place on the web where you could access health statistics and public health data? Where there is, you'll find it at Partners in Information Access for the Public Health Workforce which is the result of a collaboration of U.S. government agencies, public health organizations and health sciences libraries. Click here to access; there's even an online tutorial and training manual.

A blow to DTC advertising?

From LegalNewsline.com:

Drug companies cannot escape liability for harmful prescriptions in West Virginia by laying all responsibility on doctors, the West Virginia Supreme Court of Appeals ruled Wednesday.

Three of five Justices denied a writ that would have kept Marshall Circuit Judge Mark Karl from holding trial against Janssen Pharmaceutica.

They upheld Karl's rejection of a doctrine that would define a doctor as a "learned intermediary" between a drug maker and a patient.

Chief Justice Robin Davis treated the doctrine as a useless 82-year-old relic.

"When the learned intermediary doctrine was developed, direct to consumer advertising of prescription drugs was utterly unknown," she wrote. "Pharmaceutical manufacturers never advertised their products to patients, but rather directed all sales efforts at physicians."

She wrote that the law created an exception to the duty of a manufacturer to warn consumers directly of risks.

"For good or ill, that has all changed," Davis wrote. "... we now hold that, under West Virginia products liability law, manufacturers of prescription drugs are subject to the same duty to warn consumers about the risks of their products as other manufacturers."

Click here to read the entire article.

Gift registry?

From the New York Times article:

In the midst of a Senate hearing about the money and gifts that drug makers routinely provide to doctors, Senator Claire McCaskill mentioned that she had a brother who runs a restaurant.

“And he said that the most lucrative part of his business was the private room that is used mostly by drug companies” to entertain doctors, said Ms. McCaskill, Democrat of Missouri. “He said that you wouldn’t believe how much expensive wine these guys buy.” The tab often totals thousands of dollars, she said later.

Marjorie Powell, senior assistant general counsel for the Pharmaceutical Research and Manufacturers of America, assured Ms. McCaskill that major drug makers no longer offer doctors expensive dinners. The industry’s code of ethics mandates that free meals be modest — pizza, for instance, Ms. Powell said.

Click here to access the article.

G'day mate?

From the Sydney Morning Herald article:

The pharmaceutical industry was dealt a bitter blow this week when a three-member panel headed by Justice Robert French ruled that Medicines Australia, the industry body covering more than 90 per cent of drug companies in Australia, could only continue to self-regulate its code of conduct if all drug companies twice a year forwarded complete information on hospitality: the venues, the number and types of professionals invited, the total cost of food, travel, accommodation and entertainment. This information would be published on a freely accessible internet database.

Click here to access the article; interesting reading.

And now, the Senate Special Committee on Aging

From the Washington Post article:

For doctors, though, drug company funding "makes it very difficult to know what research to believe," said J. Gregory Rosenthal, an Ohio retinal surgeon and a founder of Physicians for Clinical Responsibility, a group pushing for tighter controls on conflicts of interest in medicine. "Even at the [specialty] academy level, you can't go onto a Web site without being confronted by sponsorship logos."

Rosenthal will testify today in a hearing before the Senate Special Committee on Aging, which is looking into physician links with the drug industry. Sen. Herb Kohl (D-Wis.), the chairman, said the commercial sponsorship of courses creates a conflict of interest.

"It appears that everyone profits from this pervasive system of gifts and payments, except the consumer," Kohl said.

The hearing marks the second time this year that the Senate has examined the independence of industry-sponsored continuing education. In April, a Senate Finance Committee study found that the Accreditation Council for Continuing Medical Education, the main accrediting body for education providers, does not scrutinize course materials for accuracy or evidence of bias toward sponsors' products. At times, sponsors have been able to select topics, and presenters have discussed off-label uses for drugs, the report found.

The article goes on to quote Murray Kopelow, ACCME CEO. Click here to access the article.

Injuries and surgeons in training

From the New York Times article:

Nearly all surgeons accidentally stick themselves with needles and sharp instruments while in training. But most fail to report the injuries, risking their health and that of their families and patients to the threat of diseases including AIDS, hepatitis and many other blood-borne illnesses, according to a survey being published today.

Their being rushed was the chief reason the surgical residents cited for the injuries, which were mostly self-inflicted. Among the reasons they cited for not reporting the potentially fatal injuries was that doing so would take too much time, could jeopardize career opportunities and might cause a loss of face among peers.

In addition, there was a false belief that getting even timely medical attention would not prevent infection. In fact, immediate treatment with antiviral drugs can prevent infection among those stuck with needles while caring for patients with the viruses that cause AIDS and hepatitis B. Immediate treatment can also prevent chronic infection among those infected with hepatitis C virus.

Click here to access the article. Click here to access the New England Journal of Medicine source article.

Shrinks and pharma dollars

From the New York Times article:

As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty.

How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Click here to read the entire article.

Teletrauma

From an interesting article in the Arizona Daily Star:

A new live two-way video link between University Medical Center and the city's 17 paramedic units is expected to put Tucson at the cutting edge of medical technology when it goes online in August.
The system allows real-time videoconferencing over the city's public safety and public works wireless Internet system — a wireless mesh that links the city's traffic signals and other public safety wireless functions.
Dr. Rifat Latifi, interim medical director of UMC's Level 1 trauma center, said the video link will be the first of its kind in the country and the world.
"We think it's an incredible thing," Latifi said. "Wherever a patient is, we're there."

Click here to access the article.

The Joint Commission 2008 National Patient Safety Goals

From the Joint Commission's press release:

Major changes in this sixth annual issuance of National Patient Safety Goals include a new Requirement to take specific actions to reduce the risks of patient harm associated with the use of anticoagulant therapy, and a new Goal and Requirement that address the recognition of, and response to unexpected deterioration in a patient’s condition. The new anticoagulant therapy Requirement addresses a widely-acknowledged patient safety problem and becomes a key element of the Goal: Improve the safety of using medications. It is applicable to hospitals, critical access hospitals, ambulatory care and office-based surgery settings, and home care and long term care organizations. The new Goal and Requirement respecting the deteriorating patient will ask hospitals and critical access hospitals to select a suitable method for enabling care-givers to directly request and obtain assistance from a specially-trained individual(s) if and when a patient’s condition worsens. Each of the foregoing new Requirements has a one-year phase-in period that includes defined milestones. Full implementation is targeted for January 2009.

Click here to read the press release; click here to access the 2008 National Patient Safety Goals.

A squirt of hope

Why should we care about the environment and all those species of flora and fauna upon the earth? Well, one reason is that one of them might save your life someday. From a science blog:

A toxin derived from a humble sea squirt, Ecteinascidia turbinata (pictured, right), shows great promise as an anti-cancer drug. This toxin, known as trabectedin (ecteinascidinin-743), shrinks and even completely removes cancerous tumors in more than half of the patients treated with it, according to a new study. The patients treated with this drug suffered from a specific type of liposarcoma cancer, which is associated with chromosomal mutations. Liposarcomas are a rare but malignant tumor that grow in the fat cells in deep soft tissue, such as inside the thigh or within the abdominal cavity.

Dr Federica Grosso, from the Sarcoma Unit of the Instituto Nazionale Tumori in Milan, Italy, and her colleagues from sarcoma centers in Boston, London, Lyon and Paris, conducted this study. Out of 51 patients with myxoid liposarcomas that were treated only with trabectedin, they found that two had their tumors disappear completely (complete response) while another 24 experienced at least a 30% shrinkage of their tumor (partial response), representing an overall response rate of 51%.

Click here to read the blog entry. This study will be published in the July issue of The Lancet Oncology.

Six innovations

Check out Doctor Richard L. Reece's essay "Six Innovations to Increase Productivity, Cut Costs and Extend Coverage." Briefly, they are:

1. Facilitating patient-physician information exchange as a key of productivity.
2. Introducing new, more focused and more productive medical specialties.
3. Lessons from retailers: Hidden in plain sight and DIG (Demand-First Innovation and Growth).
4. Demand for transparency with bundled services and bundled billing arrangements.
5. Chief innovation officers will become common.
6. Tax deductible insurance for everyone to extend coverage--with strings attached.

Click here to read more about these innovations; I especially like the Chief Innovation Officer concept (CIO has a nice ring to it).
:)

AHRQ State Snapshots

From the AHRQ website:

The State Snapshots provide State-specific health care quality information including strengths, weaknesses, and opportunities for improvement. The goal is to help State officials and their public- and private-sector partners better understand health care quality and disparities in their State.

State-level information used to create the State Snapshots is based on data collected for the National Healthcare Quality Report (NHQR).

Pretty interesting stuff! Look up your state and see how it's doing. Thanks to the SACME listserve for this information. Click here to access State Snapshots.

ACGME work rules

Yale-New Haven Hospital researchers studied the impact of the new work rules on length of stay, 30-day readmission rates and medication errors at their hospital. What did they find? An excerpt from the New York Times article:

The teaching services saw a decrease in transfers to the intensive care unit, a decrease in medication errors and an increase in discharges to home or rehabilitation. After adjusting for other variables, there was also a significant decrease in deaths. While drug interaction errors increased, they also increased on the nonteaching service, probably because of the addition of new interaction rules to the database.

Click here to read the NYT article. Click here to access the Annals of Internal Medicine abstract.

$1.3 TRILLION in pharma sales?

That's what PricewaterhouseCoopers predicts in worldwide prescription drug sales by the year 2020. But it looks like Big Pharma might need to change how they do business. From the San Francisco Chronicle article:

Pharmaceutical giants that stick with that blockbuster model will be edged out by nimble, innovative companies that tailor their drugs to specific patient populations and advance the standard of care, the report says.

If the current global drug market of $520 billion more than doubles by 2020, the rise will not necessarily make health costs unaffordable, Farino said. New drugs could be cost-effective if they work better, help patients avoid more expensive treatments or hospitalization, and save health insurance payers money in the long term, Farino said.

In the United States, prescription products accounted for 10.1 percent of the nearly $2 trillion spent on health care in 2005. Hospital spending claimed 33 percent of all expenditures, according to government figures cited by PricewaterhouseCoopers.

Do your CME activities routinely address pharmacoeconomics? Click here to read the entire article.

Army Medical Action Plan

From the U.S. Army's press release:

"As we've said before, the Army takes Soldier inpatient and outpatient care very seriously," said Army Chief of Staff Gen. George W. Casey Jr., "and remains firmly committed to returning our Soldiers to productive careers and lives. We have made improvements, but realize there is still work to be done - including work with the complex Medical Evaluation Board and Physical Evaluation Board processes. By no means is everything 'fixed' - but we are aggressively acting on what we can fix now."

Click here to access the press release (ten examples of immediate improvements are delineated).

Batter up?

The folks over the Commonwealth Fund have published a report on states relative to their health system performance ("access, quality, avoidable hospital use and costs, equity, and healthy lives"). From the Executive Summary of The State Scorecard:

The rich geographical diversity of the United States is part of its appeal. The diverse performance of the health care system across the U.S., however, is not. People in the United States, regardless of where they live, deserve the best of American health care. The State Scorecard is intended to assist states in identifying opportunities to better meet their residents current and future health needs and enable them to live long and healthy lives. With rising health costs squeezing the budgets of businesses, families, and public programs, there is a pressing need to improve performance and reap greater value from the health system.

The State Scorecard offers a framework through which policymakers and other stakeholders can gauge efforts to ensure affordable access to high quality, efficient, and equitable care. With a goal of focusing on opportunities to improve, the analysis assesses performance relative to what is achievable, based on benchmarks drawn from the range of state health system performance.

Click here to access the report.

Black and white?

Startling statistics from a study just published in JAMA; an excerpt from the www.cnn.com article:

Black people were 22 percent less likely to be transferred from a hospital that did not do such procedures to one that did, it found. And when they were, black people were 23 percent less likely to get these operations than white people, the researchers said.

In the first month after a heart attack, black people were 9 percent less likely to die than white people, the researchers said, perhaps because whites were more likely to undergo specialized procedures that sometimes can be fatal.

But in the period from a month to a year after the heart attack, blacks were up to 26 percent more likely to die than whites, the study found.

"I wished we knew what's going on," lead researcher Dr. Ioana Popescu of the University of Iowa Carver College of Medicine and the VA Medical Center in Iowa City said in a telephone interview.

The study was not designed to find the reasons for the disparities.

Click here to access the article.

The Carlat Report

Daniel Carlat, a professor at Tufts Medical School and the editor in chief of The Carlat Psychiatry Report sounds off in the New York Times:

The revelation that the diabetes drug Avandia can potentially cause heart disease is the latest in a string of pharmaceutical disappointments. Vioxx was pulled from the market in 2004 because it doubled the risks for heart attacks and strokes. Eli Lilly recently paid $750 million to settle lawsuits alleging that Zyprexa causes diabetes. Many have criticized the Food and Drug Administration as being too lax about monitoring drug safety.

While those criticisms have merit, there is another culprit: the transformation of continuing medical education into an enterprise for drug marketing. The chore of teaching doctors how to practice medicine has been handed to the pharmaceutical industry. As a result, dangerous side effects are rarely on the curriculum.

Always important to know what is being published in the lay press. Click here to access the article.

A new villain in healthcare?

The Pacific Research Institute (PRI), a think tank in San Francisco, conducted a study on health care regulation. An excerpt from the San Francisco Examiner article:

In other PRI examples: A group of surgeons is ready to invest in a clinic where they will perform only operations they specialize in, but the local acute-care hospital invokes state regulations blocking the competition. A privately insured individual wants to buy a low-premium catastrophic coverage policy while also starting a tax-exempt health savings account, but this option is unavailable under state insurance rules.

Click here to access the article.

Cap malpractice lawsuit awards and they will come

According to an article in the San Antonio Express-News, physicians are flocking to Texas:

The lower cost of being a doctor in Texas has helped trigger a stampede of applications for physician licenses, with the waiting line now up to 12 months.

Rates have fallen an average of 21.3 percent, and up to 41 percent at one insurance company, says former state Rep. Joe Nixon, a Houston trial lawyer who helped sponsor passage of Proposition 12.

An internal medicine doctor in Houston paid $18,507 for malpractice insurance in 2003 but only $13,272 in 2007, or $10,403 with a 20 percent renewal dividend, according to figures given to Nixon by the state's largest insurer, Texas Medical Liability Trust.

Apparently insurance companies are also moving to Texas since they can now "...put a numeric value on the risk of doing business in Texas, something that was not possible when the sky was the limit for juries." Click here to read this article.

New Chief Learning Officer at the American College of Cardiology

Congratulations to Joe Green, my mentor and colleague!! From the American College of Cardiology's website:

The ACC has selected Joseph S. Green, Ph.D., to serve as its chief learning officer. As the ACC’s newest vice president, Dr. Green will be responsible for shaping the College’s continuing medical education (CME) curriculum and directing the implementation of the ACC’s educational mission. Dr. Green was most recently founder and president of Professional Resource Network, Inc., a CME consulting firm. He has over 34 years of experience in medical education. He served as the associate dean of CME and associate clinical professor in the Duke University School of Medicine, and he was director of CME and vice president of educational affairs for Sharp HealthCare, an integrated health care system in San Diego. Dr. Green will begin his tenure at the ACC on Sept. 17.

"Just living is not enough... One must have sunshine, freedom, and a little flower."

So said Hans Christian Anderson. Click here to see some lovely photographs (I have no financial interest in these products and do not know this photographer, just sharing).