HAT TIP: @Bob_Watchter, @Rosskopel
What has Surveyor Health been up to?
Erick & Linda von Schweber started Surveyor Health around the time Health 2.0 started back in 2007, with the BHAG of massively improving medication safety using some very complex technology. And it has taken them a long time to embed themselves in the bowels of some huge health care organizations and to start getting traction. But it is finally happening and the impact may be substantial. I interviewed Erick and he gave me a comprehensive demo and update on their latest results. If you care about drugs and clinical care, this is compelling (if not lightweight!) viewing. (I suggest you switch to full screen for the demo).
We Spend More on Health Care Than Other Rich Countries but Have Worse Outcomes?
Here it’s argued that we need to retire the health care fallacy, “We spend more on health care than other rich countries but have worse outcomes.” The fallacy implies U.S. health care is deficient in spite of being costly. Indeed our health care costs too much, but there is little evidence that our care is less effective than care in other countries. On the other hand, there’s plenty of evidence that our social determinants of health are worse.
The argument segues off a recent article by Victor Fuchs. The case is presented by using a simple linear model to explore how life expectancy might change when we substitute the numbers of other countries’ determinants of health for U.S. numbers. After making these substitutions and holding health care spending constant the model predicts U.S. life expectancy is right there with the other OECD countries, 81.6 years compared to their average 81.4 years. This what-if modelling makes clear what should be obvious but the fallacy hides, that health care is only one part of population health.
The Fuchs Essay
Victor Fuchs’s recent essay1 impressed me. He wrote of the lack of a positive relationship between life expectancy and health care expenditures (HCE) in OECD countries. A chart was included for empirical support. I liked the idea behind the chart which demonstrated his point using data from select countries and our 50 states. Professor Fuchs has written on this topic for years (e.g., in his 1974 book “Who Shall Live?”). I posted on the fallacy in March 2013 but was not as nuanced.2
Flu Report: Providers Prescribing Antivirals at Higher Rate
Earlier this week, we reported on the current rates of influenza-like illness (ILI), based on data from roughly one million patient visits on the athenahealth network. That report showed a steep increase in ILI rates for the week ending Saturday, December 13 (see previous post). It’s not certain that this season will be as severe as that of 2012-2013 (data for pediatrics suggests that is a real possibility); however, providers are testing for flu more consistently than previous years, and prescribing antivirals more often.
Our data shows that the number of flu tests ordered, per patient visit in which ILI is diagnosed, has risen each of the past two years (Figure 1, graph A). This season, providers are ordering flu tests at a rate of 0.53 tests per visit with an ILI diagnosis, compared to 0.37 for last season and 0.34 for 2012-2013. (Note: There can be multiple tests per patient visit, e.g. Type A and B.)
I Have DCIS, Should I Have a Bilateral Mastectomy?
Benefit:
There is none. No women with DCIS have been included in a randomized controlled trial.
Harm:
Cosmetic outcomes are unclear; Second operations to fix the cosmetic outcome may be needed, but reasonable estimates for harm and complications do not exist as bilateral mastectomy has not been systematically studied in DCIS. A paper in Annals of Surgery found that out of 600 women at one institution, 42% of 209 women undergoing bilateral mastectomy had complications versus 29% of 391 women undergoing unilateral mastectomy (42-29% = 13%, added harm). Serious complications of bilateral mastectomy occurred in 14%; 4% with unilateral(14-4% = 10%, added harm).
Trade-off:
There is no trade-off between benefit and harm. Since there is no benefit, only harm is possible. Informed medical-decision-making requires a trade-off between added benefit and added harm. This is not the case for DCIS and bilateral mastectomy.
A Secret Playbook to Torment Doctors
A physician friend commented recently that he was being ‘meeting-ed to death’ and wondered if it was intentional. It turns out, he was on to something.
One of my colleagues has a neighbor whose sister’s piano tuner has a friend whose cousin is married to a nationally respected medical institution’s CEO. We were provided a copy of that institution’s management training course, on the condition that her identity not be revealed.
Here is the section on meetings:
Meetings as a Tool for Physician Control
Meetings are the ideal method for turning actively engaged and therefore troublesome physicians into apathetic sheep who are easy to manage.
Advice to Vivek Murthy: Be Nonpartisan, Use Common Sense and Move Americans
In defiance of dire predictions, children haven’t been sent to workhouses and women haven’t been chained to utensils after the GOP gained strength in the House and the Senate. And Vivek Murthy, the unabashed Obamaphile, was finally confirmed Surgeon General.
To be honest, I always thought the controversy surrounding Murthy’s nomination because of his stance on gun control was rather daft. Stopping doctors from pontificating over guns, such as the Docs versus Glocks legislation, is like banning me from trying to convert Pope Francis to Hinduism. The legislation is a parody not just for its own sake but because what it seeks to prevent is parody as well.
Murthy’s first challenge is to raise the position of the Surgeon General from that tokenism of a career UN bureaucrat to something vaguely useful. Which means Murthy must resist the call of banality, the banality of ideology and the ideology of making all of mankind’s imperfections public health problems.
CVS Health: Making Health More Affordable
[iframe src=”http://app.videostat.com/v3/iframe?publisher_id=92;video_id=3577;width=450″ width=”100%” height=”360″] More people are getting coverage…but there’s a shortage of doctors. So CVS Health is making health more affordable and accessible. With over 900 MinuteClinic locations for walk-in medical care, open nights and weekends.
#Whitecoats4Blacklives
At 3PM EST on December 10, 2014, medical and dental students at over 70 schools participated in the “National White Coat Die-In.” The event was organized on Facebook and spearheaded by students at University of California, San Francisco (UCSF) School of Medicine who described the event as “a demonstration in response to the events in Ferguson and New York because #BlackLivesMatter.”
Across the country, there have been numerous protests against the grand jury’s decision in Fergurson, Mo. not to indict officer Darren Wilson who shot and killed Michael Brown, an unarmed teenage boy. Similarly, in Staten island, NY, the grand jury decided not to indict officer Daniel Pantaleo who killed Eric Garner, an unarmed black man, using a banned chokehold.
The App Is the Outcome
Your correspondent is avidly learning about health apps for patients.
As described here, half of U.S adults now own a smartphone, half of them use them to obtain health information and approximately a fifth have at least one health app loaded on their device.
Regular readers are well aware of the potential for health apps, including lay-person education, the promotion of consumer behavior change, increased consumer-provider connectivity with greater access to care, better medication compliance as well as medication reconciliation, increased self-care, greater quality and lower costs.
But as this author’s e-health experience grows, he has encountered two under-recognized features of apps that – in his opinion – are sure to also drive their adoption:
1. The Provider App Arms Race: As competition for loyal patients grows, health systems, care organizations, insurers, buyers and provider networks are going to expect their apps to create greater consumer “stickiness.” For example, offering a tablet with a pre-configured app may enable hospitals to not only reduce readmissions, but enhance their brand recognition.
2. The App Is the Outcome: It will take years for science to prove that apps cause better outcomes. While lingering skepticism will prove to be another bonanza for outfits like this, the luster of smart-device gadgetry will be too much to resist. As a result, it’s only a matter of time until Boards and their CEOs pressure their management teams to launch their own app. While the electronic record and big data are important advances, let’s face it: they’re in the background. There’s nothing like a patient-facing app to remind customers, families and providers of the organization’s health tech chops.
Jaan Sidorov, MD, is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination. He shares his knowledge and insights at Disease Management Care Blog, where an earlier version of this post first appeared.
