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cindywilliams

Shifts in Humanitarian Aid: A Look at Post-Recession Data

Sep 8, 2011• 1

By SANJAY BASU, MD

A few agencies have recently published their concerns that the “double dip” recession will negatively affect humanitarian aid, even as the worst famine in decades continues to hit East Africa. Have aid levels really been affected by the recession? If so, which countries are likely to feel the most impact? What factors are shaping aid decisions? In this post, we look at the latest data from the OECD’s Development Assistance Committee (DAC), the definitive source for international humanitarian aid data, and discuss the changes in aid that have transpired since the start of the 2007 recession.

Overall trends

If humanitarian aid shifts during this recession, such a shift would be a new phenomenon; when we investigated global aid trends during prior recessions, we found that aid usually didn’t significantly change during or soon after economic downturns, probably because foreign assistance is such as small part of government budgets, and because aid changes are often driven by disasters and conflicts rather than supply-side politics alone.

The first graph above depicts global humanitarian aid from 2006 to 2009 (all graphs are courtesy of GHA; note that the colors in this graph are incorrect for the last column, which should be black on top and green on the bottom). As shown in the graph, humanitarian aid actually increased a bit during 2008, likely reflecting commitments made before the recession. But aid then decreased 11% to $15.1 billion in 2009. The 2010 numbers won’t be released until later this year. The available figures refer to forms of aid that reach “delivery agencies” such as United Nations subsidiaries, non-governmental organizations and the Red Cross. Of note, while the 2008 contribution from governments is smaller than 2007, it still remains higher than earlier years. Of particular interest is that private donations have increased almost 50% since 2006 and have remained steady during the recession.

The Cleveland Experiment

Sep 6, 2011• 8

By JOHN MOORE

There have been a number of research studies published that question the value of Electronic Health Records (EHRs), particularly as it pertains to improving quality of care and ultimately outcomes. Chilmark has always viewed these reports with a certain amount of skepticism. Simple logic leads us to conclude that a properly installed (including attention to workflow and thorough training) of an enterprise software system such as an EHR will lead to a certain level of standardization in overall process flow, contribute to efficiencies and quality in care delivery and ultimately lead to better outcomes. But to date, there has been a dearth of evidence to support this logic, that is until this week.

Last week the New England Journal of Medicine published the research paper: Electronic Health Records and Quality of Diabetes Care, which provides clear evidence, albeit a little fuzzy around the edges, that physician use of an EHR significantly improves quality metrics over physicians who rely on paper-based medical record keeping processes.

The research effort took place in Cleveland as part of Better Health Greater Cleveland from July 2009 till June 2010 and included 46 practices representing some 569 providers and over 27K adults with diabetes who visited their physician at least twice during the study period. Several common quality and outcome measures were used to assess and compare EHR-based care to paper-based. On composite standards of quality, EHR-based practices performed a whooping 35% better than their paper-based counterparts. On outcome measures, which are arguably more difficult for physicians as patients’ actions or lack thereof are more integral to final outcomes, EHR-based practices still outperformed their paper-based peers by some 15%. The Table below gives a more detailed breakout.

New Research Finds EHRs Improve the Quality of Diabetes Care

Sep 6, 2011• 3

By RANDALL D. CEBUL, MD

Two years ago in an address to Congress, President Obama declared his commitment to invest in electronic health records (EHRs), saying he thought it was perhaps the best way to quickly improve the quality of American health care. Just two years later, that hunch is proving true in Cleveland, Ohio.

New EHR Research Findings:

This week, the New England Journal of Medicine released research authored by my colleagues and me at Better Health Greater Cleveland showing that physician practices that use electronic health records had significantly higher achievement and improvement in meeting standards of care and outcomes in diabetes than practices using paper records.

Though most of us assumed EHRs would have some effect on patient care, we were delighted by what’s proving to be the reality in greater Cleveland. Just consider:

Care is better: Nearly 51% of patients in EHR practices received care that met all of the endorsed standards.

Only 7% of patients at paper-based practices received this same level of care– a difference of 44%.
After accounting for differences in patient characteristics between EHR and paper-based practices, EHR patients still received 35% more of the care standards.
Just fewer than 16% of patients at paper-based practices had comparable results.
After accounting for patient differences, the adjusted gap remained 15% higher for EHR practices.

Continue reading…

The Wonks Are Wrong

Sep 1, 2011• 50

By RICHARD REECE, MD

I’ve heard critics express the idea a thousand times in a thousand ways.

The idea goes like this:

The system is terrible. It is fragmented. It is inefficient. It is too costly. It relies too much on specialists. Patients with chronic disease see too many over-paid specialists who don’t talk to each other. What we need is more well-paid primary care practitioners. They will provide accessible, continuous, comprehensive, coordinated, connected-electronically, and patient-centered rather than specialist-centered, care.

The Shadow

The problem is between the idea and reality falls a shadow. Patients aren’t listening.

They prefer the choice and freedom of picking their own doctor. In many cases, this doctor is a specialist who treats their specific problem. Patients feel they have enough information to make their own decisions as to what physician to choose. The American public is specialist-oriented. This is why the typical Medicare patient with chronic disease sees 5 or 6 specialists a year, rather than going through a personal primary care doctor who directs their over-all care

Lessons Learned from Steve Jobs

Aug 30, 2011• 1

By JOHN HALAMKA, MD

I recently spoke with several reporters about Steve Jobs’ impact on healthcare, thanking him for the past 15 years of innovation. In preparing for those interviews, I reviewed Steve’s career milestones,

In 1997, Apple Computer was in trouble. Its sales had declined from 11 billion in 1995 to 7 billion in 1997. Its energies were focused on battling Microsoft. It had lost its way.

Steve Jobs made these remarks at MacWorld 1997, a few months before becoming Apple’s CEO. He outlined a simple go forward plan:

1. Board of Directors
2. Focus on Relevance
3. Invest in Core Assets
4. Meaningful Partnerships
5. New Product Paradigm

How can we apply these 5 ideas to the work we’re doing in HIT?

It’s clear that Health Information Exchanges across the country are in trouble – CareSpark closed its doors, the CEO of Cal eConnectresigned, and Minnesota Health Information Exchange ceased operations.

How to Avoid Death in the ICU

Aug 26, 2011• 7

By ELAINE SCHATTNER, MD

Something I learned as a medical intern is that there are worse things than dying.

As I recall, it was sometime in April, 1988. I was putting a line in an old man with end-stage kidney disease, cancer (maybe), heart failure, bacteria in his blood and no consciousness. Prince was on the radio, loud, by his bedside. If you could call it that – the uncomfortable, curtained compartment didn’t seem like a good place for resting.

An attending physician, a smart guy I respected, approached me as I completed the procedure.

“It’s kind of like Dante’s seventh circle,” he noted.

Indeed. A clear, flexible tube drained greenish fluid from the man’s stomach through his nose. Gauze covered his eyes, just partially. His head, hands and feet swelled with fluid. A semi-opaque hard-plastic instrument linked the man’s trachea, through his paper-taped mouth, to a noisy breathing machine. His skin, barely covered by a stained hospital gown, was pale but blotchy from bleeding beneath. An arterial catheter inserted by his wrist, just where I might have taken his pulse had he been healthier. A fresh adhesive covered the cotton gauze and brownish anti-bacterial solution I’d placed over his lower right neck.

“Yeah,” I said as we walked out of the room to review another patient’s chart.

The Untold Obama Administration Success Story

Aug 26, 2011• 14

By MERRILL GOOZNER

One wonders what the Obama administration has to do to get a little credit. I’m sitting on vacation, looking at the ocean most of the day, and spending about a half hour on line at night erasing unread emails, killing out unread RSS feeds, and checking up on my declining retirement prospects. Amid the clutter, a series of press releases from the Inspector General of the Health and Human Services Department caught my eye. Here are the headlines, with links (I’d link to the press coverage, but near as I can tell, there was none):

Miami-Area Doctor Pleads Guilty in $25 Million Health Care Fraud Scheme

Owner of Miami-Area Mental Health Care Corporation Convicted on All Counts for Orchestrating $205 Million Medicare Fraud Scheme

Miami-Area Medical Equipment Company Owners Sentenced to Prison for Medicare Fraud Scheme

That was Tuesday. On Monday, the HHS sleuths put out this press release:

FORMER CHAIR OF TEMPLE’S OPHTHALMOLOGY DEPARTMENT CONVICTED OF HEALTH CARE FRAUD

PHILADELPHIA – A federal jury today convicted Dr. Joseph J. Kubacki, 62, of Destin, Florida, of 150 counts of health care fraud, wire fraud, and making false statements in health care matters, announced United States Attorney Zane David Memeger. Kubacki was the Chairperson of the Ophthalmology Department of the Temple University School of Medicine and also served as the Assistant Dean for Medical Affairs when, between 2002 and 2007, he caused thousands of false claims to be submitted to health care benefit programs with false charges totaling more than $4.5 million for services rendered to patients whom Kubacki did not personally see or evaluate. A sentencing hearing has not yet been scheduled.

Work Hour Restrictions – A Painful Gift to Medicine

Aug 25, 2011• 2

By VIPAN NIKORE, MD

When I completed my overnight shift and left the Medical ICU the morning of July 1, I raised my arms victoriously. I uttered, “Finally, internship is done!” I may have been one of the last to speak such words.

As of July 1, 2011, intern year forever changed. In the world of medicine the first year of residency, or intern year, is when doctors earn their stripes. Traditionally it is the most demanding year in a decade-long quest to become a practicing physician. But this year, the Accreditation Council of Graduate Medical Education (ACGME) mandated that interns can no longer work more than 16 hours straight, and must have 10 hours off between shifts. Second- and third-year residents can still work 28-hour shifts, but no more 30-hour shifts for interns.

To the outsider, this may seem like a common sense change that would only improve patient safety. Within the medical field, however, this change is arguably the most controversial in the history of medical education.

Advocates believe these duty-hour modifications will decrease medical errors and improve unacceptable working conditions for residents. ACGME officials still believe that residents should be able to handle the vigorous hours and workload, but believe launching the least experienced physicians — new interns — into those demanding conditions just days after medical school is inappropriate and unsafe. As well, the general public generally favors the new changes.

The Emperor Remains Unclothed

Aug 23, 2011• 33

By PAUL LEVY

I guess I shouldn’t be surprised when two of the architects of the health care reform act write an op-ed that continues in the deception that the law would deliver access, choice, and lower costs. But that is what Ezekiel Emanuel and Jeffrey Liebman offer in their New York Times article, “Cut Medicare, Help Patients.”

The authors start by saying some things that make a lot of sense. They point out that it would be smart to “eliminate spending on medical test, treatments and procedures that don’t work — or that cost significantly more than other treatments while delivering no better health outcomes . . . [and that} can be made without shortchanging patients.”

But they quickly give up that fight: “The sad truth is, Washington is never going to do a good job of making smart cuts to Medicare. Elected officials hate being blamed for directly restricting access to medical treatments — even when those treatments are proven to be worthless.”

So then they revert to their underlying bias, er, theology: “The responsibility for ending unnecessary medical spending needs to be placed in the hands of doctors and hospitals. This can happen only if we change our fee-for-service payment system.”

And What Happens if the Individual Mandate is Struck Down?

Aug 23, 2011• 4

By ROGER COLLIER

An alarming article in Politico.com looks at what could happen if the Supreme Court determines that the Affordable Care Act’s individual mandate provision is unconstitutional—something that the current conservative leaning of the Court seems to indicate is somewhat more likely than not.

Assuming that such a possible decision by the Court follows that of the Eleventh Circuit Court of Appeals in ruling that the mandate is unconstitutional but the remainder of the ACA may stand, the Politico.com article anticipates some potentially disastrous consequences.

The provisions of the ACA—some of them already in force—include guaranteed issue, elimination of annual and lifetime limits, and a ban on basing premiums on health status, essentially decoupling coverage and premiums from insurance risk. Without the requirement for almost everyone to have coverage, there will be nothing to ensure that the risk pool contains a large percentage of individuals in good health as well as those with medical problems, and nothing to stop anyone from waiting until they’re sick or injured to demand coverage.