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Tag: Sarah Arnquist

Comparing the Effectiveness of Comparative Effectiveness Research

An increased investment in comparative effectiveness research to gather additional evidence on what medical therapies and technologies work best is often cited as a fix for the nation’s rising health costs.

Unfortunately, lessons from its use abroad and in the U.S. show that this dramatically overstates its benefits as a cost-containment tool.

Comparative effectiveness research entities, such as England’s National Institute for Health and Clinical Excellence (NICE) and Germany’s Institute for Quality and Efficiency in Health care (IQWiG), have not led to decreased national health spending on new technologies. NICE recommendations are thought to account for 10 percent of the increase in England’s health costs.

And as Tara Parker Pope reminded us this week in her NY Times Well column, the uptake and adoption of the evidence, which is just as important as the research, varies widely among physicians.

While it hasn’t always been called comparative effectiveness research, the U.S. has plenty of evidenced-based guidelines for physicians and has a long, sordid history with technology assessment (another name for CER).

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A glimpse of what might have been: Palin announces Alaska health goals

PalinAlaska Gov. Sarah Palin announced plans last week to improve Alaskans’ health.

Palin supports expanding Denali Health, the State Children’s Health Insurance Program, to families earning twice the federal poverty level. Expanding the program would make an additional 1,300 children and 225 pregnant women eligible for coverage, The Anchorage Daily News reported.

Palin’s plan also includes creating a Web site  called "Live Well Alaska" "to offer suggestions in
such health-related areas as diet and exercise as well as tips to quit
smoking."

The hockey mom governor also wants to dedicate an additional $2 million in preschool, $250,000 toward early diagnosis of autism, and establishing a state health commission to further work.

The Daily News says Palin has some "good ideas," but should go further toward universal coverage and recruiting additional primary care doctors to Alaska.

Nudging the value glacier

In just two years, seniors will spend a quarter of their monthly Social Security checks on Medicare out-of-pocket expenses, including premiums, co-payments and deductibles.Meanwhile, Medicare bookkeepers predict total health spending in the U.S. to increase from 2.2 trillion today to 4.3 trillion in 2017.

At that rate of growth, it won’t be long before the entire Social Security check goes toward medical care. So what’s the solution?

Barry Straube, CMS chief medical officer, said the solution is transforming Medicare into an active purchaser that seeks to get more bang — in terms of high quality care and improved health — for its buck.

In health care lingo, that’s called value-based purchasing – the topic of a two-day conference put on by the ECRI Institute that Straube,and other health care bigwigs attended this week in Washington D.C.

“Medicare should be paying for care that promotes health, prevents complications, optimizes quality and efficiency, and keeps health care costs down,” Straube said. “… We have a system that arguably is based on resource consumption and volume irrespective to the value associated with that care.”

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Extracting more value from the health care dollar

Americans spend more money on health care than any other nation, but get far less in return, say multiple health care executives in Sunday’s  Washington Post.

That’s not news to readers of this blog, but probably is not yet common knowledge among the general American taxpayer. That might change. The news media seems to be writing about this "value gap" more frequently, particularly in citing the growing momentum behind creating a center for comparative effectiveness research to evaluate drugs, devices and treatments to find out what works best.

Defining and measuring value is not easy, but increasingly public and
private health care purchasers are using their market power to demand higher quality care. Whether the science is
ready to support this "value-based purchasing" is the topic at the ECRI Institute’s annual conference today and tomorrow. (I’m attending the conference and will report on it tomorrow.)

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Up in smoke

Taxing cigarettes is the single-most effective way to lower smoking rates, particularly among youth. And if we could lower smoking rates, we’d save hundreds of thousands of lives and billions of dollars each year.

Good Magazine demonstrates this strong correlation on a state-by-state basis in a fantastic interactive graphic. Go check it out.

Goodmagazinesmoking_2

In a related matter, I heard Matt Myers, president of Tobacco Free Kids, recently predict a federal cigarette tax increase to fund SCHIP. He said there’s strong bipartisan support, particularly to fund an expansion of children’s health coverage.

Battling MRSA with transparency

Two weeks ago, I made an emergency trip home to Minnesota because my grandmother fell ill. She went to the emergency room on a Sunday night, complaining of fatigue and shortness of breath.

The emergency physician diagnosed her with pneumonia and admitted her for the night. Two days later, she was transferred to the intensive care unit and put on a ventilator. My grandma is only 74, healthy and energetic. Her rapid decline shocked my family.

My grandma, however, had not been taking good care of herself since her husband died three weeks earlier. He had many health issues, but at the end, died of MRSA pneumonia. My grandmother slept by his side, caring for him daily during his last days.

No one from the nursing home hospice program or the hospital warned my grandma about the seriousness of this drug-resistent staph infection. No one suggested she take precautions to protect herself or that she be tested as a carrier.

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Is Joe the Plumber responsible for our health care mess?

The financial collapse in the United States and the long, deep recession the nation will likely endure may be the calamitous event needed to finally tip the country toward adopting a universal health insurance, according to Uwe Reinhardt.

The Princeton health economics professor told students at Johns Hopkins School of Public Health last week that thanks to the Wall Street CEOs health care reform may be a possibility. They finally proved the free market can’t succeed without some government regulation and helped drive the U.S. and world into the greatest financial disaster since the Great Depression.

“I think people will realize that government has a role,” Reinhardt said. “Government is of you, it’s your creation. How can you hate your government like that? If you read the paper sometimes you’d think the government came from Mars and is occupying you.”

Then, Reinhardt expressed his deep-rooted anger at Joe the Plumber, and other “rugged individualists” who profess a hatred for government. They say no one has the right to tell them to buy insurance, but when they’re sick, they declare the “right” to lifesaving medical care.

“You chip in when you’re healthy so when you’re sick you get care,” Reinhardt. “If you don’t want to pay insurance than you should absolve me from the moral responsibility to provide care.”

Sick neighborhoods raise sick people

I live and study public health in Baltimore, a city in which one-third of its children live in poverty, another two-thirds live in single-parent families, and more than a third of students drop out of high school.

Not coincidentally, Baltimore has an infant mortality rate nearly twice that of the nation, its teen birth rate is higher than the national average, and people here live shorter lives, especially minorities and low-income residents, than their counterparts just a few miles away in the suburbs.

This is a sick city. Literally blocks of houses are boarded up – dead and rotting with crime, hopelessness and fear. If you think I’m being melodramatic, watch the HBO drama The Wire. It’s a pretty accurate portrayal.

<a href="http://www.buzzdash.com/index.php?page=buzzbite&BB_id=122624">Are health connections to poverty &amp; education adequately recognized?</a> | <a href="http://www.buzzdash.com">BuzzDash polls</a>

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The treadmill-desk mashup goes primetime

Could walking at a tortoise pace all day long in the office keep you thin or help you lose weight?

Many people seem to think so and have built themselves treadmill desks — basically a treadmill with a raised platform for their computer and phone. Moving at less than 1 mile per hour all day long helps them burn between 250 and 350 calories a day. Don’t believe me? See this New York Times article. (Illustration by Eric Lister, from Gelf)

A couple of years ago, when I wrote a story about people using treadmill desks for the online magazine Gelf, the phenomenon was just beginning to surface on personal blogs. It’s clearly taken off. (David, the Gelf editor who assigned me the story, now has is own treadmill desk.)

There’s actually a lot of science behind the idea of work-walking, which comes mostly from the Mayo Clinic. Dr. James Levine and his team published research in Science back in 2005 showing that thin people tend to fidget and move around more often than overweight people, thus burning more calories. They call it NEAT— Non-exercise Activity Thermogenesis.

Two years ago, Levine, an endocrinologist, told me that he wanted this idea to go beyond a few individuals. He wanted corporations to embrace the idea, or at least promote practices that get employees moving more.

We’re a fat nation, and our evolutionary biology combined with our current environments practically guarantee we remain so unless we adopt some creative interventions. This definitely is a step in that direction.

Wonder if your doctor is laughing at you?

That CNN headline grabbed my attention and got me to read a column that basically chastises the 17 percent of internal medicine residents who reported they had laughed at patient in a survey published in JAMA.

The author then goes on to express great relief that 94 percent of those who find humor in their patients considered it unprofessional behavior.

Lighten up! Of course, no doctor — or any professional for that matter — should laugh in a patient or client’s face or use humor maliciously. That’s basic human decency.

But humor is a release, and in a work environment as stressful as a
hospital, people need a release. Maybe that release should occur
outside the hospital walls, but funny things occur in stressful
environments and people do strange things that often merit a chuckle or
two.

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