The Health Care Blog – Page 621 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

What We Talk About When We Talk About Nursing Shortages

Jul 20, 2012• 5

By David Glenn

Not so long ago, the air was filled with dire warnings of an impending nursing shortage. By 2020, according to one widely-cited analysis, demand might exceed supply by as many as 800,000 nurses.

That analysis was made in good faith, and it was based on not-crazy extrapolations from thirty years’ worth of economic data.

But in many local labor markets in 2012, there’s no sign of a shortage. In fact, in some regions there’s evidence of a glut. A few months ago, the California Institute for Nursing & Health Care announced that 43 percent of people who received nursing degrees in California and 2010 and 2011 were not working as nurses.

I’m going to try to make some dimly-informed comments about the nursing labor market in the next few posts. But first, a few words about what it means to say that there is (or isn’t) a nursing shortage.

In this context, “nursing shortage” is used in an unsentimental labor-economics sense. A nursing shortage exists when employers are actively trying to hire additional nurses but are rubbing against supply constraints, as evidenced by:

rapidly rising wages
mandatory overtime
heavy use of temporary “agency” nurses to fill gaps on units
a greater-than-usual willingness to hire nurses with little experience or limited training
new investments in nurse-replacing technology
desperate 3 am phone calls from hospital administrators to college presidents, begging them to launch new nursing programs

To say that there is no nursing shortage today is not to say that all hospital units are adequately staffed for patient safety and decent quality of care. There is plenty of reason to believe that patients would be better off if hospitals invested in stronger nurse-patient ratios.

For America’s “Best Hospitals,” Reputation Doesn’t Hold as Much Weight

Jul 18, 2012• 3

By Molly Gamble

U.S. News and World Report has released its annual lists of the best hospitals in America, but this year the rankings were based more on performance data and less on reputation.

U.S. News and World Report began rating hospitals in 1990 when clinical data comparing hospital performance didn’t exist, according to a blog post written by Avery Comarow, senior writer and health rankings editor for U.S. News. As a result, the first editions of the list were solely based on the hospitals’ reputations. The media outlet began turning away from reputation-based rankings in 1993 when it added mortality, nurse staffing and other objective measures that reflected patient care.

That focus on performance data has continued to grow. In fact, for 12 of the 16 specialties in the latest edition of Best Hospitals, more than 65 percent of a hospital’s ranking depends largely on clinical data, most of which is from the federal government. Hospitals in the four remaining specialties — ophthalmology, psychiatry, rehabilitation and rheumatology — are ranked solely by their reputation among specialists.

U.S. News says it took steps to strengthen its reputational rankings this year, including a modification that reduced the likelihood of hospitals with the highest number of physician nominations to “bob toward the top” of rankings. As a result, this “took some of the juice out of high reputational scores” and placed more emphasis on objective, clinical data. The media outlet said some hospitals that made it to the top may not have any reputational score at all — their inclusion is based wholly on clinical performance.

Unleashing An Epidemic: Florida Gov Rick Scott Shows The Folly Of Cutting Safety Net Hospital Funding

Jul 18, 2012• 10

By David Whelan

When Florida voters elected Rick Scott back in 2010 they may have thought they were getting a health care expert. After all, his claim to fame was building the largest for-profit hospital company. Boy were they wrong.

The list of Scott’s public health missteps are vast–such as trying to gag doctors from discussing guns with patients, taking credit for refusing to perform abortions at his old company, trying to shut down a monitoring database that would keep pain pill addicts from getting more prescriptions, and pushing the sale of the state’s public hospitals to buyout funds to raise money to close the deficit.

But this latest one may be the most tragic. In March Governor Scott moved to close A.G. Holley hospital, a small 100-bed safety net institution specializing in tuberculosis. The Palm Beach County public hospital had operated for 60 years. Closing it saved only $5.4 million, which is what its costs were last year. Scott justified the closure saying that TB cases had dropped by 10% in recent years.

Hospitals Finding Patients On Google and Facebook

Jul 18, 2012

By Phil Galewitz

When the University of Pennsylvania Health System sought new patients for its lung transplant service last year, it turned to Facebook and Google.

The results of the $20,000 advertising campaign on the websites exceeded administrators’ expectations.

During a few weeks in August and September, more than 4,600 people clicked on the ads and 36 people made appointments for consultations. One of those is now on the hospital’s lung transplant waiting list, and several others are being evaluated, hospital officials say. While the response may seem small, each transplant brings in about $100,000 in revenue.

“We wanted to test the theory of how successful a digital marketing campaign could be,” said Suzanne Sawyer, the health system’s chief marketing officer. “It was like looking for a needle in a haystack,” she said, noting only about 60 lung transplants are done each year in Philadelphia, where the health system is based.

How One Man Wound Up Deciding the Fate of Healthcare Reform

Jul 17, 2012• 17

By Maggie Mahar

Personally, I am delighted that Chief Justice Roberts voted to uphold the Affordable Care Act. But, I am troubled that the fate of U.S. healthcare turned on one man’s opinion. This is not how things are supposed to work in a democracy.

Healthcare represents 16 percent of our economy. It touches all of our lives. If we don’t like the laws our elected representatives pass, we can vote them out of office. The Supreme Court, on the other hand, doesn’t have to worry whether its decisions reflect the will of the people. The Justices are appointed for life. This is why they are not charged with setting public policy.

How then, did the Court wind up with the power to affirm or overturn the ACA?

The media shapes our expectations

As I suggested when oral arguments began back in March, a “media narrative” drove the case to the Court – a fiction that caught on, in the press, on television, and in the blogosphere, where it began to take on a reality of its own. A handful of “state attorneys general and governors” saw “a political opportunity” and floated the idea that the law might be unconstitutional. The media picked up the story, repeated the heated rhetoric, and “fanned the flames … Before long, what constitutional experts thought was a non-story became a Supreme Court case.”

Palo Alto Medical’s Innovation Center Announces Seed Funding for Accelerator Program

Jul 16, 2012• 1

By Hemali Thakkar

Through the linkAges™ Developer Challenge and Accelerator Project, the Palo Alto Medical Foundation’s (PAMF) David Druker Center for Health Systems Innovation (IC) is inviting teams to create innovative solutions to help seniors age successfully.

First place winners of the three-month Developer Challenge will not only win $5,000,
but also will be invited to join the PAMF Innovation Center Accelerator, a six-month
incubator designed to refine and integrate the winning solution into the linkAges
ecosystem for rapid implementation within the PAMF community. Second and third
place winners will receive $3,000 and $2,000, respectively.

The IC is excited to make two announcements of importance of its Developer Challenge
initiative, being run in partnership with Health 2.0:

First, the IC is pleased to announce that seed funding is available and aimed at
supporting daily team activities through the 6-month accelerator phase. The winning
team can now focus on developments and delivering results. The level of funding
will be subject to negotiation, and will be made available by an investment in the IP
created by the team.

Second, the IC is excited to announce a partnership with HP Cloud from Hewlett
Packard. By way of sponsorship, participants signed up for this Challenge can gain
free access to the HP Cloud services/technical support as well as access to HP
Cloud Compute, HP Cloud Object Storage, HP Cloud Block Storage, HP Cloud
CDN. These allow the custom build of virtual servers, define access settings to local
and remote services, and create and store data in the cloud.

Who Said EHRs Can’t Talk To Each Other?

Jul 16, 2012

By Margalit Gur-Arie

When the hypothetical naked, unconscious and alone patient presents at your ER with no immediately evident reasons for his distress and presumably holding his driver license between his clenched teeth, would you find it helpful if you could see a nicely typed, or hand written, list of diagnoses and current medications for this hapless person?

When a family moves across the country and brings in their eight year old for her first visit with the new pediatrician, would it be helpful to see a slightly fuzzy image of her immunizations list from back home?

When an elderly patient you’ve been seeing for umpteen years is shipped to the hospital in the middle of the night, would it be helpful to find the admission record in your to-do list for today?

Perhaps these things would be nice to have, but EHRs can’t talk to each other, so before any of these miracles can occur we must make EHRs communicate.

How do we make EHRs talk to each other? That’s simple: we look at how people talk to each other, and apply the same principles to EHRs. Thus, EHRs have to share the same language, use the same syntax, know when to speak and when to listen, and when not in physical proximity, use a variety of paraphernalia to carry voice over large stretches of land and sea. And since EHRs are really computers and this is after all the 21st century, we have the blueprint for a solution in our hands, because any computer in Papua New Guinea can talk to any computer in Boonville, Missouri. How? By using the magic of the Internet.Continue reading…

Clinical Trials for Beginners

Jul 16, 2012• 8

By Judy Stone, MD

Have you ever wondered about what goes on behind the scenes—how new drugs are magically produced and brought forth? We’ll continue to take the mystery out of clinical research and drug development and to provide background information so that both patients and physicians can make more informed decisions about whether they wish to participate in clinical trials or not.

Why care?

To develop a medicine, from the time of discovery of the chemical until it reaches your drug store, takes an average of 12-15 years and the participation of thousands of volunteers in the process of clinical trials (Fig 1).

Very few people participate in clinical trials—it is even less than 5% for patients with cancer—due to lack of awareness or knowledge about the process. We’ll go into detail about how drugs are developed in later posts.

An inadequate number of volunteers is one of the major bottlenecks in drug development, delaying the product’s release and usefulness to the public. Of course, many people may suffer or even die during this wait, if they have an illness that is not yet otherwise treatable. So if you want new medicines, learn about—and decide if you wish to participate in—the process. I have, as a volunteer subject, researcher, and advocate.Continue reading…

How Useful Is Personal Genomics? A Case Study

Jul 16, 2012

By Seth Roberts

How much can you help yourself by getting your genome sequenced?

A lot, a little, not at all?

Scenario 1 (big help): You discover you have a greatly elevated risk of Disease X. You do various things to reduce that risk that actually reduce it.

Scenario 2: (a little help): You discover you have a greatly elevated risk of Rare Disease X. You do various things to reduce that risk but they don’t help. At least, when Disease X starts, you will be less upset.

Scenario 3 (no help): You discover that you have a greatly elevated risk for a common easily-noticed disease (such as obesity). You already watched your weight, this changes nothing. Scenario 4 (harm): You discover that you have a greatly elevated risk of Scary Disease X (e.g., bipolar disorder). It is depressing news. Later studies show that the gene/disease association was a mistake. (Many gene/disease associations have failed to replicate.)

A recent Wired article tries to answer this question for one person: Raymond McCauley, a bioinformatics scientist who had his genome sequenced four years ago and learned he was “four or five times more likely than most people to develop age-related macular degeneration (AMD)”. The article says “of all the ailments described in the 23andme profile, AMD has one of the strongest genetic associations”. If I found this in my genetic profile, I would want to know the confidence interval of the increased risk. Is it a factor of 4.5 plus or minus 1? Or 4.5 plus or minus 8? This isn’t easy to figure out. In addition to the question of variability, there can easily be bias (= estimate is too high). Let’s say I do 100 gene/disease association studies.

Gregory House, MD, RIP

Jul 15, 2012• 14

By Robert Wachter, MD

Dr. Gregory House hung up his stethoscope and cane for the last time last night and shuffled off into eternal life in the Land of Reruns. House — the brilliant, misanthropic, drug addicted, my-way-or-the-highway physician — has been an entertaining presence on FOX television for the past eight years. I enjoyed the series and even learned a little medicine. I also took some pride in the show, since House was television’s first hospitalist, a term I helped coin and now the fastest-growing specialty in modern medicine.

But as entertaining as he was, House was a throwback to an era in which the antisocial tendencies of some physicians were seen as irrelevant to their doctoring. As medical leaders strive to redefine “the great doctor” of today, House’s departure is both timely and welcome.

When I went to medical school in the 1980s, many of us valued nothing more than our autonomy. We saw medicine as an individual, not a team, sport, and interpreted professionalism as unwavering advocacy for our patients. While this was often healthy and noble, in some cases it crossed the line into obnoxiousness, even rage. (Today, we call doctors who cross this line “disruptive physicians.” Dr. House would certainly qualify.)