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"People who teach about population health underscore relatively few important areas that are powerful determinants of health: eating, moving, sleeping, smoking and stress. Paying attention to these things can go a long way towards maximizing health and could dramatically reduce health care expenditures in the bargain. But it's hard to change behaviors, and cultural changes will only come slowly." – Dr. Todd Sorensen, CEO of Regional West Medical Center, Nebraska
Imagine, for a moment, if we expected passengers to "have a dialogue" with airline pilots prior to a flight. Is this something we'd consider admirably "passenger-centered?" What about "patient empowerment" materials which ask patients to confront caregivers who don't wash their hands? It's a bad turn of events when we ask patients to ask providers to avoid dirty hands and unnecessary care...
New research in the journal Cancer
finds that Medicaid recipients are more likely to undergo cancer screening tests when their doctors receive higher reimbursements for routine office visits rather than for the tests themselves.
The first blog post I wrote about a Canadian doctor who was "diagnosing poverty" received more than 3,000 hits. I wanted to circle back to see whether or not the program had taken root. Indeed it has. "It's been a wildfire effect," Dr. Gary Bloch told me. Why can't the U.S. follow suit?...
When choosing a hospital, pay little attention to advertisements, testimonials from sick patients, boosterish stories based on press releases, or wisdom-of-the-crowd comments you find on consumer rating websites. Look for reports that measure a hospital's quality – only these can offer clues to the kind of care you might get...
Getting support from a chronic care coordinator increases blood-glucose testing and foot and eye exams in people with type 2 diabetes, but it may not improve blood-sugar control, a new study in the journal Health Services Research
Why are patients sometimes less than forthcoming? The top reason, according to a new survey, is fear of being lectured or feeling embarrassed. If doctors want their patients to be honest, they need to make an effort of their own to create a trusting, non-threatening environment that encourages patients to open up...
New research in the Journal of Adolescent Health
finds that when a young person moves from pediatric care to an adult practice, the transition is eased and better care is provided when formal processes are in place for the handoff.
As narrower insurance networks begin to limit where we can get our care and contradict the American notion of abundant choices, I thought about the Canadian health care system and rumors of its long waiting lists that grab U.S. headlines. Yet, narrow insurance networks, sky-high deductibles, co-insurance and co-pays are ways of controlling our medical expenditures. Instead of rationing with waiting lists, America rations with price...
We'd all like to believe that the average physician would have some clue about a medical crisis happening within a family she's been caring for during the past three decades. But it ain't necessarily so. If you've ever been discharged from a hospital by one doctor only to later be readmitted to the hospital under a different doctor's care, you may be surprised to learn that those doctors are not likely talking to each other...
A new report, "The Politics of Patient Harm: Medical Error and the Safest Congressional Districts," is an alarming reminder that the 200,000 or more preventable medical errors in U.S. hospitals remain stubbornly high and dangerously under-addressed. In early 2013, CFAH's founder and president, the late Jessie Gruman, challenged readers about the crisis: "It is needlessly killing a lot of people and those who have the responsibility to stop it have not made meaningful progress... Are you outraged? If not, why?"...
Colorectal cancer, or CRC, is the second-leading cause of cancer deaths in the United States. State public health programs could screen nearly eight times as many individuals and prevent nearly twice as many CRC cases by using fecal immunochemical testing, or FIT, instead of colonoscopies, finds a new study in Health Services Research
Ninety-one percent of doctors are concerned about giving patients access to their detailed electronic health records, anticipating patients will feel anxious about the results. Only 34 percent of consumers are concerned about anxiety-due-to-EHR-exposure. Welcome to the digital health chasm, the gap between what consumers want out of digital health and what doctors believe patients can handle...
I have complicated feelings about prescribing for chronic pain. On one hand, I recognize that relieving headaches, backaches, arthritis and nerve pain has been a core responsibility of the medical profession for ages. On the other hand, deaths and emergency room visits from overdoses of prescription painkillers have skyrocketed. I believe that addiction is a disease. So why do I find my patient's lies so hard to forgive?...
When a woman is in labor, the appropriate time to give an epidural during childbirth is when she asks for it, suggests a new review in The Cochrane Library
A friend of mine suddenly learned the importance of patient engagement a few weeks ago when a matter affecting his pocketbook grabbed his attention. For the last several years the mantra has been "buy generics" as a way to lower the cost of drugs for consumers but also for the nation. For a while insurers did that. Not anymore...
My friend Jane is quite a perfectionist, at least usually. I was almost certain that if she was having work done on her kitchen, she would be getting competitive bids, asking for references and reviewing vendors. But not for her shoulder surgery. Perhaps we need a concise mantra for what it means to be a health care consumer...
As many as half to two-thirds of women who’ve undergone hysterectomies or are older than 65 years report receiving Pap tests for cervical cancer, despite recommendations against it, finds a new study in the American Journal of Preventive Medicine
It's truly a dilemma for the doctor. The patient's test results are back and the news isn't good. But it's Friday afternoon and there's a decision to make: Call the patient now or wait until Monday?
A new cross-sectional study in American Journal of Preventive Medicine
finds that only half of adults in the U.S. were screened for diabetes within the last three years, less than what is recommended by the American Diabetes Association (ADA).
Jessie Gruman's Viewpoint article in the July 2014 issue of the American Journal of Nursing reflected many of the thoughts and experiences I have had as a parish nurse. "Discharge planning should start on the day of admission" is something that every nurse has heard, but I don't think I have seen that in practice at all!
Pregnant women who felt pressured to have a labor induction or cesarean section by their obstetrical care providers were significantly more likely to have these procedures, even if there was no medical need for them, suggests a new study in Health Services Research
American health care has become a gigantic game board with players of all sorts strategizing to win. Winning, of course, means getting more money from payers...
My 77-year-old parents were recently impacted by a medical error. The good news is that the story ends happily. The bad news is that it could have been averted simply by checking the date on lab tests...
Checklists are routine in other professions to standardize management, and we know they can prevent hospital infections and surgical error. But can there be a downside to checklist medical care? Consider these two examples...
Older adults who experience a serious fall may develop symptoms of post-traumatic stress disorder (PTSD) in the days following the event, finds a study published in General Hospital Psychiatry
"At the end of the day, there is a growing recognition that we need people to take better care of themselves. Too much money is being spent on the consequences of unhealthy choices and on health care. We don't think that patient engagement is just the flavor of the week. The concept of how we can take more responsibility for our health and health care is not going away." – Janice Prochaska, PhD, President and CEO of Pro-Change Behavior Systems in South Kingstown, RI
Just a few years ago it seemed that advocates for health care transparency had scored a big victory. The Centers for Medicare and Medicaid Services (CMS) announced that they would rate nursing homes by awarding five stars to the best and fewer stars to lower-quality facilities. It turns out, though, that five-star nursing homes may not be delivering five-star quality...
I am writing this post while seated comfortably in a motorized leather recliner with a window view and lots of other perks. What a legacy we would leave Saskatchewan citizens if we could figure out how to extend this first-class patient care to all patients and their families wrestling with chronic disease...
Not long ago, the only options my patients had for communicating with me were to come in to the office or relay a message through the office staff. But since recently introducing the patient portal in our electronic medical record, my practice has changed substantially for the better...
"There's a prevailing attitude on the side of clinicians that looking for and using [our own] information is not good behavior on our parts. I think that attitude is a big barrier; people don't want to be seen as troublemakers for asking too many questions, disagreeing with a clinician, or bringing information to the table." – Kelly Young – Patient Advocate, President of the Rheumatoid Patient Foundation, and Founder of Rheumatoid Arthritis Warrior blog
My new doctor and I clashed in every way. The short story is that I found another doctor who was a better fit for my "patient style." So what can you learn from my experience? First off, here are two questions you should ask yourself...
A new study in the Journal of Adolescent Health
has found that one in five young adults with chronic illnesses said the transfer of their care from pediatrics to adult-oriented health care was unsatisfactory.
That the government overpays sellers of Medicare Advantage plans is well known in Beltway circles, even if much of the public remains unaware…
One thing seems to be sure in medicine: if we just wait long enough for excellent science to guide us ahead, things we trust as ironclad rules often change. Case in point...
As I sat on a New York subway one sizzler of a day, an ad for an ice cream cone grabbed my attention. After a closer read, I realized the ad was not touting ice cream but the Center for Advanced Digestive Care, a part of New York Presbyterian, one of the city's most prestigious hospitals and well known for its TV ads designed to cultivate brand recognition. The ice cream cone was an effective attention-grabber. So was the message…
Veterans who receive mental health screening during primary care visits are generally getting adequate follow-up treatment, but the process for acquiring care could be improved, finds a new study in General Hospital Psychiatry
When you ask patients what quality is most important in a physician, they often answer "empathy." I think that's close, but not quite right. I know many "nice" and "supportive" doctors who have poor clinical judgment. When it comes to excellent care quality, one personality trait stands out to me – something that we don't spend much time thinking about...
A recent study in Health Services Research
based on 15 years of hospital data suggests that cuts in Medicare prices under the Affordable Care Act may slow the growth in overall hospital spending.
The privacy issues around data flowing out of credit card swipes, social network check-ins, digital health trackers' apps and smartphone GPS geo-location functions are thorny, especially for health – where HIPAA protections don't extend. Here are two real and documented stories from people whose "digital dust" was collected without their knowledge...
I just got off the phone with a very upset patient who discovered that her pharmacy has been giving her the wrong medication for the past five months. Despite all our fancy technology and advances in health care, medication errors can and will occur. So what can you do, as a patient, to be sure that your prescriptions are correct?...
As the number of patient centered medical homes has increased, a new report in the journal Health Services Research
finds the model offers a promising option to reduce health care costs and utilization of some health care services.
A mother takes her teenage son to an urgent care center that is part of her insurance plan's network. A clerk quickly refers him to the emergency room, across the street, which just happens to be part of the same hospital system as the urgent care center. Is this UCC sending some patients to its related hospital ER, clearly a place of high-priced care, to gin up revenue for the system's bottom line?...
Teens who have the option to privately and confidentially discuss health concerns with their doctor are more likely to talk about certain issues than they would be in discussions where a parent is present, finds a new study in the Journal of Adolescent Health
You need a refill for a prescription that's about to run out. You've taken the medication for years without any problems and can't think of any reason why the prescription can't just be automatically continued. But the doctor won't order a refill unless you make an appointment and come in to be seen. Is this an unfair burden on the patient or due diligence by the doctor?...
A new study in General Hospital Psychiatry
confirms that Blacks with depression plus another chronic medical condition, such as Type 2 diabetes or high blood pressure, do not receive adequate mental health treatment.
"When I think of patient engagement, I think of a partnership where people work together to figure out what the patient wants and how to support the process. Engagement is the knowledge base, working through the decisions and helping people to become full partners in their health outcomes." – June Simmons, MSW — Founding President and CEO, Partners in Care Foundation, San Fernando, CA
In the late 1990s, when the Institute of Medicine released their landmark Quality Chasm report saying that patients "should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them," I don't think this is what they had in mind...
We go to the hospital to get better, right? But it doesn't always work that way. Sometimes patients become sicker, not because their illnesses are untreatable, but because deadly bugs can overtake a hospital's ecosystem and wreak havoc, especially among the most ill. Not long ago, this happened to my husband...
Palliative care delivered early during hospitalization can help cut costs for critically ill patients, finds a new study in Health Services Research
"Being engaged in our health and health care makes the most difference to us as individuals. Our actions need to reflect our own goals, our values and preferences, and what we are willing and able to do to achieve them," says Rushika Fernandopulle, MD, Co-Founder and CEO of Iora Health.
The ED is convenient, it's open 24 hours, it does not require an appointment. So when the stomach bug or kitchen accident gets the best of you at 9:00 pm, and your doctor's office is closed, where are you going to go? And, yet, we still chide people – via reporting, casual comments and the communication of health systems – for using the ED for "non-emergent" needs. What I'd like to see is more hospitals flinging open the doors of their EDs and saying, "We'll take you, any time, for any reason, and you won't wait long or pay an arm and a leg"...
What is patient engagement and what does it take to accomplish? With the support of the Robert Wood Johnson Foundation, CFAH set out to explore this concept as it was viewed by various diverse stakeholders. Our interviews with 35 key health care stakeholders lead to an impressive unity of opinion...
"All your Prepared Patient essays do is complain about your health care and your doctors. That's why I don't read them." Yowzah! Do I really complain? Not to be defensive, but I don't think so. Every week I work to vividly describe insights that might shine a little light on this project that patients, caregivers, clinicians and policymakers – well, the list goes on – share of trying to make health care more effective and fair...
We've watched it many times on television or in a movie: The patient lies in the intensive care unit, gravely ill, with the family at the bedside. The doctor walks into the room and asks, "What do you want us to do?" and opens up a huge can of worms that is, in fact, ethically incorrect. The first priority that a physician has is to their patient...
Some low-income, uninsured and Medicaid patients report feeling stigma when interacting with health care providers, finds a new report in The Milbank Quarterly
To those of us who have had a loved one succumb to cancer, who had to negotiate the frightening choice between the rock and the hard place, always holding out hope for another round of chemo...we know that reining in health care costs will mean more than just raising co-pays and lowering drug costs and funding more effective interventions. It will also mean quashing hope. And learning to tell ourselves the truth...
A national survey of patients reveals that physicians don’t always fully discuss the risks and benefits of cancer screening, reports a new study in American Journal of Preventive Medicine
For years, my colleagues on the Prepared Patient site have preached the importance of being an advocate for your own care. And they've noted that at times it is necessary to push back against doctors' recommendations if a suggested treatment does not seem right. I just returned from a visit to the U.K., which drove home the importance of that advice...
I am wheeled into the operating room and walked to the bed. As I get to the table I am so cold and nervous, I begin to shake. I lay down on the operating table, thinking it seems very narrow and hoping I don't fall off. I hear one of the nurses say, "We have the Heparin ready for the new port." I freeze. I lift my head and say, "I'm allergic to Heparin." The anesthesia I've been given kicks in at that point and I drift off to sleep, hoping things go all right...
What does it means to be an "engaged" patient in the VA system today? It seems you have to know a senator who will intervene on your behalf, to give your health care a priority higher than his other constituents. This is deeply discomforting, and I hate that I am treated in a health care system where even those who are most accountable for the quality of the care it provides (the institutional leaders) can't trust the institution or the professionals who work there to routinely and uniformly deliver excellent care...
Carole Hemmelgarn is a hero. In the video that follows, Carole poignantly shares her daughter Alyssa's story, and why their family's loss has been the driving force behind the change Carole is fighting for: the delivery of safer care for all patients and families...
When I was discharged from the intensive care unit in cardiology, not one of the nurses, residents or cardiologists asked if I'd be able to afford the fistful of expensive new cardiac meds I'd been prescribed. Not one asked if there was anybody at home to help take care of me there, or if there was anybody at home who needed me to take care of them. Not one asked if I'd be returning to a high-stress job, or even if I had enough banked sick time or vacation days to take sufficient time off. Such real-life issues are simply not the concern of most of our health care providers...
Bewildered, panicked and disheartened, I watched my mother's eyes dart back and forth as she read the pharmacy's prescription cash price list, knowing she could not possibly afford her monthly medicines. We drove home, not saying a word, but I knew she was deeply distraught. When we arrived, she began cutting each tiny elliptical or rounded tablet into halves and quarters...
"All patients are alike. This one complains about the same things that the last one did." "Every patient is unique. We can never find a way to make each one of them happy." This public health paradox is alive and well today, particularly when trying to improve outcomes attributable to patient engagement. The question is, what aspects of care need to be customized to individual needs and what can be delivered in a standardized fashion to all of us?
At a recent conference about patient engagement in health care, the word "dignity" was used over 50 times in the first 90 minutes, and I was left with a little pile of meaningless sound where I had expected to find something important. Since then, I have been on hyper-alert for "dignity"...
One in every five older Americans takes medications that work against each other. And some interactions between prescription drugs and supplements can pose dangerous health risks. So what must we do to make sure that we benefit from the drugs we take?
Minority patients with atrial fibrillation, a heart condition that increases the risk of stroke, were less likely to receive common treatments and more likely to die from the condition than their white counterparts, finds a new study in Ethnicity and Disease
A new study in Health Services Research
reports that patients who get care at federally funded health centers have fewer office visits and hospitalizations, and receive similar or a better quality of preventive care when compared to similar patients of non-health center primary care providers.
The word "management" raises images of organizational charts and neat project timelines. This bears no relationship to my experience of trying to live a full, rich life with serious chronic disease. My image of having a serious chronic disease is of a cowboy riding a rodeo bull. You call that management? No. But it gives you a pretty good idea of what it feels like to have a serious chronic disease. This is our experience...
Yes, there are some data-fan, quantified-patient types out there. But most of us are not enamored of monitoring bits and bytes of our biophysical functioning. So perhaps we can turn our attention toward patients' more immediate concerns of having the right information at the right time in order to care for ourselves and those we love...
Nearly 60 percent of the variation in hospital readmission rates appears to be associated with a hospital’s geographic location, finds a new study in Health Services Research
If there is a population in which we have the biggest opportunity to see improvements in both cost and quality of care outcomes, it is older Americans. The debate on how best to deliver effective primary care has gone on a long time, sometimes frustratingly so, but it has almost never included a crucial constituency: older adults. The John A. Hartford Foundation is pleased to help change that...
Pharmacist-patient telephone consultations appear to reduce hospitalizations in patients who are least at risk, finds a new study in Health Services Research
My patient, Mary, was a 28-year-old woman who had completed chemotherapy for stage II breast cancer. After discussing surveillance, frequency of follow-up and ASCO guidelines, I recommended against further testing or imaging. Mary was well aware of the evidence, but she had different plans...
It is common for those who work in and deliver health care to overestimate our knowledge about our bodies, our illnesses and how the health care system works. Such as: Who is the nurse practitioner? Where is Dr. X's office? When is "soon"? Why are you recommending this test? To help people find good health care and make the most of it, the following video explains two key things to ask when making your appointment and three questions to get answered before you leave your doctor's office...
In boxing terms, this is completely literal, sound advice. As a figurative metaphor for illness, it's not bad, either. Because no matter how competent, how smart, how resourceful we may think we are before a catastrophic health crisis strikes, many of us may suddenly feel incompetent, ignorant and helpless when thrust inexplicably into the stress of such formidable reality...
"I walked in a person, and out a cancer patient," my dad said as we filed home. Crossing this threshold, we found ourselves on the other side of medicine – the side on the exam table or gurney, as opposed to the one standing over it. In time, it became clear we were running out of money...
I'm impressed with the health care that is now available to treat diseases that – even a decade ago – were a death sentence. And I'm so very grateful for them. But we and our doctors and nurses often overlook just how much the success of these tools depend on our active, informed participation. And many of us don't fully understand what it takes to participate well in our care...
There's a pesky cognitive bias that creates a honking big barrier to patients and families making the most of the health advice and services available to us. It's the tendency of experts to overestimate the knowledge of others. Given my current, frequent brushes with health care, I experience this all the time: "Just go to the lab and ask them," I'm told by my chemo nurse. I think: Huh? What lab? Where? Ask who? The effects of health stakeholders' overestimation of our knowledge are profound...
Patients with an existing relationship with a doctor ranked as lower performing were no more likely to switch doctors than patients with higher performing doctors, finds a new study in Health Services Research
Opponents of health care reform, especially those who resist moving to a single payer system like Canada’s, have often used a very powerful argument to sway public opinion. Any significant changes, they warn, to America's private insurance system would mean that the government will come between patients and their doctors by making decisions about the care Americans receive. But what if it's not the government that is inserting itself between you and your doctor?
We have all heard the term patient-centered medicine by now. It's in the PR materials for hospitals, in the Affordable Care Act, in health care model innovations like the "medical home" and the "accountable care organization." But what is it? What would you like to see in a health system that is truly patient-centered?
National conferences aimed at solving the problem of our wide-scale non-adherence to prescription medications feature expert reports about our misbehavior and bewail the huge number of us who fail to adhere to the ideal schedule. Then each conference gives plenty of airtime to more experts describing smart pill bottles, apps that nag at us, and how patient communities can provide important information about our drugs since our clinicians rarely do. Enough with blaming patients for our approach to taking our (many) medications...
The Prepared Patient Blog published over two hundred articles in 2013 about what it takes for people to get the most from health care and how the system can be improved to make it feasible for us to do so. Here's a recap of what engagement looks like to us – whether we are sick or well, whether we are caregivers or loved ones: Engagement is not easy and we can't do it alone. Patient engagement is not the same as compliance. It is not a cost-cutting strategy, and it is not one-size-fits-all.
A new study in General Hospital Psychiatry
finds patients visiting the hospital for a variety of ailments can be easily screened for depression and anxiety as they wait for care.
Antibiotics are often prescribed for young children who have upper respiratory tract infections, however, a new evidence review in The Cochrane Library
found no evidence to support this practice.
The $800 bottle of meds in my bathroom cabinet is a powerfully expensive reminder of my (former) family physician's lapse in attention – and my own lapse in catching her error. She'd somehow accidentally doubled both the dosage and the number of times per day to take these meds. How is this even possible? Somebody is not paying attention...
It looks like an airport lounge without the rolling suitcases. There are about 20 of us fiddling with our phones or reading the newspaper, waiting to meet with our doctor for follow-up or monitoring visits. All of us are between the ages of 20 and 70 and all of us are dressed for success – or at least for our jobs. What's wrong with this picture? Why are employed adults spending a busy Wednesday morning waiting (and waiting) for our health care appointment when we should be working?
A new evidence review from The Cochrane Library
found that administering a drug called clonidine before surgery may be a good alternative for controlling post-surgical pain and help reduce a child’s anxiety after surgery.
I've always assumed that the best way to find a new doctor or specialist – preferably within my health plan – was to rely on the advice of a doctor whom I know and trust, who knows my health history and understands what kind of expertise my condition requires. Recently, I have come to question that assumption...
What exactly is primary care? There have been a number of news stories lately that point to shifts in its traditional definitions and in what patients can (or should) expect to receive from primary care providers...
Only a quarter of U.S. primary care physicians surveyed are doing a thorough job of helping patients achieve and maintain a healthy weight, finds a study in the American Journal of Health Promotion
If hospitals, health plans and physicians expect patients to change their behavior, they themselves have to change the way they think about, communicate and relate to patients. As a first step, I suggest that they stop blaming patients for everything that's wrong with health care...
It's unfair to advise people to find out the price of a treatment when the price-transparency deck is stacked against them. So who will help patients find reliable price information and (hopefully) bring down the cost of care?
Team-based care has been endorsed by the professional organizations of our primary care clinicians, and there is a lot of activity directed toward making this the way most people receive their regular health care. What does this mean for us? It's not clear...
Hospitals that treat more poor seniors who are on both Medicaid and Medicare tend to have higher rates of readmissions, triggering costly penalties, finds a new study in Health Services Research
What's the key to reducing costly emergency room visits and readmissions? People who lack convenient access to a health care provider, with or without insurance, return to the emergency department or hospital out of need and desperation...
Many years ago, Alfred Korzybski wrote that "the map is not the territory". This distinction has implications for the role of patients' voices in health care planning and policy...
In the eighth and final part of our series, we explain who the various people are in your doctor's office, from nurse practitioners to lab technicians. Knowing their different roles can make your visit go more smoothly...
A majority of surveyed physicians said they were alerted to a potential medication error or critical lab value by an electronic health record, finds a new study in Health Services Research
In part seven of our series, we offer advice about how to make the most of your doctor's appointment. Here's what you should do before, during and after your visit...
In part six of our series, you'll find out what key pieces of information you need to know about your new doctor's office. Keep it handy with your personal health records or household files...
I read recently about a medical conference on breast reconstructive surgery following mastectomy, to which not one single Real Live Patient who had actually undergone breast reconstructive surgery following mastectomy was invited to participate...
Medical offices have a lot of staff but one common goal—helping you, the patient. Here are some of the people you may meet during your doctor’s appointment.
Patients who are placed in observation instead of being admitted to a hospital may face high out-of-pocket costs for treatment, finds a new study in Health Services Research
What can we learn from an experiment conducted on a single person? How relevant are results to other patients or populations or diseases? While most of us encounter a cascade of events throughout each of our illnesses, in the end, what we bring to the table is our experience through the lens of our own unique attitudes, beliefs and histories...
You may have noticed an uptick in messages from your health plan or clinician notifying you that "You are the captain of your health care team." My response to this message? Bad metaphor.
Many clinicians are unfamiliar with or uncomfortable with addressing the use of e-cigarettes with their young patients, finds a new study in the Journal of Adolescent Health
Veterans who suffer from anxiety may not get appropriate treatment for want of a specific diagnosis, finds a new study in General Hospital Psychiatry
For the past few years I’ve heard suggestions that patients should take a more active role in their health care by asking doctors to wash their hands. I strongly disagree...
Electronic health records collect non-clinical information that can be used to measure a medical practice’s patient-centeredness, finds a new study in Health Services Research
My ultrasound came back "likely benign" with the recommendation that I follow up in six weeks to be sure. Over the next few weeks, I received one bill after another that totaled $1,000. Unable to pay, I felt abandoned by the system to which I had committed my career and did not call to schedule a second ultrasound...
That "s.o.b." abbreviation in your chart doesn't indicate what you think it does. Health care has a language all its own consisting of ordinary words used in ways that convey certain shades of meaning. And sometimes they reinforce the paternalism and power imbalance that have historically existed between health care professionals and their patients.
A distressingly large number of people who have the letters M.D. after their names answer our health questions in such jargon-heavy ways that it makes our situation even more confusing. Time for a SMOG check – aka the "Simple Measure of Gobbledygook."
I'm concerned that the frantic drive toward evidence-based medicine as a strategy for quality improvement and cost reduction sets clinicians and patients up for a conflict about our shared picture of health care.
For people with diabetes and high blood pressure, keeping blood pressure levels lower than the standard recommended offered no benefits, finds a review in The Cochrane Library
What is patient engagement? Everyone agrees it's a good thing and that health care providers should be fostering it. How to do so, however, depends on what you believe the term means. I offer a new definition...
Last week, I was interviewed by Dr. Pat Salber and Gregg Mastors on their BlogTalkRadio show, This Week in Health Innovation, about patient-centered care, patient engagement, shared decision making and the cost/quality trade-offs involved, and what all of this means for health care delivery.
On Monday, Charlie Ornstein of Pro Publica provided the latest word on the usefulness of hospital ratings, an issue that seems never to disappear despite the growing body of work that raises questions about the methodology used to create them, their conflicts of interest with sponsors, and most importantly, their usefulness to the public.
Sharing a funny article is as simple as copying everyone on an email or clicking the "share" button on a website. But sharing the results of your medical tests with multiple physicians is rarely so easy. Our resource "Sharing Medical Information with Multiple Doctors" can help.
When price enters into examination room discussions, even straightforward recommendations can get complicated. How can you decide if the price of treatment is worth it if you don't understand why your clinician recommended this particular course of action?
How can doctors understand what it's like to be ill? These stories illustrate the power of walking a mile in a patient's shoes.
Health care providers say that older teens often go to the doctor without a parent who can provide consent for needed vaccinations, finds a new study in the Journal of Adolescent Health
If Hattie had but one flaw, it was that she held her doctors in too high esteem. So when her blood pressure came up a little high, she was too embarrassed to admit that she hadn't taken her prescription in over a week. Two days later, Hattie showed up to the emergency room...
Imagine you take your car to a mechanic and he says, "Your car looks fine to me. The paint is still shiny. It's not very old." It just wouldn't happen. So why would a doctor say to someone with rheumatoid arthritis, "Your hands don't look too bad"...
Learn about long-term care and whether you need long-term care insurance.
Health centers' front office staff are important members of the care team. They greet us when we arrive, make extra efforts to schedule appointments that fit our schedule, direct us to the right person when we call, and work to squeeze us in for those same day appointments. At least we hope they do...
I’m not concerned about HIPAA. I’m concerned about how little my doctor cares for my privacy in his own office...I say my name, realizing that if someone is interested in identity theft, the check in process with the doctor’s front desk makes me a pretty easy target...
My husband and I returned from a weekend away to find a message on our answering machine saying that we owed money to the hospital and that if we didn’t pay it within 10 days, they would send the bill to a collection agency.
People continue to struggle finding information on how much health care services cost. Toni Brayer, Barbara Bronson Gray and Ray Burow weigh in.
Health care providers are missing opportunities to improve teens’ vaccination coverage, reports a new study in the Journal of Adolescent Health
In a recent Baltimore Sun piece, healthcare writer Marie McCarren wrote an op-ed providing “A prescription for fewer medical errors” — reflections from an emergency room visit with her husband that later turned into a stay on the intensive care unit. McCarren emphasized the need for healthcare providers to work at clearly communicating the ways in which family members of patients can help make care safer.
Here’s a thought experiment presented a recent conference on healthcare consumer (ah hem, patient) advocacy. Let’s say that you’re told you need surgery of your knee. It’s an elective surgery to repair a torn knee ligament, the ACL. Your insurance covers part, but not all, of the cost. How do you choose which hospital to go to?
As health care becomes increasingly unaffordable, many believe quality would improve and costs would decrease if we treated health care like other consumer-driven markets...If only that were true...
A new study in Health Services Research
finds wide geographic variation in the adoption of electronic health records (EHRs) by ambulatory health care sites.
I couldn’t do it. I couldn’t ask the nurses and doctor who looked after my daughter to wash their hands.
Nursing homes with higher proportions of Black residents do worse financially and deliver lower-quality care than nursing homes with few or no Black residents, finds a new study in Health Services Research
Despite government efforts to expand diagnostic criteria for pelvic inflammatory disease, ER doctors are not identifying the condition any more often in adolescent girls, finds a new study in Journal of Adolescent Health.
What’s wrong with the following picture? Two medical researchers at a major academic center collaborate to study disease X. They come up with the research question, design the project, obtain grants, and collect data. Their results are published in a scientific journal and presented at several medical conferences. Based on this first study, the researchers start another cycle of idea generation, data generation, and publication.
Most sexually active teens don’t get information about sexual health from their health care providers, finds a new study in the Journal of Adolescent Health
Maligned over the last decade as places to avoid because of the price of the care they delivered, last week’s release of a study by the RAND Corporation goes a long way toward improving the image of hospital emergency rooms.
Victims of trauma are at higher risk of either dying or suffering a major complication if they are treated at a hospital that serves a large population of black patients, finds a large new study in Health Services Research.
If you want to see what health care is really like, there’s no better way than by becoming a patient yourself. To paraphrase the wisdom of Dr. Seuss, “Oh, the things you’ll learn!”
Here's the bad news: We will not benefit from the health care services, drugs, tests and procedures available to us unless we pay attention, learn about our choices, interact with our clinicians and follow through on the plans we make together.
Giving prescribers access to education and advice or imposing restrictions on use can curb overuse or inappropriate use of antibiotics in hospitals, according to a new Cochrane systematic review.
Improving people’s knowledge and skills about their medications may be best achieved with multimedia patient education materials, finds a new systematic review in The Cochrane Library.
What we look for when we participate actively in our health care differs from what our clinicians, employers and health plans believe will result when we shift from being passive to active participants. We don't have the same goals in mind. Does this matter?
A funny thing happened at my doctor’s appointment on Friday. I checked in, then a med-tech asked if she could take my picture, “for the hospital record.” I couldn’t contain my wondering self. “What is the purpose of the picture?” I asked.
People admitted to a hospital ICU with alcohol withdrawal were more likely to be readmitted or die within a year if they had a co-existing mental health condition, finds a new study in Alcoholism: Clinical and Experimental Research.
The problem with satisfaction data related to doctor-patient communication is that, at face value, it simply doesn’t correlate with other published data on the subject. There is a disconnect between what patients say in satisfaction surveys and what happens in actual practice. Here’s what I mean…
Twelve years ago, in its landmark study Crossing the Quality Chasm
, the Institute of Medicine (IOM) found that “the health care industry is plagued with overutilization of services, underutilization of services, and errors in health care practice.” In simple English, the IOM reported that health care was riddled with overuse, underuse and misuse of medical services.
Most older adults with dementia can successfully be taken off antipsychotic medications, which have negative side effects and increase the risk of death, finds a new evidence review from The Cochrane Library.
I find myself relieved that I don’t have to figure out how to document (or not document?) concerns [in patient records]...Wondering what they are? Ok, I will tell you, but shhh...don’t tell my elderly patients that I may be considering these topics as I care for them.
Should nurse practitioners, RNs, physician assistants, pharmacists, social workers and others including, yes, peer patients, take up much — or even most, of doctors’ tasks?
Primary care providers could help people with warning signs of psychosis get critical early treatment and potentially reduce the current burden on emergency departments and inpatient units, finds a study in the journal Social Psychiatry and Psychiatric Epidemiology.
The Association of Health Care Journalists (AHCJ) is making hospital inspection reports from the Centers for Medicare and Medicaid Services available at AHCJ’s new website www.Hospitalinspections.org. The site is not perfect, and there’s a lot of missing information, but still it provides some information about hospitals that has been lacking and offers a basis for asking questions.
Having had one eye surgery a few months ago, I knew what to look for. But my patient experience was much different this time and made me aware of how many places in the chain of care where mistakes can occur.
Recent health behavior research news stories: Friendships Are Good for Our Health | Obesity Lowers Quality of Life in Boys | Health Centers Have High Satisfaction Rates | Diabetes + Depression Increases Risk of Death
Have you heard that soon most primary care in the US will be delivered by teams? Yep. Team-based care is one of the characteristics of the patient-centered medical home, a way of organizing the care of patients that allows primary care clinicians to see more patients in a day while at the same time delivering better care.
In addition to dispensing, packaging or compounding medication, pharmacists can help improve patient outcomes in middle-income countries by offering targeted education, according to a new review in The Cochrane Library.
Low-income Americans are more likely to be satisfied with the care they receive at federally qualified health centers (FQHC) than at mainstream health care providers, reveals a new study in the Journal of Health Care for the Poor and Underserved.
A new report from Minnesota on medical errors shines a light on the fact that their frequency remains stubbornly high. Can patients and caregivers make a difference?
We do better when we have meaningful conversations with our clinicians about our health care. Proposals to require and document that such conversations take place at strategic points are growing. Here’s a cautionary tale.
In these essays, I reflect on what I wish I'd known earlier about getting good care following active cancer treatment for five different cancer diagnoses, based on my own experience and what I have learned from others.
These 10 steps will help you get the information you need for your doctor’s appointment.
Doctor’s appointments are often brief. Here’s how to quickly explain what’s wrong so you can get the help you need.
How to ask your doctor questions so that you can understand your diagnosis and treatment options.
Consumers are awash in information they can use to find the best deals on everything from dishwashers to car insurance. But is it possible to comparison shop for a hospital?
Complications from my cancer sent me to the hospital again recently. The news that I was in trouble came unexpectedly from my oncologist’s office on Thanksgiving eve, following a routine blood test. “Your liver numbers are out of whack.” My response was “Really?” as if I’d been notified that my driver’s license had expired.
Choosing a doctor and building a relationship with him or her is an important first step to getting and staying healthy.
Here's advice on how to locate a new physician to make sure you get care that fits your needs.
Sometimes, choosing a hospital is a matter of picking the one closest to you, the one where your doctor works. But if you have options, there are resources to help select the best one for you.
Delirium, a condition developed by many patients in hospital intensive care units (ICU), is associated with higher mortality rates, more complications, longer stays in the ICU, and longer hospitalizations, finds a new meta-analysis in General Hospital Psychiatry.
Recovering from a knee replacement is difficult under the best of circumstances, but for Herminia Briones, the year following her surgery was filled with unexpected pain, complications and confusion. Her repeated attempts to draw attention to her problems went unheeded, beginning an unfortunate and not uncommon struggle with medical error. Why do medical errors happen and how can you help protect yourself from harm?
You and your doctor need accurate information from each other. Open communication with your doctor is one of the most important factors in getting and staying healthy.
Recently, I spent some time answering the questions on one of those CAHPS surveys for doctors. CAHPS stands for Consumer Assessment of Healthcare Providers and Systems, and these days hospitals ask patients to use them to review not only their hospital experience but their experience with their doctors as well.
The quality of doctors and hospitals varies. Here is information to help you find the right care.
A few months ago, I spent 8 days in the hospital at the bedside of a loved one. Although I squirmed the whole way through a tenuous ICU course and brief stop-over in a step-down unit, it was good for me to be reminded of what it feels like to be a patient - or at least the family member of one - in the hospital.
As a medical student, I held the medical world in great awe. All that changed the day my mother became a patient and I began to see firsthand not only how difficult it is to navigate the healthcare system, but also how scary and unwelcoming the hospital can be.
What does it take for us and our families to find good care and make the most of it? And what can be done to help those who lack the skills, resources or capacities, or who are already ill, compensate for their inability to do so? This collection of essays identifies some of the key challenges posed to most of us by health care as it is currently delivered in many settings.
The essays collected here reflect on what it felt like as a patient with a serious illness, to cobble together a plan with my clinicians that works and to slog through the treatments in the hope that my cancer will be contained or cured and that I will be able to resume the interesting life I love.
“Rooming in,” keeping mother and her newborn in the same room 24/7 to encourage breastfeeding, does support the practice, at least in the short term, finds a new review in The Cochrane Library.
Passage of a bill in 1999 requiring minimum nurse-to-patient ratios in California hospitals increased the number of nurses but resulted in mixed quality of care, according to a new study in the journal Health Services Research.
After writing about trying to choose the best hospital for my upcoming cataract surgery, I wondered if a few quality measures might offer a clue or two about how to better honcho some of my care, like the one that asks hospital patients if a nurse explained medications given to them. Since many ratings schemes rely on patient satisfaction data collected by the government, I decided to explore further.
On Friday afternoon of Labor Day weekend three years ago, my doctor called to tell me that the pathology report from a recent endoscopy showed that I had stomach cancer. Maybe you can imagine what happened next.
Inpatient hospital treatment accounts for the largest proportion of health care spending in the U.S., with the use of diagnostic imaging services such as MRIs, frequently implicated as the probable cause. A new analysis in Health Services Research finds that the biggest expense may not be imaging technology but from supplies including medical devices, such as stents and artificial joints.
After learning recently that I may need cataract surgery, it was time for me to check out the hospitals where that procedure might take place.
Fundamentally rethinking and refocusing on patient-centeredness is central to building a health care system that improves quality and controls cost. But patient-centeredness must permeate an organization from the 'exam room to the board room'.
“...If you need a wheel chair to take you to the door, I’ll call for one. If not, you can go home. Take care of yourself. You are going to do great!”
Now I am a sucker for encouraging words, but right then, I panicked...It was 8:45 in the morning. My husband hadn’t yet arrived. I was free to walk out the [hospital] door.
Patients with diabetes or congestive heart failure who receive care from doctors with high levels of patient overlap have lower total health care costs and lower rates of hospitalization, according to a new study in the Journal of General Internal Medicine.
Urban areas that are segregated by race, ethnicity or income have more Federally Qualified Health Centers (FQHC), which provide primary care services for disadvantaged populations, despite an adequate supply of private sector physicians, reveals new findings published in Health Services Research.
Hospitals that mostly serve Black patients have worse mortality outcomes for both Black and White patients with three common conditions: heart attack, congestive heart failure or pneumonia. The new study in Health Services Research suggests that there is an urgent need to improve care at predominately black-serving institutions.
In the past two days I have filled out two post-dining surveys from Open Table, and it occurred to me that it would be great if there were something similar that could provide the immediate guidance we need to participate in our care.
The gap between the demands placed on us by U.S. health care delivery and the ability of individuals even the most informed and engaged among us to meet those demands undermines the quality of our care, escalates its cost and diminishes its positive impact on our health.
People with cancer often receive fragmented and uncoordinated care, as their treatments often require help from multiple clinicians. However, a new review by The Cochrane Library finds no evidence that three main strategies designed to improve coordination of cancer care are effective.
After being on the 'other side' of medicine, Kevin R. Campbell, M.D., experienced the stressors of waiting for someone going through surgery and has learned ways to improve his practices as a clinician to help make the experience less worrisome for loved ones.
Hospitals that use supportive management practices across diverse care providers and frontline staff are more likely to deliver quality patient care, according to a new study in Health Services Research.
Another hospital report card showed up last week adding to the pile of ratings already available. A few years ago there were more than one hundred offered by various for-profit and not-for-profit businesses and government agencies. The newest one is the Hospital Safety Score report card from the Leapfrog Group...
It's difficult to imagine that professionals working in a practice or department or unit where they are constrained by their own colleagues misbehavior are going to have the energy to invite us to learn about and share in decisions about our treatment...
Neil Versel shares his personal experience of his dad's passing and the lack of quality of care that he received at one hospital contrasted with well-managed care at another facility. He wants to educate as many people about the disease his father had (multiple system atrophy), the dangers of uncoordinated care and poorly designed workflows.
The pianist was playing Chopin in the beautiful but deserted four-story lobby of the new hospital where my father was being cared for. The contrast between that lovely lobby and the minimal attention my dad received over the weekend, combined with a report about the architectural 'whimsy" of a new hospital at Johns Hopkins make me cranky.
You are increasingly being held accountable for the outcomes of the health care you deliver. Pay for performance; shared savings in ACOs; public report cards'the list of strategies to monitor and measure the effects of your efforts is lengthening. Many of you seem dismayed by the increased weight accorded to the patient experience of care ratings embedded in most of these programs.
I understand you are leaving [this hospital]'..By way of wishing you well, here are some thoughts that might help you in your new position
Hospitals vary widely in their admissions to intensive care units, which some experts believe are overused, costly and potentially dangerous. A new study in Health Services Research finds that the actions of hospitals - not the kinds of patients they attract - appear to be responsible for part of the difference in ICU use.
I personally dread the car buying experience for many reasons but one thing that bothers me is the discontinuity. You often see the sales person several times and to some extent the character of your relationship with him/her impacts the decision to purchase the vehicle.
New research released online in the American Journal of Preventive Medicine shows that body mass index (BMI) data, commonly available in electronic medical records, can accurately identify adults between 30 and 74 years-old at risk for cardiovascular (heart) disease, the leading cause of death in the U.S.
A hospital's claims of highly rated care or state-of-the-art, multimillion dollar equipment may be only part of the equation for where you seek care.
A new research review suggests that the use of one popular method of fetal monitoring does not improve maternal and fetal outcomes and makes women more likely to have cesarean sections.
The hospital can be a frightening place without having to worry about common medical errors that can complicate your treatment and recovery. Why do so many hospitals still struggle to prevent medical errors, how do they happen, and what's the solution?
New research finds that patients may not always receive all of the screening tests and counseling services that are due during their medical checkups, according to a study in the American Journal of Preventive Medicine.
Frontline health workers—including nursing assistants, paramedics and pharmacy technicians—who received a combination of benefits and support from their employers had greater job satisfaction and provided a higher perceived quality of care, finds a new study in Health Services Research.
While commuting to work in September 2009, Ashley Finley stopped her bike short to avoid a pedestrian ' and flew over the handlebars, hitting her head on the pavement. Her chin gushing blood and with concerns about head injury, Ashley and her partner, Goldie Pyka*, immediately headed to an ER. Though their wait time in the Washington, D.C., emergency room was minimal, Pyka says she felt surprised by the number of people who participated in Ashley's care. 'I was expecting to see one person, tell them what happened and have that person help. I wasn't expecting to interact with that many people and to not really be told who they were and what they were there for. I felt we were very passive in the whole experience,' Pyka says.
Patients with breast cancer report greater satisfaction when their cancer doctor co-manages care with other specialists, finds a new study in Health Services Research.
My wife was lying in the back of an ambulance, dazed and bloody, while I sat in the front, distraught and distracted. We had been bicycling in a quiet neighborhood in southern Maine when she hit the handbrakes too hard and catapulted over the handlebars, turning our first day of vacation into a race to the nearest hospital.
I believe that it is unrealistic to expect that we will easily understand and ably engage in team care, shared decision making, care coordination and make use of patient portals of EHRs. Each of these carries the risk of being misunderstood by us in ways that further disenfranchise our efforts and good will unless it is discussed ' and recognized ' as the valuable tool it is.
Even when you know you should see a doctor, it can be hard to know whether to visit your primary care provider or consult a specialist. In this roundup, physician bloggers consider the range of services covered by PCPs.
I was first diagnosed while on vacation in 1994. A doctor entered the room and, without warning, said that I had 'a terminal and incurable form of leukemia' and 'less than five years to live.' Just like that. Turns out he was wrong'
The American people, long protected from the price of health care by insurance, are now forced to act as consumers. This situation is a free marketer's dream.
Nobody likes to wait. And patients and doctors alike are frustrated by the general waiting that seems to be an inevitable part of delivering and receiving care. Here, Art Markman, Lisa Gualtieri, and anonymous patient blogger WarmSocks share their views.
Hospital patients over 65 who are referred for a psychiatric consultation and found to have delirium are more likely than those without delirium to die within one year following diagnosis, according to a new study published in the journal General Hospital Psychiatry.
When my son Ben came down with a sore throat this past summer, he went to his doctor for antibiotics. Both agreed it sure sounded like strep, so without having to wait for the throat swab test results, Ben left the office with a prescription for antibiotics. But were they the appropriate treatment? Do all bugs need drugs?
Two recent speaking engagements provided me the opportunity to think deeply about the discharge process, an area of healthcare delivery rampant with errors and missed opportunities to support sustained healing and health for patients.
New research shows that physicians who say they are fluent in a second language may be overestimating their actual skills.
Erica Kosal's husband, Jim Young, has battled complications of chronic Lyme disease since his diagnosis in 2008. In 2010, Jim's hospitalization for respiratory problems took a turn for the worse, resulting in a 3-week ICU stay.
In January 2010, after beginning treatment for chronic Lyme disease, 53-year-old Jim Young lost significant weight and struggled to breathe. Within 15 hours, his wife Erica Kosal received a call about his imminent transfer to the intensive care unit (ICU). "I can remember he was hooked up to all kind of machines. He looked so deflated.'
I sit looking at the phone. I'm having a medical problem that needs attention, but I don't know who to call. Here's why...
This interview with Molly Mettler is the third in a series of brief chats between CFAH president and founder, Jessie Gruman and experts - our CFAH William Ziff Fellows - who have devoted their careers to understanding and encouraging people's engagement in their health and health care.
When safety net hospitals close or switch from not-for-profit to for-profit status, certain vulnerable groups suffer disproportionately, a new study finds.
Those involved in health care and HIT may have noticed the increased federal and private sector discourse around "consumers" and meaningful use. This week's Inside Health Care collects some recent posts that discuss various new tools, programs, and enhancements aimed at providers, patients, caregivers, and members of the public.
How do you calibrate care so that it is neither too much nor too little? In this collection of recent posts, health care professionals search for that 'just right' level of care.
Hospitals with higher surgical volumes for certain procedures are less likely to cause unintentional serious injuries to hospitalized patients when compared to those hospitals that perform the procedures less often.
A new study shows that 21% of adult Americans delay seeking health care for reasons other than cost. In this collection, a doctor, a journalist, and a health care manager discuss the need for improved systems and candor to support better doctor-patient communication.
Do you suffer from decision fatigue when you are sick or anxious or overwhelmed by bad health news? Does your doctor make less well-reasoned decisions about the 10th patient she sees before lunch? How about the surgeon during his second operation of the day? How about the radiologist reading the last mammogram in a daily batch of 60? A provocative article by John Tierney in Sunday's NYTimes Magazine
adds a new layer of complexity to the body of knowledge collecting around decision-making processes.
Past research shows that minorities suffer higher rates of advanced cancer and deaths from all types of cancer compared to whites. The role of “patient navigator” is emerging as a tool to address these disparities.
Given the current lack of useful objective information, we should be wary of imprecations for us to thoroughly check out any doctor before we consult him. For many of us, the idea that we can pre-judge the competence of a physician is presumptuous.
People who suffer headaches after a spinal tap might have a relatively simple way to ease the painful throb: a caffeine tablet.
Word comes from Nature News that the NIH is dropping a proposed requirement for universities to disclose researchers' financial ties to industry on websites. This is a loss for patients, who may not be aware of their doctors' relationships with pharmaceutical companies and others who fund clinical trials, fellowships, conference junkets and other perks for physicians.
Older people rushed to the emergency room are more likely to be living at home up to a year later if they receive a comprehensive and age-appropriate evaluation during their hospital stay.
A new review says that oxytocin, a medication often used to quicken slow-paced labor in its early stages, doesn’t decrease a woman’s risk of having a complicated birth involving forceps or a cesarean section.
A new study suggests there has been some improvement in reducing the gap in stroke hospitalization between white and minority patients.
I sat in a dingy pharmacy near the Seattle airport over the holidays, waiting for an emergency prescription. For over two hours I watched a slow-moving line of people sign a book, pay and receive their prescription(s). The cashier told each customer picking up more than one prescription or a child's prescription to wait on the side.
Several months ago my 80-year-old father had triple bypass surgery. As any family member would be, my father's wife, my siblings, and I were both worried and hopeful. We were told that the surgeon was the best and my father was in good hands. Afterwards, we were told that the surgery went well. However, one of the night nurses in the coronary care unit reported that my father took a swing at one of the doctors.
Fewer than half of primary care physicians talk to their patients about diet, exercise and weight management consistently, while pediatricians are somewhat more likely to do so, according to two new studies.
When one partner in a couple is infected with HIV and the other isn’t, treatment with antiretroviral drugs can dramatically lower the chances of the infected partner passing along the disease to his or her mate, a new evidence review finds.
Medication mishaps are a widely recognized problem in health care and a new study finds that ambulatory care settings, not ERs, deal with them most.
When doctors can self-refer for MRI, patients are more apt to receive scans – and even surgery – for low back pain.
When nurse staffing levels are higher on hospital units, patients tend do to better after discharge, as long as overtime isn’t involved.
There appears to be no area that social media cannot soak through to: farming, politics, dating, death and even taxes. It comes as no surprise then that social media has diffused into the world of health care. Clinicians, researchers, patients and hospital CEOs are blogging, tweeting and sending Facebook messages. This post reveals some of the recent dialogue on the web surrounding social media and its use by health care professionals.
Fascinating, how in the same week two giants of evidence-based medicine have given such divergent views on the future of quality improvement. Donald Berwick, the CMS administrator and founder and former head of the Institute for Health Care Improvement, emphasizes the need for quality as the strategy for success in our healthcare system. But one of the fathers of EBM, Muir Gray, states that quality is so 20th century, and we need instead to shine the light on value. So, who is right?
Expansion of health care coverage mandated by health reform will push demand for primary care providers sharply upward, and thousands of new physicians are needed to accommodate the increase, a new study finds.
Checklists are not just for rocket launches. Family doctor, Dr. Davis Liu, Rep. Giffords' trauma surgeon, Dr. Randall Friese, former hospital CEO, Dr. Paul Levy, and a fifth year medical student, Ishani Ganguli, post on the importance of using checklists to promote patient safety. A new British Medical Journal study agrees.
Makers say that mechanical devices perform CPR more effectively than human efforts alone. However, a new review comparing mechanical to manual chest compressions has failed to demonstrate that one is superior to the other.
While commuting to work in September 2009, Ashley Finley stopped her bike short to avoid a pedestrian and flew over the handlebars, hitting her head on the pavement. Her chin gushing blood and with concerns about head injury, Ashley and her partner, Goldie Pyka*, immediately headed to an ER. Though their wait time in the Washington, D.C., emergency room was minimal, Pyka says she felt surprised by the number of people who participated in Ashley's care. 'I was expecting to see one person, tell them what happened and have that person help. I wasn't expecting to interact with that many people and to not really be told who they were and what they were there for. I felt we were very passive in the whole experience,' Pyka says.
A large study found that patients in certain large chain facilities are significantly more likely to die than those treated elsewhere. Mortality was also higher in for-profit than non-profit dialysis centers.
When I was in high school, the singer Kitty Kallen had a #1 hit - "Little Things Mean a Lot." The ballad is decidedly uncool by current standards, but as a teen-ager I liked its romantic dreaminess. The song popped into my mind as I was musing about the after visit summary I was given at the end of an appointment with my primary care physician yesterday.
A collection of professional voices from around the web including Dr. Herbert Mathewson in The Health Care Blog, Dr. Kevin Pho of KevinMD.com, and Dr. Rob Lamberts on his blog, Musings of a Distractible Mind. These highlight the patient experience from a professional perspective and the power of touch.
Would you keep using a doctor who collected $300,000 or even $300 in speaking fees from drug companies for saying a good word about their products? That's the question the non-profit, investigative journalism outfit ProPublica is inviting thousands of patients to ponder.
Forceps might be a better instrument than a vacuum cup for assisting a successful birth, but new mothers might experience more trauma and complications after a forceps delivery, according to a new review of studies.
Nursing homes that improve their quality of care – and thereby score high on public report cards – might see financial gains.
Well, what do you know? Another study surfaced this week raising more questions about the usefulness of the information on the federal government's Hospital Compare web site, just at a time when most of us are thinking about choosing new health plans for next year. For some time now, the standard advice has been to look at all available data for the doctors and hospitals in the plans you are considering. That has meant heading to the Medicare Web site and its Hospital Compare data set.
Rick Hamlin, in an op-ed essay last week, recounted how his surgeon assured him that he would be able to go on a family vacation to Spain three weeks after his open-heart surgery. In the New York Times
piece, Rick described his disappointment and despair at the unexpected six months of fatigue, pain and depression that constituted his recovery.
In a recent iHealthBeat post, Steve Findlay talks about a provision in the new meaningful use rules for health information technology issued by DHSS. Findlay noted that nothing seems to have moved the needle on people completing advance directives. He expressed hope that this can now be rectified if hospitals embrace the optional (menu set) meaningful use objective that promotes recording the existence of an advance directive in a person's EHR. It's a start.
From WHIO, a news talk radio station in Dayton, Ohio, comes word that four area hospitals rank in the top five percent nationally for emergency care. That is impressive, I guess. If you have an emergency, your chances of having a good outcome in one of them are probably pretty high. At least that's a reasonable assumption. The story went on to say that HealthGrades, the outfit that gives the awards, evaluates the hospitals based on their mortality rates for 11 of the most common conditions for patients needing emergency treatment. Furthermore, only 255 of the 4,900 acute care hospitals in the country got the award. A viewer might be doubly impressed.
Most of us like it when our health care decisions are simple and straightforward -- when the potential benefit of one option far outweighs the benefits and risks of the other. Should I smoke? No. Should I get a mammogram? Yes. However, advances in screening, preventive measures, diagnostic technologies and treatments have rendered our preference for the certainty of the simple choice obsolete.
Your mother is in the hospital. The nurse comes in to give her a drug. You ask what drug it is and it's something to which she's allergic a fact noted on the long list of things you had to provide at admission. The nurse apologizes profusely and gets a substitute drug for her. The next day about the same time, a different nurse comes in to give your mother a drug. Again, you ask and again it is the wrong drug.