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Hospital Performance Improved But Are Measurements Accurate? September 17, 2011

Posted by jomaxx in : health care news, health care reform, health reform, Hospitals, medicine, patient care, Physicians, Public Health , add a comment

Is performance or reputation more important?

Does reputation equate to performance?

Are the data being measured of real patient care value?

A new report released by the Joint Commission on Accreditation of Hospitals (JCAH) suggests that on a variety of fronts hospitals are doing a better job of patient care. They looked specifically at five areas of care: heart attack, heart failure, pneumonia, surgical, children’s asthma.  The report shows that in terms of several quality measures, such as administering antibiotics in a timely manner to surgical or ICU patient, giving aspirin to heart attack patients on admission to the ER and the like, overall hospitals have improved in last couple of years.

The new report identifies 405 hospitals out of over 3,000 (14%) accredited by the JCAH.   Those selected had to achieve a compliance score of at least 95% in one or more of the five key areas monitored during this review.  Some hospitals achieved these scores in only one category, others in two, three or more.  The complete list has been published.

Of note is the finding that none of the 17 medical centers listed by U.S. News & World Report on its “Best Hospitals Honor Roll” this year are on the Joint Commission’s list of 405 hospitals that received at least a 95% composite score for compliance with treatment standards. About one-third of a hospital’s score in the U.S. News methodology is also based on its reputation as gauged by a survey of physicians.

The findings bring into question how deserving these institutions are of their reputations.  Still other measures of quality are out there including Medicare’s Hospital Compare site which lists among other things, mortality and morbidity rates for hospitals based on Medicare data.

It should also be noted that many hospitals that did not make this list still scored very highly and only missed the list by a few percentage points.  In fact it could well be that the difference in some cases was not performance at all, but simply lack of detailed documentation, which is really all JCAH and Medicare can go by in their respective data compilations.

The entire “science” of medical comparative outcomes is still really in it’s infancy, with many confounding factors needing to be considered and analyzed to achieve a true picture of outcomes and valid comparisons between facilities and treatments.  Still, it is clear that with increasing data collection, better analytical evaluation can be undertaken and a more informed patient and provider population will result.

Report Finds Improved Performance by Hospitals – http://is.gd/STHqr4

2010 Top Performers on Key Quality Measures – http://is.gd/YK09jV

Hospital Compare – http://is.gd/QfMaQ9

The Hippocratic Oath March 8, 2010

Posted by Obi Jo in : medicine, patient care, Physicians, Public Health , add a comment

The Hippocratic Oath (OrkoV) is the most widely known of Greek medical texts. It requires a new physician to swear that he/she will uphold a number of professional ethical standards. One of the best known prohibitions is, “to do no harm” (epi dhlhsei de kai adikihi eirxein or in Latin, primum non nocere).  Little is known about who wrote it or first used it, but it appears to be more strongly influenced by followers of Pythagoras than Hippocrates and is often estimated to have been written in the 4th century BC.

Hippocrates of Cos or Hippokrates of Kos (ca. 460 BC – ca. 370 BC) was an ancient Greek physician of the Age of Pericles (Classical Athens), and is considered one of the most outstanding figures in the history of medicine. He is referred to as the Western father of medicine in recognition of his lasting contributions to the field as the founder of the Hippocratic School of medicine. This intellectual school revolutionized medicine in ancient Greece, establishing it as a discipline distinct from other fields that it had traditionally been associated with (notably theurgy and philosophy), thus making medicine a profession.

However, the achievements of the writers of the Corpus, the practitioners of Hippocratic medicine, and the actions of Hippocrates himself are often commingled; thus very little is known about what Hippocrates actually thought, wrote, and did. Nevertheless, Hippocrates is commonly portrayed as the paragon of the ancient physician. In particular, he is credited with greatly advancing the systematic study of clinical medicine, summing up the medical knowledge of previous schools, and prescribing practices for physicians through the Hippocratic Oath or Corpus and other works.

Asclepius (pronounced /æsˈkliːpiəs/, Greek Ἀσκληπιός Latin Aesculapius) is the god of medicine and healing in ancient Greek religion. Asclepius represents the healing aspect of the medical arts; his daughters are Hygieia (“Health”), Iaso (“Medicine”), Aceso (“Healing”), Aglæa/Ægle (“Healthy Glow”), and Panacea (“Universal Remedy”). The rod of Asclepius, a snake-entwined staff, remains a symbol of medicine today, although sometimes the caduceus, or staff with two snakes, is mistakenly used instead. He was associated with the Roman/Etruscan god Vediovis. He was one of Apollo‘s servants.  Some legends hold that the family of Hippocrates was descended from Asculapius.

Over the centuries, the Hippocratic Oath has been rewritten often in order to suit the values of different cultures influenced by Greek medicine. Contrary to popular belief, the Hippocratic Oath is not required by most modern medical schools.  This is in our opinion unfortunate. . . jomaxx and obi jo

Hippocratic Oath

I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgement, I will keep this Oath and this contract:

To hold him who taught me this art equally dear to me as my parents, to be a partner in life with him, and to fulfill his needs when required; to look upon his offspring as equals to my own siblings, and to teach them this art, if they shall wish to learn it, without fee or contract; and that by the set rules, lectures, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to students bound by this contract and having sworn this Oath to the law of medicine, but to no others.

I will use those dietary regimens which will benefit my patients according to my greatest ability and judgement, and I will do no harm or injustice to them.

I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

In purity and according to divine law will I carry out my life and my art.

I will not use the knife, even upon those suffering from stones, but I will leave this to those who are trained in this craft.

Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.

Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.

So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time. However, should I transgress this Oath and violate it, may the opposite be my fate.

Translated by Michael North, National Library of Medicine, 2002 – http://www.nlm.nih.gov/hmd/greek/greek_oath.html

Hippocrates – http://en.wikipedia.org/wiki/Hippocrates

Aesculapius – http://en.wikipedia.org/wiki/Asclepius

The Vanishing Oath (a film) – http://www.crashcartproductions.com/home

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Kidney cancer patients lose out on life-prolonging meds in England September 5, 2009

Posted by Obi Jo in : health reform, patient care, politics , 1 comment so far

In November 2008, the NICE Citizens Council met to discuss whether there were circumstances in which NICE should recommend treatments that we would not normally consider to be cost effective. The resulting report was presented to the NICE Board at its meeting in Belfast on 22 May. When deciding whether a treatment is cost effective, NICE’s independent Appraisal Committee and other advisory bodies use a measure called a QALY (quality-adjusted life year). If a treatment costs more than £30,000 per (about$49,500 US dollars) QALY gained, it is not normally recommended for use in the NHS (see reference below).

Well, this is the type of commission (no doubt headed by another czar) that the Congress and apparently the President wish to place in control of decisions regarding health care options and choices.  Under these NICE guidelines in England, it is very difficult to see how Senator Edward Kennedy would have received any treatment at all beyond pain management as his care clearly cost well, well in excess of the current NHS/NICE threshold of just under $50,000 dollars US per year.  So what would happen? Perhaps what has happened to many in England who are clamoring for access to other forms of treatment for kidney cancers that have failed to respond to traditional measures.  You would be denied access, unless you have the freedom to choose to go where you wish and pay what is needed to get the other treatments.  Is this on the basis of economics . . . yes, it is.  We live in a market based capitalist economy and that has served us well versus the rest of the world for almost three centuries.  Is it fair?  Yes.  The basis of our system rests on the ability of the individual to succeed and in the end take care of his self interest and that of those closest to him – family and friends.  We have offered many serious proposals to enhance health insurance coverage and therefore health care access without resorting to what can only be described as socialistic approaches (don’t be fooled by the new use of the word progressive; liberal=progressive=socialist).  We can have meaningful reform without a federal takeover of 1/6th of the economy.  A takeover which will forever dominate the social landscape of our nation.  We can do better than that in America . . . obi jo and jomaxx

Thousands of kidney cancer patients are likely to lose out on life-prolonging drugs

The NHS rationing body, NICE, has confirmed a ban on three out of four new treatments.  It has reversed its position on just one, Sutent, which will now be allowed for patients with advanced cancer. But campaigners who fought NICE’s original blanket ban said this was not enough. They said some patients with heart problems cannot tolerate Sutent. Kate Spall, head of the Pamela Northcott Fund campaign group, said the ruling meant that fewer than half of newly diagnosed patients would be eligible for therapy. She added: ‘Families will be denied time together and doctors will be unable to give patients the best treatment.’ Campaigners are angry that NICE appears to have ignored new official guidelines widening access to life-prolonging drugs. Sutent, also known as sunitinib, can double the life expectancy of patients, to 28 months, compared with standard interferon treatment. It costs around £24,000 a year.

The rejected drugs – bevacizumab (Avastin), sorafenib (Nexavar) and temsirolimus (Torisel) – have similar costs and are used in other countries. Nicole Farmer, of Bayer Schering Pharma Oncology, which makes Nexavar, said: ‘This shows why the UK sits 16 out of 18 EU countries with regard to cancer outcomes’.

Dr Thomas Powles, Clinical Senior Lecturer, at Barts and The London NHS Trust, said the ‘one size fits all’ policy would disadvantage many of the 7,000 patients diagnosed each year with kidney cancer.  He said: ‘This one dimensional approach will leave some patients without potentially beneficial treatments, indeed some patients will not be eligible for any effective treatments whatsoever.’

Stella Pendleton, executive director of the Rarer Cancers Forum, said: ‘This decision contradicts the spirit of the recommendations made by Professor Mike Richards on improving access to medicines for NHS patients, and highlights flaws in the current system for appraising drugs. ‘We call on Nice to reverse this decision.’

Kidney cancer patients denied life-saving drugs by NHS rationing body NICE by staff writer, April 29, 2009 Daily Mail (UK)

Kidney cancer patients denied life-saving drugs by NHS rationing body NICE – http://www.dailymail.co.uk/health/article-1174592/Kidney-cancer-patients-denied-life-saving-drugs-NHS-rationing-body-NICE.html

National Institute for Health & Clinical Excellence – http://www.nice.org.uk/

Citizens Council report on departing from the threshold – http://www.nice.org.uk/newsroom/features/CitizensCouncilReport.jsp

With quality treatment, Kennedy fought hard and long – http://www.boston.com/news/local/massachusetts/articles/2009/08/26/fighting_hard_fighting_long/

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"Stealth" health measures under guise of information techology fix February 11, 2009

Posted by Obi Jo in : health reform , add a comment

The stimulus plan as been debated ad nauseum but yet many of the details are unknown, unpublicized and little discussed.  This is one that is most important.  While it is true, that modern data systems are important to the future of medicine, and this site has voiced strong support of information technology integration into the medical system, it is also true that fully Federalized and centralized data collection can be misused.   The most disturbing facets of this are as outlined in the article from Bloomberg below.  A counter argument from AARP misses the point – the approach being outlined in this bill is similar to programs established by the NHS in England which essentially are designed to ration care.  We can be thankful that socialized medicine affecinado Mr. Daschle has driven off into the sunset with his limo and driver.  Nevertheless, we must guard against this potentially evil – and that is the word I mean – usurpation of individual rights and professional autonomy in the care of the sick.  Afterall, physicians have been at this officially for over 2,500  years.  The US government, not so long . . . jomaxx

Ruin Your Health With the Obama Stimulus Plan

Republican Senators are questioning whether President Barack Obama’s stimulus bill contains the right mix of tax breaks and cash infusions to jump-start the economy. Tragically, no one from either party is objecting to the health provisions slipped in without discussion. These provisions reflect the handiwork of Tom Daschle, until recently the nominee to head the Health and Human Services Department. Senators should read these provisions and vote against them because they are dangerous to your health. (Page numbers refer to H.R. 1 EH, pdf version).

The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors.

But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

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