Category: Health Care Quality

Scary Facts about Antibiotics

What is indisputable is that the status quo is untenable. An estimated 48,000 people die in Europe and the U.S. each year from infections caused by antibiotic-resistant bacteria, and this number is very likely to increase in years to come. “This is a global issue and a moral issue that needs to be dealt with in collaboration,” says Otto Cars, of the Swedish Institute for Communicable Disease Control in Solna.

From Nature Medicine via Kevin Outterson.

A Diagnostic Laboratory You Can Carry in Your Purse!

Hardware and software medical applications are increasingly being developed for smartphones. This one is a convenient mini-laboratory powered by a smartphone.  As reported in MedCity News:

Although molecular diagnostic devices tend to be expensive, Biomeme figured out how to build one that uses a smartphone and sells for roughly $1,000. In addition to STD testing…it’s developing tests for dengue fever, yellow fever, and malaria, among others.

One of the interesting things about the company is how wide the applications are for healthcare sectors and beyond. It currently has 10 partnerships with groups in agriculture, environmental monitoring, along with military uses.

Can States Overturn the FDA’s Limits on Compassionate Use?

At National Review Online, Jillian Kay Melchior, reports on a cancer patient who has run out of therapies. There are medicines under development that might help, but drug-makers won’t let her have them under the FDA’s “compassionate use” doctrine.

ClVariety of Medicine in Pill Bottlesinical trials accept only “typical” patients — Mikaela’s rare form of kidney cancer has ruled her out, but for others in her situation, complications as common as diabetes or high blood pressure could also be reason for ineligibility. And the Food and Drug Administration’s approval process for “compassionate use” of an experimental drug outside of clinical trials is extremely arduous.

First, a pharmaceutical company has to be willing to provide the experimental drug — a high-risk proposition, given that an atypical result in an atypical patient can prompt the FDA to delay approval or require significant and expensive additional testing…And approval from a pharmaceutical company is just the first step. Next, patients and doctors must fill out an exhaustive paperwork disclosure to submit to the FDA, which is estimated to take at least 100 hours to complete. The FDA then begins a review, which is supposed to take no longer than a month — but if the agency’s reviewers have any additional questions or need more information, that 30-day clock is reset. Finally, the hospital’s institutional review board has to give approval — and if a patient is being treated at a small hospital that lacks such an administrative panel, the case has to be reviewed by a bigger facility, often one unfamiliar with the patient.

Are Foreign Drugs Safer Than You Think?

There are no reported examples of Americans dying by taking real, but F.D.A.-unapproved, medication bought online from a foreign pharmacy that requires valid prescriptions. This is after tens of millions of prescriptions have been filled online and internationally over the past 15 or so years, since online pharmacies were created. (NYT)

How Much Does Health Care Matter?

Austin Frakt reviews the literature supporting the idea that health care has a large impact on health.

Robin Hanson gives the other side:

So I want to say loudly and clearly what has yet to be said loudly and clearly enough: In the aggregate, variations in medical spending usually show no statistically significant medical effect on health. (At least they do not in studies with enough good controls.) It has long been nearly a consensus among those who have reviewed the relevant studies that differences in aggregate medical spending show little relation to differences in health, compared to other factors like exercise or diet. I not only want to make this point clearly; I want to date other health policy experts to either publicly agree or disagree with this claim and its apparent policy implications.

Giving “Insanity” a Whole New Meaning

This is from The Wall Street Journal:

woman-scaredInside the U.S. Department of Health and Human Services sits an agency whose assignment since its creation in 1992 has been to reduce the impact of mental illness and target services to the “people most in need.” Instead the Substance Abuse and Mental Health Services Administration, known as Samhsa, uses its $3.6 billion annual budget to undermine treatment for severe mental disorders…

For instance, Samhsa’s Guide to Mental Illness Awareness Week suggests schools invite as speakers such radical organizations as MindFreedom, which rejects the existence of mental illness and stages “human rights” campaigns against drug treatment and commitments. Or the National Coalition for Mental Health Recovery, which “holds that psychiatric labeling is a pseudoscientific practice of limited value in helping people recover.”

I Guess the British NHS Was an Exception

This is David Blumenthal, former national coordinator for health information technology, interviewed by James Fallows in The Atlantic:

Laptop and StethoscopeWhen the benefits of using better technology are “internalized,” as the economists would say, there has been much more rapid, complete, and effective adoption of electronic medical records. So, the VA: the benefits are internalized, because the VA has to live within a budget. In private health-care organizations like Kaiser or the Geisinger plan in Pennsylvania, or the Group Health Cooperative in Puget Sound, electronic medical records were adopted decades ago, and are widely used and highly effective.

Here is Linda Gorman on health IT in the National Health Service.

The Medieval Guild Lives On

LawiStock_000005825665XSmalls concerning nurse practitioners (NPs) vary across states, but the three biggest regulations that affect NPs are those that limit their ability to write prescriptions, to practice independently and to receive direct reimbursement from insurers:

  • When doctors are required to supervise NPs when prescribing controlled substances, physician wages increase by 7 percent while nurse practitioner wages decrease by 14 percent.
  • Those restrictions also increased the number of physician hours worked by 6 percent to 9 percent while decreasing the number of hours worked by nurse practitioners by 6 percent to 14 percent.
  • The price of a well-child medical exam rises by 3 percent to 16 percent due to these laws.

However, none of these regulations appeared to reduce infant mortality rates or malpractice premiums

Source: NBER Working Paper.

Pay for Performance Fails Again, and Again, and Again

Aaron Carroll writes:

Hand Holding Paper CurrencyI’m getting to be a broken record in my skepticism about pay for performance. Here, here, here, here, here, and here just to name a few posts. But there’s another study out in the Annals of Surgery, “Does Pay-for-Performance Improve Surgical Outcomes? An Evaluation of Phase 2 of the Premier Hospital Quality Incentive Demonstration

…This study involved nearly a million procedures in 12 states over six years. They tried to reduce severe complications and mortality within 30 days. Did paying for performance work?

While mortality went down over time, it didn’t go down faster in the P4P hospitals than the non P4P hospitals. There were no great improvements in complications, and there were no great improvements in mortality. Even in the worst 20% of hospitals (where there is the most room for improvement), P4P was not associated with great improvements over non P4P.

Uninsured Trauma Patients Get Better Care than Insured

Why? Perhaps because non-trauma community hospitals would prefer to have insured rather than uninsured patients. So, uninsured patients are more likely to be transferred to trauma centers, where they are likely to get better care.

According to Kit Delgado, and colleagues, presenting research results in JAMA Surgery, both privately insured and Medicaid patients were significantly more likely (11 percent and 14 percent more) to be admitted to a non-trauma hospital than transferred.

Their conclusion:

Patients with severe injuries initially evaluated at non-trauma center EDs were less likely to be transferred if insured and were at risk of receiving suboptimal trauma care. Efforts in monitoring and optimizing trauma inter-hospital transfers and outcomes at the population level are warranted.