Communicating Health Quality Measures

Educating patients, (a.k.a. “consumers”), to make the “best” health care choices has been a fundamental principle in some health reforms schools, including those advocating for more high-deductible health plans.  While this concept makes sense in economic theories, it also requires belief that patients can and will make good use of the information available to them – particularly when they are ill.

Another fundamental necessity for making such consumer-directed healthcare work to improve quality and lower costs is that the information provided to people is meaningful and accurate.  A study published in the November/December 2008 issue of Health Affairs illustrates the complexity of providing accurate information.…

Read More

Darwinian Politics of Health Reform in the U.S.

Tomorrow is Charles Darwin’s 200th birthday, and the Economist had a very interesting article about how his original theories have evolved over the past 200 years – and how a greater understanding of human evolution have revealed insights into human society and economics.

One of the most interesting observations in the Economist article is the differing levels of belief in evolution among countries.  The article explains these differences as possibly arising from the country’s safety nets for vulnerable people, i.e., individuals who have less concern about being able to obtain food or housing may be less likely to believe in God and be more likely to believe in evolution. …

Read More

Osteoporosis – Increasing Rates and New Treatments

A press release from the NIH yesterday announced a new discovery about the biology of bone remodeling that may lead to a new way to treat osteoporosis.  The study, (published in Nature), described how a compound found in the blood helps control the development of bone destroying cells called osteoclasts.  (Osteoclasts break down bone while osteoblasts build new bone – The balance between these two cell types determines whether bone density and strength stays the same, increases or decreases.)

Lead for New Treatments for Osteoporosis
The effects of this compound, (sphingosine-1-phosphate), on osteoclasts may lead to the development of new treatments for osteoposorisis since the existing treatments have focused on the activity of more mature osteoclasts and osteoblasts. …

Read More

Chronic Wellness Promotion v. Chronic Disease Management in Medical Homes

One of the hottest health reform topics is Medical Homes: Medicare has Demonstration Project starting this year, several states have implemented, (or are implementing), medical home related initiatives, the Center for Studying Health System Change (CSHSC) released a great white paper titled “Making Medical Homes Work,” and the New York Times just had a story about how IBM is teaming up with United Healthcare to promote Medical Homes for their 11,000 employees and dependents in Arizona.

Definition of Medical Homes
One of the controversies in Medical Homes is the definition.  CSHSC and many others use the definition developed by 4 national medical societies which combines aspects of preexisting primary care and chronic care models with the goal of creating a primary care “home” that can more effectively address the needs of patients with chronic conditions.…

Read More

Advancements in Understanding Head Trauma and Preventing Long-Term Problems

When I was training to become an orthopedic surgeon, one of the senior physicians said that the two best learning sources for orthopedic surgeons were football and war.  Over the past year I’ve been talking with friends and colleagues about another connection between war and football – how minor repetitive head trauma has long-term serious consequences.

It has become clear with the increasing reports about the neurological, cognitive and personality problems military personnel have experiences after repeated minor concussive events, (often from being inside vehicles hit by IEDs), that this is a real and serious situation.  While the VA health system has taken steps to understand the consequences of repetitive minor head trauma and work to provide appropriate diagnostic and treatment methods, I have been telling people that this new understanding of neuro-trauma will have implications for football.…

Read More

States Poaching Biotech Companies

In the Boston Globe there have been a couple of articles and an ad that pointed out the challenges states have in promoting and keeping productive and growing companies in their states.

In today’s paper there is an article about how the Governor of Massachusetts  is going to the West Coast to “to network with executives at computer and energy companies that have large facilities here, aiming to shore up and even expand their employment and investments in Massachusetts.”  While this is presumably a very good thing for Massachusetts, it raises two thoughts:

  • When I moved to Massachusetts in 2002 people were talking about how the state had lost its lead in the computer industry in the 1970s and 80s to California
  • The article doesn’t mention biotechnology, life sciences or healthcare – industries where Massachusetts still has a leadership position

This second point is particularly important because Saturday’s Globe had an article about how state regulations scheduled to take effect July 1st requiring disclosure of industry payments to physicians may cut down on medical meetings in Boston. …

Read More

Improving Cancer Care and Medicare’s Cancer Coverage

The New York Times and Wall Street Journal both had articles yesterday about a new rule clarifying how Medicare would decide whether or not to pay for off-label uses of medicines to treat cancer.  These articles describe controversies around Medicare relying on several compendia containing information about such off-label uses to make these coverage decisions, how some of the compendia may have industry connections, and how the new rule might increase Medicare spending.

I have a long history with this issue.  As a Legislative Assistant working for Congressman Sander Levin in the early 1990s, I was very involved in writing the legislation that first changed Medicare law to require Medicare Part B to pay for off-label used of medicines to treat cancer. …

Read More

Quality of Care in Medical Practices – Size Does Matter

The Journal of General Internal Medicine published a study last month that looked at primary care medical practices in Massachusetts to see how well they were able to provide the quality improving capabilities of Patient-Centered Medical Homes.  These structural capabilities represent process measures that assess the quality of care in medical practices.  However, these same measures could also help patients select their own primary care physicians.

Study Finds Larger Practices Have More Quality Related Capabilities
Not surprisingly the study found that larger practices, (and to a lesser extent those affiliated with larger networks of practices), provided more capabilities to improve the quality of patient care.…

Read More

Making Physicians Better, and Making Better Physicians

A few recent reports point to ways for improving the quality of physician delivered care that has little to do with technology or complex interventions.  The first involves how physicians interact with patients, and the second examines the work hours for physicians in training.

Etiquette in Medicine
The first article, by Dr. Michael Kahn in the New York Times, describes six recommended actions for physician to create a good rapport with hospitalized patients. Dr. Kahn collectively calls these actions “etiquette-based medicine”:

  1. Ask permission to enter the room; wait for an answer
  2. Introduce yourself; show your ID badge
  3. Shake hands
  4. Sit down.

Read More

Napping to Increase Productivity

The New York Times had a great short report about a scientific study comparing a short nap to caffeine for improving a person’s memory.  The study found what many people have suspected for years – a nap is better than caffeine.

The benefits of napping are something that proponents of “power napping” have known for years. (Disclaimer: I’ve used the 20 minute power nap for years to re-energize and turn an afternoon impaired by a severe case of “the weakies” into several very productive hours.)

The study specifically found that naps were better for improving recall of a word list after both 20 minutes and 7 hours. …

Read More

Baby Biotechs Treading Water

Monday’s Boston Globe had an article about how smaller biotech firms are having to cut spending to stay afloat since the current economic environment has made it almost impossible to raise more cash.  This shouldn’t be surprising given that these companies spend years (and years) developing new treatments and technologies before they are ever able to sell anything – assuming that their R&D does produce something that can be sold.  And the investing/lending world is currently not very interested in such long-term and speculative prospects. The immediate result is that these companies are laying people off, reducing their office space and actually mothballing research projects.…

Read More

Serotonin: Brains, Bowels, Bones and Beyond

One of the fascinating aspects of medicine and biology is how one substance can have so many functions.  A recent article about the effects of serotonin on bone cells and bone formation in the New York Times illustrates this point. While this finding about serotonin and bone formation may be important for developing new ways to treat osteoporosis, it is especially fascinating because serotonin does so many other things in the body.

Serotonin is probably best known for how its levels affect mood – which is the basis for the medicines to treat depression in the class known as “Selective Serotonin Reuptake Inhibitors,” or SSRIs.…

Read More