When being a good clinician is just not enough for our patients and the communities we serve…

It remains both a shock and disgrace that so many health disparities begin in early childhood.  An August 2014 Issue Brief by the Robert Wood Johnson Foundation: Early Child Hood Experiences Shape Health and Well-Being Throughout Life highlights the impact of early childhood in starting down the road to later illnesses:

“The association between socioeconomic factors and child health is evident from birth.
Factors such as nutrition, housing quality, and safety at home and in the community—all linked with family resources—are strongly associated with child health. Research shows that children’s nutrition varies with parents’ income and education and can have lasting effects on health throughout life; for example, inadequate nutrition is linked with obesity during childhood, which in turn is a strong predictor of adult obesity and its accompanying risks of chronic disease, disability and shortened life. Similarly, children exposed to lead-based paint, most commonly found in lower-income neighborhoods, are more likely to suffer from lead-poisoning, which can lead to irreversible neurological damage.”

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The View from the Bottom

According to a recent report published by the Commonwealth Fund* on how the U.S. health care system compares internationally, the United States is not doing so well as a health care system:

“Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.”

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“I’m ninety-three, and I’m feeling great. Well, pretty great, unless. . . .”

The Stories Behind the Stats: We Treat People not Numbers

In his classic work on illness and narrative: The Wounded Storyteller Arthur Franks writes:

“This book presents ill people as wounded storytellers.  I hope to shift the dominate cultural conception of illness away from passivity- the ill person as ‘victim of’ disease and then recipient of care- toward activity.  The ill person who turns illness into story transforms fate into experience: the disease that sets the body apart from others becomes, in the story, the common body of suffering that joins bodies in their shared vulnerability.”

We are experiencing a moment of history where stories about illness are being transformed and combined into data at an incredible pace.  Reimbursement rates and outcomes often come down to meeting cold hard numbers, and of course when it comes to population health we need these numbers to understand and manage healthcare. Read More

Is Medicine a Team Sport?

What skills do doctors need to make the patient care team successful?

A change in Medicare policy will now pay Doctors to manage the care of some of their patients according to an article in the New York Times.  This is the latest change in a general move by Medicare and Medicaid to rethink the role of doctors and to compensate accordingly.  According to the Times article:

“As part of the new service, doctors will assess patients’ medical, psychological and social needs; check whether they are taking medications as prescribed; monitor the care provided by other doctors; and make arrangements to ensure a smooth transition when patients move from a hospital to their home or to a nursing home.”  Read More

Is Value Based Purchasing getting it right?

Value Based Purchasing (VBP) is the program CMS uses to financially reward and punish hospitals based on the quality of the care the hospitals provide and their ability to cut costs.  Two stories from Kaiser Health News highlight the stakes involved for the hospitals and the details of the evaluation process.

Like many Pay for Performance (P4P) programs, the concerns with VBP lie less in the concept- no one is against better outcomes and accountability- and more in the details and assumptions contained in how quality is measured and addressed.  Read More

MedPAC weighs in on quality

The Medicare Payment Advisory Commission’s (MedPAC) recent report to Congress provides an important and thoughtful rethinking of how quality is measured in the health care delivery system. The report lists 3 major critiques of the current way that quality is measured. First the current regime relies too heavily on “clinical process measures” that may lead to both the overuse of services and may not even correlate to better health outcomes. Read More

Burnout: Is it me or is the system designed that way?

It feels like doctor burnout could always be in the news. It is not so much a story as a constant fact.  The numbers, like the situation, are depressing.  Dr John La Puma in a KevinMD post cites a 2012 JAMA article by Tait D. Shanafelt, MD et al on physician burnout that is offered free on the JAMA web site.  In the article they write: Read More