Kaiser Permanente, the health system based in California that combines a nonprofit insurance plan with its own hospitals and clinics, announced Thursday that it would open its own medical school in the state in 2019.
The system's leaders said their central goal was to teach Kaiser's model of integrated care to a new generation of doctors who will be under pressure to improve health outcomes and control costs by working in teams and using technology.
"Health care is evolving at a very, very rapid pace in our country and we have a model of care that's increasingly being looked to as an answer," said Dr. Edward M. Ellison, executive medical director for the Southern California Permanente Medical Group, who is helping to oversee the medical school's creation.
Kaiser already trains about 600 medical residents in its own program, and several thousand more complete a portion of their training in it each year. But its medical school, planned for Southern California, would be one of the first run by an integrated health system without an academic partner, said Dr. George E. Thibault, president of the Josiah Macy Jr. Foundation, which encourages innovation in medical schools.
"If health care is increasingly going to take place in integrated systems," Dr. Thibault said, "a large part of the medical education experience should be what it's like to work in a system like that: the efficiencies and the processes and the ways in which patient care is benefited."
Dr. Thibault added that while Kaiser would not be the only integrated health system involved in medical education, it is "larger than any of them, has greater reach than any of them, greater resources."
Kaiser runs 38 hospitals in eight states and the District of Columbia, with 18,000 doctors working for its affiliated medical groups and more than 10 million patients, mostly in California. It receives a fixed amount for medical care per member, so there is a strong financial incentive to keep people healthy and out of the hospital, a model that Kaiser pioneered and that is now being followed around the country.
Dr. Ellison said Kaiser's use of technology, through electronic medical records and new types of telemedicine that allow patients to receive "care anywhere in a way that's safe and effective," will also be crucial to its medical school curriculum.
More ...
http://www.nytimes.com/2015/12/18/business/kaiser-permanente-plans-to-open-a-medical-school.html?
Friday, December 18, 2015
Your New Medical Team: Algorithms and Physicians - The New York Times
Can machines outperform doctors? Not yet. But in some areas of medicine, they can make the care doctors deliver better.
Humans repeatedly fail where computers — or humans behaving a little bit more like computers — can help. Even doctors, some of the smartest and best-trained professionals, can be forgetful, fallible and prone to distraction. These statistics might be disquieting for anyone scheduled for surgery: One in about 100,000 operations is on the wrong body part. In one in 10,000, a foreign object — like a surgical tool — is accidentally left inside the body.
Something as simple as a checklist — a very low tech-type of automation — can reduce such errors. For example, in a wide range of settings, surgical complications and mortality fell after implementation of a basic checklistincluding verification of patient identity and body part for surgery, confirmation of sterility of the surgical environment and equipment, and post-surgical accounting for all medical tools. Though simple procedureswould all but eliminate certain sources of infections in hospitals, thousands of patients suffer from them in American hospitals every year.
More ...
http://www.nytimes.com/2015/12/08/upshot/your-new-medical-team-algorithms-and-physicians.html?
Humans repeatedly fail where computers — or humans behaving a little bit more like computers — can help. Even doctors, some of the smartest and best-trained professionals, can be forgetful, fallible and prone to distraction. These statistics might be disquieting for anyone scheduled for surgery: One in about 100,000 operations is on the wrong body part. In one in 10,000, a foreign object — like a surgical tool — is accidentally left inside the body.
Something as simple as a checklist — a very low tech-type of automation — can reduce such errors. For example, in a wide range of settings, surgical complications and mortality fell after implementation of a basic checklistincluding verification of patient identity and body part for surgery, confirmation of sterility of the surgical environment and equipment, and post-surgical accounting for all medical tools. Though simple procedureswould all but eliminate certain sources of infections in hospitals, thousands of patients suffer from them in American hospitals every year.
More ...
http://www.nytimes.com/2015/12/08/upshot/your-new-medical-team-algorithms-and-physicians.html?
Did Hospitals Kill Her Mom? - The Daily Beast
Over the course of her lifetime, Paula Schulte survived painful scoliosis that contorted her spine, a head injury that left her in a coma for weeks, and cancer that cost her part of a lung.
What she couldn't survive was 11 weeks in Florida hospitals.
Schulte, 64, was living an engaged life—staying in touch daily with her daughter, Stephanie Sinclair, a photojournalist, and taking afternoon drives with her husband, Joe. When she suffered an unexpected bout of seizures in August 2012, doctors said she would need only a short hospital stay until the drugs kicked in to remedy things.
Instead, her treatment triggered a cascade of medical mistakes.
More ...
http://www.thedailybeast.com/articles/2015/12/18/did-hospitals-kill-her-mom.html
What she couldn't survive was 11 weeks in Florida hospitals.
Schulte, 64, was living an engaged life—staying in touch daily with her daughter, Stephanie Sinclair, a photojournalist, and taking afternoon drives with her husband, Joe. When she suffered an unexpected bout of seizures in August 2012, doctors said she would need only a short hospital stay until the drugs kicked in to remedy things.
Instead, her treatment triggered a cascade of medical mistakes.
More ...
http://www.thedailybeast.com/articles/2015/12/18/did-hospitals-kill-her-mom.html
Wednesday, December 16, 2015
The Lancet: Women’s Contribution to Healthcare Constitutes Nearly 5% of Global GDP, but Nearly Half Is Unpaid and Unrecognized
A major new Commission on women and health has found that women are contributing around $3 trillion to global health care, but nearly half of this (2.35% of global GDP) is unpaid and unrecognised.
Published in The Lancet, the Commission offers one of the most exhaustive analyses to date of the evidence surrounding the complex relationships between women and health, and demonstrates that women's distinctive contribution to society is under-recognised and undervalued—economically, socially, politically, and culturally.
The report underlines that women are important providers as much as recipients of health care, and that globally, their changing needs in both of these respects are not being met.
According to Professor Ana Langer, head of the Women and Health Initiative at Harvard T. H. Chan School of Public Health in Boston, USA, who co-led the commission, "Too often, women's health is essentially equated to maternal and reproductive health. However, the evidence outlined by this Commission overturns this conventional interpretation, and we urge the global health community and policymakers worldwide to embrace a more holistic – and realistic – understanding of women and health. It's time to acknowledge women's comprehensive health needs throughout their lives, and their productive contributions to health care and society as a whole, as well as their similarly important roles as mothers and homemakers."
The Commission, which brought together leading thinkers, heads of programmes, and activists from around the world, examines the complex links between biological, economic and social factors in improving women's health throughout their lives – including the substantial effects of rapid globalisation, urbanisation, and climate change, all of which have inequitable effects on women's health.
According to Professor Afaf Meleis from the University of Pennsylvania School of Nursing, Philadelphia, USA, who co-led the Commission with Langer, "Often urban areas are developed without any input from women, and without addressing their needs for adequate lighting, safe transportation, access to healthy food, to infrastructures that promote community connectivity, and to integrated health care, child and elderly care. This puts women at increased risk of violence, non-communicable diseases and stressful life overload, which may in turn have adverse consequences for their families."
More ...
Tuesday, December 15, 2015
Jobs for Medical Scribes Are Rising Rapidly but Standards Lag - US News
A national campaign for electronic health records is driving business for at least 20 companies with thousands of workers ready to help stressed doctors log the details of their patients' care – for a price. Perhaps 1 in 5 physicians now employ medical scribes, many provided by a vendor, who join doctors and patients in examination rooms. They enter relevant information they hear about patients' ailments and doctors' advice in a computer, the preferred successor to jotting notes on a clipboard as doctors universally once did.
The U.S. has 15,000 scribes today and their numbers will reach 100,000 by 2020, estimates ScribeAmerica, the largest competitor in the business. After buying three rivals this year, it employs 10,000 scribes working in 1,200 locations.
Regulation and training are not rigorous. Scribes are not licensed. About a third of them are certified and that's voluntary, according to the sole professional body for scribes. The American College of Scribe Specialists was created by ScribeAmerica's founders in 2010.
"This is literally an exploding industry, filling a perceived gap, but there is no regulation or oversight at all," says George Gellert, regional chief medical informatics officer at Christus Santa Rosa Health System in San Antonio, which uses scribes.
Others suggest that scribes can be a benefit to doctors and patients by shouldering the minutia of recording many of the details on a computer. "They're capturing the story of a patient's encounter – and afterword, doctors make sure everything is accurate. That way the doctor can focus on interacting with the patient and give them good bedside manner," says Angela Rose, a director at the American Health Information Management Association, a professional group that has published a set of best practices for scribes.
More ...
Sunday, December 13, 2015
‘The Death of Cancer,’ by Vincent T. DeVita Jr. and Elizabeth DeVita-Raeburn - The New York Times
When I was doing my medical training nearly 20 years ago, there were two kinds of residents: those who were planning on specializing in oncology and those who couldn't tolerate the subject for even a month. One night when I was on call, I worked with someone in the second camp. He told me about a patient of his, an elderly woman with pancreatic cancer that had grown into her bile duct and metastasized through her intestinal tract. She had been through several rounds of chemotherapy without success and was ready to quit treatment, but was afraid to tell her oncologist. "She told me, 'I don't want him to think I'm giving up,' " my colleague said, obviously disgusted that she didn't feel comfortable speaking freely about her goals.
He encouraged her to choose hospice care. Two weeks later, he said to me, his patient's hospice aide came up to him on the ward. "She told me that my patient made her promise that the day she died, she would come find me and tell me. She said my patient wanted to thank me for encouraging her to die the way she wanted to."
I thought of this story at various points while reading "The Death of Cancer," Vincent DeVita Jr.'s fascinating if hubristically titled new book, co-authored with his daughter, Elizabeth DeVita-Raeburn, a science writer. Today, more than four decades after President Nixon declared war on cancer and with so many new weapons in our arsenal supported by big budgets and a decidedly aggressive posture, when is it O.K. to give up? When is it best to surrender?
More ..
http://www.nytimes.com/2015/12/13/books/review/the-death-of-cancer-by-vincent-t-devita-jr-and-elizabeth-devita-raeburn.html?
He encouraged her to choose hospice care. Two weeks later, he said to me, his patient's hospice aide came up to him on the ward. "She told me that my patient made her promise that the day she died, she would come find me and tell me. She said my patient wanted to thank me for encouraging her to die the way she wanted to."
I thought of this story at various points while reading "The Death of Cancer," Vincent DeVita Jr.'s fascinating if hubristically titled new book, co-authored with his daughter, Elizabeth DeVita-Raeburn, a science writer. Today, more than four decades after President Nixon declared war on cancer and with so many new weapons in our arsenal supported by big budgets and a decidedly aggressive posture, when is it O.K. to give up? When is it best to surrender?
More ..
http://www.nytimes.com/2015/12/13/books/review/the-death-of-cancer-by-vincent-t-devita-jr-and-elizabeth-devita-raeburn.html?
Why do doctors choose a $2,000 cure when a $50 one is just as good? - The Washington Post
I'm a doctor with a miracle drug. Three of them, in fact. Their names are Avastin, Lucentis and Eylea. I use them to treat the number one cause of blindness in Americans over sixty-five: wet age-related macular degeneration (AMD). Calling them a miracle is no understatement. If your doctor delivers the unlucky news that you've developed wet AMD, it means blood vessels under your macula have started to leak or bleed, robbing you of the sight you rely on to read books, see faces, watch TV or drive.
Enter the miracle drugs—eye injections that limit those leaking submacular vessels, giving us our first treatment capable of bringing vision back. But somehow, these drugs have become among the most controversial in all of medicine.
All three treat wet AMD very effectively. Their most significant difference is cost. Lucentis and Eylea cost approximately $2,000 and $1,850 per dose, respectively. Avastin? Only $50.
Medicare covers them all, so retina doctors and their patients are free to choose whichever medication they wish. A recent survey of our field showed that 64.3 percent of us choose Avastin as our first-line drug. Yet about 35 percent of retina specialists continue to use the expensive medicines as their first treatment of choice. Why?
Most likely, because they feel these drugs are better than Avastin. After all, we're taught to adhere to the ethical duty to "treat patients the way we'd treat our mothers, or ourselves," right? That's a mental check of ethics I employ during virtually every patient visit, every single day.
But what if, in addition to an ethical duty to do what we feel is best, we also had an ethical duty to recommend the most cost-effective care?
More ...
Subscribe to:
Posts (Atom)