In the quest to reduce health care spending in the United States, the idea held incredible promise: By addressing the medical and social needs of the most expensive patients, you could keep them out of the hospital.
These individuals, frequently struggling with addiction or homelessness, have extremely complicated medical conditions. By finding them and connecting them to the right doctors and social services, dozens of costly hospital stays could be avoided. The idea has been adopted in numerous communities around the country.
Dr. Jeffrey Brenner, a family physician in New Jersey, founded the Camden Coalition of Healthcare Providers in 2002. He created teams of nurses, social workers and others to coordinate the care of people he saw cycle in and out of the hospital. Dr. Brenner, who was profiled in a 2011 New Yorker piece, "The Hot Spotters," and who won a MacArthur Foundation fellowship — known as a "genius" grant — in 2013, became the program's chief evangelist.
But a new study, published Wednesday in the New England Journal of Medicine, showed that the Camden program did not result in fewer hospital readmissions in the six months after a patient left the hospital. While the program appeared to lower readmissions by nearly 40 percent, the same kind of patients who received regular care saw a nearly identical decline in hospital stays.
More ...
https://www.nytimes.com/2020/01/08/health/camden-coalition-chronic-illness.html
Thursday, January 9, 2020
Sunday, January 5, 2020
How one medical checkup can snowball into a ‘cascade’ of tests, causing more harm than good - The Washington Post
My pager emits the same urgent beep no matter the occasion. That afternoon, it was the local preoperative clinic to say my 80-something patient, Lily, had been given an electrocardiogram (EKG) "just to be safe" before a minor office procedure.
The EKG was a little off, the page went on. Could I take a look? Lily (I'm identifying her by only her first name at her request) felt fine. No chest pain. No trouble breathing. But now that the irregularity was out there, the procedure would be delayed until we had answers.
Flash forward one borderline blood test result, several phone calls between myself, Lily, and the anesthesiologist, 14 emails, an office visit, and a completely normal stress test. Lily (and her heart) were in no better health, yet she was slightly less well off and more than slightly distressed by all the trouble she went through. I was disappointed that I'd failed her.
And this was a relatively good outcome.
"If You Give a Mouse a Cookie," Laura Numeroff's classic children's book, is a cautionary tale about the downstream consequences of a single, seemingly innocuous decision. You gave the mouse the cookie. Naturally, he wanted a glass of milk to go with it. Before long, the mouse was moving in and sharing your Netflix password.
This pattern is familiar to many of us, whether as doctors or as patients: A medical test spurs a "cascade" of phone calls, office visits, tests and treatments, each a logical, even inevitable, progression from the one before.
More ...
https://www.washingtonpost.com/health/how-one-medical-checkup-can-snowball-into-a-cascade-of-tests-causing-more-harm-than-good/2020/01/03/0c8024fc-20eb-11ea-bed5-880264cc91a9_story.html
The EKG was a little off, the page went on. Could I take a look? Lily (I'm identifying her by only her first name at her request) felt fine. No chest pain. No trouble breathing. But now that the irregularity was out there, the procedure would be delayed until we had answers.
Flash forward one borderline blood test result, several phone calls between myself, Lily, and the anesthesiologist, 14 emails, an office visit, and a completely normal stress test. Lily (and her heart) were in no better health, yet she was slightly less well off and more than slightly distressed by all the trouble she went through. I was disappointed that I'd failed her.
And this was a relatively good outcome.
"If You Give a Mouse a Cookie," Laura Numeroff's classic children's book, is a cautionary tale about the downstream consequences of a single, seemingly innocuous decision. You gave the mouse the cookie. Naturally, he wanted a glass of milk to go with it. Before long, the mouse was moving in and sharing your Netflix password.
This pattern is familiar to many of us, whether as doctors or as patients: A medical test spurs a "cascade" of phone calls, office visits, tests and treatments, each a logical, even inevitable, progression from the one before.
More ...
https://www.washingtonpost.com/health/how-one-medical-checkup-can-snowball-into-a-cascade-of-tests-causing-more-harm-than-good/2020/01/03/0c8024fc-20eb-11ea-bed5-880264cc91a9_story.html
Subscribe to:
Posts (Atom)