Blog Archives - Page 16 of 22 - The BioContinuum Group

Notes & Links: August 13, 2013

Anthony Cirillo writing contributing to Healthworks Collective looks at data that was published last month regarding suicide rates for men and women of a certain age.

The CDC analyzed National Vital Statistics System (NVSS) mortality data from 1999–2010. The results of this analysis indicated that the annual, age-adjusted suicide rate among persons aged 35–64 years increased 28.4%, from 13.7 per 100,000 population in 1999 to 17.6 in 2010.

Among men, the greatest increases were among those aged 50–54 years and 55–59 years, (49.4%, from 20.6 to 30.7, and 47.8%, from 20.3 to 30.0, respectively). Among women, suicide rates increased with age, and the largest percentage increase in suicide rate was observed among women aged 60–64 years (59.7%, from 4.4 to 7.0).

One of the reasons Cirillo gives for this increase in suicide is the stress of caregiving. He addresses the need for caregivers to see what they do as an opportunity. Which if you read my essay at Mayo Social Media Network agrees with his view.

7 Ways to Get More Patients Online

Jonathan Govette contributed to Healthworks Collective and this is a great article with a lot of practical advice and tips. There are some infographics on FB G+ that ring so true not just for patients but for anyone looking to post. (Note: he says 7 I am struggling to find #7 there are only 6 listed)

According to TeleVox, 51% of people say they’d feel more valued as a patient through digital health communications. This means that it is time to strengthen your relationships with potential patients online to ensure that awareness of your practice is reaching the most amount of relevant people as possible.

All I can say is word up. And for people to feel more valued we need to know the problems they want to solve and offer them solutions that they can integrate into their experiences.

Here are the 6 ways:

Pay Per Click Advertising
SEO
A Healthcare Database and Booking Service
Content Marketing (The most important especially if you address problems that can be solved)
Social Media (Great tips and tricks here)
Email Marketing

We all know these ‘ways’ but to find them in one place is a good resource. Take a look well worth the time. Check out the optimum timing for posts on social media.

Maker Movement Meets Healthcare

If you are slow like me you scratched your head when you read Maker Movement’ and healthcare in one line.

Basically, for one of these it’s health literacy education & outreach via hands on geek project, and for the other two, there were real world problems that have expensive, time-consuming or often inaccessible solutions, for which people came up with their own solutions and alternative

PF Anderson on her blog Emerging Technologies Librarian has share some great links. How can you not smile at a 12 year old named Sylvia on Make Magazine who shows us how to build a pendant that shows your heart beat. She is so damn perky for this early in the morning.

Take a look great stuff.

Notes & Links: August 12, 2013

How Obamacare Affects You

Toprntobsn.com has a simple easy to read info graphic on Obamacare. An interesting fact about the ACA that really speaks to the complexity of healthcare in America.

It is twice as long as the Defense Authorization Act of 2010. The entirety of U.S. code is 45 million words making H.R. 39620 0.5% of all U.S. Code!

It is easier to go to war it seems.

Americans Don’t Understand Insurance, Let Alone Obamacare Research Shows

Bruce Japsen contributing to Forbes presents some surprising data on Americans knowledge of Health Insurance.

“Researchers looked at two surveys of Americans between the ages of 25 and 64 who have private coverage. Among their findings, researchers uncovered that just 14 percent of respondents had an understanding of the most basic insurance concepts of “deductible, copay, co-insurance and out-of-pocket maximum.”

All the more reason we need to spread the word on the excellent info graphic on Obamacare linked above. Just as more and more Americans are using the web to learn about their health and become active participants the need to understand and make decisions about health insurance will make a difference.

Americans’ Health Insurance Illiteracy Epidemic-Simpler is Better

Jane Sarasohn-Kahn writing on her blog HealthPopuli is addressing the issue of our understanding of health insurance with an excellent review of new research by George Loewenstein from Carnegie Mellon Published in Journal of Health Economics.

Here is a sample of a chart from that study and it is speaks volumes about what we don’t know and need to know.

Notes & Linkes: August 8, 2013

“Validity of Web-Based Self-Reported Weight and Height: Results of the Nutrinet-Sante Study”

Lassale, Peneau, et. al. have published an article in JMIR examining the trending in healthcare of e-pidemiology and the validity and reliability of self-reported data.

Compared with the clinical data validity was high. Intraclass correlation coefficient ranged from 0.94 for height and 0.99 for weight. They reported a slight underreporting of weight and over reporting of height which lead to underreporting of BMI (p<.05) for both men and women. I guess we all lie about our weight and height a little

Conclusions: Web-based self-reported weight and height data from the NutriNet-Santé study can be considered as valid enough to be used when studying associations of nutritional factors with anthropometrics and health outcomes. Although self-reported anthropometrics are inherently prone to biases, the magnitude of such biases can be considered comparable to face-to-face interview. Web-based self-reported data appear to be an accurate and useful tool to assess anthropometric data.

This study supports web-based self reporting and for my two cents it is another tool to aid outcomes that resides outside the office visit. But for my money it strikes me as an important step in demonstrating to providers a way to lower utilizations costs while improving physician patient engagement.

Glad to see more studies like this every month. We need to know what is happening from a data .

“What’s CBS worth? How About Just the Programs”

If you live in NYC or LA TWC shut down CBS and Showtime (Dexter!!!!!) over money.

Doc Searls examines this issue and what may happen going forward. I know I am looking to find a way to cut the cable cord myself. Most of the tech heads I follow have done it to some degree but tend to return. There is a real opportunity for change in pricing and access to TV shows and networks. I wonder about Apple and their iTV. Networks will not roll over like the cheap suits of music due to the impeccable logic of one Steve Jobs. But with Netflicks and others producing high quality content we may just be at the cross roads. I sure hope so.

“Top 5 Reasons Hospitals Are Losing Money”

Only 5? Each one of us can identify three more.

Danyell Jones posting in HealthWorks Collective presents the follow sobering data

With such a high cost of care, many assume that hospitals in America are turning a healthy profit; however this just isn’t the case. In fact recent estimates indicate that nearly 67% of US hospitals are losing money, particularly when it comes to the treatment of Medicaid/Medicare patients.

The five are:

Denials and Coding Issues
Service Level Discrepancies
Front Desk Processes
Look at your Patient Mix
Evaluate Your Contracts and Negotiate to Win

Color me surprised a post on an industry supported site first blames Medicaid/Medicare patients. Gee that was easy. Listen to the Terry Gross on Fresh Air interviewed Elisabeth Rosenthal, MD from the New York Times about her series on cost of healthcare in the US.

It costs $13,660 for an American to have a hip replacement in Belgium; in the U.S., it’s closer to $100,000.

Rosenthal examination of the issue from an investigative journalist does not lay the blame (i.e. reasons) on Medicare/Medicaid. Our system drives the need to price healthcare at an al la carte basis with layer upon layer of costs for each procedure.

We may never change our system but all of us will be looking at costs going forward and that may help to put pressure on lowering prices while delivering care, not excess. To that point a friend just delivered a baby at a major NYC hospital and said for the two days she was there every time there was a service delivered (i.e. cleaning the room, coaching breast feeding, etc.) there was a survey immediately following. Gotta love a corporation humping outcomes. In fact my friend said for the breast feeding coaching session there were no less then four people in the room. It takes a village of al a carte services.

PS: Why does a class money filled operation like NPR hang its graphic hat on crappy stock art of the lowest order. Gee show me pills spilled on $20 bills. Nothing says cost in medicine like that. NOT!

“Why Reports of the Death of Physician Participation in Medicare May be Greatly Exaggerated”

Dan Diamond writing in The Health Care Blog quotes the usual suspects on the demise of care for Medicare patients

“Half of primary care physicians in survey would leave medicine … if they had an alternative.” — CNN, November 2008

“Doctors are increasingly leaving the Medicare program given its unpredictable funding.” – Forbes, January 2013

And least we forget our favorite healthcare resource for evidence based knowledge

The Wall Street Journal last month portrayed physician unhappiness with Medicare as a burning issue, with a cover story that detailed why many more doctors are opting out of the program.

And yes, the number of doctors saying no to Medicare has proportionately risen quite a bit — from 3,700 doctors in 2009 to 9,539 in 2012. (And in some cases, Obamacare has been a convenient scapegoat.)

Oh no Mr. Bill the WSJ didn’t report on some data? I am shocked.

What the Journal didn’t report is that, per CMS, the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013.

And other providers aren’t turning down Medicare, either. The number of nurse practitioners participating in the program has only gone up, Jan Towers of the American Academy of Nurse Practitioners says.

Yes there is frustration and HCP are pissed at low revenue and more work. My hope is as the system lowers cost overall dollars can be shifted to the HCP to care for the elderly who suck down a lot of dollars. Outcomes measures will do much to drive that balance.

What’s In A Caregiver Toolbox? Let’s Build One

Many of know or remember that I wrote an essay for The Mayo Clinic Social Media Health Network on caregiving. The essay is here. If you haven’t read it please take a look, comment, and vote. (Okay that was my shameless pitch for like me like me.) To the bigger point I want to make, caregiving extends beyond caring and giving of two parties. It is a necessary and highly valuable part of healthcare and healthcare’s future. In my essay I mention the need to create a tool box. We may not need to create it just use the tools we have.

An article in JAMA last month “The Critical Role of Caregivers in Achieving Patient-Centered Care” by Muriel R. Gillick, MD. Opens the idea of caregivers and tool box.

Achieving high-quality, cost-effective medical care remains an elusive goal of the US health care system, but there is widespread agreement that patient-centered care will be a key ingredient.1 Yet for frail elders and patients with advanced illness, many of whom have multiple chronic diseases, patient-centered care is impossible without caregiver involvement.

Gillick addresses the fact that the elderly suffer substantial disabilities in the final year of life and that demands active and daily care from a loved one. The stats are mind blowing.

In the year before death, only 17% of individuals experience no disability, 22% have persistent severe disability, 18% have accelerated disability, and 24% have progressive disability.4 Some of these patients have advanced organ failure and experience frequent exacerbations of illness, with a fluctuating need for personal assistance. Other patients, who together constitute the largest group of dependent elders, are frail (28%) or have advanced dementia (14%).4

Gillick presents four points on implementing patient-centered care and how to integrate caregivers.

Understand the patients underlying health status
Prioritize goals for care with the caregivers
Designing a plan of care
Perform a comprehensive assessment of both the patients and patients surroundings

Finally Gillick shares the critical need to have care plans available across all sites of care and this should include EMR etc. This is the core of the caregivers tool box, HCP, patient, caregiver planning and goals.

Family Caregiver Alliance

This the national center on caregiving. It calls itself a public voice for caregivers with information, education, services, research, and advocacy. There is so much on the site it is somewhat overwhelming but that’s me and my attitude toward design. They have a valuable tool a map to view caregiver resources for all 50 states.

This is another tool to add to the caregiver toolbox.

Broadcasting Bereavement

Scott Simon @nprscottsimon writing on The Dish presents the case for speaking about, dealing with, and conquering grief. He captures my very feelings when he says

Grief is the flip side of love. Mourning has become an all too isolated experience—but Facebook and Twitter have become a place (strange as it may seem) where the bereaved can find community, a minyan of strangers to share their prayers

Another tool.

CS Lewis in his essay “A Grief Observed” clearly captures the reality when he says

“…bereavement is not the truncation of married love but one of its regular phases–like the honeymoon.”

Further down he states

“The less I mourn her the nearer I seem to her.”

Grief and bereavement is part of the caregiving process and the natural extension. We need tools for caregivers to aid and support and help prepare them and guide them. I believe that caregiver will have a lower incidence of complicated grief when they are actively supported and aided durning caregiving. Indeed another tool in the toolbox.

In the end caregiving is what we do it is an extension of our love and who we are. But as huge segments of our population ages and more and more of us get ill caregiving will be a critical part of each one of our lives. We cannot escape it. We can only manage it and make it a task that is less horrific and painful. It will never have joy but perhaps it can have a place in our hearts where it gives us peace.

Notes & Links: July 31, 2013

User Evaluation of the Effects of Text Simplification Algorithm Using Term Familarityon Preception, Understanding, Learning and Information Retention

That title is a mouthful but as with most mouthfuls once you digest it you are filled with wholesome goodness. Leroy, et. al out of Claremont Graduate University publishing in Journal of Medical Internet Research have completed a study whose objective is:

To develop an evidence-based writer support tool to improve perceived and actual text difficulty. To this end, we are developing and testing algorithms that automatically identify difficult sections in text and provide appropriate, easier alternatives; algorithms that effectively reduce text difficulty will be included in the support tool. This work describes the user evaluation with an independent writer of an automated simplification algorithm using term familiarity.

Term familiarity is a new term for me. The authors describe it how easy words are for readers and is measured using Google Web Corpus. The authors identified unfamiliar word and tagged for replacement with easier words. They measured both perceived and actual text difficulty.

…our conclusion that lexical simplification is beneficial and has an immediate impact on understanding and learning. However, we did not find an effect of simplification on retention of information. This may be due to a lack of sustained learning or it may be due to the study design.

I would offer that part of retention and improved understanding and learning is to test participants with an HCP to help them or within a social media with others who have read the same article. Small group dynamics and learning will drive results some much better.

Hive Marketing In Healthcare: Creating and Maintaing Communities of Shared Interest

The Healthcare Marketer defines Hive but it strikes me that what he is describing is community of practice. Etienne Wenger on his Web site defines community of practice as:

Communities of practice are formed by people who engage in a process of collective learning in a shared domain of human endeavor: a tribe learning to survive, a band of artists seeking new forms of expression, a group of engineers working on similar problems, a clique of pupils defining their identity in the school, a network of surgeons exploring novel techniques, a gathering of first-time managers helping each other cope.

The Healthcare Marketer makes the following point:

By creating these online environments, something health insurance companies, pharmaceutical companies and patient advocacy groups have already pioneered, the provider organization changes its relationship with its constituents.

These groups may have ‘pioneered’ this but the reality Jean Lave and Etienne Wenger coined the phrase in 1991 in a book titles ‘Situated Learning’. And further I am not sure how active learning is within the framework of insurance companies etc. We have a fairly sophisticated and savy group of healthcare learners who are cynical.

That Awkward Moment When The Woman You Try Robbing Know Systema

This has nothing to do with healthcare but everything to do with “You Go Girl” How can you not fall in love with that woman? Hehehe Thank you Daring Fireball for the tip.

The Harmony of Loss Found in the Caregiver Community

There have been many comments to my essay for the Mayo Clinic Patient Caregiver Scholarship contest. I am struck by them all. Struck by the resonate chord and the harmony we share as caregivers. They fill me with hope and understanding.

What touches me the most is that we share a similar sense of loss while at the same time we have a strength of knowledge and understanding. This comes from our collective sharing of experiences and using that knowledge to move forward to find some peace. Peace that does not come easily while the pain is mitigated by knowing we are not alone.

If you can read the essay and the comments leave one if can but most of all feel the sense of place we share.

Notes & Links: July 29, 2013

10 Reasons Why ObamaCare is Good for US

HealthPopuli has listed reasons she believes ObamaCare is good for us and the US. You’ve seen most of these enumerated else where but her list is more. It explains why each point will make a difference to us as consumer and the US as a nation. If you are looking to arm yourself for arguments with those who want to strike the ACA down the language and support here will serve you well.

Github: How an Open Source Programming Tool With a Funny Name Could Help Revolutionize Medical Research.

Joyce Lee, MD writing on The Health Care Blog brings a great idea from the tech world of programers and code writers to healthcare. Use open source GitHub to share medical research. Her thoughts on this really clarify how to make this idea work. But more important she has seeded the idea with her her own project.

Why Healthcare Facilities Belong on Pinterest

I have made fun of Pinterest calling it Twitter for people who can’t read. Well Michael Sherman posting on HealthWorks Collective makes the case why Pinterest works and changes my mind. Guess I will have to stop laughing at my own jokes.

Moms, Are Your Autoantibodies Causing Autism?

Provocative headline from and equally provocative study out of University of California, Davis. Emily Willingham contributing to Forbes does an excellent job of clarifying the data and putting into understandable writing for all of us.

Second, and probably more significant, is a question nags at me when I read these fetal-exposure-to-autoantibody studies. Once mothers make these autoantibodies, they don’t stop. Thus, if the autoantibodies are causative or play a big role in autism risk, I’d expect to see a higher rate of younger autistic siblings of autistic children whose mothers test positive for these autoantibodies or fall in the 99% specificity category. The evidence equation adds up like this: Researchers can show (1) the presence of autoantibodies around birth + (2) having an autistic child + (3) a greater autism risk or rate among younger siblings of that child than already exists for siblings of autistic children. Such results would, I think, help solidify these indicators that for a subset of cases of autism, maternal autoantibodies during fetal development play a role.

Notes & Links: July 26, 2013

Chromecast vs. AirPlay: How do They Compare?

The Verge has a comparison of Google’s new Chromecast to Apple’s established AirPlay.Great review well balanced with a handy dandy chart to compare features.

What’s So Wrong About Sexting, Anyway?

Glenn Cohen on The Health Care Blog Op-Ed takes a serious look at sexting and Mr. Weiner. I have deliberately stayed away from reading much about this except for the passing headlines including those in the NY Post.But I read this entire op-ed piece and found it thoughtful and well measured.

Reaching Rare Disease Communities

Pam Todd writing on HealthWorks Collective addresses the need for patients with rare diseases to find useful, clear, concise, and practical information. I agree.

Pam opens with the following quote “If you can’t outspend, outreach”. Sorry but money buys reach plan and simple. Though I will say those with rare disease are likely avid, relentless, and over the top aggressive searchers and knowledge consumers. They may make reach beat spend. May is the operative word.

What’s The Role of A Hospital In 10 Years?

Dave Chase writing in Forbes takes a look at the changes facing the hospital of today and does a great job of comparing it to the previous and current plight of print newspapers.

While no analogy is perfect, health system boards would be well advised to study what newspaper industry leaders did (or perhaps more appropriately, didn’t do) when faced with a dramatic industry change. Turn back the clock 15 years and the following dynamics were present:

Notes & Links: July 25, 2013

I’m a Patient and I Read Like a Seventh Grader: This is Your Problem

Chen Sirkis writing on HealthWorks Collective makes the case for a collective need for content focused on the below average reader. Use videos, pictures, and collateral material aimed at a 15 year old. JAMA Internal Medicine published a study on readability.

The research determined that such materials often are too complex for their intended audience. The main reason is that the average American adult reads at approximately a seventh- to- eighth-grade level.

We can do better with this audience since they are the key to driving durable improvements in outcomes. Currently we are collectively speaking in an echo chamber to ourselves. Additionally I wonder if this audience is more at risk when visiting sites that do not speak to evidence based medicine or proven science. Will they make decisions based on bad information?

Social Media Gets Strep Throat Epidemic Under Control

Michael Sherman writing on HealthWorks Collective share an article from Clinical Infectious Diseases how 18 of 63 party goers came down with strep throat.

After seeing a large number of posts on Facebook related to strep throat, one parent alerted the Minnesota health department that this wasn’t just a coincidence. The department then conducted phone interviews with attendees and their family members and analyzed DNA from strep bacteria samples.

I hope we see more studies show social media being part of improved identification of disease and its effect on specific populations.

Identifying “good” and “bad” hospitals

The Incidental Economist takes a look at a new paper from JAMA Internal Medicine “Mortality for Publicly Reported Conditions Overall Hospital Mortality Rates“. The study looks at reportable data for hospital mortality rates indicate overall hospital performance. IE does a great job at reviewing this study.

A hospital’s 30-day mortality rates for Medicare’s 3 publicly reported conditions—acute myocardial infarction, congestive heart failure, and pneumonia—were correlated with overall hospital mortality rates, even in clinically dissimilar fields. Hospitals in the top quartile of performance on the publicly reported mortality rates had greater than 5-fold higher odds of being top performers for a combined metric across 19 common medical and surgical conditions, translating into absolute overall mortality rates that were 3.6% lower for the top performers than for the poor performers. Finally, performance on the publicly reported conditions far outperformed 2 other widely used markers of quality: size and teaching status. […]

Perhaps the crap load of data we are collecting and sharing will help patients make better healthcare decisions that improves overall outcomes. The real issue will be how well we teach patients to find and appraise this data and what it means especially in light of the article on patient reading skills. We got our work cut out for us.

Mayo Patient/Caregiver Scholarship

I have to pay more attention to the rules. I didn’t notice that the essay I submitted to Mayo Clinic Patient/Caregiver Scholarship had the following:

All entries will be reviewed for compliance with contest rules, and beginning July 15 those that qualify will be published on this page for public comments and voting.

So if you would take a look HERE and comment and vote. Only if you feel my essay works. And as they say in Chicago vote early vote often.

Thanks

Mark