Articles Posted in Outpatient Care

eldercare-300x168Uncle Sam soon will step up what may be a positive trend: getting hospitals and nursing homes to halt the unacceptable boomeranging of elderly patients between them. But will Trump officials be as quick with health care providers as they have been with poor, sick, and old patients to employ not just carrots but also sticks to get better outcomes?

The nonprofit, nonpartisan Kaiser Health News Service deserves credit for looking ahead to this fall, when the administration aims to accelerate the end of perverse incentives that have hospitals and nursing homes shuttling the sick and elderly between them far too often. As Jordan Rau of the news service reported:

With hospitals pushing patients out the door earlier, nursing homes are deluged with increasingly frail patients. But many homes, with their sometimes-skeletal medical staffing, often fail to handle post-hospital complications — or create new problems by not heeding or receiving accurate hospital and physician instructions. Patients, caught in the middle, may suffer. One in 5 Medicare patients sent from the hospital to a nursing home boomerang back within 30 days, often for potentially preventable conditions such as dehydration, infections and medication errors, federal records show. Such re-hospitalizations occur 27 percent more frequently than for the Medicare population at large.

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Breast cancer patients may get a welcome respite from one of the disease’s dreaded aspects — its aggressive and costly treatments. New research suggests that thousands of women with early-stage breast cancer who now are told to get chemotherapy don’t need it, while a larger, significant number of patients can benefit by halving the time they’re told to take an expensive drug with harsh side-effects, especially for the heart.

Although this information should be taken in a positive light, patients should consult with their doctors about appropriate treatment for their individual case.

The prospective shifts in breast cancer treatment, based on new findings, may add to rumblings and criticisms about over-treatment and whether doctors have taken too lightly the toll — physically, mentally, and financially — that this and other forms of cancer inflict on patients.

mdanderson-300x168With cancer care raining down more than $200 billion in billings on providers, giant hospitals and specialty treatment centers are resorting to unacceptable marketing and advertising hype, including pitches that “sell out” the credibility of science and a pillar of medical practice, commentators say.

Credit’s due to journalist Steve Salerno and the Wall Street Journal for a recent Op-Ed that’s worth a read as it makes the case outlined in the piece’s headline: “In war on cancer, truth becomes a casualty.”

Salerno blasts MD Anderson Cancer Center, Memorial Sloan-Kettering, and the Cancer Treatment Centers of America and others for waging costly, nationwide ad campaigns targeted at desperately sick patients. He faults these well-known institutions for relying on pure emotion and not fact to sell themselves. He says they resort to tugging at heart strings with “tear-jerker” patient testimonials, or by using pitch people with no other credibility than their celebrity.

walmartclinic-300x209Americans are showing with their feet and their money how they feel about doctors’ offices and  shiny hospitals, places they’re shunning more and more. They’re racing to neighborhood clinics and urgent care centers that seem to be popping up on every suburban street corner and shopping mall.

Before these facilities transform U.S. health care, would it be worth asking what this trend might mean, not just for profit-seeking retailers, drug store chains, and, yes, also hospitals and doctors who are shifting into new lines of business?

The New York Times found that:

jetsons-300x231Although big, rich hospitals and their sprawling campuses jammed with shiny new buildings may be reaching a point where they’re unsustainable for competitive cost, safety, and efficiency reasons, a rising health care alternative already may be hitting its own major woes that can’t be ignored.

The Wall Street Journal and New York Times have put up pieces with intriguing projections about the future of hospitals, including how economics may force them, as is occurring now, to spin off major functions, including many kinds of surgery, which will be handled, instead, in smaller, free-standing surgical centers.

At the same time, USA Today and the independent and nonpartisan Kaiser Health News Service have presented their investigation into dangers and deaths that patients encounter at the such centers, which already are burgeoning nationwide.

us-cash-184x300Here’s something that many Americans likely would want to think twice about letting happen: Should good health and long lives be just another of the spoils reserved to the rich?

Vox, a news and information site, has posted a provocative dig into national data on longevity — a measure that has raised experts’ concern with its recent rare, two-years-in-a-row dive, notably due to fatal overdoses of opioid drugs, including prescription painkillers, heroin, and fentanyl.

Experts scrutinizing the data, Vox says, keep finding that “what’s often lost in the conversation about the uptick in [U.S.] mortality … is that this trend isn’t affecting all Americans. In fact, there’s one group … that’s doing better than ever: the rich. While poor and middle-class Americans are dying earlier these days, the wealthiest among us are enjoying unprecedented longevity.”

blkmom-300x222The bad news for expectant black moms isn’t confined to those living in the nation’s capital: A new investigation has found higher risks of harm for women in New York, Florida, and Illinois when they deliver at hospitals that disproportionately serve black mothers.

ProPublica, a Pulitzer Prize-winning investigative site, analyzed two years of hospital inpatient discharge data from the three states to “look in-depth at how well different facilities treat women who experience one particular problem — hemorrhages — while giving birth.” Reporters found negative patterns that underscored big woes identified by other research before:

[B]lack women … fare worse in pregnancy and childbirth, dying at a rate more than triple that of white mothers. And while part of the disparity can be attributed to factors like poverty and inadequate access to health care, there is growing evidence that points to the quality of care at hospitals where a disproportionate number of black women deliver, which are often in neighborhoods disadvantaged by segregation. Researchers have found that women who deliver at these so-called ‘black-serving’ hospitals are more likely to have serious complications — from infections to birth-related embolisms to emergency hysterectomies — than mothers who deliver at institutions that serve fewer black women.

usfs-thomas-fire-300x200The clock may be counting down to 2017’s end but Mother Nature isn’t giving up on whipping up calamities that wreak havoc on parts of the nation’s health care system and millions of Americans’ well-being. After swaths of the country were inundated by hurricanes and flooding, the West Coast is now battling yet more huge blazes.

Raging wildfires in Southern California not only have added big time to the billions of dollars that such blazes have caused this year in damage and suffering to people, property, and animals, they also have provided the entire coast with a harsh reminder of the importance of air quality to health.

With luck, public cooperation, and outstanding work by fire fighters, police, and other first-responders, the loss of life has been low in a series of blazes on the Westside of Los Angeles, in the city’s northern reaches, in San Diego, and most especially in Ventura and Santa Barbara. The “Thomas Fire,” burning over hundreds of acres in Ventura and Santa Barbara, has become the third largest wildfire in California record books. The Southern California blazes follow hard on the heels of disastrous infernos in Northern California’s wine country.

asthma-300x123Even as they rake in big bucks and ride  a tsunami of mergers and consolidations sweeping the U.S. health care system, big hospitals and academic medical centers must step up on patients’ behalf, doing much more, for example, to battle America’s growing asthma woes and the opioid drug abuse epidemic.

Kaiser Health News, the Capital News Service, and the Washington Post deserve credit for their report on “Forgetabout Neighborhood,” the “worst asthma hot spot” in Baltimore. This part of the city is filled with “decrepit houses, rodents and bugs” that “trigger [asthma] and where few community doctors work to prevent asthma emergencies,” the news organizations have found. They say that residents of this neighborhood “visit hospitals for asthma flare-ups at more than four times the rate of people from the city’s wealthier neighborhoods.”

This area, zip code 21223, also sits in the shadow of not just one but two renowned medical centers, noted, among other things, for their respiratory expertise: Johns Hopkins, and the University of Maryland Medical Center. As the news organizations have reported:

jet-300x154Tens of thousands of Americans will hit the skies in the next few days, struggling to squeeze in that last bit of business before the holidays shut down 2017 opportunities. Are these business travelers harming their own health?

The New York Times has put up an interesting report on the ubiquity and stress of business-required travel, arguing that jet-setting for work not only has lost whatever glamor it once may have held but also that experts increasingly are worried about the health toll it inflicts.

The paper, noting that more formal research needs to done, cites studies showing that “frequent business travel accelerates aging and increases the likelihood of suffering a stroke or heart attack, and that more than 70 percent of business travelers report some symptoms of an unhealthy lifestyle, including poor diet, lack of exercise, excess drinking, stress, mood swings and gastrointestinal problems.”

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