Articles Posted in Quality outcome measures

cdcinoculate-300x240The “warp speed” race to develop a Covid-19 vaccine has gotten hit with a yellow flag.

It could be a good thing that the product’s makers — Oxford University and AstraZeneca — followed medical-scientific protocols and paused their Phase III clinical trial due to a participant’s unexplained illness.

Officially, the company offered spare information about the occurrence, especially because it affects the private medical information of a single individual.

vaccination-300x199As the novel coronavirus infections and deaths keep skyrocketing, Americans more and more have been forced into tough risk analyses, and frankly, too often thinking like gamblers. They are, for example, looking a lot at the much-promoted possibility of a Covid-19 vaccine in desperate poker ways — “betting on the come” and playing “river, river …”

Experts are asking just how savvy this health care approach is, putting in high stakes in the hopes the deck is dealt just so, or believing in a cliff’s edge rescue when the last cards on the table are flopped over to reveal a winner? Is it reality check time? And is there is a Plan B?

Vaccine makers around the world are racing to produce a viable response to Covid-19. U.S. infections have skyrocketed past 4 million and the disease is heading toward killing 150,000 Americans. Politicians and public health officials continue to speak optimistically about “Operation Warp Speed” and other campaigns globally to develop a vaccine that experts say will play a vital role in blunting Covid-19’s sickening and lethal spree through humanity.

silence-300x192Historian Doris Kearns Goodwin highlighted a crucial strength of the 16th U.S. president as he led the nation through one of its most divisive times: Abraham Lincoln encouraged dissent and welcomed opposing points of view, going so far as to appoint three better-known political rivals to top positions in his administration.

That extraordinary lesson in crisis leadership seems to be getting lost in the nation’s battle with the novel coronavirus.

Too many doctors, nurses, and experts in science and medicine have been censored, disciplined, and dismissed for speaking truth to power, warning, for example, about unacceptable conditions for health workers treating Covid-19 infections, news organizations have reported.

drugsinhand-201x300Whoa, Nelly. For Americans stuffing their heads with vague data about potential drugs to treat Covid-19 — including chloroquine, hydroxychloroquine, azithromycin, remdesivir, ritonavir, lopinavair, Actemra, Oseltamivir, Ribavirin, Umifenovir, interferon, baricitinib, imatinib, dasatinib, nitazoxanide, camostat mesylate, tocilizumab, sarilumab, bevacizumab, fingolimod, and eculizumab — let’s get a little perspective, please.

Let’s put things simply, especially for most ordinary folks who have no desire to play at being pharmaceutical experts: As of this writing, as noted online in a meta-review by the respected Journal of the American Medical Association, this is the reality about drugs for the novel coronavirus:

 “No proven effective therapies for this virus currently exist.”

covidtestinggapnyt-300x185Public health experts and many politicians agree that the pursuit of any next steps in dealing with the Covid-19 pandemic will rely on testing, testing, testing. The nation will need significantly more tests, with faster and better results, that show who is infected now. Further, many, many more people will need to take blood antibody tests to determine who was infected with the disease and may have some level of immunity from it.

This is the problem: Weeks after the novel coronavirus swept the nation, infecting hundreds of thousands and killing thousands, the testing available is too scant, takes too long, and — despite much bloviating and promises — is mired in unacceptable ways.

The gulf between the needed level of testing and what is occurring is Grand Canyon sized (see NYT graphic, based on Harvard University research, above), and this is a giant problem in potentially relaxing Covid-19 restrictions now in place.

covidstayhome-sharonmccutcheon-200x300With President Trump, members of his administration, and other politicians shoving back against public health officials’ recommendations on when to get Americans out of their homes and returning to work, the ultimate decision may be up to individuals: Do we give up the existing physical-distancing guidance? Or not?

The data on Covid-19 infections and deaths is still building, but it may be worth reviewing what is known about the disease, whom it afflicts, and how.

Based on the deaths of those diagnosed with the novel coronavirus, it has been deadlier for men than women. It is taking a terrible and disproportionate toll among African Americans, with Latinos afflicted at high rates, too.

ACAsigning-300x176As the coronavirus pandemic causes Americans sky-high anxiety about their health and how they might access and afford extensive medical treatment if infected, the nation slid with only modest public attention into the second decade of one of its landmark health care experiments — the Affordable Care Act.

Obamacare became the law of the land on March 23, 2010, when the 45th president signed the 2,000-page bill for which he had campaigned long and hard. Republicans in the White House and Congress have attacked the ACA relentlessly ever since.

Researchers have spent a decade scrutinizing the ambitious act’s outcomes with zeal. The New York Times summarized some of the independent, nonpartisan evaluations, finding key areas that the public may wish to recognize in how Obamacare changed the complex U.S. health care system, on which Americans spend more than $3.5 trillion annually. In brief, as a result of the ACA, the newspaper reported (with boldface emphases mine):

AAMedals-300x156Although federal experts estimate that alcohol abuse leads to 88,000 Americans’ deaths annually and economic costs of almost $250 billion, one of the nation’s oldest and best-known programs to deal with this problematic behavior has long been surrounded by doubts.

Critics have questioned its effectiveness, criticized its “irrationality,” and focused on its stepped regimen, desperate and self-enrolling participants, and core tenets, including its spiritual appeals to higher and external powers.

But after a deep dig into the building and rigorous evidence about it — including scrutiny of 27 studies, (some of them randomized clinical trials) with more than 10,000 participants — researchers from Harvard, Stanford, and Europe have concluded in a published, research review for the respected Cochrane Collaboration that Alcoholics Anonymous, indeed, can be beneficial for many but not all excessive alcohol users.

cjdlogoCold, hard facts — not hunches, arguments, or theories — matter most when tough health care decisions must be made. Americans have been reminded of this by painful headlines on the opioid and overdose crisis, the rise of lung injuries and deaths due to vaping, and, yes, now the rapid spread of a new coronavirus. Doctors, hospitals, insurers, Big Pharma, and other major parties in the U.S. health care system aren’t always as candid as they need to be, especially in disclosing how they harm and even kill patients.

That’s a truth (with a small “t”) that readers can discover quickly in the Center for Justice and Democracy’s latest edition of its annual “Briefing Book: Medical Malpractice by the Numbers.” The center, at New York Law School, provides evidence about a field that has become the bogeyman for politicians, policy makers, and medical practitioners eager to hide egregious errors with extreme counter factual assertions.

Malpractice cases in the civil justice system provide important insights and checks on how doctors and hospitals care for the sick, injured, and vulnerable.

HowardUhospital-300x126Big hospitals keep getting bigger. But, contrary to what the suit-wearing MBAs may claim, the rising number of institutional mergers and acquisitions isn’t necessarily better for patients and their care.

At hospitals subjected to corporate wheeling and dealing, the quality of care got worse, or, at best, it stayed the same and didn’t improve, a new study in the New England Journal of Medicine reported.

Researchers scrutinized federal data “from 2007 through 2016 on performance on four measures of quality of care … and data on hospital mergers and acquisitions occurring from 2009 through 2013,” they said. These measures, the Wall Street Journal reported, included: patient satisfaction; deaths within a month of entering the hospital; return trips to the hospital within a month of leaving; and how often some heart, pneumonia, and surgery patients got recommended care. They looked at 246 hospitals involved in M&A activity,  controlling their findings with data from 1,986 institutions not similarly affected.

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