Tag: prevention

Another Swing at the Windmill of VAP

Apr 4, 2011• 1

By MARYA ZILBERBERG, MD

Sorry, folks, but I have been so swamped with work that I have been unable to produce anything cogent here. I see today as a gift day, as my plans to travel to SHEA were foiled by mother nature’s sense of humor. So, here I am trying to catch up on some reading and writing before the next big thing. To be sure, I have not been wasting time, but have completed some rather interesting analyses and ruminations, which, if I am lucky, I will be able to share with you in a few weeks.

Anyhow, I am finally taking a very close look at the much touted Keystone VAP prevention study. I have written quite a bit about VAP prevention here, and my diatribes about the value proposition of “evidence” in this area are well known and tiresome to my reader by now. Yet, I must dissect the most recent installment in this fallacy-laden field, where random chance occurrences and willful reclassifications are deemed causal of dramatic performance improvements.

So, the paper. Here is the link to the abstract, and if you subscribe to the journal, you can read the whole study. But fear not, I will describe it to you in detail.

In its design it was quite similar to the central line-associated blood stream infection prevention study published in the New England Journal in 2006, and similarly the sample frame included Keystone ICUs in Michigan. Now, recall that the reason this demonstration project happened in Michigan is because of their astronomical healthcare-associated infection (HAI) rates. Just to digress briefly, I am sure you have all heard of MRSA; but have you heard of VRSA? VRSA stands for vancomycin-resistant Staphylococcus aureus, MRSA’s even more troubling cousin, vancomycin being a drug that MRSA is susceptible to. Now, thankfully, VRSA has not yet emerged as an endemic phenomenon, but of the handful of cases of this virtually untreatable scourge that has been reported, Michigan has had plurality of them. So, you get the picture: Michigan is an outlier (and not in the desirable direction) when it comes to HAIs.Continue reading…

The Price of Marginal Thinking in Healthcare Policy

Jan 31, 2011• 5

By MARYA ZILBERBERG, MD

I find it fascinating how our brains have this propensity to latch on to what is at the margins at the expense of seeing the bulk of what sits in the center. This peripheral only vision is in part responsible for our obscene healthcare expenditures and underwhelming results.

I have blogged ad nauseam about the drivers of early mortality in the US. In one post I reproduced a pie chart from the Rand Corporation, wherein they show explicitly that a mere 10% of all premature deaths in the US can be attributed to being unable to access medical care. The other 90% is split nearly evenly between behavioral, social-environmental and genetic factors, of which 60%, the non-genetic drivers, can be modified. Yet instead of investing the bulk of our resources in this big bucket of behavioral-environmental-social modification, we put 97% of all healthcare dollars towards medical interventions. This investment can at best produce marginal improvements in premature deaths, since the biggest causes of the effect in question are being all but ignored.

A couple of other striking examples of this marginal magical thinking have surfaced in a few recent stories covered with gusto in the press. One of the bigger ones is the obesity epidemic (oh, yes, you bet it was intended), and its causes. This New York Times piece with its magnetic headline “Central Heating May Be Making Us Fat” entertains the possibility that because of the more liberal use of heat in our homes we are no longer engaging our brown fat, which is a furnace for burning calories. And this is all well and good and fascinating, in a rounding out sort of a way.

The Cost of Mammography Screening for Women Under 50

Jan 13, 2010• 12

By MERRILL GOOZNER

The tempest that greeted the United States Preventive Services Task Force guidelines on mammography screening for women in their 40s prompted the Senate to insert a mandate in its health care reform bill that every insurer cover every mammography screening test at no cost to beneficiaries. If it passes, it will spark an upsurge in mammography screening, especially among women under 50, and raise the nation’s health care tab.

The Journal of the American Medical Association this morning provides a timely article (subscription required) reminding physicians and women about the serious health costs of adopting that policy.Continue reading…

Your Money or Your Wife

Dec 11, 2009• 33

By JD Kleinke

Talk about perfect timing. Just as the last “death panel” falsettos fade into the droning no-government- takeover chorus, along come those “faceless government bureaucrats” from the U.S. Preventative Services Task Force to stop the music in the nation’s busy and profitable mammography suites.

No more breast self-exams or mammograms for low-risk women under 50; mammograms only every other year after the age of 50; nothing for any woman over 74. That was the thunderclap pronouncement from the acrobatically acronymic USPSTF, the dreaded “they” from the gub’mint that has the folks at Fox in full fulmination.Continue reading…

Prevention is Not Only Good Health Policy, It’s Good Economic Policy

Nov 24, 2009• 26

By KENNETH THORPE, PhD

The current debate around how to best control burgeoning health costs has pushed the issue of prevention to the forefront. That’s right where it should be. By shifting our health care to be more pro-active and prevention-oriented, we can make a major impact on common and costly chronic diseases such as diabetes. In turn, this will help to secure the financial stability of our health care system and continued economic growth and prosperity.

Over the past century, the burden of disease among Americans has shifted from acute and infectious illness to chronic disease. With more than 75 cents of every dollar in this nation spent on patients with chronic disease, prevention offers the opportunity not to spend more money — but spend smarter. By embracing prevention, we can help more Americans lead healthier, active lives free from disease, so that they can avoid costly complications and hospitalizations, and remain productive in their communities and workplaces.

Prevention today involves a lot more than flu shots, cancer screening, and annual checkups. It is a pro-active strategy of disease avoidance and mitigation that should be embraced throughout and beyond the health system. In the context of chronic illnesses such as asthma, cancer, depression, heart disease and diabetes, prevention runs the gamut from lifestyle changes to screening for risk factors and symptoms, to early intervention to slow or reverse disease, to active management of already present cases.

Controlling Health Care Costs: How to “Bend the Curve”

Nov 10, 2009• 5

Stephen Shortell

As Congress nears passage of the first substantial health care reform in decades, there is an ominous challenge: No reform will be sustainable unless we slow the rapid growth of health care spending.

Health care costs are rising at a staggering pace. Expenditures have been increasing at 2.7% per year faster than the rest of the economy over the past 30 years. In 1980 the US spent about 8% of GDP on health care. We now spend over 17%. We need to rein in growth of health care spending to levels no higher than overall economic growth — or ideally “bend down” the growth curve to an even lower figure.

How do we “bend the curve”? What are the best ways to slow the growth of health care costs, thus making other reforms sustainable?There are three major areas in which reforms will help bring health care spending under control.Prevention: US health care is burdened by diseases that are preventable. If we can improve lifestyle issues – nutrition, exercise, obesity, tobacco use – we will lower the future incidence of diabetes, heart disease, cancer, and other costly maladies. Current health reform proposals that allocate $10 billion for a Prevention and Wellness Fund represent a major step in the right direction. Disease prevention likely provides the greatest return on investment regarding health care costs of anything we do.

Hospital and Physician Behavior: Hospitals have no incentives to prevent unnecessary hospitalization. Physicians, paid mostly by fee-for-service, have every incentive to order more tests and procedures. Neither is rewarded directly for making – or keeping – patients healthy. Key to controlling health care costs in the future will be to realign these incentives.

This will require performance measurement and public reporting for both cost and quality. Provided that predetermined quality criteria are met, hospitals and physicians who can provide better care for less money would share in the savings.

To Change Health Care, Change Diabetes.

Sep 29, 2009• 14

By DANA HAZA

As we work to change health care in America, we must recognize the need to dramatically change diabetes. Twenty-four million Americans have diabetes at a cost to our nation of an estimated $218 billion for diabetes and pre-diabetes, according to a series of studies recently published in Population Health Management. Imagine the effects diabetes will have on our health and economy in the future if we don’t take action now. The prevalence and economic burden of undiagnosed and pre-diabetes make the case for the importance of policies that promote early diagnosis and prevention. About 25 percent of Americans with diabetes aren’t even aware they have the disease. And, those with undiagnosed diabetes result in $18 billion in health expenses, or $2,864 per person each year, according to one of the studies mentioned above.

Ornish Alienates HuffPo’s Class Warriors

Sep 1, 2009• 3

By MERRILL GOOZNER Goozner

Ariana Huffington recently anointed diet-and-exercise guru Dean Ornish as her chief medical correspondent. With all the guff her site had taken from the science-based medicine crowd for giving free rein to anti-vaccinists, faith healers and the no-evidence-needed alternative medicine freaks, I thought it was a smart move — a tack toward the responsible center, if you will.But in a post this week, Ornish recounted his 14-year-battle to get Medicare to pay for a pilot project to test lifestyle intervention as a cure for heart disease (which wouldn’t save Medicare money, but would save more lives for the same money expended as, say, giving those people cholesterol-lowering medication). What he drew from his saga was that the government can’t be trusted to run health care, and that health care reformers needed to rise above the right-left divide and unite around reimbursing physicians for keeping people well.It was a classic case of crunchy granola versus the class warriors. The comments section was overwhelmed with hostile attacks on Ornish’s above-the-fray moralizing. The commentators defended single-payer, pointed out the indiscriminate nature of many diseases, articulated the special needs of the poor whose stress and multiple jobs make them especially prone to disease, etc. etc. What was striking was how thoughtful and well-reasoned many of the comments were, a far cry from conspiracy-minded rants of that usually dominate the comments space.

Separating Fact from Fiction and Health from Health Care

Aug 31, 2009• 23

By JAMES S. MARKS, ROBERT WOOD JOHNSON FOUNDATION

In an editorial on Wednesday, The New York Times debunks the often-cited claim that America has the best health care system in the world. For the politicians who routinely use this as a plank in their efforts to stifle reform, the Urban Institute study (disclosure: this study was funded by the Robert Wood Johnson Foundation) is an objective rebuke. The U.S. health care system is not the best – far from it. And Americans, with a life expectancy that still trails many other countries, are not the healthiest people in the world.

Clearly, this country desperately needs health reform. But the study, the editorial, and the entire current discourse around health care neglect an important truth about reform: fixing the health care system alone will not significantly improve Americans’ health.

For example: medical spending consumes 16 percent of the U.S. GDP and is projected to reach a staggering one dollar for every five earned by 2018. And yet, only 10-15 percent of preventable mortality is linked to health care. This and our terribly poor international rankings in length of life are telling signs that our tremendous investment does not do enough to address the factors that make us sick in the first place.

Our current national debate must look beyond health care – the so-called repair shop of our health system – and focus on our health. Fixing health care will require insurance reform, cost containment and sound economic policy. Fixing health will require us to look at our neighborhoods, our schools and our workplaces. From our earliest years of life, these are the places that determine how long and how well we live in America. The recommendations of the Robert Wood Johnson Foundation Commission to Build a Healthier America, which identify pockets of success where programs are making a real difference in people’s health, provide a useful place to start.

In schools, where obesity threatens the current generation of children with sicker and shorter lives than those of their parents, solutions are critically needed. By guaranteeing daily physical activity in schools – which fewer than 3.8 percent of elementary schools provide – and linking federal funds for school meals to their nutritional value, we can reverse the epidemic and help our children grow up healthy.

In our neighborhoods and communities, we must consider the health impact of investments and development to ensure that they help promote physical activity, make healthy foods more readily available and lay a foundation for prosperity. With public-private partnerships, we can bring grocery stores and nutritious food into underserved neighborhoods and help both the stores and the neighborhoods thrive. By incorporating bike lanes, sidewalks and trails into our transportation planning, we can help make the daily lives of Americans more physically active.

All of this amounts to a change in the way we think about health in this country. Health care reform, while critically important, will not avert the crisis of poor health that we’re facing. The Times editorial and Urban Institute study shine an important light on the dubious claim that we have the best health care system in the world, but they don’t go far enough. It’s time that we debunk the larger myth, that Americans are the healthiest people in the world, so all of us – from the halls of Congress to the family dinner table – can start working to improve the health of the country we love.

Dr. James S. Marks, M.D., M.P.H., senior vice president at the Robert Wood Johnson Foundation and director of the Foundation’s Health Group. Dr. Marks oversees all of the Foundation’s work in childhood obesity, public health and vulnerable populations. Prior to RWJF, Dr. Marks was an assistant surgeon general and director of CDC’s National Center for Chronic Disease Prevention and Health Promotion.

Op-Ed: The Payoff from Preventative Healthcare: How disease screening saves lives and money

Jul 29, 2009• 9

By MARK GUMZ Mark2

To understand and effectively navigate the current healthcare debate, every U.S. CEO must now be a healthcare leader.

From the health, well being and productivity of employees and their families to the impact on a company’s bottom line, healthcare is a major business concern for everyone. Five consecutive years of double-digit health insurance premium increases have hit the business community hard.

If we don’t identify new efficiencies in the way we administer employee-based healthcare programs, the negative impact of these costs on businesses will only grow. Healthcare spending currently accounts for 18 percent of U.S. economic output. It could reach 34 percent by 2040, according to a June 2, 2009 report by the White House Council of Economic Advisers, if the current rate of cost growth continues.