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Health disparities persist despite quality improvements
Despite slow but steady improvements in the quality of health care nationwide, closing disparities in care for minorities and low-income residents continues to be a challenge, according to the Agency for Healthcare Research and Quality. Overall, there were improvements in about two-thirds of 179 health care quality measures tracked by the federal government in the AHRQ's 2010 National Healthcare Quality and Disparities Reports. But only 30% of 22 measures of access to care showed improvement, while 30% remained stagnant and 40% showed declines. "Every American should have access to high-quality, appropriate and safe health care," said AHRQ Director Carolyn M. Clancy, MD. "We need to increase our efforts to achieve that goal because our slow progress is not acceptable." The reports, released June 1, show that blacks had worse access to care than whites for one-third of six core measures, such as having a usual primary care physician and insurance coverage. Hispanics had worse a [Read more]
Most uninsured hospital stays go unpaid
Washington -- Hundreds of thousands of Americans without health insurance have racked up tens of billions of dollars annually in hospital bills that they cannot pay, according to a Dept. of Health and Human Services report. In 2008, hospitals had 2.1 million hospitalizations of uninsured people. About 1.2 million, or 58%, ended up with hospital bills in excess of $10,000. Hospitalizations with costs of more than $100,000 accounted for 6% of uninsured hospital stays. There's no truth to the assertion that people without health insurance can get care with no problem, HHS Secretary Kathleen Sebelius said in a May 10 statement accompanying the release of the study. Uninsured families cannot pay the full hospital admission bills 95% of the time, because they lack enough money in individual savings accounts. "The result is families going without care or facing health care bills they can't hope to pay," Sebelius said. "When the uninsured cannot afford the care they receive, that cost [Read more]
With asthma more prevalent, study calls for better patient education
Educating patients with asthma about how to manage the chronic respiratory condition and avoid exposure to irritants could improve the health of this growing group of Americans, said the Centers for Disease Control and Prevention. Asthma prevalence increased 12.3% in the United States between 2001 and 2009, according to a study published May 6 in the CDC's Morbidity and Mortality Weekly Report. More than 24 million Americans had the disease in 2009. But nearly one in three has not been taught how to respond to an asthma attack, the study said. "The best thing for providers is to take time to explain to patients how to take care of the disease, how to use the medication prescribed and when to call [a physician]," said Hatice Zahran, MD, MPH, co-author of the study and a CDC epidemiologist. "Physicians should not just give [patients] a prescription and let them go. They should take time and explain to patients how they can manage their disease." The study authors recommend that [Read more]
Feeding tube risks for dementia patients often not discussed
The decision to insert a percutaneous endoscopic gastrostomy tube in a family member with advanced dementia is often made with inadequate discussion of the risks involved, said a study published May 3 in the Journal of the American Geriatrics Society. Nearly 90% of patients with advanced dementia have problems feeding themselves, lose weight or choke on food. About 40% of these patients die within six months of developing eating problems, previous research shows. But feeding tubes may not be the right response to the problem. Observational studies have found that feeding tubes do not prolong life, reduce aspiration pneumonia risk or improve quality of life for these patients. And the tubes come with risks. Patients with advanced dementia who have tubes inserted often attempt to pull the tubes out, with the result that many patients are physically restrained or sedated. Feeding tubes also can become clogged and cause diarrhea. Yet those risks are not usually discussed, said [Read more]
Donor families join anatomy students at ceremony honoring their loved ones
In front of her fellow first-year medical students, Natsai Nyakudarika spoke about the difficulty she had looking at the face of her anatomy class cadaver, a man named Gerald. "I can't look at Gerald's face," she said. "I'm afraid that I will see in it the face of everyone I've loved who has died." Nyakudarika was among several students at Northwestern University's Feinberg School of Medicine in Chicago who talked about their experiences with dissection as part of the school's closing ceremony for its anatomy class. Most medical schools now host such ceremonies, but Northwestern is unusual in that it invites cadaver donors' family members to attend. "We never did that before last year," said Larry R. Cochard, PhD, who directs Northwestern's anatomy lab and helps organize the annual ceremony. "It's a whole different dynamic with the families here. We didn't know what to make of that, but it's been great." Of the 29 cadaver donors honored, the families of six donors were p [Read more]
Oregon governor supports 19% Medicaid pay cut
Oregon Gov. John Kitzhaber, MD, is backing across-the-board Medicaid pay cuts to close nearly the entire remaining $735 million revenue shortfall in the state's two-year, $15 billion 2012-13 budget. The proposal would reduce Medicaid rates by 19% in fiscal 2012, which begins July 1, and could require an additional 15% cut in fiscal 2013 if a new care coordination program fails to produce enough savings, according to estimates by the Oregon Assn. of Hospital and Health Systems. Oregon Medicaid physician pay rates already are as low as 60% of what Medicare pays, said Betsy Boyd-Flynn, spokeswoman for the Oregon Medical Assn. These cuts "would really reduce access, and they would probably drive more physicians into retirement." Hospital Medicaid rates cover only about 70% of costs, said Andy Van Pelt, a spokesman for the hospital association. Some primary care doctors already limit their Medicaid participation. In 2009, 53% of all Oregon physicians accepted new Medicaid patien [Read more]
Caregivers' limited English skills can add to hospital stay
Children hospitalized with infections are likely to stay in the hospital longer if their parent or other primary caregiver speaks limited English, says a study published online May 2 in the Archives of Pediatrics and Adolescent Medicine. Such patients also are 80% less likely to be referred for home health care services than patients whose caregivers speak proficient English. The findings are significant, given that about one in five U.S. residents speaks a language other than English and about half of those have limited English proficiency, the study said . "The most concerning consequences of such disparities always fall on the patients," said Michael N. Levas, MD, lead study author and third-year pediatric emergency medicine fellow at Children's Mercy Hospital in Kansas City, Mo. "Families that have a prolonged length of stay have to deal with more time off of work, child care issues for the children not admitted and cost of a prolonged hospital stay." Researchers studie [Read more]
Disclosing medical errors can lower liability lawsuit expenses
Disclosing medical errors to patients mitigates medical liability lawsuits, increases safety and ensures long-term financial benefits for medical practices, according to a new report. The report, released online May 12 by the privately owned international insurance broker Lockton, reviewed previous studies on error disclosures between 1987 and 2010 and analyzed the financial impact of such disclosure on health care professionals. The Lockton report cited an analysis of the University of Michigan Health System's 2001 medical disclosure approach. The study, in the Aug. 17, 2010, issue of Annals of Internal Medicine, showed: About 20 fewer lawsuits each year were filed after the program's implementation. Lawsuit resolution time went from 1.36 years before the program started to 0.95 afterward. The average cost per lawsuit decreased from $405,921 to $228,308. Research shows that disclosure programs make the best financial sense for health care organizations, along [Read more]
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