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Graduate medical education getting Medicaid support from fewer states
Several states have ended or considered ending their Medicaid funding for graduate medical education since 2005, but overall funding for GME still grew since then, according to a 50-state survey released in May by the Assn. of American Medical Colleges. "Compared to earlier reports, this is a significant change in direction overall for Medicaid support," said Tim Henderson, MSPH, report author and consultant for AAMC. He's also a professor in the Dept. of Health Administration and Policy at George Mason University in Northern Virginia. Most states provide additional Medicaid payments to teaching hospitals based on their direct and indirect costs of training medical residents. Direct costs include salaries of residents and the cost of their supervision. Indirect costs include higher spending on patients due to additional tests ordered by residents, for example. The federal government matches the state support. Forty-one states and the District of Columbia made Medicaid payments [Read more]
Guillain-Barré risk same for H1N1 and seasonal flu shot
People who received the 2009 influenza A(H1N1) vaccine had nearly the same risk of contracting Guillain-Barré syndrome as did those immunized against the seasonal flu, the Centers for Disease Control and Prevention said. Preliminary data indicate fewer than one excess case of the neurological disorder for every 1 million people vaccinated against H1N1, according to a study in the CDC's June 4 Morbidity and Mortality Weekly Report (www.cdc.gov/mmwr/preview/mmwrhtml/mm5921a3.htm/). Seasonal flu vaccine yielded similar results, with about one excess case of Guillain-Barré in a million people immunized. "We conducted a very large surveillance for Guillain-Barré syndrome ... and we found that in respect to [GBS], the H1N1 vaccine seems just as safe as the seasonal flu vaccine. There's no reason to believe they're different," said Oliver Morgan, PhD, a CDC epidemiologist who led the analysis for the report. Researchers examined data from a population sample of about 45 million [Read more]
Hospital violence increasing, Joint Commission warns
Physicians and other health care professionals and staff need to be extra vigilant in efforts to prevent violent crimes in hospitals and other health care facilities, according to a new Joint Commission alert. Patients, visitors and staff in recent years increasingly have been victims of assault, rape and homicide, said the commission's Sentinel Event Alert, issued in June (www.jointcommission.org/sentinelevents/sentineleventalert/sea_45.htm). Since 1995, there have been 256 reports of violent crimes to the commission's Sentinel Event Database, one of the nation's most comprehensive voluntary reporting systems for serious adverse events in health care. The greatest number have occurred in the past three years: 33 in 2009, 41 in 2008 and 36 in 2007, the database analysis showed. And these figures are likely "significantly below" the actual number of these violent crimes, the alert notes. "While not an accurate measure of incidence, it is noteworthy that the assault, rape and [Read more]
Small companies see highest hikes in health insurance costs
Health insurance premiums have long been experiencing growth that outpaces inflation, but a survey released June 2 suggests that companies with fewer than 50 employees are the hardest hit. The Council of Insurance Agents & Brokers surveyed 108 members. Approximately 86% noted a growth in rates among small businesses since November 2009, with 18% of that group recording increases of 20% or more. Another 24% had rate increases between 16% and 20%. Mid-size companies also were hard hit. Nine percent reported rate hikes of more than 20%. An additional 24% had premiums grow between 16% and 20%. "Several members commented that they are seeing large increases," said Ken A. Crerar, the council's president. "Brokers have some uncertainty about business going forward, but most believe there will be new demand for their services." Small- and medium-sized businesses have long complained that they are taking the biggest hit from health insurance premium increases. Several small business [Read more]
Evidence-based care poorly understood by patients
Patients increasingly are being asked to make evidence-based health care decisions in managing chronic conditions, choosing treatments and selecting health care professionals. But a report released online June 3 in Health Affairs found deep-rooted misconceptions, lack of understanding of terms such as "medical evidence," "quality guidelines" and "quality standards," and a reluctance to ask questions of physicians. Researchers with the American Institutes for Research in Washington, D.C., surveyed more than 1,700 people through focus groups, in-depth interviews and an online survey conducted from August 2006 to December 2007. Among their findings: * 41% of respondents said they had not asked questions or told their doctors about problems because they were unsure how to talk to doctors or because physicians seemed rushed. * Only 34% recalled their physicians ever discussing what medical research had shown about the best way to manage their care. * A substantial [Read more]
Health care ranks lower in U.S. than in other countries
The U.S. health care system does a poor job providing efficient access to quality care compared with health systems in six other industrialized countries, according to a recent survey. The report, released in June by the Commonwealth Fund, said the United States scored low in measures of quality, efficiency, access, equity of care and ability of people to lead healthy and productive lives. "It's disappointing, but not surprising that despite our significant investment, the U.S. continues to lag behind," Commonwealth Fund President Karen Davis, PhD, said in a national teleconference on the report. The U.S. spends more on health care -- $7,290 per capita in 2007 -- than do any of the other countries studied. By comparison, the Netherlands ranked highest for care and spent $3,837 per capita. "We simply are not getting commensurate care for the amount we are spending on health care," Davis said. Also ranked in the annual report were Australia, Canada, Germany, New Zealand an [Read more]
Electronic pill bottles might help medication adherence
Pill bottles that electronically alert patients to take their medications show promise for increasing compliance, according to research from the Center for Connected Health, a division of Partners Healthcare in Boston. A randomized controlled study of patients who used electronic pill bottles wirelessly connected to the Internet found a 27 percentage point higher rate of medication compliance compared with patients who didn't use the electronic bottles. The bottles, called GlowCaps and produced by Cambridge, Mass.-based Vitality, alert patients with light and sound when it's time to take their medicine. The bottles also generate missed-dose reminder phone calls and refill reminders. Automated progress reports also are sent to the patients' physicians, family or caregivers. For the study, 139 patients on antihypertensive medication were enrolled in a six-month program. They were divided into three groups: a control group that did not receive any communication; an intervention g [Read more]
Hospital related tv drama shows inspire ethics lessons
It was bad enough that Seattle Grace Hospital intern Isobel "Izzie" Stevens, MD, fell in love with a patient in need of a heart transplant. But she really crossed the ethical line when she cut the wires to his left ventricular assist device so his health would deteriorate and he'd move higher on the United Network for Organ Sharing waiting list. That behavior -- portrayed by actress Katherine Heigl on the hit ABC TV medical drama "Grey's Anatomy" -- is probably the most outrageous example of scores of unethical medical actions shown on "Grey's" and Fox TV's "House," according to a study in the April Journal of Medical Ethics (jme.bmj.com/content/36/4/203.abstract). Researchers analyzed 50 episodes of the two programs and found that bioethical issues came up 179 times, with informed-consent discussions the most common. Of 49 consent talks, the study said, 57% were inadequate -- rushed, one-sided and lacking information about the down side of risky procedures. Meanwhile, the TV [Read more]
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