Wednesday, November 25, 2015

Kaiser program brings hospital care to the patient's home

Who says primary care is dead?  It is just of the 21st Century

Audio from this story

Frequent medical visits had become a way of life earlier this year for John and Audrey Stanton of Hemet in Riverside County.  
John, 86, suffered from serious eye problems; a painful skin infection called cellulitis, and more recently, repeated shortness of breath — all of which kept landing him in the hospital."It was one thing after another. Like the doctor said, 'Somebody is after you!'" Stanton laughs. And for his 81-year-old wife Audrey, the nearly two-hour drive to-and-from Kaiser in Riverside was a tough haul."I’m not a long distance driver so I had to be real careful," she says. "It was stressful." 
But that stress dissipated last summer when John was admitted to the hospital — at home.  
"I thought, 'Wow! This is amazing. I love this!'" he says. "This is what people need!"

Pneumonia, cellulitis or congestive heart failure  Stanton is one of about 125 patients who’ve been enrolled in an experimental hospital at home program run out of Kaiser’s Permanente’s Riverside Medical Center.  Launched two years ago, the program is designed for people who need treatment - typically only given in the hospital — for one of three conditions: pneumonia, cellulitis or congestive heart failure.

"Our goals are to have patients be safe at home and to have them recover at home and to have a high-quality experience," says Dr. Earl Quijada, one of three Kaiser doctors assigned to the program. Not every patient with one of the three conditions qualifies for the program. It's restricted to those who are not at risk for complications that could require more intensive care, says Dr. Nirav Shah, senior vice president and chief operating officer for clinical operations at Kaiser Permanente Southern California. 
"We ask if that patient wants to be admitted [to the hospital] or admitted at home," Shah says. "If they choose to be admitted at home, we'll send a truck home with them with all the equipment they need."
For John Stanton, the program saved two to three days in the hospital as well as a number of return trips for follow-up visits, Quijada says.   

"Things are just so much more relaxed"

Stanton’s at-home care for a pneumonia diagnosis involved an intravenous antibiotic; a phlebotomist to check his blood and house calls from a nurse and Quijada. Hospital rounds — usually done by the patient's health care team in the hallway outside the patient's room — took place instead on the phone. 

Kaiser program brings hospital care to the patient's home 

Tuesday, November 24, 2015

The Affordable Care Act is it Working ?

If you are a Republican chances are very good you say  Obamacare (ACA) is a failure. If you are a Democrat you talk about its successes. The corollary is if you don't like Obamacare you are a Republican and if you like it you are a Democrat.
Which came first is like the chicken and the egg conundrum.

Obamacare is entering it's third year of transition.  Some pundits have it as entering a holding area to be monitored as some of it's vital organ systems are struggling to survive.

The ACA was passed during a political firestorm, and a majority Democratic congress. The only people who knew what was written in the statute were those who wrote the actual Bill. Some prominent Democrats overtly expressed "you won't know what is in it until we pass it".  Enough time has passed that we know that to be  true, but we also don't know what is coming next.

The health landscape has changed dramatically in the past decade as has the economy. The calculus has changed in regard to reimbursement models and organizational stability.

Several things are happening that should set off warning bells (if congress even listens or cares) in the middle of world crises.

Politics and health care have been mixed,and patients now find their health is competing with ISIS, the war on terror and everything in the national budget.  Physicians have always known and saw this several decades ago in 1963 when Medicare was added to social security entitlements..  As health expenses were met with an 80% coverage, and with  the lack of cost containment  medicare fueled health inflation. For more than two decades health expenditures grew at more than twice the rate of the gross domestic product, fueled by the black hole of the federal government and it's ability to manipulate budgets by borrowing and printing more currency.  Now it is a part of the seventeen trillion dollar national debt. Annually health contributes to 17% of the GDP.

The ACA went into effect in 2013 and beginning then there have been enormous changes in health care financing, the administration and delivery of medical care.

Health insurance companies,  health plans, and related enterprises such as pharma are adjusting to the limitations on profitability for operations.

Mergers and acquisitions have long been part and parcel of the health business scene. However the rate and size of the shifting health space has increased in numbers and size.

Health care business will survive in this hostile environment, as a necessity of life, the demand for services is infinite. The balance between restricting necessary health care and it's availability is precarious

Aetna, Anthem reassure investors on forecast, exchanges   
Pfizer, Allergan announce $160 billion merger, 'inversion' deal would shift HQ overseas

LAO Finds Rapid Medi-Cal Enrollment

Some insurers are treading lightly and reassessing their involvement in health insurance exchanges

Sunday, November 22, 2015

INFOGRAPHIC: Electronic Health Records History | Patients & Families |

INFOGRAPHIC: Electronic Health Records History | Patients & Families |

What Patients need to know about EHR and HIT

Putting the I in Health IT

This video provides inspiring patient testimonials and informational interviews with representatives from the government on how health IT makes a difference in consumers' lives.

Ensuring the Security of Electronic Health Records Video:

It is vital to do as much as possible to protect sensitive health information in EHRs. Find out more about how providers are keeping individual health information safe and secure through cybersecurity.

Health IT Stories:
The best way to understand the value of health IT can be through personal testimonials from consumers and patients who have personal experiences using it to improve their health and health care. These videos are a small excerpt which represent many personal stories of consumers using e-Health and health IT tools to manage their care.

I’ve Seen the Disaster Averted”  

Dottie Bringle, R.N., is a hospital executive in Joplin, MO. Three weeks before Joplin's devastating tornado in May 2011, her hospital completed a switch to an EHR – so even though her hospital building was destroyed, doctors and nurses were able to provide care to Joplin residents in their time of need.

Lilianne Wright, upon hiking in the Grand Canyon, suffered from severe stages of diabetic ketoacidosis, which brought her to the brink of death. Ms. Wright recovered, but found that managing her disease was and still is complicated, because her doctors can't easily share her medical records. Today, her two children are reaping the benefits of EHRs.

A stage 4 kidney cancer survivor, Dave de Bronkart has learned first-hand that good health care depends on good information. Now he blogs as "e-patient Dave," writing about how health information technology and electronic health records can improve health care by empowering patients to access their health information and take an active role in their own care. This is his story.
Health IT, Advancing America's Health Care  pdf download

Saturday, November 21, 2015

Are You Depressed ? Take a Motrin

Depression has been linked to many other illnesses, genetics, lack of certain vitamins, poor nutrition, lack of exercise and more. 

About one third of people with depression have high levels of inflammation markers in their blood. New research indicates that persistent inflammation affects the brain in ways that are connected with stubborn symptoms of depression, such as anhedonia, the inability to experience pleasure.

The results were published online on Nov. 10 in Molecular Psychiatry.
The findings bolster the case that the high-inflammation form of depression is distinct, and are guiding researchers' plans to test treatments tailored for it.
Anhedonia is a core symptom of depression that is particularly difficult to treat, says lead author Jennifer Felger, PhD, assistant professor of psychiatry and behavioral sciences at Emory University School of Medicine and Winship Cancer Institute.
"Some patients taking antidepressants continue to suffer from anhedonia," Felger says. "Our data suggest that by blocking inflammation or its effects on the brain, we may be able to reverse anhedonia and help depressed individuals who fail to respond to antidepressants."
In a study of 48 patients with depression, high levels of the inflammatory marker CRP (C-reactive protein) were linked with a "failure to communicate", seen through brain imaging, between regions of the brain important for motivation and reward.
High CRP levels were also correlated with patients' reports of anhedonia: an inability to derive enjoyment from everyday activities, such as food or time with family and friends. Low connectivity between another region of the striatum and the  was linked to a different symptom: slow motor function, as measured by finger tapping speed.
As a next step, Felger is planning to test whether L-DOPA, a medicine that targets the brain chemical dopamine, can increase connectivity in reward-related  regions in patients with high-inflammation depression. This upcoming study is being supported by the Dana Foundation.
Felger's previous research in non-human primates suggests that inflammation leads to reduced dopamine release. L-DOPA is a precursor for dopamine and often given to people with Parkinson's disease.

Inflammation linked to weakened reward circuits in depression

Thursday, November 19, 2015

In 5 Minutes, He Lets the Blind See - The New York Times

HETAUDA, Nepal — WATCHING the doctor perform is like observing miracles.

A day after he operates to remove cataracts, he pulls off the bandages — and, lo! They can see clearly. At first tentatively, then jubilantly, they gaze about. A few hours later, they walk home, radiating an ineffable bliss.
Dr. Sanduk Ruit, a Nepali ophthalmologist, may be the world champion in the war on blindness. Some 39 million people worldwide are blind — about half because of cataracts — and another 246 million have impaired vision, according to the World Health Organization.
Dr. Sanduk Ruit, a Nepali ophthalmologist, may be the world champion in the war on blindness. Some 39 million people worldwide are blind — about half because of cataracts — and another 246 million have impaired vision, according to the World Health Organization.

In 5 Minutes, He Lets the Blind See - The New York Times

Monday, November 16, 2015

Rapper, Internist ZDoggMD on the 'Hard Doc's Life'

 In this segment of Medscape One-on-One, Editor-in-Chief Eric J. Topol, MD, interviews Zubin Damania, MD, a practicing internist who uses musical parody as a clinical teaching tool and to bring attention to the concerns facing practicing clinicians. Performing under the name ZDoggMD, Dr Damania has used music to broach many topics from conveying the need for a more humane approach to end-of-life care to the frustrations of using a less-than-intuitive electronic health record (EHR) system.

After spending 10 years in the "Hard Doc's Life" working as a hospitalist in the Silicon Valley, he was lured to Las Vegas by Zappos CEO Tony Hsieh, a former classmate of Dr Damania's wife. There, Dr Damania founded Turntable Health as part of Mr Hsieh's $350 million investment to revitalize downtown Las Vegas.

Rapper, Internist ZDoggMD on the 'Hard Doc's Life'