Individualized exam schedule for diabetic eye disease | National Institutes of Health (NIH)

At a Glance

• Researchers suggest a new exam schedule for diabetic retinopathy, a vision-threatening eye disease, based on individual risk level.
• The next step is for experts to consider modifying clinical guidelines for eye exams for people with type 1 diabetes. 

People with diabetes have blood sugar (glucose) levels that are too high. Over time, high levels of blood glucose can cause health problems, such as eye damage. The part of the eye most at risk for damage is the retina, the light-sensitive tissue that lines the back of the eye. Without treatment, retinal damage can lead to permanent blindness.

Signs of diabetic retinal disease (retinopathy) can be detected through a comprehensive dilated eye exam before symptoms occur and in time take action to prevent vision loss. Pupil dilation, or widening, is an important part of the exam because it allows a much better view of the retina. To diagnose diabetic eye disease while it is treatable, experts currently suggest that people with type 1 diabetes get an eye exam at least once a year starting three to five years after diagnosis.

Recent studies to find out whether the exam frequency could be tailored to individual risk, researchers analyzed 30 years of data from about 1,400 people with type 1 (insulin-dependent) diabetes. The study was funded mainly by NIH’s National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIH’s National Eye Institute (NEI) and others also provided support. Results were published on April 20, 2017, in the New England Journal of Medicine.

 The researchers analyzed data from about 24,000 eye exams with retinal photography. The results enabled them to develop a model to predict the likelihood of an individual progressing to significant, vision-threatening retinopathy based on their current retina exam and blood glucose level.

The findings from the research gives pause to the current recommendation.  

The analysis showed that, among people with type 1 diabetes and recent blood glucose level near the normal range (as measured by an A1C level of 6%), those with no detectable retinal damage could be screened every four years. Those with mild retinal damage could be examined every three years without increasing the risk of vision loss. People with moderate or severe retinal damage, the researchers found, should be examined more often than the current recommendation: every six or three months, respectively. On average, this tailored schedule would result in fewer eye exams and earlier detection and treatment to save vision.  

Telemedicine offers more convenience with remote fundus photography performed in primary care physician offices using retinal fundus cameras connected to the internet, and having images read by a qualified ophthalmologist.

Individualized exam schedule for diabetic eye disease | National Institutes of Health (NIH)

Message Heard? Pain Med Prescribing Down Second Year in Row

Acetaminophen/hydrocodone, the opioid pain reliever commonly sold under the brand name Vicodin, was the most dispensed prescription medicine in 2007.

And 2008. And 2009. And every year after through 2013, according to the QuintilesIMS Institute, which tracks medicine use and spending.

Then, in 2014, this staple of the opioid abuse epidemic fell to second place behind levothyroxine, which treats hypothyroidism. By 2016, acetaminophen/hydrocodone was the fourth most prescribed drug in the nation, with the volume of prescriptions down 7.2% from 2015 and 34% from 2012.

This downhill story helps capture a trend for pain medications in general and the clinicians who prescribe them. The volume of dispensed prescriptions for all pain meds has decreased for 2 straight years now, falling 2.7% in 2015, and 1.7% in 2016, QuintilesIMS reports in its annual review of medicine use and spending, which was released today. Pain meds include both narcotic and non-narcotic analgesics as well as muscle relaxants and topical pain treatments.

The study attributes the decline to more controls placed on pain meds in response to the opioid abuse epidemic. These controls include more stringent prescribing guidelines in recent years, particularly a set issued for primary care in March 2016 by the Centers for Disease Control and Prevention (CDC). The CDC cautioned that opioids are not first-line therapy for chronic pain, and that clinicians initially should consider nonopioid pain relievers and nonmedicine options such as exercise and cognitive behavioral therapy. When clinicians do prescribe opioids, they should start patients off at the lowest dose possible and limit treatment for acute pain to no more than 7 days. In addition, clinicians should monitor patients to ensure the drugs are helping with pain and function without inflicting harm.

"The CDC guidelines have been very powerful in changing physician behavior because they've had a larger audience," said Steven Stanos, DO, president of the American Academy of Pain Medicine, in an interview with Medscape Medical News.

Message Heard? Pain Med Prescribing Down Second Year in Row

Senate bill expands the use of telehealth services, remote patient monitoring for Medicare Beneficiaries

6 senators of U.S. have launched legislation seeking to remove hurdles to the use of telehealth services and remote patient monitoring for Medicare beneficiaries.

“Telehealth is the future of healthcare. It expands access to care, lowers charges and assists more people stay healthy,” stated Schatz. “Our bipartisan bill will assist change the way sufferers get the care they need, improving the healthcare system for both patients and healthcare providers.”

The CONNECT for Health Act builds on the provisions of another recently launched Senate bill—the CHRONIC Care Act—which targets to improve health outcomes for Medicare beneficiaries living with chronic ailments by, among other provisions, expanding access to telehealth services.

For its part, the CONNECT for Health Act calls for:

• Expansion of telehealth services in accountable care organizations (ACOs) and Medicare Advantage, as well as for home dialysis and telestroke services for purposes of evaluating acute stroke
• Broadening the utilization of remote patient monitoring for certain high-risk, high-cost sufferers
• Bolstering telehealth services and remote patient monitoring services in rural health clinics, federally qualified health centers, Native American sites, and permitting global and bundled payments
• Developing direct authority for the Secretary of the Department of Health and Human Services to lift existing restrictions on telehealth when certain quality and cost-effectiveness criteria are met
• Expanding the utilization of telemental health by providing the HHS secretary the authority to lift restrictions for few mental health services

The legislation has been endorsed by more than 50 agencies, involving ACT|The App Association, American Telemedicine Association (ATA), College of Healthcare Information Management Executives and the Healthcare Information and Management Systems Society (HIMSS).

“The CONNECT for Health Act gives a carefully crafted approach to star assisting countless American Medicare recipients realize the benefits of connected health technology,” claimed Morgan Reed, executive director of The App Association. “By lifting arduous limitations on the use of telehealth and motivating Medicare physicians to use creative remote monitoring technologies, responsible and secure connected health solutions might be introduced more broadly throughout the continuum of care to make better the patient health outcomes.”

“Medicare beneficiaries deserve access to telehealth services already available within nearly every other health program involving Medicaid, Veterans Health, private insurance policies and most recently TRICARE,” stated Jonathan Linkous, CEO of the ATA. “This bill might be their best hope for this Congress.”

Likewise, HIMSS appreciated the bill and pledged their support for its reforms.

“We consider that the CONNECT for Health Act will modernize healthcare delivery for Medicare beneficiaries by removing obstacles to the use of telehealth and other healthcare technologies like remote patient monitoring, resulting in higher access to high-quality care, improved continuity of care and better value for sufferers and the Medicare program,” stated HIMSS in a written statement.

Telehealth promises to bring a sea-change to health care delivery and access.

Senate bill expands the use of telehealth services, remote patient monitoring for Medicare Beneficiaries

How to share preventative measures for Stroke Awareness Month

Stroke . Part II

How do you know if you or someone else is having a stroke ?  Much of it depends on the severity of a stroke.

A common warning may be a TIA (transient ischemic attack) This is short lived temporary slurring of speech or blindness, numbness, or even a loss of speech entirely.  This may last several seconds to several minutes, with a complete recovery.  A complete stroke may occur in minutes, hours, or days.

Stroke is not uncommon. Stroke is a medical emergency...call 911.  Do not attempt to drive to a hospital.

Being proactive and knowledgeable may save a life.

May is Stroke Awareness Month








How to share preventative measures for Stroke Awareness Month | Articles | Main

Free medical schools? | Arlen Meyers, MD, MBA |

Is it time to re-think the current model of medical school financing ?



The average undergraduate student debt has risen to $30,000. The average medical student debt is about $170,000. Minorities are underrepresented, many deem the selection process as flawed and the debt burden has an impact on specialty selection and geographic maldistribution, the ability to buy a house and start a family and many other downstream effects. The effects are magnified when one indebted medical student marries another medical student, particularly if they get divorced.

While many are advocating for medical student education reform, changing the business model is lower on the list. Meanwhile, all of this is happening in the face of headwinds created by a lack of basic research funding, meager legislative budgets for state supported schools and decreasing reimbursement for academic clinical services. Many are looking to philanthropreneurship or innovation centers to fill the gaps.


Philanthropy already fills some of the vacuum for private medical schools. Scholarship, and grants are made possible by wealthy individuals who are alumni leaving a legacy gift to their alma-mater.  However, this is a relatively small fraction of an incoming class.  Military or public health funding is available for those willing to devote 4 or 5 years to military service. The amount can extend also to post-graduate residency time.


At one time, small cities, otherwise lacking medical care would select a deserving student for a grant, with the promise of returning to their home to practice medicine.


In the UK some years in the past  college was free. Since that time things have changed and students were demonstrating in the streets and the liberal establishment was pushing back against charging students to attend universities.


A recent analysis of the effects of charging tuition in the UK has analyzed the results. There are lessons to be learned that might apply to the medical school funding business model. The authors conclude that "rather than looking to emulate the English model of the 1990s, the U.S. might instead consider emulating some key features of the modern English system that have helped moderate the impact of rising tuition, such as deferring all tuition fees until after graduation, increasing students’ ability to cover living expenses, and automatically enrolling all graduates in an income-contingent loan repayment system that minimizes both paperwork hassle and the risk of default. No model is without its challenges. But the English experience suggests that making college completely free is hardly the only path to increasing quantity, quality, and equity in higher education. Indeed, the story we tell here shows how a free system can sometimes work against these goals."



Medical education needs a makeover. Here are some principles of medical education reform:

1. Whatever we recommend should be aligned with the vision and mission of the institution. 2. Teaching hospitals are but a part of a community of care and their roles are being redefined not just in the areas of clinical care, but research and education as well . 3. The goal is to create graduates who can serve the needs of the community by improving population health, reducing per capita costs and improving the patient and provider experience.  4. Education and research are step children to clinical care. Just follow the money.   5. Education is different than training.  6. Management is different from leadership, entrepreneurship and innovation.  7. Terms like innovation, value and disruption are used often, with great passion, misinterpretation and misunderstanding.  8. Those that don't walk the talk can only come back to the well so many times.  9. Teaching is not easy or free, only considered by those who pay the bills to be so. 10. What, who, when,and how we teach and measure outcomes is insufficient, costly and badly in need of innovation.  11. Education needs to be responsive to the forces driving the 4th Industrial Revolution .  12. Students should be selected based on their Steampathie (thanks Thomas Friedman) .  13. The business model needs to change to conform to the realities of the environment . 14. We need to address student demands for non-clinical career development, like entrepreneurship, and alternative work-life arrangements other than full-time employment .  15. Learning objectives and curriculum should be driven, in part, by market based determinants including digital health, value based care, interprofessional learning, team based care and cultural competence.

New York has just established "free universities" . Maybe we can learn some things from our friends across the pond when it comes to medical school financing and loan repayment models. Or, we can just sell the assets to private equity. 

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs

Free medical schools? | Arlen Meyers, MD, MBA | Pulse | LinkedIn

Neuralink wants to wire your brain to the internet – what could possibly go wrong?

The next step in human evolution. Credit: Shutterstock

Neuralink – which is "developing ultra high bandwidth brain-machine interfaces to connect humans and computers" – is probably a bad idea. If you understand the science behind it, and that's what you wanted to hear, you can stop reading.

But this is an absurdly simple narrative to spin about Neuralink and an unhelpful attitude to have when it comes to understanding the role of technology in the world around us, and what we might do about it. It's easy to be cynical about everything Silicon Valley does, but sometimes it comes up with something so compelling, fascinating and confounding it cannot be dismissed; or embraced uncritically.

Putting aside the hyperbole and hand-wringing that usually follows announcements like this, Neuralink is a massive idea. It may fundamentally alter how we conceive of what it means to be human and how we communicate and interact with our fellow humans (and nonhumans). It might even represent the next step in human evolution.

Neurawhat?

But what exactly is Neuralink? If you have time to read a brilliant 36,400-word explainer by genius Tim Urban, then you can do so here. If you don't, Davide Valeriani has done an excellent summary right here on The Conversation. However, to borrow a few of Urban's words, NeuraLink is a "wizard hat for your brain".

Essentially, Neuralink is a company purchased by Elon Musk, the visionary-in-chief behind Tesla, Space X and Hyperloop. But it's the company's product that really matters. Neuralink is developing a "whole brain interface", essentially a network of tiny electrodes linked to your brain that the company envisions will allow us to communicate wirelessly with the world. It would enable us to share our thoughts, fears, hopes and anxieties without demeaning ourselves with written or spoken language.

 However, unlike Tesla and Space X, Neuralink operates in a field where there aren't any other major players – for now, at least. But Musk has now fired the starting gun for competitors and, as Urban observes, "an eventual neuro-revolution would disrupt almost every industry".

 But this is an absurdly simple narrative to spin about Neuralink and an unhelpful attitude to have when it comes to understanding the role of technology in the world around us, and what we might do about it. It's easy to be cynical about everything Silicon Valley does, but sometimes it comes up with something so compelling, fascinating and confounding it cannot be dismissed; or embraced uncritically.

More criticism of Neuralink

Antonio Relagado, senior editor for biomedicine for MIT Technology Review, isn’t too impressed with Elon Musk’s claims for Neuralink. In particular, he explains that the 8-10 year time line for the first available implants is absurd and impossible.

Let’s deal with Musk’s time line first. A brain implant is a medical device that requires neurosurgery. Proving that it works requires a stepwise series of experiments that each takes years, starting in rats or monkeys.

Here’s a time line from the real world: a company called NeuroPace was started in 1997 to develop an implant that controls epileptic seizures. It actually senses a seizure coming and zaps your brain to stop it. The device got approved in 2013—16 years later. And that was for a very serious medical condition in which brain surgery is common.

Putting an implant in healthy people? That would require extraordinary evidence of safety. And that’s hard to picture, because as soon as you open someone’s head you put that person’s life at risk. We at MIT Technology Review know of only one case of a healthy person getting a brain implant: a crazy stunt undertaken in Central America by a scientist trying to do research on himself. It caused life-threatening complications.

Musk doesn’t seem to be considering the ethical problems at all. It’s cool tech, but I wouldn’t let anyone stick wires in my brain unless it was to treat a serious medical problem with tested procedures.

So it’s not crazy to believe there could be some very interesting brain-computer interfaces in the future. But that future is not as close at hand as Musk would have you believe. One reason is that opening a person’s skull is not a trivial procedure. Another is that technology for safely recording from more than a hundred neurons at once—neural dust, neural lace, optical arrays that thread through your blood vessels—remains mostly at the blueprint stage.

So what facts am I missing? What makes it even remotely okay that Musk and Facebook are promising the public telepathy within a few short years?

We criticize religions for making false promises without evidence; we imprison people for bilking people out of money on false pretenses; so yes, I agree, why do we give billionaire industrialists a pass when they make secular claims that don’t stand a chance in hell of coming true, and when they do it on behalf of profit-making companies?

  


Neuralink wants to wire your brain to the internet – what could possibly go wrong?

45 Minutes to diagnose a stroke. Don't miss the Window of Opportunity Artificial Intelligence Versus M.D. -

The 45 minute window of  a stroke. 

This is the time window before permanent changes occur in the brain after an obstruction of one or more arteries in your brain.

The time frame and liklihood of your receiving treatment during this period is not good. Time is of the essence and immediate recognition is imperative. If you are alone the odds get worse. 

The earliest signs may be double vision, or loss of vision, numbness, vertigo, weakness on one side, slurred speech, a sudden inability to speak.

Unless being proactive most patients and/or families are in denial when it occurs.  Chances are good that it will be one or more hours until you are at an emergency room.

The time log is critical as to when did the earliest symptoms begin?  The emergency department stop watch began as the patient came in through the doors, plus how long it took to get to the Emergency department.

Therefore it is imperative treatment begin as early as possible.  Televideo offers a significant decrease in time of stroke to treatment.  If properly used this modality offers great hope for better survival and decreased morbidity.

Telemedicine and EMS: The future is now

A time is coming whereby 'First responders', EMTs will have advanced training in treatment of stroke.  They will be able to start an IV and discuss their finding in real time with an emergency physician at the destination hospital. When indicated, the EMT will be able to begin intraveous treatment with clot-busting drugs as ordered by the emergency doctor.

At the least the ED will be prepared immediately when the patient arrives at the E.D.

Consumer technology can provide this, now, using commonly used video applications. It is a step in the right direction until a HIPAA application is applied.  Anyone using Facebook, Viber, Google Hangouts, Zoom, Livestream does this daily.

Another and important aspect of diagnosis when a patient arrives at the emergency department is proper diagnosis using CT or MRI Scans.

For example:

One evening last November, a fifty-four-year-old woman from the Bronx arrived at the emergency room at Columbia University’s medical center 
with a grinding headache. Her vision had become blurry, she told the E.R. doctors, and her left hand felt numb and weak. The doctors examined her and ordered a CT scan of her head.

A few months later, on a morning this January, a team of four radiologists-in-training huddled in front of a computer in a third-floor room of the hospital. The room was windowless and dark, aside from the light from the screen, which looked as if it had been filtered through seawater. The residents filled a cubicle, and Angela Lignelli-Dipple, the chief of neuroradiology at Columbia, stood behind them with a pencil and pad. She was training them to read CT scans.

“It’s easy to diagnose a stroke once the brain is dead and gray,” she said. “The trick is to diagnose the stroke before too many nerve cells begin to die.” Strokes are usually caused by blockages or bleeds, and a neuroradiologist has about a forty-five-minute window to make a diagnosis, so that doctors might be able to intervene—to dissolve a growing clot, say. “Imagine you are in the E.R.,” Lignelli-Dipple continued, raising the ante. “Every minute that passes, some part of the brain is dying. Time lost is brain lost.”

Strokes are typically asymmetrical. The blood supply to the brain branches left and right and then breaks into rivulets and tributaries on each side. A clot or a bleed usually affects only one of these branches, leading to a one-sided deficit in a part of the brain. As the nerve cells lose their blood supply and die, the tissue swells subtly. On a scan, the crisp borders between the anatomical structures can turn hazy. Eventually, the tissue shrinks, trailing a parched shadow. But that shadow usually appears on the scan several hours, or even days, after the stroke, when the window of intervention has long closed. “Before that,” Lignelli-Dipple told me, “there’s just a hint of something on a scan”—the premonition of a stroke.



Lignelli-Dipple pulled up a second CT scan, taken twenty hours later. The area pinpointed by the resident, about the diameter of a grape, was dull and swollen. A series of further scans, taken days apart, told the rest of the story. A distinct wedge-shaped field of gray appeared. Soon after the woman got to the E.R., neurologists had tried to open the clogged artery with clot-busting drugs, but she had arrived too late. A few hours after the initial scan, she lost consciousness, and was taken to the I.C.U. Two months later, the woman was still in a ward upstairs. The left side of her body—from the upper arms to the leg—was paralyzed.

For a radiologist and other physicians who read images pattern recognition become ingrained in their brain..a specific portion of their brain lights up on fMRI studies. If you want to learn more about it, read the entire article......



A.I. Versus M.D. - The New Yorker

Major healthcare lobbying groups urge Trump, Congress to fund ACA subsidies | Healthcare Dive

• 
  
• Seven major healthcare organizations, including the American Hospital Association, the American Medical Association and America's Health Insurance Plans, as well as the U.S. Chamber of Commerce urged the President Donald Trump administration and Congress "to take quick action to ensure [cost-sharing reductions] are funded" in a letter sent on Wenesday.
• "The most critical action to help stabilize the individual market for 2017 and 2018 is to remove uncertainty about continued funding for cost sharing reductions (CSRs)," the letter states.
• Many of the major healthcare lobbying groups made clear what they want from Trump and Congress over the individual insurance market: A piece of mind that the subsidies will be funded.
  Whether or not the HHS will continue to pay CSRs to insurers in light of House v. Price (formerly known as House v. Burwell) has been a bit unclear. The administration finds itself in a quandary with the lawsuit. Congressional Republicans had challenged the Obama administration in court over the legality of CSRs. Last year, a judge ruled in favor of the Republicans, but the Obama administration filed an appeal to reverse the decision and was allowed to continue the payments while the appeal is still in process. The suit began with Democrats in charge of the executive branch and with Republicans now in control, they need to decide how to proceed with the appeal while also working on healthcare reform.
• 
  

  Recommended Reading:

  •  AHIPHow Changes to Cost-Sharing Reductions Could Affect You
  •  The Washington PostTrump changes course again, says health-care repeal must happen before tax overhaul
  •  Healthcare DiveContinuation of cost-sharing subsidies won't ease insurers' uncertainty 
  •  VoxThe bizarre lawsuit that could still blow up the ACA insurance markets

Major healthcare lobbying groups urge Trump, Congress to fund ACA subsidies | Healthcare Dive

TOO MANY WHITES IN . CLINICAL TRIALS AND NOT ENOUGH ETHNICITIES

Accurate clinical trials depend upon a wide and diverse population for accurate results. If one particular ethnic group participates, the results may be skewed and highly inaccurate.

Tammie Denyse, a breast cancer survivor, entered a clinical trial years ago, partly to ensure more participation by black women. She is a part-time youth pastor at Cho Un Korean United Methodist Church in Orangevale.

Getting diagnosed with cancer was “horrific” enough. But discovering that very few African American women like herself were enrolled in clinical trials to find a cure? That was almost as distressing for Tammie Denyse, a longtime breast cancer survivor in Sacramento.

After her Sutter Health oncologist offered her a slot in a clinical trial to test a new breast cancer drug treatment, the youth pastor carefully checked the study’s protocols for potential side effects. Then promptly signed up.

The lack of participation amongst Latino's, African-American and others may be due to a lack of knowledge about what clinical trials are?  Providers also may inadvertently or otherwise fail to educate their patients about clinical trials. The answer may be to educate providers to teach this group about trials.  Public health announcement need to be targetted to those groups as well. Last month, the California Medical Association Foundation and its ethnic doctor groups launched a statewide campaign to encourage more participation by diverse patients. The campaign features posters in doctors’ offices and short videos for patients that discuss the value of clinical trials.

“We’re hoping to start conversations with their physicians,” said Dr. Margaret Juarez, an obstetrician-gynecologist in the San Gabriel Valley who chairs the Network of Ethnic Physician Organizations representing more than 25 ethnic doctor groups statewide.

Read more here: http://www.sacbee.com/news/local/health-and-medicine/article145292374.html#storylink=cpy

“The most important thing about being in a clinical trial is that I was giving back,” said Denyse, 52, a part-time pastor at Cho Un Korean United Methodist Church in Orangevale. By participating in a clinical trial, she gained an “opportunity as an African American woman to impact medicine … to know that this horrific cancer journey I was on was not in vain.”

Denyse, however, is not the norm. According to federal data, participants in U.S. clinical trials have historically been overwhelmingly white and predominantly male.

In a 2011 report, the Food and Drug Administration noted that blacks were 12 percent of the population but only 5 percent of clinical trial participants; Hispanics, at 16 percent of the population, represented only 1 percent.

So what’s keeping people away? It’s a combination of misunderstanding, fear, lack of awareness and financial and cultural barriers, say medical experts.

“It can be harder to recruit minority populations, but it does not mean Latinos, African Americans and Asians aren’t willing. They may not know of these trials,” said Dr. Sergio Aguilar-Gaxiola, director of the UC Davis Center for Reducing Health Disparities.

There also may be unconscious bias by researchers who find it more problematic to enroll diverse patients, particularly those with limited English proficiency, he added.

“If you’re a patient and don’t know what ‘clinical trial’ means, you might be thinking: ‘Does my doctor want me to be a guinea pig or take me to court?’ ” said Chen. “For a person who doesn’t know medicine, the words create an ambiguous and negative connotation.”

Time and logistics also can be barriers, he noted. A clinical trial can require more doctor visits, meaning patients need to leave work or arrange child care to get to appointments. Patients may also need to take additional medications or tests.

Read more here: http://www.sacbee.com/news/local/health-and-medicine/article145292374.html#storylink=cpy

Read more here: http://www.sacbee.com/news/local/health-and-medicine/article145292374.html#storylink=cpy

Read more here: http://www.sacbee.com/news/local/health-and-medicine/article145292374.html#storylink=cpy

Read more here: http://www.sacbee.com/news/local/health-and-medicine/article145292374.html#storylink=cpy

Read more here: http://www.sacbee.com/news/local/health-and-medicine/article145292374.html#storylink=cpy

ANYONE WISHING TO LEARN ABOUT CLINICAL TRIALS CAN FIND THEM HERE: Clinical Trials

Illinois hospital offers housing to curb ER superusers

One of the biggest drivers in hospital spending is the rising number of “superusers,” patients who visit the emergency room or are admitted to a general acute care hospital several times a year.

But an Illinois hospital noticed that many of its most frequent users were chronically homeless patients, who didn’t always come for medical care. In many cases they just needed a warm place to stay on a cold night.

To better help care for these patients—and cut costs—the University of Illinois Hospital (UI-Hospital) and Health Sciences System launched a housing initiative in 2015 to provide furnished apartments and support services for homeless patients.

Prior to the program, seven of the top 10 users of the organization’s ER were chronically homeless and accessed the system between 30 and 120 times a year. The organization’s $250,000 investment in the program has led to impressive results, reported AHA News. So far, the monthly hospital visits have declined by 35% and the annual cost of care for these patients dropped more than 40%.

In addition to housing, patients are assigned a case manager who coordinates their care and helps them manage money.

“We see funding housing as a way of improving health," Avijit Ghosh, M.D., CEO of the UI Health Hospital & Clinics, said on the hospital website. "Actions like this are important to address the problems facing our community. By helping those who rely on UI Health, we're improving the health of both the individuals and our community overall."

Peter Toepfer, associate vice president of housing for the Center for Housing and Health in Chicago, which partners with the hospital, told AHA News that hospitals and health systems must view patients who are chronically homeless the same way they consider chronic illnesses. The best prescription, he said, is providing a homeless patient with permanent supportive housing.

Homelessness in the United States

Bronx hospital invests in low-income housing to improve public health

Why Hospitals Are Housing the Homeless

Suffering significant health problems, the woman was in and out of hospitals constantly. She did not take prescribed medications because they made her groggy — an unsafe condition for a woman living on the streets.

“And, of course, within a week or two her medical condition would deteriorate again,” says Shannon Nazworth, executive director of Ability Housing, a nonprofit organization serving northeast and central Florida. “She was just cycling in and out of the hospital, not because anybody was not giving her good care or did not care about her, but because the system was broken.”

In the two years before the woman was placed in an apartment, three hospitals spent more than $750,000 on her care.

“In the year after she moved in, she went to the hospital once for a couple of days,” Nazworth says. “The other factors that were affecting her health were addressed by just getting her housing. She needed a place to sleep at night, a place to store her medicine and the security of a door to lock.”

Patients like this woman exist throughout health care, but, traditionally, most health systems have not seen a way to address homelessness and other social factors that exacerbate individuals’ health problems. That is changing as health systems pivot to population health management and new payment systems that reward them for proactively improving patients’ health status.

“Whatever has been done in the past has not been working, and we have to really think very differently,” says David Perlstein, M.D., president and CEO of SBH Health System in the New York City borough of the Bronx.

In his case, that means proactively reducing inpatient capacity, selling part of the SBH campus to a developer to build low-income housing and opening an urgent care center and other outpatient facilities in the new development. In other places, provider organizations are donating cash. For example, five hospitals and a nonprofit health plan in Portland, Ore., are donating $21.5 million to help build nearly 400 housing units for homeless and low-income people. Still other health care organizations are building apartments that they own and operate themselves, and some are paying the rent for homeless people to have a place to live.

Solutions such as this stem from innovators who think out of the box, merging hospital care with public health issues and other socially demanding problems.

What would work in your community ?

This information is attributable to FierceHealthCare

California needs more medical residency options

Our health system is broken ! Another situation that defies common sense in a state that is underserved.

Read the story about a medical student who wants to practice primary care and psychiatry, who cannot find a suitable residency in California.

By Trevor Cline

California and its public education system is the only home I’ve ever known. I’m a proud alumnus of UC Berkeley and soon-to-be alumnus of the UC Davis School of Medicine.

I understand my state’s needs and want more than anything to serve urban California communities as a dually trained internist and psychiatrist. In order to realize my dream, I need to match into a residency program, otherwise known as a graduate medical education program.

There is currently only one dual-training residency program in our entire state. Because of that, there is a very real possibility I will have to leave California, the only place I want to live and work, to continue my medical training.

This lack of graduate medical education training positions, especially in primary-care specialties like the one I wish to match into, is problematic in many ways.

First, it deprives our state of its physician workforce, as doctors are more likely to permanently live and work within 80 miles of where they receive GME training. It also perpetuates an existing health care access crisis and physician shortage that exists throughout our state.

California ranks 32nd in access to doctors compared to our neighboring states. Nearly 40 percent of our state’s counties fall below what is considered a minimum physician-to-population ratio to allow those seeking medical care to be able to do so in a timely manner.

To compound this issue, most GME programs are funded by federal Medicare dollars, which haven’t increased in nearly 20 years to keep pace with an increasing population and demand for doctors.

The lack of coordination of health care at the state level and federal level defies understanding when Obamacare increased the patient load abruptly.  Why was an increase in graduate medical funding included ?

Additionally, it’s projected that California needs 8,423 new primary-care doctors by 2030 to meet our population’s need for care services, and we don’t have nearly enough graduate medical education programs to meet that need.

To help ensure that California patients can see a doctor promptly when they need one, our Legislature passed a budget in 2016 that committed to investing $100 million over three years ($33 million each year) to fund the Song-Brown Program, an existing grant program housed within the Office of Statewide Health Planning and Development that supports primary-care residency programs in medically underserved areas.

However, Gov. Jerry Brown’s current budget proposal eliminates $33.4 million in health care workforce funding and redirects $50 million in tobacco tax revenues (Proposition 56) that was intended to go to GME programs.

It’s disappointing that Gov. Brown dropped his commitment to open more GME programs to keep more highly qualified California medical students in our state.

Anyone concerned with the future of our state’s health should contact their state representatives and Brown’s office. Tell them to stop raiding tobacco tax revenues and invest those funds toward the Song-Brown program and other means of expanding GME programs in California. The future of my profession and the health of our state depend on it.

— Trevor Cline is a student at the UC Davis School of Medicine. He is a dedicated health policy advocate and a medical student leader in the California Medical Association Medical Student Section.

California needs more medical residency options