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Fixing healthcare is a complex issue that involves addressing various factors such as access, cost, and quality of care. Some potential solutions include:
Expanding access to healthcare through measures such as Medicaid expansion and implementing a universal healthcare system.
Lowering healthcare costs through initiatives such as price transparency, negotiating lower drug prices, and reducing administrative costs.
Improving the quality of care by investing in preventative care, promoting healthy lifestyle choices, and implementing programs to detect and manage chronic diseases.
It's also important to consider the role of the private sector and government in healthcare, as well as the need for ongoing research and evaluation to determine the most effective solutions.
Hospitals have always been challenged with improving patient flow from emergency rooms, elective admissions to final discharge. Inefficient utilization increases cost by decreasing reimbursements.
Whether it is fee-for-service or managed care, the lack of proper utilization has the same effect. Computer guidance coupled with a command and control center helps hospital administrators to address this challenge.
The command center is abuzz as more than a dozen experts monitor the constant flow of real-time information. When alerts emerge on one of the 32 computer screens, team members jump into action to resolve problems that range from minor obstacles to mission-critical challenges.
This sleek, high-tech room looks like the fabled site NASA uses to keep astronauts safe, but it is located inside Michigan Medicine’s University South Hospital in Ann Arbor.
Seven years in the making, this state-of-the-art facility – officially known as the M2C2: The Michigan Medicine Capacity Operations and Real Time Engagement Center – is improving patient care by leveraging real-time data and predictive analytics to not only identify bottlenecks and other barriers hindering care but also to get ahead of potential problems. Building on the success of similar initiatives at other cutting-edge hospitals, including Johns Hopkins and Yale in the United States and several medical centers outside the US, Michigan’s M2C2 reflects the innovative use of technology to enhance care and reduce costs.
The relationship between doctors, nurses and patients has always been at the heart of medicine and M2C2 is designed to improve outcomes by streamlining the complex behind-the-scenes logistical challenges that have profound impacts on the care they deliver.
In addition to expert caregivers, patients need hospital beds, MRI machines, surgical theaters, and recovery rooms and so much more available as needed so their treatment is a steady flow. The command center is designed to optimize these and other resources so that logistics do not impede care.
Hospitals have, of course, always addressed logistics. But they have typically been handled by separate units that did not have clear and easy channels of communication to seamlessly coordinate their actions. The rise of electronic health records during last decade, which greatly facilitates access to and the sharing of information across a hospital’s sprawling operations, makes it not only possible but necessary to unify these efforts which impact patient experience and outcomes.
Command centers such as Michigan Medicine’s M2C2 bring together a broad range of trained experts, including patient flow coordinators, admission triage coordinators, admission triage associates, clinical expediters, data analysts, management and support staff who monitor and analyze data entered into the electronic health records system to improve capacity decision making. A few examples:
It is not uncommon for patients to remain in the hospital awaiting a test or lab result. Specially designed software alerts the command center to such instances, allowing staff to address the cause of the delay and, whenever possible, expedite care which allows patients to more quickly receive the care they need and be discharged, freeing up rooms and caregivers for others.
Traditionally, Mondays and Tuesdays have been slower days for surgeries, with demand building toward the end of the week. The command center deploys advanced analytics that help guide OR schedulers so they can smooth out these scheduling bumps, relieving pressure on surgical teams and facilities.
Advanced algorithms built into the command center dashboards enable staff to analyze a wide range of data to determine which patients might be vulnerable to deterioration and to get ahead of the situation.
As real-time information appears on the command centers dashboards, the team identifies issues that require further attention and work with various teams — including nursing, physicians, pharmacy, physical and occupational therapy, and radiology, to name a few – to address them.
Michigan’s M2C2 just began operating on Nov. 29 but similar initiatives at other institutions have shown significant benefits in patient care covering the full spectrum of services from admission to discharge. After opening its command center, Johns Hopkins Hospital in Baltimore reported that its critical care team was dispatched 63 minutes sooner to pick up patients via ambulance from outside hospitals and “a 60 percent improvement in the ability to accept patients with complex medical conditions from other hospitals around the region and country.” Patients were assigned to a bed “30 percent faster after a decision was made to admit him or her from the Emergency Department” and transfer delays from the operating room after a procedure was reduced by 70 percent. Hopkins also reported that “twenty-one percent more patients were discharged before noon.”
These are game-changing results. As my colleague Vikas Parekh, M.D., associate chief medical officer for U-M Health and an executive sponsor of the M2C2 project, put it, “If we get the right information at the right time to the right people, that will drive the right outcome for our patients.”
Marschall S. Runge, MD, PhD, is Executive Vice President for Medical Affairs and Dean of the Medical School for the University of Michigan. He serves on the Board of Directors for Eli Lilly and Company.
This article was originally published by RealClearHealth and made available via RealClearWire.
Nearly three years into the pandemic, COVID’s mortality burden is growing in certain groups of people
Today in the U.S., about 335 people will die from COVID—a disease for which there are highly effective vaccines, treatments and precautions. Who is still dying, and why?
WHO?
Older people were always especially vulnerable and now make up a higher proportion of COVID fatalities than ever before in the pandemic. While the total number of COVID deaths has fallen, the burden of mortality is shifting even more to people older than age 64. And deaths in nursing homes are ticking back up, even as COVID remains one of the top causes of death for all ages. COVID deaths among people age 65 and older more than doubled between April and July this year, rising by 125 percent, according to a recent analysis from the Kaiser Family Foundation. This trend increased with age: more than a quarter of all COVID fatalities were among those age 85 and older throughout the pandemic, but that share has risen to at least 38 percent since May.
Where people live also affects their risk level. The pandemic first hit urban areas harder, but mortality rose dramatically in rural areas by the summer of 2020—a pattern that has held. The gap is currently narrowing, but people living in rural areas are still dying at significantly higher rates. Rural death rates fell from 92.2 percent higher than urban rates at the end of September to 38.9 percent higher in mid-October. COVID vaccines have helped reduce some disparities. “Vaccination shrinks racial inequality,” Feldman says. “It’s that simple.” But the same factors putting many people of color at risk, including racism and systemic oppression, persist. For example, booster access in communities of color has been inequitable, driving death rates higher.
WHEN ?
President Joe Biden’s administration is bracing for 30,000 to 70,000 more deaths this winter. A bad flu year, in comparison, brings about 50,000 deaths.
Incidence of Stroke following COVID Booster Several controversial studies involving a bivalent vaccine reported an incidence of stroke after vaccination, however, the current Covid 19 boosters showed no propensity for stroke.
Grapefruit interacts with a wide variety of medications, potentially causing serious side effects.
Grapefruit Is One of the Weirdest Fruits on the Planet
Eventually, with Bailey leading the effort, the mechanism became clear. The human body has mechanisms to break down stuff that ends up in the stomach. The one involved here is cytochrome P450, a group of enzymes that are tremendously important for converting various substances to inactive forms. Drugmakers factor this into their dosage formulation as they try to figure out what’s called the bioavailability of a drug, which is how much of a medication gets to your bloodstream after running the gauntlet of enzymes in your stomach. For most drugs, it is surprisingly little—sometimes as little as 10 percent.
Grapefruit has a high volume of compounds called furanocoumarins, which are designed to protect the fruit from fungal infections. When you ingest grapefruit, those furanocoumarins take your cytochrome P450 enzymes offline. There’s no coming back. Grapefruit is powerful, and those cytochromes are donezo. So the body, when it encounters grapefruit, basically sighs, throws up its hands and starts producing entirely new sets of cytochrome P450s. This can take over 12 hours.
This rather suddenly takes away one of the body’s main defense mechanisms. If you have a drug with 10 percent bioavailability, for example, the drugmakers, assuming you have intact cytochrome P450s, will prescribe you 10 times the amount of the drug you actually need, because so little will actually make it to your bloodstream. But in the presence of grapefruit, without those cytochrome P450s, you’re not getting 10 percent of that drug. You’re getting 100 percent. You’re overdosing.
And it does not take an excessive amount of grapefruit juice to have this effect: Less than a single cup can be enough, and the effect doesn’t seem to change as long as you hit that minimum.
None of this is a mystery, at this point, and it’s shockingly common. Here’s a brief and incomplete list of some of the medications that research indicates get screwed up by grapefruit:
Benzodiazepines (Xanax, Klonopin, and Valium)
Amphetamines (Adderall and Ritalin)
Anti-anxiety SSRIs (Zoloft and Paxil)
Cholesterol-lowering statins (Lipitor and Crestor)
Erectile-dysfunction drugs (Cialis and Viagra)
Various over-the-counter meds (Tylenol, Allegra, and Prilosec)
And about a hundred others.
In some of these cases, the grapefruit interaction is not a big deal, because they’re safe drugs and even having several times the normal dosage is not particularly dangerous. In other cases, it’s exceedingly dangerous. “There are a fair number of drugs that have the potential to produce very serious side effects,” says Bailey. “Kidney failure, a cardiac arrhythmia that’s life-threatening, gastrointestinal bleeding, respiratory depression.” A cardiac arrhythmia messes with how the heart pumps, and if it stops pumping, the mortality rate is about 20 percent. It’s hard to tell from the statistics, but it seems all but certain that people have died from eating grapefruit.
This is even more dangerous because grapefruit is a favorite of older Americans. The grapefruit’s flavor, that trademark bitterness, is so strong that it can cut through the decreased taste sensitivity of an aged palate, providing flavor for those who can’t taste a lot of other foods very well. And older Americans are also much more likely to take a variety of pills, some of which may interact with grapefruit.
Despite this, the Food and Drug Administration does not place warnings on many of the drugs known to have adverse interactions with grapefruit. Lipitor and Xanax have warnings about this in the official FDA recommendations, which you can find online and are generally provided with every prescription. But Zoloft, Viagra, Adderall, and others do not. “Currently, there is not enough clinical evidence to require Zoloft, Viagra, or Adderall to have a grapefruit juice interaction listed on the drug label,” wrote an FDA representative in an email.
This is not a universally accepted conclusion. In Canada, where Bailey lives and works, warnings are universal. “Oh yeah, it’s right on the prescription bottles, in patient information,” he says. “Or they have a yellow sticker that says, ‘Avoid consumption of grapefruit when taking
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