The (Portland) Oregonian has done a nice review of the surge in the joint-replacement industry. That surge has been fueled by an aging population and heavy marketing by providers who see joint replacements as a bonanza.
Consider that “Knee replacements nearly doubled across the country between 2000 and 2010 to almost 720,000 operations, and hip replacements rose even more to 330,000 procedures, according to the latest statistics by the Centers for Disease Control and Prevention.”
This article in the New England Journal of Medicine looks at the Institute of Medicine’s new report titled “Improving Diagnosis in Health Care — The Next Imperative for Patient Safety.”
The authors of the NEJM piece, Hardeep Singh, M.D., and Mark L. Graber, M.D., conclude:
“Now could be an opportune moment to create a national public–private partnership to propel progress. The Department of Veterans Affairs and the Agency for Healthcare Research and Quality have made commitments to improving diagnosis, but the Centers for Disease Control and Prevention, the National Institutes of Health, and the ONC also have interests that intersect with patient safety and could contribute to research and implementation initiatives for elucidating and reducing diagnostic errors. On the private side, a movement is being led by the nonprofit Society to Improve Diagnosis in Medicine, …which petitioned the IOM to study this issue and aims to spearhead a national coalition of professional societies and other interested parties to translate the recommendations into action.
“For the past 15 years, the patient-safety movement has focused on treatment-related harms. But interactions that are too brief to permit clinicians to listen to patients, productivity pressures, and reimbursement systems that don’t adequately support clinicians’ cognitive work are highlighting additional safety issues. ‘Improving Diagnosis in Health Care’ restores balance to the patient-safety quest by calling attention to diagnosis, the other half of medicine. We are optimistic that the report will spark a renaissance of interest in improving diagnosis and reducing patient harm from diagnostic error.”
Tom Frieden, M.D., director of the Centers for Disease Control and Prevention, writes in The New England Journal of Medicine that providers must deal with five levels of a “pyramid” model to optimize public health.
- The base: socioeconomic determinants — income, employment status, race and education, followed by, in this order:
- Such public-health interventions as expanded health coverage or contraception access.
- Long-term preventive interventions, such as immunizations.
- Clinical interventions such as blood-pressure management.
- Public education and outreach efforts.
Dr. Frieden says that major long-term population-health improvement depends on preventive and clinical interventions.
Some key elements in successful population-health initiatives include, he says:
- Team-based care.
- Patient-centered care.
- Continual improvement in delivery and treatment.
- Registry-based information systems.
In this antibiotic-resistance test, bacteria are streaked on the dish with antibiotic-impregnated white disks. Bacteria in the culture on the left are susceptible to the antibiotic in each disk, as shown by the dark, clear rings where bacteria have not grown. Those on the right are fully susceptible to only three of the seven antibiotics tested.
The Centers for Disease Control and Prevention are pressing health facilities in each region to share data with a central public-health facility to help stem the increasing number of drug-resistant “superbugs.” It says that such sharing and coordination could save more than half a million lives over five years.
The Washington Post notes that “Hospitals or nursing homes try to control infections on their own, but they rarely tell each other when a patient being transferred into another facility is carrying antibiotic-resistant bacteria. That lack of information greatly increases the risk that the germ will be spread.”
In this area, too, America’s fragmented and exorbitantly priced health “system” needs to have more silos blown up.
Video and text: The Centers for Disease Control and Prevention is targeting older people in a drive to prevent and control diabetes.
The agency notes:
“These past few years we have been setting up the National Diabetes Prevention Program (DPP). It has caused us to work with a variety of groups and a variety of populations. The original DPP research study demonstrated that the intervention is even more effective in patients older than 60 years of age. It is 58 percent effective for the general population and 71 percent effective for those older than 60 years of age. This is certainly a population that will benefit from this intervention. To that end, the Centers for Medicare & Medicaid Services has given out some grants to help study this.”
Given how bad diabetes is in itself and how associated it is with other life-threatening and expensive ailments, most people will applaud this initiative.