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Veterans Administration

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Racial disparities persist at VA patient-centered medical homes

Racial and ethnic disparities have persisted at Veterans Administration patient-centered medical homes, says a Health Affairs article. The authors conclude:

“Improved clinical outcomes and equity are dual aims of quality improvement overall, particularly in the context of patient-centered medical homes. Overall, improvements in clinical outcomes had not been achieved for whites or most racial/ethnic groups four years into VA’s systemwide roll-out of the PACT {Patient-Aligned Care Team} initiative. Though we found that greater PACT implementation was associated with higher percentages of veterans who achieved hypertension or diabetes control, most racial/ethnic disparities in achieving control also persisted. The potential PACT effects on racial/ethnic outcomes and disparities were likely offset by factors internal and external to the VA, such as increased patient demand, variable PACT implementation (especially in facilities with large proportions of minority veterans), and social determinants of health among VA users.

“Within the context of PACT implementation, the finding of persistent racial/ethnic disparities broadly suggests that additional strategies are needed to reduce disparities. Health care systems seeking to promote health equity should incorporate tailored strategies aimed at reducing disparities into health care innovations such as patient-centered medical homes and should monitor outcomes and experiences of their patients by race/ethnicity.”

Areas for bipartisan healthcare-system fixes next year


Despite this very nasty election campaign, there are areas in which the next president and Congress are likely to cooperate in improving the nation’s healthcare system in general and  the Affordable Care Act in particular.

An article in Health Affairs lists these areas as possibly including, first in the ACA:

Streamlining employer reporting rules and removing restrictions on small businesses offering employees Health Reimbursement Accounts to cover insurance premiums and out-of-pocket medical expenses.

Beyond the ACA, Health Affairs cites these areas likely to see bipartisan successes:

Extending funding for the Children’s Health Insurance Program, community health centers and Medicare payment increases to some rural and/or low-income providers;  continuing to fix clinical and administrative problems at Veterans Administration hospitals,  and advancing mental-health legislation, especially  to adjust privacy rules to make it easier for families to help mentally ill  adult relatives.

To read the HealthAffairs article, please hit this link.

Refining questions for the dying


David Casarett, M.D., the director of palliative care at Penn Medicine, discusses  in this New York Times blog entry his lessons from the Veterans Administration and elsewhere on how to provide end-of-life care.

He writes that providers often do not ask dying patients and their families the right questions.

Patients, for instance,  understandably might not care how good a hospital’s parking is.

Dr. Casarett writes that “{I]f we’re not asking the right questions, we won’t know how well we’re doing. We won’t know whether we’re giving patients and families enough information about an illness and its likely trajectory and prognosis. We won’t know whether we’ve done enough to help them preserve their sense of dignity and control. We won’t know whether we’re helping them to use the time they have left in the best way possible. And if we don’t know how well we’re doing, we can’t improve.”

“We could include questions about emotional and spiritual support, control over decisions, adequacy of information and respect for dignity. Those sorts of questions are arguably important for all of us, but they’re particularly relevant to those who are facing advanced, incurable illnesses.”

Radio report: Physicians seek to create cancer-drug database

Radio:A group of physicians is trying to create a database on cancer drugs showing effectiveness and cost. This comes as providers and insurers voice outrage on the cost of some new brand-name drugs. And  there’s  a resurgence of demands that Medicare, like the Veterans Administration, be allowed to negotiate prices with pharmaceutical companies.

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