Hospitals and weekends don’t mix

An interesting piece on BNET today from Ken Terry.  Click here for the full article.  Here are some snippets (with commentary below):

Patients admitted to the hospital on weekends are 30 percent more likely to die there than those who arrive on weekdays. And guess why? It turns out that most doctors are reluctant to work irregular hours, which in turn delays care for weekend patients.

According to a new study from the Agency for Healthcare Research and Quality (AHRQ), delays in treating conditions such as heart attacks, angina, gall bladder problems and complicated hernias were much more common for patients admitted on weekends than for those hospitalized during the week. Just 36 percent of weekend-admitted patients received major procedures on the day of admission, versus 65 percent of those admitted on weekdays.

Of the 19 percent of all hospitalized patients who were admitted on the weekend, 2.4 percent died during their stay. In contrast, only 1.8 percent of patients admitted on weekdays died in the hospital. To some extent, this reflects the fact that far more patients admitted on weekends (65 percent) than on weekdays (44 percent) came in as emergency cases, rather than scheduled admissions.

But both sets of patients had similar characteristics, and their average lengths of stay and costs per admission were close. So the higher number of emergency cases on weekends does not fully explain the higher mortality rate among those patients. Moreover, emergency cases usually require more prompt attention than patients who come in for elective procedures. Delays in providing treatment may “be an indicator of [low] quality of care,” the researchers said.

In an organized system of care, an adequate supply of physicians would be available to care for acutely ill patients every day of the week. But in the U.S., specialists and surgeons routinely refuse to be on call at the hospital unless they’re paid extra. If they don’t have an inpatient procedure scheduled, they’d rather be seeing patients at the office or operating on them in ambulatory surgery centers. And on weekends, they’d rather be home. So the hospitals pay them to come in.

Making matters worse, many patients are only in the ER in the first place because they have no access to their regular physicians. In the U.S. and Canada, three of five doctors have no after-hours arrangements, according to an international study by the Commonwealth Fund. Not surprisingly, U.S. and Canadian patients also have the highest use of the ER for care that could have been provided by their regular doctor.

I know what you’re thinking: it’s a selection issue with sicker patients coming in via ERs on a weekend than the full and diverse population who come in for a variety of reasons during the week, including scheduled, non-emergent procedures.  Ken Terry does a nice job, however, debunking this.

Focusing on weekend and off hour coverage is a critical issue in home care as well.  The VNA of Boston has done so by providing excellent options for the home-based patient population, whether through our certified home health offerings, hospice programs or private care affiliate.  Click here for more information.

Image courtesy of CFB Borden.

Diabetes... nearly 50%... and growing!

Recently, the Visiting Nurse Association of Boston's Joan Fall cited some American Diabetes Association data.  According to the ADA:

17.9 million people in the US have a diagnosed Type 1 or Type 2 diabetes
Another 5.7 million have diabetes but  are still undiagnosed
23% of people over the age of 60 have Type 2 diabetes and it is projected by the year 2050 that this will rise to 66% for people age 65 and older
Total cost of diagnosed diabetes in the US in 2007 was $174 billion with an additional $54 billion in related costs
Diabetes is the leading cause of newly diagnosed blindness and renal failure in the US

The VNA of Boston is launching a new clinical center of excellence designed to improve the care we provide to diabetic patients at home.  Already a leader in the industry, the VNA of Boston is seeking to improve oral medication management, reduce emergent care visits due to hyper/hypoglycemia and make other measurable strides through the development of new practice guidelines and documentation standards, creating new educational programs for our clinicians and formally testing competency based on industry leading standards of care.  Additionally, we're implementing policies that are culturally sensitive and appropriate for the communities we serve.

According to Joan: "Here at the VNA of Boston, over 49% of our patients who are age 65 or older have a primary, secondary or tertiary diagnosis of diabetes.  I believe we can make a huge difference for our diabetic patients' lives by providing each individual with the tools needed to manage his/her own diabetic self care.  The Core Concepts lead presenter starts off her patient teaching sessions by asking the question: 'What is standing in the way of you managing your diabetes?'  What a great question for us to use when starting that discussion with our patients.!"

We'll post our results here and elsewhere as this new program launches.

Spectacular City Skylines

Check out this website for some visually stunning city skyline photos.  Click here.  For you world travelers out there, how many of these cities can you name?

Light Stalking is a very decent photo site.  Worth checking out...

Fire on the Water

An abstraction... which is not my typical thing.  Does it work?

Give the people what they want

Uwe Reinhardt has an interesting piece on Health Affairs Blog (click here for the article) regarding the ideological gulf that exists in this country.  His observations stem from watching the recent health reform “summit” in which said ideological gulf was on display.  In his post, Mr.. Reinhardt describes the gap between leftward leaning politicians and Americans (“plebs” as he describes them) and more rightward leaning ones.  He poses ten health system characteristics shared by most American plebs.  Americans want a system that:

1. Lets only patients and their own physicians determine how to respond clinically to a given medical condition, never an insurance clerk or, even worse, government bureaucrats.
2. Limits their families’ out-of-pocket payments for health care to make it “affordable.”
3. Keeps insurance premiums and taxes for health care low.
4. Does not ever ration health care, because that is un-American and practiced only by un-American alien nations with inferior health systems.
5. Does not allow public or private insurers to let “costs” or “cost-effectiveness” ever enter coverage decisions, because that would implicitly put a price on human life which, in America, unlike elsewhere in the world, is priceless.
6. Does not mandate individuals to purchase health insurance, if they do not wish to do so, if for no other reason than that this would be unconstitutional and, therefore, un-American.
7. On the other hand, grants every American the moral right – backed up by a government mandate called EMTALA– to receive critically needed and possibly high cost health care from hospitals and their affiliated doctors, even if they are uninsured and could not possibly pay for that expensive care with their own resources.
8. Controls Medicare spending, which is widely thought to be completely out of control, as long as it does not reduce payments to hospitals or to doctors or to producers of medical technology, or to any other provider of health care.
9. Provides universal health insurance coverage to all Americans, provided it does not mean raising taxes or cutting Medicare spending or raising premiums on healthy Americans.
10. Keeps government out of health care but somehow makes sure that insurance companies do not exploit patients through incomprehensible fine print, no one engages in price gouging – e.g., charge $10 for an aspirin — and no one in health care earns excessive profits (or any at all).

To which I would say: Is that all?  Piece of cake.

Evening Glow

There was a warm and exaggerated glow in the sky this evening.

Best restaurant in the North End?

I say Massimino's.  Click here for more information.

Three shots from around the North End.  And it all culminated at Mike's.  Of course.

This is what Home Care looked like in 1920!

Decor, outfits and interesting “swing set style” hospital bed notwithstanding, it looks pretty much the same today.

125 Years of Caring!

Today, we officially launched our 125th Anniversary Celebration planning initiative.  There are some seriously exciting things coming from the Visiting Nurse Association of Boston.  Stay tuned…

“This is where we’ve ended up.”

A year after President Obama made health care reform his top domestic priority and less than a week after a summit meeting to debate the initiative with emboldened Republican and restless Democratic legislators, the President has stated that the time to act is now.  Experts expect some modest changes designed to acquiesce to the opposition party while not alienating a reluctant Democratic base.  He will be appearing shortly at the White House and it will be interesting to see what kind of public reaction his comments and proposal receive.

The past week’s events and comments coming from Washington suggest that this President does not mind staking his reputation and perhaps prospects for re-election on this one issue.  That he would willingly feed gasoline into Tea Party fires igniting all round the country either means that: (a) he believes that those happy with a shotgun approach to reform legislation will outnumber (electorally speaking) those who are unhappy or (b) he feels there will be enough time between passage and the November elections for Democrats to recover and even sell the positive aspects of the plan.  My suspicion is that Obama the Pragmatist is more in control here than Obama the Idealist and that if the deal is sealed, we’ll see whole scale health reform selling through the rest of 2010.

Republicans are meeting as we speak to deny this President that opportunity.

Ten Minutes at the Fort Point Channel

A day full of meetings, including one in the Fort Point Channel area of Boston.  As I made my way to the luncheon, I snapped a few...

Two messages, one future…

From an email to all VNAB staff:

I recently heard some interesting comments from two individuals I respect… and thought I’d pass them along to you.

I first became acquainted with Guy Kawasaki in the 1980s and have been reading his articles since in Entrepreneur and Forbes, among other places. He describes himself as an “early stage venture capitalist” but his most famous experience was working at Apple in the early days. He was part of the team that developed the Macintosh Computer which has always fascinated me because Apple was focused on other products at the time and came very close to not supporting the development of this new platform. Apple experienced many “near death” moments in their history, but persisted and reinvented themselves several times over. Such innovations include the Macintosh itself, the iPod, iPhone and soon, the iPad. Not long ago, Apple was not even in the music business. Today, more people purchase music from the Apple iTunes store than any other place on the planet.

I heard Guy speak a few weeks ago about innovation – a topic he is well qualified to discuss as his resume would surely indicate. He was speaking to a group of home care executives and describing the fact that, in his experience, the most innovative products and services, the ones that significantly alter an industry, are deep (you anticipate what your customers want in advance and try to incorporate that into what you offer), intelligent (cleverness counts… it helps you to offer unique products and services), complete (the more you can minimize handoffs to others, the more likely you’ll succeed) and elegant (there’s a “coolness” factor; people see your product or experience your service and are inherently drawn to it). Guy’s message to the home care industry: it’s time to innovate.

In my four months at the Visiting Nurse Association of Boston, I’ve seen some interesting innovations. I wrote about them here, here and here. In the highly (and increasingly) competitive world of home care, I have little doubt about the importance of our continuing to innovate in this very manner.

Last Friday, I met with John Auerbach, Massachusetts Commissioner of Public Health. I know John, but this was the first time I’ve seen him since joining the VNA of Boston; that gave me a good opportunity to speak with him about our organization and his thoughts about it. I wish I could have recorded what he said as it was most impressive. He stated that we are different from other home care agencies. And different from other health care organizations as well. The term he used repeatedly was “stepped up”. Back when HIV and AIDS were poorly understood and greatly feared, the VNA of Boston stepped up and served patients in their homes. When the Department needed to focus on bioterrorism and emergency preparation nearly a decade ago, we stepped up and more recently, our organization stepped up when the Department was contending with both widespread and contained infectious disease outbreaks. We stepped up. And this is what makes us different.

Our future? Our future stems from the convergence of these two different messages. We need to continue to differentiate ourselves… to innovate. We need to embrace and continue our 125 year mission of being there, of stepping up. We need to do both.

That’s our shared task and responsibility. It’s the key to our future and our success.

And I’d love to hear your thoughts…

Rey