Health and Disability

In the first 2 years of the Pioneer ACO Model, beneficiaries aligned with Pioneer ACOs, as compared with general Medicare FFS beneficiaries, exhibited smaller increases in total Medicare expenditures and differential reductions in utilization of different health services, with little difference in patient experience.

In what is a major step towards the prevention of recurring bouts of Clostridium difficile (Cdiff) infection, an international team led by Dale Gerding, MD, Hines Veterans Administration (VA) research physician and professor of Medicine at Loyola University Chicago Stritch School of Medicine, has shown that giving spores of non-toxic Cdiff by mouth is effective in stopping repeated bouts of Cdiff infection which occurs in 25-30 percent of patients who suffer an initial episode of diarrhea or colitis. The study is published in the May 5 issue of the Journal of American Medical Association (JAMA).

That synergy between chronic pain and sleep disorders suggests health care providers should consider jointly treating the two conditions in some patients, the authors stated. Both cognitive-behavioral therapy and medications are used to treat the two conditions separately, the authors noted, so further studies should look at using these methods to treat the conditions together.

A new study found one in five nursing home residents with advanced dementia harbor strains of drug-resistant bacteria and more than 10 percent of the drug-resistant bacteria are resistant to four or more antibiotic classes. The research was published online in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

"Nursing home residents with advanced dementia usually have an increased need for healthcare worker assistance, as well as frequent exposure to antibiotics. This combination may be leading to a subset of vulnerable long-term care residents at high risk of both acquiring and spreading these dangerous bugs," said Erika D'Agata, M.D., an infectious disease physician at Rhode Island Hospital and lead author of the study. "Frequent hospitalization among these residents also provides a constant influx of drug-resistant bacteria into the hospital setting, further fostering the spread throughout the healthcare delivery system."

Drug-resistant Escherichia coli (E. coli) and Proteus mirabilis (P. mirabilis) were the most common bacteria found among the study subjects. Nearly 90 percent of the bacteria found were resistant to three types of antibiotics, most notably ciprofloxacin, gentamicin and extended-spectrum penicillins.

"Ongoing efforts to curb the acquisition and spread of this bacteria among nursing homes residents is crucial since this is an issue that goes beyond just one realm of care," said D'Agata. "Healthcare institutions must work together to help curb the transmission of these emerging, dangerous pathogens."

Enrollees in plans bought through an exchange rated satisfaction at 696 in 2014 (on a 1,000-point scale), compared with an average of 676 for traditional, mostly employer-based plans, according to the study. One main reason people shopping through the marketplaces are more satisfied is the choice of plans available, says Rick Johnson, health care practice leader at J.D. Power in Washington. In fact, when comparing marketplace plan satisfaction and employer-sponsored plans that offer a choice of plans, the satisfaction level is equal at 696. “Choice has a role in driving the statistics when people can pick a plan that meets their needs at a price point they want,” Johnson says.

Medicaid and CHIP work together to provide robust coverage for low- and middle-income children. We already know they have increased health insurance coverage rates for children, now at a remarkable 92 percent. These important public coverage programs have shielded families from the risk of high out-of pocket costs, they’ve increased accessand they’re important tools for reducing health disparities for children of color. Finally, we know that CHIP has led to higher rates of entrepreneurship, and past expansions of Medicaid eligibility for children has been linked to higher earnings later in life. This month, the Institute for Research on Poverty released a new study that provides further confirmation that Medicaid and CHIP contribute to the long-term health and success of children.

The Institute for Research on Poverty at the University of Wisconsin-Madison found that expansions in Medicaid eligibility for low-income pregnant women in the 1980s and 1990s increased the likelihood that their children experienced upward mobility into adulthood. Their findings not only confirm the importance of Medicaid and CHIP for children and families, but also their importance for the country as a whole. When children succeed, everyone benefits, and robust, affordable health coverage is a key component of that success.

We must consider this new data in the context of the populations that these public programs serve. According to areport from the Kaiser Commission on Medicaid and the Uninsured, Medicaid and CHIP cover more than half of Hispanic children and Black children, compared to a little over a quarter of white and Asian children. We already know that economic security is deeply intertwined with health, and that health care coverage is a vital tool in keeping kids and parents healthy. Considering that Medicaid and CHIP play roles in increasing health care access for children of color and now also in helping low-income children climb the economic ladder, it is clear that Medicaid and CHIP are instrumental in combating health disparities and advancing health equity.

High Reliability science is one area we are looking to for answers to systems failures in healthcare. High reliability organizations stress the importance of “Stopping the Line” when a worker senses something doesn’t feel right. The concept has been shown to help reduce harm in many high risk environments. What if something similar existed for communication concerns in the healthcare environment? 

The following short video, entitled Please See Me, created by patients and caregivers for patients and caregivers, offers a possible solution. Can “Please See Me” become that safe space, where patients and family members can stop the line and share those words if they feel their needs are not being heard or addressed? At the same time, can caregivers use the same phrase when they feel they are not being understood by patients and family members?

Narratives are the systems of stories that compose our human histories and identities; healthcare narrative methods are the carefully designed prompts and processes that elicit these stories, in ways that positively impacts health, care, and healing.

Narrative methods are by nature versatile. Patients, providers, or caregivers can use them. They facilitate processing thoughts and emotions related to healthcare experiences, identifying patterns affecting health or healthcare choices, or reflecting on clinical interactions (and course-correcting when necessary). They include the acts of articulating, reflecting on, listen to, and sharing the stories of our experiences.

With support from the Robert Wood Johnson Foundation, the Patient Experience Lab at the Business Innovation Factoryunited thirty thought leaders in healthcare narrative methods for a Healthcare Narrative Participatory Design Studio (PDS). In this facilitated space, participants identified and shared healthcare narrative best practices. Several areas of opportunity for healthcare narrative use emerged:

• Ensuring that lines of communication are functioning optimally and continually, so that a patient’s context is understood and adequately addressed by his or her provider in plans for care.
• Enabling communication that allows patients to advocate for their needs, and to allow all parties to process their healthcare experiences in a way that contributes to their well-being.

Below are only two examples of the many healthcare narrative methods that address these areas of opportunity.

Patients admitted to the hospital on weekends are more likely to get a preventable illness or injury during their stay than people admitted during the week, a large U.S. study finds.

Even after adjusting for patient characteristics, including the severity of the condition that brought them to the hospital, weekend admission was still linked with more than a 20 percent increased likelihood of hospital-acquired conditions when compared to weekday admissions, lead author Dr. Frank Attenello, a researcher at the University of Southern California, said by email. 

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Even though most admissions - 81 percent - were on weekdays, preventable complications were more common on weekends. Hospital-acquired conditions occurred in 5.7 percent of weekend admissions, compared to 3.7 percent in people admitted on weekdays.