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After reviewing a September draft of the IG report, Medicare officials became interested in using the IG’s investigative techniques, methods not normally used in measuring nursing home quality, Dorrill said. For example, the IG and CMS are working to condense the report’s list of 261 instances of actual harm so that nursing home operators and government inspectors could quickly identify health problems noted in a medical record as something that occurred because of poor treatment rather than the natural progression of disease in an elderly patient, she added. The initial list of 261 instances was compiled by a team of expert physicians, geriatricians and nurse consultants who scoured the selected records to make these determinations on a case-by-case basis.
Another strategy CMS plans to use, Dorrill said, is the "trigger tool" IG experts developed to identify instances of potential harm. This tool is a list of 49 medical problems that are warning signs, such as when a resident has to go to the hospital or if a resident's blood glucose level drops dangerously low.
Interesting...
Dr. Patrick and Dr. Ames show that serotonin, oxytocin, and vasopressin, three brain hormones that affect social behavior, are all activated by vitamin D hormone. Autism, which is characterized by abnormal social behavior, has previously been linked to low levels of serotonin in the brain and to low vitamin D levels, but no mechanism has linked the two until now.
Recently, Righttime Medical Care, a chain of urgent care centers in Maryland, opened a number of HeadFirst sports injury and concussion centers in the state, staffed with health professionals who can assess injuries for concussions as well as evaluate students for return to play—in consolation with a team of experts who work with HeadFirst staff. HeadFirst will this year be presenting and publishing data on the more than 10,000 youth it has examined and treated for concussion in just the past two years.
“Honoring Choices” is the title of a Community Life quality improvement program that addressed a vexing problem that they encountered over and over again. The program’s success was recognized by The Fine Foundation, Jewish Healthcare Foundation and the Pittsburgh Regional Health Initiative with a bronze award at the recent Fine Award for Teamwork Excellence in Care at the End-of-Life.
“Honoring Choices” was about Community Life trying to get to the bottom of this problem and set it right. What they discovered was that the loop of communication wasn't closing - the patients may have stated their wishes, and the Community Life physicians may have heard them and recorded them, but when a patient got sick after hours or a family member became acutely concerned about their health, they went to the emergency room. Once there, a series of physicians (emergency, "moonlighter" admitting patients to the hospital, hospitalist attending and occasionally even an intensivist) who were not around the table when that compact was made were making decisions, without benefit of knowing the "plan." The acute episode wasn't usually discussed by Community Life staff until the next morning, by which time the wheels were often turning in the hospital - often without anyone communicating with the Community Life physician about it first. At discharge, the instructions given to the patient and family often didn't make it into the hands of Community Life staff - setting up the patient to "bounce back" (to the hospital, not to their previous state of vigor).
http://www.medicalnewstoday.com/releases/273498.php
The recommendations could make the difference illustrated by two scenarios, Rich said. Both begin with the imprisonment of a 28-year-old man with severe hypertension. In one case the condition is diagnosed and treated in prison. Treatment with inexpensive medications continues after release a decade later because the man has health insurance and access to a doctor who understands his medical and personal history. In the other case, either the hypertension is left untreated in prison or it's not managed after he's released because he has no insurance or continuity of care. A decade later he develops kidney failure and goes on dialysis, costing the health care system a lot more money.
"Health reform gives people with a history of jail time access to continuous health care for the first time ever," says lead author Marsha Regenstein, PhD, who is a professor of health policy at SPHHS. "The hope is that such coverage will help keep individuals and entire communities healthier and reduce the nation's health care costs." The report appears in the March issue of the journal Health Affairs.
A study by Medicare’s inspector general of skilled nursing facilities says nearly 22,000 patients were injured and more than 1,500 died in a single month — a higher rate of medical errors than hospitals.
The doctors found that 22 percent of patients suffered events that caused lasting harm, and another 11 percent were temporarily harmed. In 1.5 percent of cases the patient diedbecause of poor care, the report said. Though many who died had multiple illnesses, they had been expected to survive.
The injuries and deaths were caused by substandard treatment, inadequate monitoring, delays or the failure to provide needed care, the study found. The deaths involved problems such as preventable blood clots, fluid imbalances, excessive bleeding from blood-thinning medications and kidney failure.
This study was primarily intended to assess safety and tolerability of the diets for ALS patients: patients given the high-carbohydrate/high-calorie diet experienced fewer adverse events (23 vs 42), and significantly fewer serious adverse events (0 vs 9) including deaths from respiratory failure than the control group.
Patients given the high-carbohydrate/high-calorie diet also gained slightly more weight than the other groups (an average of 0·39kg [about 0·86lbs] gained per month, compared to an average gain of 0·11kg [0·24lbs] per month in the control group, and an average weight loss of 0·46kg [1·01lbs] in the high-fat high-calorie diet group).
According to Dr Wills, “There is good epidemiological evidence that, in ALS, survival is determined by nutritional status. This pilot study demonstrates the safety of a novel, simple, low-cost treatment for a devastating disease where currently, very few treatment options are available. The adverse outcomes that we feared might result from weight gain, such as diabetes or heart disease, were not observed in our study period of five months.”*
The key findings were as follows:
- Nearly half of patients (47%) required at least some surrogate involvement in major medical decisions. About half of the time, the surrogate made all of the decisions. The other half of the time, the surrogate and patient jointly made the decisions.
- Surrogate decision making is not just for ICUs! As expected, surrogate decision making was particularly common in the ICU, but even on the medical wards, surrogates were involved in over 40% of major decisions.
- Surrogate decision making is not just about code status! Surrogates were instrumental in many decisions that had profound short and long term consequences for the patient's care. 49% of surrogates participated in decisions about procedures about operations and 47% of surrogates helped make decisions about discharge planning.