Health and Disability

A new study has identified distinctions in patient diagnoses and different patterns of Emergency Department usage between individuals who are more or less likely to return to the ED for care within a 72-hour period. These results, based on statistical analysis of patient data from more than one million electronic healthcare records (EHR), are described in an article in Big Data, the highly innovative, peer-reviewed journal from Mary Ann Liebert, Inc., publishers. The article is available to download free on the Big Data website until March 31, 2016.

In "Understanding Emergency Department 72-Hour Revisits Among Medicaid Patients Using Electronic Healthcare Records," James Ryan, James Hendler, and Kristin Bennett, Rensselaer Polytechnic Institute, Troy, NY, demonstrate the ability to build predictive models for risk of 72-hour ED readmission based on EHR data analysis. The researchers suggest that future use of EHR data to build even better predictive models could make it possible to identify patients at high risk of revisiting the ED and to develop interventions to improve care and minimize ED readmissions.

Keep your eyes peeled for these seven common signs of burnout. If you find yourself thinking or saying these things, you may want to seek help from your doctor and consider finding some respite care:

According to new research from the UCLA School of Nursing, published online in the Journal of Sleep Research, people with sleep apnea show significant changes in the levels of two important brain chemicals, which could be a reason that many have symptoms that impact their day-to-day lives.

UCLA researchers looked at levels of these neurotransmitters -- glutamate and gamma-aminobutyric acid, known as GABA -- in a brain region called the insula, which integrates signals from higher brain regions to regulate emotion, thinking and physical functions such as blood pressure and perspiration. They found that people with sleep apnea had decreased levels of GABA and unusually high levels of glutamate.

GABA is a chemical messenger that acts as an inhibitor in the brain, which can slow things down and help to keep people calm -- like a brake pedal. GABA affects mood and helps make endorphins.

Glutamate, by contrast, is like an accelerator; when glutamate levels are high, the brain is working in a state of stress, and consequently doesn't function as effectively. High levels of glutamate can also be toxic to nerves and neurons.

"In previous studies, we've seen structural changes in the brain due to sleep apnea, but in this study we actually found substantial differences in these two chemicals that influence how the brain is working," said Paul Macey, the lead researcher on the study and an associate professor at the UCLA School of Nursing.

Macey said the researchers were taken aback by the differences in the GABA and glutamate levels.

Since papers, inks, and computers can release fumes that are too toxic for some of us to breathe, adversely affecting our ability to remain functional, and since there’s no getting away from papers and technology in modern society, an assistive device was invented some decades ago that could be useful to bring back as a more popular accessory: the reading box!

I recently ran across an ad on Craigslist for one that was for sale in the US, and then someone found an old catalogue (2002 PDF) with a few other pics, so I thought I’d share the info and images here in case they can help anyone else.

A reading box is basically a box made of wood, glass, or metal, with an opening in the front, and glass on top to read through. A vented box will also have a dryer hose out the back, and a fan of some sort to push the air through the hose and out of a window. A barrier with a vent sized exhaust hole would also be needed to cover the window opening being used.

Medicare patients in hospice care were less likely to be visited by professional staff in the last two days of life if they were black, dying on a Sunday or receiving care in a nursing home, according to an article published online by JAMA Internal Medicine.

Hospice programs do not have any mandated minimum number of required visits for the most common level of hospice care referred to as routine home care (RHC). However, a hospice program must deliver the highest possible quality of care for the dying person and support family members in their role as caregivers with the payments they receive from Medicare.

Joan M. Teno, M.D., M.S., of the University of Washington, Seattle, and coauthors examined Medicare administrative claims data for the federal fiscal year 2014 to look at patterns in visits by hospice professional staff to the dying patient and their family in the final two days of life

“Telehealth is the future of health care,” Senator Brian Schatz (D-Hawaii) said in a prepared statement. “It saves us money and improves health outcomes. Our bipartisan bill puts us on a path to transform health care delivery, making it less costly and more convenient for patients and providers.”

Roughly 50 health care and aging industry groups and associations have endorsed the bill, including the National Association for Home Care & Hospice (NAHC).

“Telehealth and remote monitoring are important for achieving the goals of value-based care, providing more access to primary care and behavioral health, improving chronic care management and advancing patient engagement,” NAHC and other organizations wrote in a letter of support for the legislation.

The bill would also eliminate many of the current limitations on telehealth use, such as provider site restrictions, geographic limitations and restrictions on which providers can offer these services. 

In a paper from the January 2016 issue of Health Affairs, Abe Dunn and colleagues from the U.S. Bureau of Economic Analysis (BEA) introduce readers to their innovative new Health Care Satellite Account (HCSA) and use the data to provide insights about the recent slowdown in health spending growth rates. Rather than focusing on health spending by type of service or product (hospital care, physician services, prescription drugs, etc.), the HCSA presents spending by medical condition. It combines this with information on numbers of persons being treated so that spending growth rates can be decomposed into a volume effect (persons treated) and a price effect (spending per person treated) for each of an all-inclusive set of conditions.

This should be very exciting to those involved with population health, public health, and clinical care as they can now regularly track health spending in terms that relate so much more directly to their areas of concern — the prevalence of disease and the patterns and costs of treatment.