healthy4u

Medication errors cut in [Eastern Pennsylvania] area

Philadelphia Inquirer, January 6, 2005 (free subscription required to read fulltext) An interesting article on reducing medical errors in hospitals appeared in the Philadelphia Inquirer today. In the article, it is stated that: <blockquote>A regional effort to prevent hospital patients from being harmed by medication errors has made progress, but more must be done, according to a new report. Launched in February 2001 by the Delaware Valley Healthcare Council and two leading patient-safety organizations, the Regional Medication Safety Program for Hospitals sought to give hospitals the tools needed to reduce mistakes that injure and kill patients. A report on the program being released today concludes that participating hospitals had a 22 percent improvement toward meeting the council's goals. </blockquote> The article describes the metrics used to arrive at the 22% improvement figure, and goes on to state: <blockquote>"The implementation of computerized medication orders will reduce errors between 60 and 95 percent when the appropriate pharmacy safeguards are in place," said John J. Kelly, chief of staff at Abington Memorial Hospital. Abington has required that all medical orders be entered in the computer since the system was fully implemented at the Montgomery County hospital three years ago. One problem with such information systems is the cost. Kelly said Abington spent more than $30 million on its project. Thomas Jefferson University Hospital spent $20 million, not including the training and ancillary costs. Main Line Health is in the midst of a 5- to 10-year, $21 million project to add computerized order entry at its three hospitals and its rehabilitation facility. In this region, about one-quarter of all hospitals have such systems. Leapfrog [the Leapfrog Group business consortium] found that 4.4 percent of the nation's 1,257 hospitals that responded to its survey have computerized order entry. </blockquote><blockquote></blockquote>Disclaimer: Dr. Jack Kelly was my Medical Residency Program Director. He is a superb clinician and in his new role as Chief of Staff, I am certain he will make major strides in quality improvement at Abington Memorial, a truly excellent hospital already. My concern is on implementation costs of these POE (physician order entry) systems. In my website "<a href="http://home.aol.com/medinformaticsmd/failurecases.htm">Common Examples of Health IT Failure</a>" I wrote about some of the factors that cause costs to spiral and projects to encounter costly difficulty and even failure. Factors such as inadequate IT personnel and management consultant experience in complex clinical environments, vendor overpricing and sweetheart ("padded") deals, political and territorial infighting, and poor relations between clinicians, IT staff and hospital executives are examples. The AMA case study "<a href="http://www.ama-assn.org/amednews/2003/02/17/bil20217.htm">Doctors Pull Plug on Paperless System</a>" is a poster-child example of these problems. (My response from the medical informatics perspective, "<a href="http://www.health-itworld.com/enews/09-21-2004_415.html">How to Avoid CPOE Failure a Second Time" </a>, appeared in the journal Health-IT World). Unfortunately, there are no metrics to robustly determine whether or not hospital IT staff (usually of a business-IT and not clinical-IT background) are performing in the most cost-effective manner, and/or if hospitals are getting "fleeced" by information technology companies and healthcare IT management consultants. I suspect they often are, and have seen it in my own experiences. This is an issue that should be addressed before the remaining 78% of the "quality improvement gaps" are addressed. Hospitals, of all organizations, have precious little extra capital and expense in their budgets to pad the incomes of healthcare IT companies, IT vendors and management consultants. I should also add that the "22% improvement" figure is disappointing considering the time, expenditures, publicity, public pressures, and other factors at play in the hospital/healthcare sector five years after the Institute of Medicine (IOM) landmark 1999 report, "<a href="http://www.iom.edu/report.asp?id=5575">To Err Is Human</a>", which cited 98,000 preventable deaths each year. -- SS

Medication errors cut in [Eastern Pennsylvania] area

Philadelphia Inquirer, January 6, 2005 (free subscription required to read fulltext) An interesting article on reducing medical errors in ho...

Đọc thêm »

Drugs, risks, benefits, and honesty

A review in the 4 December BMJ (BMJ 2004;329:1317) finds that when we get right down to it, NSAIDs (both traditional and COX-2's) have minimal effect over and above placebo for osteoarthritic pain. Aside from being humbling (but not overly surprising, really), it caused me to think about the role of hope and expectation in health care and also the role of alternative medicine. As others have recently pointed out on this blog, all the pain meds can be bad for us. As it now seems, they aren't particularly good for us either, leaving one to wonder whether the balance does in fact lie on the positive side of the scale. Perhaps the answer is to be a bit less rosy-eyed in our own tendency to overestimate the benefits and underestimate the risks of what we prescribe, and to inform patients honestly about the magnitude of benefit and risk so they can make their own decisions. (That's really what got Merck into trouble over Vioxx: not that it caused harm, but that they knew it and concealed it while simultaneously inflating claims of benefit.) But then if we tell patients "this stuff can eat your stomach, might give you a heart attack, and doesn't really do any more for your knee than those M&M's over there", how will patients respond? People come to us for doctoring, not just technology. The pills we prescribe represent hope: the doctor prescribed them, and they are powerful "medicine" (in the sense that my Chippewa ancestors meant it, not in the sense pharmacists mean it). If we're addressing people's strongly felt (and I believe absolutely legitimate) need for doctoring by prescribing something that can hurt them, costs a lot, and doesn't really do much, and we're not leveling with them about that, are we committing the quackery we accuse alternative providers of? Hmm. I'm not about to start defending the nutbars of pseudoscience, but if we're scientific we have to apply our standards ourselves too, eh? I recommend glucosamine a lot lately. It doesn't work any less well than NSAIDs or COX-2s, it doesn't plug arteries or eat gastric mucosa, and it's pretty cheap. At bottom, I have to respect what the patient came to me for. If it's almost a placebo... let's not knock 'em, just pick safe ones.

Drugs, risks, benefits, and honesty

A review in the 4 Dec ember BMJ ( BMJ 2004;329:1317) finds that when we get right down to it, NSAIDs (both traditional and COX-2's) hav...

Đọc thêm »

Your Health Care Tax Dollars at Work?

Doctors hear again and again about how the health care they provide is too expensive, but we hear little about how large health core organizations drive up the costs of care. Here are some miscellaneous stories about dubious spending decisions by government bureaucrats in a variety of health care organizations.... Golden Parachutes for the TB Sanitarium District Board Cook County, in Illinois, may be the last to have a separate agency to care of tuberculosis patients. The Cook County Tuberculosis Sanitarium Board, circa 1947, no longer has any sanitariums, but runs four TB clinics. Independent from local public health agencies, it has the power to levy real estate taxes to support itself. It has been charged in the past with some dubious management practices, such as failing to bill insured patients for its services, continuing to levy taxes when its reserve funds exceed its annual budget (<a href="http://www.aegis.com/news/ct/2004/CT040708.html">per the Chicago Tribune</a>), and paying for its Board Chairman's health insurance despite legal prohibitions (<a href="http://www.suntimes.com/output/news/cst-nws-tb04.html">per the Sun-Times</a>). As a recent political battle swirled over whether to fold the agency into the Cook County Bureau of Health, the TB Sanitarium Board voted to award "golden parachutes," <a href="http://www.suntimes.com/output/news/cst-nws-tb05.html">according to the Chicago Sun-Times</a>, to outgoing employees and board members, only to have judge hand out a temporary restraining order against it. Federal Investigations of the Failed Bay Pines VA Medical Center Computer System The Justice Department and the Veterans Affairs Inspector General have opened criminal and civil investigations of how Department of Veterans Affairs managers had spent over $200 million on the Core FLS computer system, a system which never worked, reported <a href="http://www.usatoday.com/tech/news/2004-12-22-va-system-scrutiny_x.htm">USA Today </a>and the <a href="http://www.sptimes.com/2004/12/22/Southpinellas/Bay_Pines_system_draw.shtml">St. Petersburg Times</a>. The Core Financial and Logistic System, developed by BearingPoint (formerly KPMG Consulting), flunked its trial at the Bay Pines VA Medical Center. P<a href="http://news.tbo.com/news/MGBEUE7Y6XD.html">er the Tampa Tribune</a>, "CoreFLS was intended to keep better track of hospital supplies and improve financial management. Instead, it led to supply shortages that delayed surgeries and spurred complaints." More Charges About NIH African Nevirapine Study A former NIH physician has charged publicly that a study of nevirapine to block maternal-fetal HIV transmission was so sloppily done as to be invalid, but was kept in operation because NIH officials were "so heavily invested in the trial's outcome." Dr. Jonathan Fishbein also charged that the NIH is trying to fire him because he blew the whistle on this study's problems, but the NIH says he performed poorly during his probabitionary period. (AP report available <a href="http://washingtontimes.com/national/20050104-102727-7319r.htm">here</a>, as well as many other places.) This story, including the apparent role of political considerations in decisions to keep the research study running, was previously discussed on Health Care Renewal <a href="http://hcrenewal.blogspot.com/2004/12/politics-and-nih-nevirapine-study-in.html">here</a>.

Your Health Care Tax Dollars at Work?

Doctors hear again and again about how the health care they provide is too expensive, but we hear little about how large health core organiz...

Đọc thêm »

Small tests for big drugs?

From article "<a href="http://www.thestreet.com/_yahoo/stocks/melissadavid/10201457_2.html">Merck Mess Shows FDA's Flaws</a>" in TheStreet.com (a whole series is being published this week, see <a href="http://www.thestreet.com/_yahoo/stocks/melissadavid/10201457.html">sidebar</a> on page 1 of the article):<blockquote>Prior to FDA approval, Psaty [an epidemiologist and drug-safety specialist who testified at the recent Senate hearings on drug approval] explained, Vioxx had been tested -- at common doses of 12.5 and 25 milligrams -- on just 371 patients for at least one year. The only large study to explore the drug's cardiac risks had yet to be completed. </blockquote>As a medical informatics specialist used to designing EMR systems meant to capture clinical information on thousands or tens of thousands of patients (or more) routinely, the Clinical Trials and FDA approval processes seem like fossils from the 1950's. Clearly, if medicine is to become more data-driven, industry and government can do far better than this. It might help to clean out some of the deadwood that allow drugs for millions to be approved after tests in hundreds. -- SS

Small tests for big drugs?

From article " Merck Mess Shows FDA's Flaws " in TheStreet.com (a whole series is being published this week, see sidebar on p...

Đọc thêm »

News Flash: All Drugs have Risks!

On the heels of recent findings regarding Vioxx, Celebrex, and Alleve, comes a new warning regarding ibuprofen. According to a study from Baylor College of Medicine, in Clinical Gastroenterology and Hepatology entitled <a href="http://www2.cghjournal.org/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=as1542356504006032&nav=abs">Visible small-intestinal mucosal injury in chronic NSAID users</a>, ibuprofen is unsafe for long-term use. It found that <blockquote>Some 71% of the NSAID patients showed signs of small bowel injury, compared to just 10% of the controls.</blockquote> According to researcher <a href="http://news.bbc.co.uk/1/hi/health/4144775.stm">Dr. David Graham</a>, <blockquote>"We saw some ulcers and we saw lots of erosions. Anybody who takes aspirin or (other) NSAIDS for a year has a 1% to 4% risk of serious gastrointestinal complications." </blockquote> Unfortunately, that leaves us with just tylenol and various narcotics as pain relievers. As <a href="http://www.townhall.com/columnists/thomassowell/ts20041228.shtml">Thomas Sowell</a> discusses, all decisions have trade-offs between risks and benefits. No choices come completely free of risk. <blockquote>Where do people not recognize trade-offs? Where they are making decisions for other people. That's where they make unrealistic demands, including demands for "safety." Maybe Vioxx or Celebrex is too dangerous, all things considered. Maybe not. The problem is that all things are not considered.</blockquote> He makes the excellent point that "nothing is categorically safe", and that all of life involves weighing weighing risks, benefits and alternatives. If we really considered absolute safety as our primary objective in life, we'd never get into an automobile. Ever. We would give up chemotherapy, surgery and antibiotics as well, for they have even larger risks than do painkillers. The recent march against NSAIDs and COX-2 inhibitors is especially foolish, inasmuch as we have frighteningly few pain medicine alternatives. Next news flash: tylenol, aspirin and narcotics are bad for you!!

News Flash: All Drugs have Risks!

On the heels of recent findings regarding Vioxx, Celebrex, and Alleve, comes a new warning regarding ibuprofen . According to a study from B...

Đọc thêm »

Good Old-Fashioned Doctoring

I was amazed to see this in the main-stream business media, of all places. In his 2005 predictions for the pharmaceutical industry, <a href="http://www.forbes.com/business/2004/12/15/sp05_12_mherper_.html">Matthew Herper wrote</a>: <blockquote>Medicine needs to be reorganized more than it needs any scientific breakthrough. The problem is no longer inventing new lifesaving drugs or devices, but getting them to the right patients. Armies of specialists prescribe tons of pricey pills but fail to deliver basic medical care. Patients don't get drugs that could save them, and medical errors crop up with alarming frequency. New computer systems could help. But what we really need is good, old-fashioned doctoring--the kind that takes the time to take care of the whole patient. </blockquote> Does this mean that the folks in various big health care organizations are going to introspect about how health care (dis)organization and (mis)governance has gotten in the way of primary care and generalism, which is what I think he means to promote?

Good Old-Fashioned Doctoring

I was amazed to see this in the main-stream business media, of all places. In his 2005 predictions for the pharmaceutical industry, Matthew ...

Đọc thêm »

Tooting My Own Horn

My description of the Allegheny Health Education and Research Foundation (AHERF) case just appeared in the <a href="http://www.acponline.org/chapters/ri/nl-fall04.pdf">Rhode Island Chapter American College of Physicians (ACP) Governor's Newsletter</a>. Although it was hard to do justice to this very complicated case in the space I had available, I think I was able to include some aspects of this case that have only heretofore appeared in individual newspaper articles. My summary was: "the AHERF case illustrated a large and powerful health care organization whose governance did not represent key constituencies, and was secretive, unethical, and unaccountable. The human and financial costs of its mismanagement have never been clearly accounted. Yet the case received relatively little publicity and has generated sparse discussion in the medical and health care arena. However, failing to acknowledge cases like this risks their repetition. " By the way, although space did not permit listing any references, every statement in the case description was derived from the extensive coverage of the case in the media. References are available to anyone interested.

Tooting My Own Horn

My description of the Allegheny Health Education and Research Foundation (AHERF) case just appeared in the Rhode Island Chapter American Col...

Đọc thêm »