For mothers-to-be, finding health care in a group

From the Fixes Blog at the New York Times:

Recently in a nondescript conference room near Union Square in Manhattan, eight very pregnant women, husbands, boyfriends and a sister sat in a circle around a small patchwork quilt for two hours and talked about managing the discomforts of pregnancy.

The remedies discussed ranged from the ultimate — epidural: yes or no? — to the prosaic, including that cliché of pregnancy: “I don’t get acid reflux if I have a pickle,” said a woman named Kimberly, to general laughter. “I have two pickles right before bed and it’s fine.”

They drank seltzer and ate strawberries, bananas, hummus and carrots and cereal bars. They watched videos about labor pain and interviewed doulas. The meeting looked like a social gathering or a support group.

It did not look like what it was: a doctor’s appointment.

The Institute for Family Health runs the group, using a model created by the Centering Healthcare Institute. Centering Pregnancy sites provide group medical visits for pregnant women; Centering Parenting sites gather new mothers and their babies for the first year of life.

When they arrived, one by one the patients rotated through stations to get their regular prenatal checkups. They took their own blood pressure, weighed themselves, stretched out on a cot behind a screen so Dr. Insung Min could listen to the baby’s heartbeat, and sat with Dr. Rachel Rosenberg (no relation) in another corner for the traditional chat with the doctor. The usual checkups, however, are only part of the health care the group provides. Being part of a community, the research shows, is also good medicine.

The idea behind Centering (the name refers to care that is centered on the patient) is to help mothers — especially low-income mothers — become more involved in their own care, to acquire the skills and confidence to take care of themselves and their babies, and to have a community.

Read more here.

“Toward Quality Measures for Population Health and the Leading Health Indicators”

If you, like me, missed this report when it first appeared last summer, visit the Institute of Medicine website to read the free PDF (or to order a copy).

coverPublic health practice and health care delivery in the United States share a common goal: longer, healthier lives for all. Quality in health care is essential for achieving this goal and is a central focus of implementing the Affordable Care Act. However, the notion of quality in the public health system and more broadly in the multisectoral health system – public health, health care, and other partners – has received less attention. Identifying measures of quality for the healthy system is essential to the work of assessment and quality improvement, and for demonstrating accountability throughout these systems.

The IOM was asked to examine the intersection of HHS’s public health quality effort and the Leading Health Indicators (LHIs) in Healthy People 2020, the nation’s 10-year agenda for advancing toward long, healthy lives for all. The IOM committee finds that every community should use measures of quality to monitor progress on the LHIs and recommends criteria for selecting measures of quality. The recommendations in the committee’s report are designed to inform and support the development, endorsement, promotion, and use of a unified and coherent set of quality measures useful across a range of settings.

Inequality at the core of high health care spending: A view from the OECD

From the Health Affairs blog:

It is commonly said that the US spends more than twice as much on health care as other developed countries, yet its outcomes are worse. The inference is that too much care is provided, to no good end.

Such international comparisons are drawn from the Organization of Economic Cooperation and Development (OECD), a group of 34 developed countries. Analyzing these data is a multi-step process, like peeling an onion, and the truth resides deep within its core.

The process starts by adjusting health care spending for “purchasing power parity” (PPP) and expressing it in US dollars. By that measure, per capita spending in the US is 160 percent more than the OECD mean (Panel A, left bracket), and this is the basis for the notion that the US spends more than twice as much. But it is only the first layer.

The second layer is the economy. The US spends more principally because it is wealthier (Panel A, right bracket), but even in proportion to its gross domestic product (GDP), the US spends more, about 60 percent more. But that is only the second layer.

The third layer is price. Health care prices are inordinately high in the US and inordinately low in many other countries, particularly those that exercise price controls. Therefore, to understand how much care is given, comparisons of health care spending must be adjusted for the purchasing power parity of health care (HC-ppp). When so adjusted, spending in the US is still higher relative to its GDP, but by only 31 percent (Panel B). This represents the core difference in services. Some are administrative, but most are health care services.

What explains this 31 percent? A large body of evidence suggests that it results from poverty and income inequality, which are more prevalent in the US than in any other OECD country except Chile, Mexico and Turkey. And poverty is associated with substantial increments in spending. For example, the poorest decile of Medicare beneficiaries spends 30-40 percent more than the wealthiest; overall hospital utilization rates in large urban areas are 25-35 percent more than in their wealthiest Zip codes; and hospital readmissions are most prevalent from poor neighborhoods and in safety-net hospitals.

Read the complete post here.

New from AHRQ: Policies to reduce healthcare disparities

AHRQ_InnovationsExThe new issue of the Agency for Healthcare Research & Quality (AHRQ)’s Heath Care Innovations Exchange focuses on policies to reduce health care disparities.

    • The featured Innovations describe three programs that implemented policies to help reduce health care disparities and ensure that vulnerable populations receive equitable health care. The programs include one that subsidized the costs of electronic health record implementation for primary care practices in underserved areas and another in which a Medicaid plan collected and verified patient race, ethnicity, and language data to help identify and address disparities; as well as State legislation in California requiring that cultural competency curricula be included in continuing medical education.
    • The featured QualityTools include the 2012 National Healthcare Disparities Report, which identifies and tracks the ways that some populations receive poor or worse care than others; a toolkit to help physicians and health care teams redesign office practices to provide the highest quality care possible to patients with limited English skills; and a guide to help hospital leaders identify and address disparities in order to achieve equitable care for patients.

New web site for USHIK database

The United States Health Information Knowledgebase (USHIK) is an on-line, publicly accessible registry and repository of healthcare-related data, metadata and standards. USHIK is funded and directed by the Agency for Healthcare Research and Quality (AHRQ) with management support in partnership with the Centers for Medicare & Medicaid Services (CMS).

The web site was recently redesigned for clarity and usability:  it’s easier to search and filter information, to find things on the menu, which now is on top, Draft Measures available for public feedback are in a new portal, and the site now better meets requirements for section 508 accessibility and usability.

See the new web site here.

Healthcare in two Americas

From the Commonwealth Fund Blog:

Blumenthal2Americasblog_halvesEconomists at Harvard University recently reported that geography is a particularly powerful predictor of economic mobility in the United States. For those of us who work in health care, this should not be surprising: we already have abundant evidence that where you live matters a lot when it comes to health and the quality of care you receive. Increasingly, the U.S. is not one country, but two―divided geographically by persistent, troubling differences in people’s access to affordable, high-quality health care.

This is a clear message of The Commonwealth Fund’s state and local scorecards on health system performance, which have documented these divisions over much of the past decade. And the message will be reinforced in our newest health system scorecard, which focuses on low-income populations in the U.S. (look for it next month). Certain regions of the country―the Northeast and Northwest, parts of the Midwest, the North-Central states―regularly perform well. Other regions―generally the South, Southeast, and Southwest―perform poorly. The former have health outcomes that are among the best in the industrialized world. Results in the latter look more like those of developing countries in South Asia, South America, and Latin America.

Read the complete post here.

Toward a scientific approach to workplace wellness

From the Health Affairs blog:

We thank Health Affairs for the opportunity to respond to Professor Ron Goetzel’s comments on our recent Health Affairs article, “Wellness Incentives in the Workplace: Cost Savings through Cost Shifting to Unhealthy Workers.” In many respects our article was quite limited in scope. We started by noting that companies are increasingly adopting wellness programs based on the idea that, with the help of financial incentives, employees will improve their health and employers will save money. We set out to explore the assumptions underlying this idea and found scarce high-quality evidence on the subject of workplace wellness incentives. What evidence we found offers, at best, limited support to justify these assumptions.

We hope that others will conduct the much needed research about whether financial incentives can change behavior, improve health, and control spending. We also hope that the body of causal research will be expanded to a wider variety of populations, such as the elderly, and other related issues, such as the effects on incentives of absenteeism, productivity, and long term health, or to programs that do not involve financial incentives or do not claim to control costs. These other effects and other types of programs are worthy of consideration, but we have not considered them in our article.

The Ethics Of Incentive Programs

Unfortunately, Professor Goetzel misunderstood the scope of our research. Contrary to Professor Goetzel’s assertions, we did not suggest that people should avoid making choices consistent with their health (and other goals), or that employers should not act in the best of interest of employees, employees’ health, or society at large. Still, we are skeptical that wellness programs of the sort encouraged by the Affordable Care Act (ACA) create, as Professor Goetzel suggests, a “win—win—win” situation: good for all workers, good for society, and consistent with the financial interests of employers, firms, and their owners. Rather remarkably, despite the potential for workplace wellness to become a large “social experiment”, we found scant reliable evidence that implementing wellness programs can easily save costs through health improvements without being discriminatory.

Read the complete post here.

Data sources for 2012 National National Healthcare Quality and Disparities Reports released

From the Agency for Healthcare Research and Quality (AHRQ):

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness. The National Healthcare Disparities Report (NHDR) examines disparities in health care among priority populations, such as women and racial and ethnic minority groups. The reports are compiled from multiple Federal, State, and private data sources, including databases and surveys.

Find the complete list of sources on the AHRQ site.

Using patient-reported data to improve chronic disease care

The new issue of AHRQ’s Innovations Exchange describes several new tools that allow patients to track information esaily and share it with clinicians to improve health care.

    • The featured Innovations describe a tool that uses self-reports from patients with diabetes to generate intervention options, a self-assessment for patients with mental illness that improves communication with providers, and a smartphone application that allows patients with Crohn’s disease to track health information and share it with providers.
    • The featured QualityTools include a pre-visit questionnaire for asthma patients, a quality-of-life assessment for diabetes patients, and a tool to help patients track and monitor their blood pressure, cholesterol, blood glucose, diet, and physical activity.
    • Read more innovation profiles related to the use of technology and patient-reporting to improve chronic disease care http://go.usa.gov/TKgB on the Innovations Exchange Web site, which contains more than 775 searchable innovations and 1,525 QualityTools.

National Quality Measures Clearinghouse Measures Matrix

National Quality Measures ClearinghouseNQMC_logoThe National Quality Measures Clearinghouse (NQMC) is a public resource for evidence-based quality measures and measure sets.  You can find different types of quality measures  by topics (linked to a particular term derived from the U.S. National Library of Medicine’s (NLM) Medical Subject Headings (MeSH), organization, national quality strategy, among others); expert commentary on guidelines and measures; tutorials on quality measures; and much more.

New on this site is the Measures Matrix, that allows you to filter NQMC content by Measurement Settings (such as ACOs or ICUs) and Primary Measure Domain (such as Process, Access, Patient Experience). The resulting table can be downloaded to Excel.

Explore the Measures Matrix here.