Idea #280 for November 25th, 2009: Looking Over Your Shoulder or A Simple Way to Boost Hand-Washing Compliance in Hospitals

Proper hand-washing compliance remains a problem across many medical facilities. Not thoroughly washing hands can lead to the spread of pathogens including MRSA. A program recently instituted at UCLA Medical Center, however, has led to dramatic changes in the compliance rate of hand-washing there. It could serve as model for other hospitals in the future.

UCLA has achieved their success with using a simple method: enlisting undergrads to observe hand-washing in the hospital and report on the results. They have seen their compliance with hand-washing guidelines rise from 50% to 93% since the program began. Apparently, simply having people watch over medical staff during washing can make them more careful. It’s something for other medical facilities to keep in mind, especially if they are looking for a low-cost way raising compliance.

Read more about this program in the Wall St Journal.

Idea #278 for November 23rd, 2009: Tag-Team Healthcare or Physicians and Pharmacists Working Together To Improve Patient Outcomes

Under normal circumstances, a physician prescribes a high-blood pressure medication and a pharmacist fills the prescription as written. But when doctor and pharmacist work together, patients with hypertension fare better. New research supports that notion: a study of 400 hypertensive patients showed that patients whose pharmacists and doctors worked together had much better outcomes.

In this case, working together meant that both physician and pharmacist had a say in the medications and dosages the patient received. In the control group, whose patients were prescribed blood pressure medications in the conventional manner, 30% of the patients saw their blood pressure drop to the recommended level within six months. On the other hand, 64% of patients who had the physician/pharmacist team working together reached that level in the same time frame. That’s a remarkable difference.

Methods like this are being employed by some practices in the country already. If the results of the study hold up, it makes sense to expand this type of collaboration. Previous research has shown similar success in treating other conditions like diabetes and high cholesterol with this system as well. The authors of the study think we can encourage more collaboration by employing incentives via Medicare payments for those who setup these partnerships.

Read more about this news here.

Idea #261 for November 6th, 2009: Addiction 101 or Improving Drug Abuse Education for Medical Students

Amid a number of other efforts in the healthcare world to combat the abuse of drugs, the National Institute on Drug Abuse (NIDA) has launched new teaching tools for medical students and residents. The intent here is to make up for deficits in the current curriculum for medical students surrounding the diagnosis and treatment of substance abuse. Right now, the subject of drug abuse is not taught to all medical students, and the amount of time dedicated to the matter varies widely across schools.

The tools that NIDA has released include lectures, case studies, faculty workshop, and a web tool for assisting in teaching drug abuse curricula. Also, similar material may be incorporated into continuing medical education courses in the future. NIDA hopes that doctors will be able to screen patients for drug abuse in the same manner patients are screened for other diseases today. It’s important that doctors are able to spot and diagnose drug abuse related issues, especially when dealing with prescribing opioid drugs. Making it a part of their education is the best way to ensure that future generations of doctors have the training necessary to detect and treat patients that are abusing drugs.

Read more about this in the NIDA press release and in the Wall St. Journal.

Idea #206 for September 12th, 2009: Free Speech or Improving Communication Between African American Patients and Doctors

Sometimes trends in healthcare emerge that show disparities in treatment across various ethnicities or races. New research suggests that African Americans with high blood pressure are not sufficiently communicating with their providers, leading to further health problems.

The study involved recording the audio from over 200 hypertensive patients in Baltimore while visiting their primary care providers. The recordings revealed that African American patients had shorter visits and had less verbal interaction with their providers than white patients. Researchers postulate that lack of trust, or a feeling of disconnect may be at play. Further, physicians may not be as apt to engage in dialogue with quiet patients, the study suggests. If trust is an issue, then efforts should be focused on correcting that issue so that communication can become more free. Lack of communication may lead to higher rates of hypertension and its complications, which is especially a concern in the African American population.

See more about this study in US News.

Idea #200 for September 6th, 2009: The Trust Factor or Restoring Faith In The Healthcare System

A survey conducted by researchers in Baltimore suggests that gaining patients’ trust is key to ensuring they maintain their wellness. People who have skeptical or negative views of the healthcare system are less likely to keep medical appointments, fill prescriptions, and continue medical care. It wasn’t just a mistrust of individual doctors that marred the peoples’ opinions, but a mistrust of multiple parts of the system including insurers and hospitals.

Making sure that patients have faith in the healthcare system is important for several reasons. For one, people will neglect or delay treatment for conditions that will likely worsen with time. That leaves patients sicker, and costs of treating them only increase down the road. Further, patients who inherently distrust the system are more likely to enter malpractice litigation, further driving up healthcare costs. So it’s important that doctors, insurers, and other players in healthcare make efforts to gain the trust of patients. It’s a factor that should be carefully considered in the course of the ongoing healthcare reform debate.

Read  more about the study in this US News article.

Idea #187 for August 24th, 2009: Bringing The Doctor To You or How House Calls Can Save Money

Once, house calls were a common way for providers to treat patients. Now the notion seems antiquated and inefficient. But a group of doctors in Richmond, VA is finding that this old-fashioned method can actually save money in some cases. By visiting chronically ill patients at home, providers can help patients avoid emergency rooms and the Medicare costs associated with ER visits.

The group from Richmond is made up of four doctors and five nurse practitioners who visit about 275 patients within a 15 mile radius of the hospital. The program costs about $1 million annually, but they estimate that for every day a patient is kept out of the hospital, that saves $1,500. From 2003-2006, the program cut in half the number of days the patients were in hospitals, which amounted to about $2 million in savings.

One problem with this system is that doctors who are not affiliated with hospitals do not benefit financially from the patient’s reduced hospitalizations. A provision in the House healthcare bill would address that problem by giving providers a cut of the savings that Medicare will see if this system is implemented. With Medicare on course to run out of money in the upcoming years, creating incentives for more house calls makes sense as a money-saving tactic.

See the story on this in the LA Times.

Idea #180 for August 17th, 2009: Washing Up or Encouraging Proper Hand-Washing in Hospitals

The act of hand-washing is more important than many realize, and that is especially true in medicine. A study in 2000 by the Institute of Medicine claimed that, of all the hospital-related errors that lead to death, the spread of bacterial infections was one of the top causes. Insufficient hand-washing may be partly to blame for that stat.

Cedar-Sinai came up with an interesting way to make sure more doctors were washing their hands. At the time, only about 65% of the doctors were washing their hands to the degree that it was compliant with JCAHO standards. So a team of staff there began handing out Purell bottles to doctors in the parking lot, as well as giving Starbucks giftcards to doctors who they found washing up properly. Soon the rate of compliance jumped to 80%, which was an improvement, but still not acceptable.

Then came the idea that changed the culture of hand-washing at Cedar-Sinai forever. Hospital leadership decided to take handprints on petri dishes of some of the doctors and culture those prints to show the bacterial colonies. The results were visually striking, displaying forests of bacteria in the outline of a hand. One such image was then used as the standard screen-saver for all computers at the hospital, and staff were confronted with it frequently. Hand-washing compliance rose to nearly 100%, where it still is today. It’s a fascinating way of getting a message across, and that type of non-standard methodology could be used in other locations that suffer from the same problem.

Read about this story in the NY Times.

Idea #163 for July 31st, 2009: Sunlight Is The Best Disinfectant or Eli Lilly Discloses Registry of Doctor Payments

Earlier this year, under mounting pressure from the Obama administration, industries in the health field including drug companies promised to make some concessions to do their part in reforming healthcare. Eli Lilly announced this month they will publish a registry of doctors who served as paid consultants during the first quarter of this year. A total of $22 million went to those providers earlier this year, with the average consultant making about $1000.

Payments to doctors by drug makers, device makers, and other industry groups always create the perception of conflict of interest. In the past few years, Eli Lilly has disclosed some of its other financial dealings like grants to non-profits and academic institutions. Increased transparency is always welcomed. This may be just the start of more concessions made by those in the healthcare industry in the coming months. Patients should be able, in the near future, to search for providers’ dealings with industry when deciding who to seek for treatment.

Read more about this in the Wall St Journal, and see Eli Lilly’s registry here.

Idea #21 for March 11th, 2009: Do You Really Need That Check-Up? or The Physical Exam Debate

Annual physical exams have long been lauded for their role in preventive care. Moreover, they allow physicians to chart changes in patients’ medical histories, and they can help in fostering a rapport between provider and patient. A growing number of doctors, though, feel that physical exams are not a yearly necessity in most cases.

Currently, about 20% of adults get annual physical exams at a cost of $7.8 billion per year. The exams account for 8% of total doctor visits, and an oftentimes unnecessary battery of tests during physicals, like urinalysis and blood tests, account for $350 million a year in health spending. Some healthcare experts wonder if the benefits of annual physicals are worth the costs and diversion of resources. Nobody doubts the importance of preventive care, but experts do question the way it is administered. It turns out that most preventive care is not administered during physical exams; 80% of preventive care actually occurs during other office visits, like when a patient comes in for an illness.

So should patients do away with the yearly physical? Not in all cases. For one thing, they should discuss it with their physician first. Screenings for diseases, like breast cancer or prostate cancer, are still important and require doctor visits. And people who never find themselves in doctors offices for illnesses or any other reason should probably be on annual physical exam regimens, if only so doctors will have a chance to give preventive care. For the rest of us, who may see a doctor now and then for various reasons, a yearly physical exam is probably not worth the time or money.

In the media, Time magazine, the NY Times, and CBS news have stories on the debate.