The controversy concerning Medtronic's payments to its doctor-consultants has erupted in Australia, as a newspaper in the country
cited confidential documents in saying that the medical technology giant devised a "secret marketing strategy" in 2007 to woo doctors' loyalty by paying fellowship grants. The documents indicate that the $1.5 million spent on 18 fellowship grants would likely reap a 200% return on investment in the first year.
For 60 years, the American Medical Association has been a lobbying powerhouse that frustrated healthcare initiatives by Democrats and Republicans alike, notes this article from the Chicago Tribune. The AMA has turned back almost every plan to revamp healthcare, but now the AMA is working not to defeat President Barack Obama's proposals but to get them enacted into law. And among the many reasons for the AMA's historic shift is that Obama's plan promises to provide millions of government dollars to help millions of patients pay their doctor bills.
When doctors counted the number of medical scans patients underwent in the emergency room at Brigham and Women's Hospital, some patients clearly stood out. One 45-year-old woman with a history of kidney stones had 70 CT scans over 22 years. The cumulative radiation exposure from those scans, the researchers estimated, raised her lifetime risk of cancer by about 10%. Partly because of these results—overall 5% of patients studied underwent at least 22 scans in the 22-year study period—the hospital plans to become one of the first in the United States to notify doctors of their patients' imaging histories, and resulting cancer risk.
Boston University is launching a major global health initiative, investing $10 million to bolster research and education, and helping to build a nationwide consortium of universities devoted to improving health in the Third World. The new Center for Global Health and Development will connect specialists from BU's medical and public health schools with engineers, social workers, and educators on the main campus to grapple with diseases that cause millions of deaths each year in the developing world.
In the debate over a healthcare overhaul, Maryland's experience with setting hospital rates suggests the federal government could realize savings on health spending, but at a price of more regulation for health providers. President Barack Obama and some congressional Democrats are pushing for an independent agency to set Medicare payment rates as a key to controlling costs. In Maryland, an independent agency has been setting rates since 1977 for all patients, including Medicare beneficiaries, at the state's acute-care hospitals.
The children's hospital in San Miguel de Tucumán, Argentina, handled many cases during a recent swine-flu outbreak, and then there was the sudden deaths of two of its own nurses in July. Now, hundreds of angry health professionals in the city have launched a series of demonstrations and work stoppages, seeking a safer workplace and better salaries. Argentina illustrates the stresses the H1N1 epidemic is placing on healthcare workers, according to this article from the Wall Street Journal. The World Health Organization recently said that when a vaccine is released, health workers should be the first to receive it.
Nonprofit organizations say they are upset that Congress and the Obama administration have not addressed their rising healthcare costs in the various healthcare proposals. The main bill in the House would award a tax credit to small businesses that provide their employees with health insurance, but nonprofits do not pay income taxes and thus would not benefit. Some nonprofit groups have called for a subsidy along the lines of the Earned Income Tax Credit, in which money would be returned to organizations that demonstrate they have paid for an employee's healthcare.
As the second wave of H1N1 infections begins in the United States, federal, state, and local health authorities nationwide are scrambling to prepare for the strains on emergency medical systems. In response, officials across the country are rewriting disaster plans and stocking up on masks, gowns, drugs, and other supplies. One key line of attack will be encouraging people who are not really sick or are suffering only mild symptoms to recover at home. And experts are searching for ways to help healthcare providers quickly screen those who do seek help and separate bad cases from less-severe ones.
Delegates at the biennial convention of the 86,000-member California Nurses Association/National Nurses Organization voted unanimously on Thursday to endorse and join a new RN "super union."
"Let it be known this was a unanimous vote by the house of delegates," CNA/NNOC Co-President Deborah Burger, RN, told hundreds of cheering delegates gathered in San Francisco. "This is truly a historic moment and I hope it sends chills down the backs of those employers who would want to keep us down."
Two other major nursing organizations—United American Nurses and Massachusetts Nurses Association—are also expected to support the merger at separate ratifying conventions. When they do, the new National Nurses United will have 150,000 members and a national organization following a founding convention in Scottsdale, AZ, on Dec. 7-8.
On hand for the vote were several officers from the once-rivals UAN and the MNA, including MNA Executive Director Julie Pinkham, who said, "The entire healthcare agenda is up for grabs. It's a sea change—a great opportunity and a great risk.
The NNU's agenda will include improving patient care and RN standards from coast to coast, winning union representation for all un-represented RNs, passing state and national legislation to protect patients, including national RN-to-patient safe staffing ratios, and working for guaranteed healthcare for all.
CNA/NNOC Executive Director Rose Ann DeMoro says the new union will facilitate "nurses from all over our nation coming together and standing tall with one voice, one vision, and one purpose to build the most incredible, powerful, unshakeable force in the history of nursing and healthcare.
"A unified, national nurses movement has enormous significance for patients and the ability of RNs to work together to improve care standards and transform our broken healthcare system," DeMoro says. "For direct care RNs, it means the opportunity to resist the employer onslaught on the nursing profession and secure a better future for RNs and their families."
In today's culture, many hospitals are increasing their focus on patient-centered care—that is involving patients in their own care decisions to improve outcomes. One route that facilities are more often choosing to take is creating a patient advisory board or committee.
"There are studies that have demonstrated that an engaged patient who becomes informed and participates in their own healthcare have better outcomes," says Kathryn Leonhardt, MD, MPH, patient safety officer and medical director, care management for Aurora Health Care in Milwaukee, WI. "We realize we need to find better ways to engage our patients—if patients are not engaged it's because we as the healthcare system have not been effective in engaging them. The role of a patient advisory committee is to help us understand from the patient perspective processes and tools to facilitate that engagement."
Leonhardt was part of a team at Aurora Health Care that received a grant from the Agency for Healthcare Research and Quality (AHRQ) to create a patient advisory committee toolkit. The grant, which ran from 2005 through 2007, allowed Leonhardt to study best practices for forming and maintaining a functioning patient advisory council, and measure outcomes.
The toolkit, titled Guide for Developing a Community-Based Patient Safety Advisory Council, came out of one of 17 grants in AHRQ's Partners Implementing Patient Safety (PIPS) grant series. The series broadened the scope of AHRQs grants at the time, which were mostly focused on developing new health services research. In 2005, however, as information started to come in from earlier grants, the AHRQ decided to broaden the scope of its grants and focus on existing interventions to see if those could be shared with other hospitals across the country.
"AHRQ always thinks about patient safety as being something very local, so we knew that maybe one size didn't fit all in terms of implementation, but we thought it would be a good start to fund some projects that implemented certain patient safety interventions," says Deborah Queenan, patient safety task officer at the AHRQ. Queenan has been in charge of coordinating the PIPS grants. From there, AHRQ could determine if the project would be adaptable for many different types of facilities. The grant concerning patient advisory councils was adapted for use by hospitals in March 2008.
Using the toolkit as a resource to build a patient advisory board will help move the industry away from its previous lack of soliciting patient feedback.
"As a system on a whole, the healthcare system has not generally been developed around patient-centered care and engaging patients," says Leonhardt. "With some of the studies around understanding quality and safe outcomes, we've just now realized the importance of patient engagement. The traditional healthcare system has really been much more provider-centric."
The beginnings of a patient advisory board
Forming a patient advisory board that will be functional and provide valuable information starts with the healthcare team adequately scoping the project. This is for advisory boards that are being developed to solve a certain problem. Even for more general patient safety advisory boards, however, it's necessary to identify areas of focus.
"We kept scoping and scoping and scoping to a more narrow, specific area," says Leonhardt. "That really helped us identify the participants on the committee, and also helped us keep our project moving forward."
A patient advisory board can only be successful if the right patients and community are chosen to serve. Asking hospital staff members for recommendations should be a first stop.
"As with any relationship, many of these providers have known patients for years," says Leonhardt. Explaining to providers what the council's goals and objectives are, as well as the time commitment that will be asked of participants will help them give you their best suggestions.
Roberta Mikles, RN, director of Advocates4SafeCare, serves as a member of the patient advisory board at Sharp Memorial Hospital (SMH) in San Diego, CA. Mikles is a retired nurse who has devoted most of her time to patient advocacy and was approached by SMH to serve on its patient advisory committee in April because of a past experience she had at the facility during which her father acquired MRSA. Another good way to find valuable members to serve on an advisory board, Leonhardt says, is to reach out to patients or family members of patients who have brought forth concerns to the facility related to patient care. It's often those people who want to do what they can to make sure an error they have suffered does not occur to another patient.
Next, Leonhardt recommends conducting one-on-one interviews with potential advisory board members. It's important that potential members have specific skills, like the ability to communicate well, collaborate, knowledge of the topic/issue at hand, is from a certain demographic etc.
