tag:blogger.com,1999:blog-6725336294050023887.post1056915354611476792..comments2023-07-19T05:48:15.283-05:00Comments on Healthcare Propeller Heads: Required ReadingDan Miershttp://www.blogger.com/profile/13353561587618535324noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-6725336294050023887.post-34195766478430797332009-06-29T20:21:07.395-05:002009-06-29T20:21:07.395-05:00The best advice for Congress comes directly from t...The best advice for Congress comes directly from the New Yorker article for first to "fund research that compares the effectiveness of different treatment treatments" as Julie said use evidence based medicine and second "fund research... different systems of care to reduce uncertainty about which systems work best for communities" Planning is the first step towards successful Healthcare reform. The problem is to complex to rush through Congress spending trillions of dollars without a plan.Terry macnoreply@blogger.comtag:blogger.com,1999:blog-6725336294050023887.post-72498100455321733522009-06-25T22:29:42.152-05:002009-06-25T22:29:42.152-05:00You can easily redecorate your living room if it&#...You can easily redecorate your living room if it's built inside a fireproof box! That's exactly what we will be doing if we provide universal access without defining the amount, the kind, and the mode of health care delivery every citizen has a right to obtain. Massachusetts has demonstrated just how costly universal access becomes when levels of care are not defined and more importantly, when prevention and health promotion are not included in the equation.<br /><br />I agree that evidenced-based protocols and procedures, as well as basic health promotion (via 'old' public health strategies?) must be agreed upon before we throw a trillion dollars in the healthcare cauldron.Julie G.https://www.blogger.com/profile/07384416433145882888noreply@blogger.comtag:blogger.com,1999:blog-6725336294050023887.post-47539336094164949352009-06-15T17:29:12.150-05:002009-06-15T17:29:12.150-05:00A dear friend is negotiating end of life care for ...A dear friend is negotiating end of life care for her 87 year old mother who has end stage COPD. Try as she might to keep her mother home and comfortable she now lies in the ICU on a ventilator. Coordination of her care in the home could have prevented this costly episode of care. <br /><br />"The Gawande article makes an elegant analogy:<br />Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check." <br /><br />My friend's mother is getting a lot a metaphorical outlets, faucets and cabinets,most of which she does not need or want. The cost of this "care" will far exceed what it would have cost to keep her home. You might say she could have had hospice but she wanted to continue to fight illness in whatever way she could. She was okay with treating UTI's with antibiotics, monitoring her CO2 and using BIPAP and nebulizers to get through the rough spots. She just couldn't get this type of care at home and when she felt poorly she couldn't get into the doctor's office. So off to the ER she went.<br /><br />What incentive did the doctor have to coordinate her care? He can't bill for phone calls and takes on a huge liability for practicing medicine over the phone. I can't help but think that if there were reimbursement for managing care remotely that the medical profession could quickly come up with standards for managing care over the phone.<br /><br />Even when she went to the ER of the hospital, where she had recently been a patient, her care did not include information gained in that episode of care. A champion CO2 retainer she is strictly kept on 1.5 liters. The ER placed her on 4 liters and were not dissuaded by her daughter who was the only one who seemed to be interested in coordination of care but alas was seen as unqualified. Like the poor homeowner who tries to be the general contractor of a home renovation project she was regarded as a complainer, a problem. The result was a CO2 level I rarely if ever saw in my 15 years of critical care nursing. <br /><br />I've been on the medical side of that situation where a patient's family asks a million pesky questions. I like to think that I did a good job of giving them what they needed but I fear that my financial incentives did not align with their needs. What I never recognized is that they were trying to coordinate care. They instinctively knew something that the medical community seems to have missed.<br /><br />As in the first comment I will very interested to see how the newest idea on the healthcare block - Medical Home - pans out. But whether it is this model or some other there is no doubt in my mind that coordination of care is glue that is missing in our shattered healthcare system.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-6725336294050023887.post-22458713462744971052009-06-11T12:22:26.059-05:002009-06-11T12:22:26.059-05:00In reading the article about McAllen Texas having ...In reading the article about McAllen Texas having the highest health care costs in the country as reported in The New York Times issue, maybe President Obama and his thinking tank should consider the adoption the 'medical home' concept to more effectively manage preventable medical problems in this area. Regardless of technology and state of the art equipment that may be available at the medical facilities, 'medical home' ideology may provide immediate benefits to the patient population at most risk.mromohttps://www.blogger.com/profile/04286083050284984821noreply@blogger.com