Great article from Fox News about a nurse training program in Anbar province, Iraq. The women, mostly in their mid-thirties, are being trained as nurses' aids. They are paid $200 a month by the U.S. State Department's Reconstruction team. For many of them, it is their first career.
Historically, nurses in Iraq have been met with suspicion, due to their willingness to work long hours in a coed setting. The founder of the program, Dr. Ayad al-Hadith, is a physician who specializes in child and maternal health and has devoted his professional life to loweing maternal health in Anbar province. He hopes some of the women trained will go on to become RNs.
Tuesday, June 30, 2009
Sunday, June 28, 2009
new research about racial health disparities in nyc
In May, the Community Service Society (CSS) published the first report (seond link from bottom in sidebar) of a two part series looking at health care in New York. CSS is an advocacy group for the poor of New York, but this first report focused on the health care quality and its variance across racial groups. While the data is no longer new, I came across it relatively recently and think it’s worth blogging.
The report was based on data gathered from the Quality Assurance Reporting Requirement (QARR). This program enables the city to offer pay for performance incentives to various health care plans using the data generated. The study’s authors requested the data logged about all Medicaid enrollees over the course of three years. However, the information they received from the Department of Health and Human Services was primarily from 2007. The study’s authors felt that using data from only publicly insured patients would help control for differences in health outcomes based on wealth.
One of the report’s more depressing findings was that, “On a number of key health indicators, African Americans in New York experience disproportionately worse outcomes than other groups.” The report went to say that African Americans had statistically worse outcomes than the aggregate of other groups on 10 of the 12 measured outcomes
The outcomes measured by the study were divided into two categories: preventative care and management, and management of diabetes. The outcomes categorized as preventative care and management included: mammography, childhood immunizations, childhood dental visits, child asthma, and adult asthma. The management of diabetes outcomes were: HbAIc testing, poor HbA1c control, lipid profile, lipids controlled, blood pressure controlled, dilated eye exam (diabetics must have one dilated eye exam per year to screen for diabetic retinopathy), and nephropathy screening. Of these, the only two outcomes for which African Americans had similar outcomes to the population as a whole were childhood immunizations and nephropathy screening.
Other analyzed groups included: Caucasians, Asian/Pacific Islander, and Latino. Whites performed statistically better than the aggregate at childhood dental visits, child and adult asthma, poor HbA1c control, and blood pressure. They had worse outcomes in childhood immunizations, mammography, and nephropathy screening. Asian/Pacific Islanders had the better outcomes than the aggregate in every outcome except for nephropathy screening and childhood immunization. Latinos did better than the aggregate at childhood immunizations, childhood dental visits, mammography, and lipid profile and lipid control. They performed similarly to the aggregate for all other outcomes.
The report concluded with a few policy recommendations. The first was that the state monitor and report on disparities in health care among publicly insured individuals, breaking the data down by plan. The second was that the state use its purchasing power to promote health equity by using additional pay-for-performance initiatives targeted to reduce racial disparities in health care as well as and more aggressive monitoring. Elisabeth R. Benjamin, one of the authors of the study, told the New York Times, “Our position is that the health system is failing African-American folks, and we know that pay-for-performance works.” She went on to say, “We’re saying let’s use it [pay for performance] with a race lens, which has never been done in the country…We think this is one of the areas where New York State can take a lead in the country.”
The second report in the two part series, which I hope to read and write about later, analyzes involuntary disenrollments from public insurance plans.
The report was based on data gathered from the Quality Assurance Reporting Requirement (QARR). This program enables the city to offer pay for performance incentives to various health care plans using the data generated. The study’s authors requested the data logged about all Medicaid enrollees over the course of three years. However, the information they received from the Department of Health and Human Services was primarily from 2007. The study’s authors felt that using data from only publicly insured patients would help control for differences in health outcomes based on wealth.
One of the report’s more depressing findings was that, “On a number of key health indicators, African Americans in New York experience disproportionately worse outcomes than other groups.” The report went to say that African Americans had statistically worse outcomes than the aggregate of other groups on 10 of the 12 measured outcomes
The outcomes measured by the study were divided into two categories: preventative care and management, and management of diabetes. The outcomes categorized as preventative care and management included: mammography, childhood immunizations, childhood dental visits, child asthma, and adult asthma. The management of diabetes outcomes were: HbAIc testing, poor HbA1c control, lipid profile, lipids controlled, blood pressure controlled, dilated eye exam (diabetics must have one dilated eye exam per year to screen for diabetic retinopathy), and nephropathy screening. Of these, the only two outcomes for which African Americans had similar outcomes to the population as a whole were childhood immunizations and nephropathy screening.
Other analyzed groups included: Caucasians, Asian/Pacific Islander, and Latino. Whites performed statistically better than the aggregate at childhood dental visits, child and adult asthma, poor HbA1c control, and blood pressure. They had worse outcomes in childhood immunizations, mammography, and nephropathy screening. Asian/Pacific Islanders had the better outcomes than the aggregate in every outcome except for nephropathy screening and childhood immunization. Latinos did better than the aggregate at childhood immunizations, childhood dental visits, mammography, and lipid profile and lipid control. They performed similarly to the aggregate for all other outcomes.
The report concluded with a few policy recommendations. The first was that the state monitor and report on disparities in health care among publicly insured individuals, breaking the data down by plan. The second was that the state use its purchasing power to promote health equity by using additional pay-for-performance initiatives targeted to reduce racial disparities in health care as well as and more aggressive monitoring. Elisabeth R. Benjamin, one of the authors of the study, told the New York Times, “Our position is that the health system is failing African-American folks, and we know that pay-for-performance works.” She went on to say, “We’re saying let’s use it [pay for performance] with a race lens, which has never been done in the country…We think this is one of the areas where New York State can take a lead in the country.”
The second report in the two part series, which I hope to read and write about later, analyzes involuntary disenrollments from public insurance plans.
Thursday, June 25, 2009
EMR transition could be source of jobs
Last week, CBS News published an article about the job opportunities created in the health field by the transition from paper-based records to electronic charting.
Millions of charts will have to be transitioned from paper. Claire Dixon-Lee, of the American Health Information Management Association, points out that these charts will not only come from hospitals, but from doctor's offices, long-term care facilities, and even dentists. Her group has estimated that over 75,000 new jobs will be created in the health care industry to manage this transition. There is even a new field, "health information management", growing to accommodate the need. Typically, people going in to the field get and associate's degree and then can command salaries of $25,000-45,000.
New York City has an unusually strong health IT support. The Primary Care Information Project (PCIP) was designed and implemented by the city to encourage providers to transition to electronic charting. PCIP has targeted practices in underserved areas, and claims that 53% of the "smallest practices" work with the project, compared to a national average of 2%.
Millions of charts will have to be transitioned from paper. Claire Dixon-Lee, of the American Health Information Management Association, points out that these charts will not only come from hospitals, but from doctor's offices, long-term care facilities, and even dentists. Her group has estimated that over 75,000 new jobs will be created in the health care industry to manage this transition. There is even a new field, "health information management", growing to accommodate the need. Typically, people going in to the field get and associate's degree and then can command salaries of $25,000-45,000.
New York City has an unusually strong health IT support. The Primary Care Information Project (PCIP) was designed and implemented by the city to encourage providers to transition to electronic charting. PCIP has targeted practices in underserved areas, and claims that 53% of the "smallest practices" work with the project, compared to a national average of 2%.
Monday, June 22, 2009
the lancet discusses global health
The British medical journal The Lancet's most recent issue features several articles of analysis of global health initiatives. This editorial (you have to register for the site to read it) serves as an interesting quick read of the broad trends discussed in this issue.
The editorial discusses the rising importance of nongovernmental, non-UN actors in global public health, such as the Gates Foundation or the World Bank. It points out this has its advantages, like more money going in to global public health, as well as its disadvantages, like a decreasing sense of financial/administrative ownership of the the health care system in the national governments of some of the countries receiving the most aid.
The editorial discusses the rising importance of nongovernmental, non-UN actors in global public health, such as the Gates Foundation or the World Bank. It points out this has its advantages, like more money going in to global public health, as well as its disadvantages, like a decreasing sense of financial/administrative ownership of the the health care system in the national governments of some of the countries receiving the most aid.
Saturday, June 20, 2009
staten island steps up
On Thursday the Staten Island Ryan White HIV CARE Network launched its "Staten Island HIV Status Check Campaign". The campaign is designed to promote HIV testing among residents of Staten Island, and features a snazzy postcard that has information about free local testing centers. The postcard is available in English and Spanish, and will be distributed by local businesses and organizations along with HIV-related education literature and condoms.
A coordinator for the campaign, Karina Ryan, noted that 56% of Staten Island residents have never been tested for HIV. She also notes that while Staten Island has the lowest rate of infection of the five boroughs, it also has the highest HIV-related mortality rates. As with everywhere, Hispanics and blacks are disproportionately affected by the disease, comprising 19% and 50% new diagnoses in 2007 respectively, despite representing only 12% and 10% of the Island population.
For the campaign, the CARE Network is working with the Black Leadership Commission on AIDS and the City Council's Communities of Color Faith Initiative.
A coordinator for the campaign, Karina Ryan, noted that 56% of Staten Island residents have never been tested for HIV. She also notes that while Staten Island has the lowest rate of infection of the five boroughs, it also has the highest HIV-related mortality rates. As with everywhere, Hispanics and blacks are disproportionately affected by the disease, comprising 19% and 50% new diagnoses in 2007 respectively, despite representing only 12% and 10% of the Island population.
For the campaign, the CARE Network is working with the Black Leadership Commission on AIDS and the City Council's Communities of Color Faith Initiative.
Wednesday, June 17, 2009
nyc singled out as having great health IT
Healthcare Information and Management Systems Society (HIMSS), a healthcare technology lobbying group, has singled out NYC's Primary Care Information Project (PCIP) as a potential model for future health IT projects across the nation.
The recent stimulus package offered a financial incentive to those providers who incorporate a "meaningful use" of health IT into their practices by 2011. To facilitate this, the government proposed establishing regional IT centers to support providers making the transition to electronic medical records (EMRs). PCIP, HIMSS argues, is a perfect model for just such a regional IT center.
PCIP was established in 2007 by the NYC Department of Health and Mental Hygiene. It currently targets providers looking to use EMRs who serve large groups of patients who rely on public insurance. PCIP helps them transition to EMRs by bulk purchasing eClinicalWorks, an EMR software, and contracting with its makers to provide two years of support to the providers who opt to use it. PCIP itself also works with these providers, developing trainings for the software, and evaluation rubrics that providers can access to assess how well they are using the software.
PCIP boasts a high level of buy in from targeted providers. The director of PCIP, Farzad Mostashari, told HIMSS, “We have been able to reach Medicaid providers in the city’s poorest neighborhoods in Harlem, the South Bronx, central Brooklyn...With the smallest practices that nationally have a 2 percent implementation rate of electronic health records, 53 percent of them are in our project.”
The practice I'm at for clinical uses eClinicalWorks, and it seems great to me. While I have never used any other EMR, and so can only compare it to paper charting, the difference between those two is huge. The program makes it incredibly easy to access notes from previous appointments, healthcare maitenance information like immunization status, and personal and familial medical histories, and to apply them immediately. Paper charts leave you fumbling for such information, and often present it in fragments so it's difficult to use in the moment.
The recent stimulus package offered a financial incentive to those providers who incorporate a "meaningful use" of health IT into their practices by 2011. To facilitate this, the government proposed establishing regional IT centers to support providers making the transition to electronic medical records (EMRs). PCIP, HIMSS argues, is a perfect model for just such a regional IT center.
PCIP was established in 2007 by the NYC Department of Health and Mental Hygiene. It currently targets providers looking to use EMRs who serve large groups of patients who rely on public insurance. PCIP helps them transition to EMRs by bulk purchasing eClinicalWorks, an EMR software, and contracting with its makers to provide two years of support to the providers who opt to use it. PCIP itself also works with these providers, developing trainings for the software, and evaluation rubrics that providers can access to assess how well they are using the software.
PCIP boasts a high level of buy in from targeted providers. The director of PCIP, Farzad Mostashari, told HIMSS, “We have been able to reach Medicaid providers in the city’s poorest neighborhoods in Harlem, the South Bronx, central Brooklyn...With the smallest practices that nationally have a 2 percent implementation rate of electronic health records, 53 percent of them are in our project.”
The practice I'm at for clinical uses eClinicalWorks, and it seems great to me. While I have never used any other EMR, and so can only compare it to paper charting, the difference between those two is huge. The program makes it incredibly easy to access notes from previous appointments, healthcare maitenance information like immunization status, and personal and familial medical histories, and to apply them immediately. Paper charts leave you fumbling for such information, and often present it in fragments so it's difficult to use in the moment.
Monday, June 15, 2009
two important points about domestic violence
This post is mostly for people who are health care or social workers. Two Mondays ago I listened to a great lecture about screening for domestic violence, and I've been meaning to blog about it since. The highlights of the lecture were two very important points, one of which I had considered before and one of which I hadn't. The first point was that nobody minds being asked by a health care professional if they feel safe when they're with their partner. I ask this question at least twice a day at clinical, and not once has anyone had a problem with it. Moreover, the presenter on Monday had run with a study in partnership with Mailman, Columbia's school of public health, which had corroborated my experience. People just don't mind. That said, I am sure one day I will offend one patient by asking. And on that day, I will be able to tell him/her, "I ask everyone." I am equally sure that one day when I ask this question, one of my patients will say, "No, I don't feel safe."
Honestly, I don't feel prepared for that moment. I don't feel like I'll know the right way to respond, and I'm concerned that if that is the first time my patient has told anyone about his/her situation, me screwing it up will have consequences. And this was where the second important point came up. When you ask someone if they feel safe, you're screening. Your goal is not to fix the situation by asking this question any more than it is to cure HPV by doing a pap smear. You're detecting the problem so the person can get help from someone who has more experience and more training. Once you've listened what the person has to say (obviously key), the presenter urged us to say something like, "What you are telling me is very important, and, if you are willing, I want you to share it with someone with a lot of experience with this kind of thing." And then give them a damn good referral, preferably in person. Like, walk them down the hall to the appropriate office. If that is not an option (private practice, social worker out that day) leave a message for the worker involved and ask the patient to schedule a follow up with you ASAP.
This ideas were really helpful for me, since I am obviously not a trained counselor, but am someone who wants my screenings to go somewhere. If anyone has any experience with this, please let me and other readers know via comments.
Honestly, I don't feel prepared for that moment. I don't feel like I'll know the right way to respond, and I'm concerned that if that is the first time my patient has told anyone about his/her situation, me screwing it up will have consequences. And this was where the second important point came up. When you ask someone if they feel safe, you're screening. Your goal is not to fix the situation by asking this question any more than it is to cure HPV by doing a pap smear. You're detecting the problem so the person can get help from someone who has more experience and more training. Once you've listened what the person has to say (obviously key), the presenter urged us to say something like, "What you are telling me is very important, and, if you are willing, I want you to share it with someone with a lot of experience with this kind of thing." And then give them a damn good referral, preferably in person. Like, walk them down the hall to the appropriate office. If that is not an option (private practice, social worker out that day) leave a message for the worker involved and ask the patient to schedule a follow up with you ASAP.
This ideas were really helpful for me, since I am obviously not a trained counselor, but am someone who wants my screenings to go somewhere. If anyone has any experience with this, please let me and other readers know via comments.
Friday, June 12, 2009
that's too bad
Another article, this one in the Wall Street Journal, about how the current recession has put the kibosh on the nursing shortage. Subawesome news for new grads like myself, great news for patients. I saw another article to this effect earlier in the Washington Post. Both articles said many nurses were returning to the workforce to alleviate the financial pressure created when a spouse lost a job, and both said this effect of the recession is a band aid on the nursing shortage, which will re-emerge. The WSJ article quoted a study which said the nation will be short a quarter of a million nurses by 2020; a pretty significant deficit in an industry that is meant to employ about two million per year.
Wednesday, June 3, 2009
ny daily news op/ed
There was an interesting opinion piece in Sunday's Daily News. Errol Louis focused his discussion on the fact that HIV infected New Yorkers who receive housing assistance through the city's HIV/AIDS Service Administration often have to put large chunks of their income to rent; he quotes figures as high as 56, 59, and 70%. Since the percentage is so high, Louis claims, evictions are common. Louis suggests that Albany simply cap that figure at 30% of income.
Louis rightly points out that keeping people with HIV/AIDS in stable housing situations is beneficial to public health. He states that people who are homeless are less likely to take their HIV medications as prescribed than those in stable housing, and points out such people are can wind up in emergency rooms at taxpayer's expense. He also claims that "studies show they [presumably HIV positive people, possibly not] are more likely to turn to prostitution", which would pose an obvious public health risk. That said, I have never heard of such a study. That sentence also does not make clear to whom HIV positive people are being compared by these studies, or even who exactly "they" are. Does he mean HIV positive people generally, or just HIV positive people with nowhere to live? Hmmm...
Finally, there is one paragraph in the column I find a little worrying. With regards to the eviction of HIV positive people, Louis writes:
I am, perhaps, reading this ungenerously, but is he implying that it is "risky" for an uninfected person to live on the streets/share a bathroom/occupy the same room with an infected person? It seems that he is, which is disturbing. HIV can only be spread via infected needles or sex. Period.
Louis rightly points out that keeping people with HIV/AIDS in stable housing situations is beneficial to public health. He states that people who are homeless are less likely to take their HIV medications as prescribed than those in stable housing, and points out such people are can wind up in emergency rooms at taxpayer's expense. He also claims that "studies show they [presumably HIV positive people, possibly not] are more likely to turn to prostitution", which would pose an obvious public health risk. That said, I have never heard of such a study. That sentence also does not make clear to whom HIV positive people are being compared by these studies, or even who exactly "they" are. Does he mean HIV positive people generally, or just HIV positive people with nowhere to live? Hmmm...
Finally, there is one paragraph in the column I find a little worrying. With regards to the eviction of HIV positive people, Louis writes:
That's an expensive and risky proposition for our city. People with AIDS or advanced HIV who get evicted often wind up living on the streets or sharing bathrooms with noninfected neighbors in homeless shelters, single-room occupancy buildings and welfare hotels.
I am, perhaps, reading this ungenerously, but is he implying that it is "risky" for an uninfected person to live on the streets/share a bathroom/occupy the same room with an infected person? It seems that he is, which is disturbing. HIV can only be spread via infected needles or sex. Period.
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