OK, vacation's over, and I'm back to blogging. This post is kind of a grad student/public health combo. The grad student aspect of the blog is this: one more semester to go. I have one more semester until I am supposedly qualified to diagnose and treat a wide variety of ailments. Yike. The summer semester of my program, which ended just before my last post, was frighteningly bereft of clinical information. I had a class on violence and ways it may come up in clinical practice, which did make some excellent points. I had another class on the logistics of being an NP. It was devoted to admin things like licensing, practice agreements, insurance, etc. Important stuff, but it didn't really feel like it should take priority over, say, more diagnosis and management. Finally, we had a seminar where we presented cases, and that was useful. But we only met for two hours every other week, so...Anyway, suffice it to say I've gone online and bought some review books to supplement my already expensive education.
Now to public health. The President and CEO of the Kaiser Family Foundation, Drew Altman, recently wrote one of his "Pulling It Together" columns about the state of HIV prevention funding in the US. He notes that NYS is the top funder of HIV prevention, spending $88 of the $600 million spent nationally. This is slightly less impressive than it sounds, since NY is home to 17.6% of the people in the US living with HIV, and $88 million is only 14.6% of the overall funding. Still, a good start. However, the column notes these figures are for FY07, and things are likely to have changed since then thanks to the economy's shenanigans. The column also links to one of previous columns about attitudes towards HIV nationally.
Monday, August 17, 2009
Thursday, July 23, 2009
whew
So it's been awhile since I last posted, and the main reason for that has been that I have been swept up in the process of looking for and moving in to a new apartment. My roommates and I, after nearly eight months of a never-quite-gone bed bug problem, left our old place after the lease was up. We moved from Washington Heights to Hamilton Heights, a neighborhood in northwest Harlem. So far, no bugs. :)
Bed bugs have been a huge problem in NYC of late: there have been articles in the New York Times, The Economist, and by the BBC covering the epidemic. NYC's governing bodies have formed committees to address the situation. However, the problem seems to be worsened because despite such committees, the bed bug problem has no real home in city government. The obvious candidate, the Department of Health, makes the point that the bugs are not disease carriers, and hence are not a public health threat. One might argue that bugs that bite you while you sleep, producing large, itchy, reddened wheals on the face, neck, arms, legs, and torso, don't need to carry disease to be a public health threat. But really, who's to say?
Anyway, now that the bed bug/moving situation has been sorted out, my next stop is a camp in upstate New York. The camp is designed for kids that have medical needs greater than those most camps are willing to accomodate. I'll be working as a nuse/nurse practitioner student.
Back to something that is an agreed-upon public health issue in New York: it seems the ban on trans fats is working. A recent study published in the Annals of Internal Medicine has found that the ban has reduced the number of restaurants in NYC using artificial trans fats from 50% rto 2%, resulting in foods with a significantly improved fatty acid profile. The total amount of saturdated and trans fat in French fries, for example, has decreased by 50%. Also, it seems others are following NYC's lead: thriteen other jurisdictions in the USA, including California, have adopted similar bans.
Bed bugs have been a huge problem in NYC of late: there have been articles in the New York Times, The Economist, and by the BBC covering the epidemic. NYC's governing bodies have formed committees to address the situation. However, the problem seems to be worsened because despite such committees, the bed bug problem has no real home in city government. The obvious candidate, the Department of Health, makes the point that the bugs are not disease carriers, and hence are not a public health threat. One might argue that bugs that bite you while you sleep, producing large, itchy, reddened wheals on the face, neck, arms, legs, and torso, don't need to carry disease to be a public health threat. But really, who's to say?
Anyway, now that the bed bug/moving situation has been sorted out, my next stop is a camp in upstate New York. The camp is designed for kids that have medical needs greater than those most camps are willing to accomodate. I'll be working as a nuse/nurse practitioner student.
Back to something that is an agreed-upon public health issue in New York: it seems the ban on trans fats is working. A recent study published in the Annals of Internal Medicine has found that the ban has reduced the number of restaurants in NYC using artificial trans fats from 50% rto 2%, resulting in foods with a significantly improved fatty acid profile. The total amount of saturdated and trans fat in French fries, for example, has decreased by 50%. Also, it seems others are following NYC's lead: thriteen other jurisdictions in the USA, including California, have adopted similar bans.
Wednesday, July 8, 2009
atul gawande on health care costs
Great article from the New Yorker (usually not my favorite publication) about controlling health care costs. Its author, MacAurthur Fellow Atul Gawande, investigated the out of control health care costs of McAllen, Texas, in an effort to understand why health care in America costs so much. I think it's an especially important read for clinicians.
Tuesday, June 30, 2009
iraqi nursing program
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.
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.
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.
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