Archive for June, 2008

As Gas Prices Rise, Obesity Rates Fall

June 26th, 2008 by Melanie Matthews

Can't afford to drive, well, anywhere anymore? Rest assured there is a silver lining in your ever-empty gas tank. As gas prices creep higher and higher each day and $3.91 a gallon is suddenly "cheap gas", Americans are starting to change their driving habits — and their exercise habits, too.

According to a study from Washington University in St. Louis, for every dollar increase in the average price of gas, levels of obesity in the United States would decline by 16 percent after seven years. With gas averaging over $4 a gallon, drivers are dusting off their helmets and taking their bikes whenever they can. The study also shows that the average person walks or bicycles an average of 0.5 times more per week if the price of gas rises by $1.

When (or if) gas prices ever decrease (or at least when they level off some time after Labor Day), will these healthy trends continue? Will people notice the positive difference less driving and more exercise is making in their lives, and not just the negative difference it is making in their wallets? Stay tuned.

Five Steps to Increasing Patient Satisfaction in Hospitals

June 26th, 2008 by Melanie Matthews

hospital patient satisfaction
Healthcare organizations are increasingly sensitized to patient satisfaction levels and their effect on quality ratings. A recent post on ragan.com called A patient's advice to hospital communicators illustrates that the basics of customer satisfaction in a hospital setting really haven't changed that much over the last 30 years.

The piece was written in 1980 by Larry Ragan, who founded Ragan Communications in 1968 with the launch of The Ragan Report. He died in 1995 after a two-year bout with Lou Gehrig's disease. His original column appeared on June 30, 1980 and was reprinted on June 23, 2008.

Besides the standard complaints about hospital gowns and waiting times, Ragan suggests that common courtesy can greatly enhance the experience:

Healthcare providers, don't call patients by their first names unless they ask you to do so. And nurses, refer to the doctor by using his or her title and the last name rather than saying "The doctor will see you now."

Communicators, patients and healthcare organizations respond to an entreaty that holds up after 28 years.

Five-Star Nursing Homes and Other Healthcare Report Cards

June 24th, 2008 by Melanie Matthews

School's almost out, and we're awaiting final report cards at my house. In this week's news, report cards also went out to many hospitals, health plans and nursing homes. The AMA issued its first National Health Insurer Report Card on claims processing to Medicare and seven national commercial health insurers, in an effort to hold health insurance companies accountable for "timeliness, transparency and accuracy of claims processing." Also, CMS reported dramatic improvements in the performances of the 250 hospitals in its Premier Hospital Quality Incentive Demonstration (HQID). The 112 top performers share $7 million in incentive payments for "substantial and continual advancement in quality of care."

We also learned that nursing homes will be subject to greater scrutiny by CMS, which by year's end will activate a five-star system on its Nursing Home Compare Web site to rank quality of care. CMS already assigns stars to health and prescription drug plans available to Medicare beneficiaries.

Depending on the grades, some summer work may be in order for hospitals, insurers and nursing homes that don't want to be left behind.

Generations and Healthcare: Health Coaching for the Ages

June 18th, 2008 by Melanie Matthews

According to a recent study from Gordian Health Solutions, members of different generations not only prefer to access their healthcare information in different ways, but they respond differently to health coaching programs.

Some of the report's most interesting findings were:

  • While seniors 65 years and older and referred to as "The Greatest Generation" are concerned about accuracy of health information on the Web, some estimates show they outdo teens in time spent online.
  • It is difficult to give incentives to the Baby Boomer generation, those born between 1946 and 1964, to participate in health coaching programs.
  • Generation X ("Next Generation"), born between 1965 and 1976, are constantly communicating via cell phone and are always up-to-date on the latest and most fashionable technologies and accessories. They need health coaches to be available through a variety of modes, including telephone and Internet.
  • Generation Y, the "Millennials" born between 1979 and 1999, are impatient and "crave positive feedback." Their health coaching programs should reflect that by being fun, easy to use and always available. The report also suggests offering social networking options within health coaching programs targeted at this generation.
  • Realizing that people from different generations require different approaches to healthcare and health coaching, Gordian offers "iCoaching" services, based on the needs of the individual.

    "In order for a health coaching program to be effective, it must be truly personalized and flexible in its delivery, to address consumer preferences," said Roger Reed, executive vice president for market operations at Gordian.

    And the differences do not stop with the generations. According to Scott Schroeder, president and CEO of Cohorts, it's not as easy as saying that marketing to Generation X should be done consistently across the entire generation.

    "Our belief at Cohorts is that knowing customers is a critical first step in effective marketing programs," said Schroeder. "There’s much diversity within that segment. It is important to understand how to reach each of those segments because there are differences that are important to marketers. There are certain things that healthcare providers might find helpful in reaching out to these distinct segments."

    U.S. Could Face Shortage of Primary Care Physicians by 2025

    June 17th, 2008 by Melanie Matthews

    By 2025, the wait to see a doctor could get a lot longer if the current number of students training to be primary care physicians doesn't increase soon, according to a new University of Missouri study. Jack Colwill, professor emeritus of family and community medicine in the MU School of Medicine, and his research team found that the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years, due to a skewed compensation system that rewards specialists increasingly more than primary care practitioners. The researchers are more optimistic about the future supply of general pediatricians.


    • The number of generalist graduates has fallen by 22 percent and declines continue as medical school graduates enter other specialties. At the same time, the U.S. population is increasing by about 1 percent each year and the baby boomer generation will significantly increase the number of Americans older than 65 by 2025.
    • Older adults seek care from generalists nearly three times each year, double the rate of adults younger than 65. Because of this, the researchers for this study expect the number of doctor visits to increase by 29 percent by 2025.

    Men’s Health Week

    June 13th, 2008 by Melanie Matthews

    This Monday kicked off Men's Health Week, which runs until Sunday, June 15 --- Father's Day. With these events in mind, this week's Disease Management Update takes a look at some health concerns for men, including prostate cancer and heart attack.

    One in Eight Lower Manhattan Residents Had Signs of PTSD Years After 9/11

    June 13th, 2008 by Melanie Matthews

    For many residents of Lower Manhattan, the terrorist attacks of September 11, 2001, had lasting psychological consequences. New findings released by the Health Department's World Trade Center Health Registry show that one in eight Lower Manhattan residents likely had post-traumatic stress disorder (PTSD) two to three years after the attacks. This new study --- based on surveys of 11,000 residents through the World Trade Center Health Registry --- is the first to measure the attack’s long-term effect on the mental health of community members.


    • Lower Manhattan residents developed PTSD at three times the usual rate in the years following 9/11. The rate among residents (12.6 percent) matched the rate previously reported among rescue and recovery workers (12.4 percent).
    • Aside from injured residents --- 38 percent of whom developed symptoms of PTSD --- the most affected groups were those who witnessed violent deaths and those caught in the dust cloud after the towers collapsed. Roughly 17 percent suffered PTSD in each of those groups. The symptoms most commonly reported were hyper-vigilance, nightmares and emotional reactions to reminders of 9/11.

    Like Medical Home, Dental Home Also Rooted in Pediatrics

    June 13th, 2008 by Melanie Matthews

    In a post this week on the AOA Daily Report, AOA Executive Director John D. Crosby reports on a continued study of primary care serving as a medical/dental home and its advantages in addressing vulnerable populations in healthcare. I obtained more details on the dental home model from the HRSA's Advisory Committee on Training in Primary Care Medicine and Dentistry, which is preparing the report. The following is excerpted from its September 2007 meeting minutes:

    The third speaker was James J. Crall, DDS, ScD, Professor and Chair of Pediatric Dentistry at the University of California-Los Angeles School of Dentistry. He said that dentists deal primarily with the two chronic, multi-factorial diseases: dental caries which appear in primary teeth and periodontal disease. While the American Academy of Pediatric Dentistry (AAPD) developed a policy statement about dental home in 2001, the concept has been built into dental care for a long time. The AAPD encourages general dentists to be part of the movement. It defines dental home as an ongoing relationship between a dentist and a patient including all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated and family-centered way, and ideally established by 12 months of age.

    Dr. Crall said that the primary care delivery system is establishing better linkages between medical and dental homes. He cited a program in Michigan where the dental community is organized in geographic communities and lists generated of dentists willing to see children in need and other examples of the use of patient navigators and community oral health coordinators. He stressed the importance of identifying high risk children early and modifying their risk factors. Interdisciplinary primary care training should reengineer how people are taught and consequently how they will practice.

    What Women (and Dave Barry) Want from Healthcare

    June 6th, 2008 by Melanie Matthews

    Before I get too far into this post, let me state two things. First, a study from the AAFP is serious. Second, a video of Dave Barry is not. I wouldn't ordinarily feel compelled to say so, but after hearing Dave Barry speak to our Specialized Information Publishers Association this week, I feel I should. The humorist told us that many readers have taken him to task over "inaccuracies" in his columns over the years.

    In the video excerpt below, Barry shares a baby boomer's health woes and some thoughts on male and female expectations of healthcare. (Disclaimer: The shakiness of the video is directly related to the number of laughs Barry received.)

    On a more serious note, U.S. women have very clear expectations from healthcare, according to a new Harris Poll survey commissioned by the AAFP. If these results are any indication, most American women will be very comfortable moving into a medical home.

    The poll results indicate that 90 percent of American women shoulder healthcare responsibilities for themselves and their families. The survey, "Fixing Health Care: What Women Want," was conducted March 20-24 and gathered responses to questions about healthcare from 1,270 U.S. women age 18 and older.

    Here are a few findings from the survey, followed by some additional "wishes" expressed by some female colleagues:

    • Women put better access to their PCPs at the top of their wish lists, with 68 percent of women surveyed rating same-day appointments as "very important" or "extremely important." Only 40 percent of women considered evening or weekend appointments an important piece of their access to healthcare.
    • Sixty-three percent of women want their PCP to hold the medical history and records of all of their family members.
    • Sixty-three percent of respondents would like to have one PCP manage all of their family's chronic medical conditions.
    • Sixty-two percent of women want a physician who can coordinate care with the other healthcare providers who are participating in a patient's care.
    • 57 percent want the same doctor to provide healthcare for everyone in the family. Only 39 percent of women said all members of their family currently share the same PCP.
    • About half of those surveyed want their PCP to electronically communicate with them, schedule appointments and send their prescriptions to the pharmacy.

    These survey results were a topic of discussion in our office, so I'm sharing some additional suggestions from female HIN staffers:

    "I appreciate my pediatrician using a blackberry to send prescriptions directly to my pharmacist. As a busy, working, multitasking mother of three, every minute counts. Having a sick child who needs to visit the doctor already throws the week out of sync."

    "I would love to see better appointment scheduling and handling. Waiting in waiting room, waiting in the exam room. Surely, there's a more efficient way to deliver care than waiting 20 minutes in a waiting room and another 20 minutes in an exam room.

    "And while, e-prescribing is gaining traction in the marketplace, it has not yet reached the physicians that I visit. Nothing is more frustrating than having a sick child, dropping a prescription off at a pharmacy that is within shouting distance of our pediatrician and having to return to that same pharmacy an hour later to retrieve the prescription."

    Last but not least, a four-point strategy proposed by another female colleague who also helps manage her aging parents' healthcare needs:

    1. I would like my primary care physician and my parents' primary care physician to offer evening and weekend hours to accommodate work schedules.

    2. I would like tests such as MRI's, ultrasounds, etc to be available digitally so that they can be sent from one doctor to another. Currently, some physician offices can only view films, while others have the ability to view digital formats. I would like to see a standardization. Presently, my father has vascular diagnostic tests on disc, but the next specialist he needs to see does not have the technology in his office to view the discs, and only wants to see film, which is not the format the test results are available in. I have encountered this problem on several occasions, and feel a standardization of test result formats would benefit everyone. In addition to this, large films (MRI's, etc) are cumbersome and present storage problems for the families that must keep them.

    3. I would like to see more primary care physicians participate in major insurance plans. Currently, many primary plan physicians in this area will offer a receipt to submit to the patients insurance company, but are not participating providers in any network.

    4. I would like to see more coordination of care between the hospital, the primary care physician, and Sub-acute rehab centers. Currently, sub-acute rehab centers such as Meridian, do not coordinate with or allow visits from the patients primary doctor. This causes problems because the center's visiting doctor does not know enough about the patient's personal medical history, and this results in a reduced level of care when there are complications if the patient has other chronic conditions.

    Thanks to my colleagues for their insightful comments, and to Dave Barry for a healthy dose of laughter this week.

    Spreading the Word About Infectious Disease Control

    June 5th, 2008 by Melanie Matthews

    A cruise line I recently traveled with had an interesting method for infection and germ control. Each time we boarded the ship, they sprayed our hands with sanitizer. At the entrances and exits to every restaurant there were hand sanitizer dispensers. In the casinos, in the hallways and in the lounges — hand sanitizer. The cruise line's attempt at controlling and preventing the spread of disease was a very visible means to calm the fears of many passengers who might be worried about the possibilities of obtaining and spreading diseases in such confined quarters. Moreover, the CDC has established a Vessel Sanitation Program within the organization to better prevent and control the introduction, transmission and spread of gastrointestinal illnesses (GI) on cruise ships.

    This isn't too far off from what many hospitals and healthcare organizations are doing to stamp out outbreaks of MRSA and other infectious diseases. This week's Disease Management Update highlights some tactics for infection control and how better hand hygiene is reducing MRSA outbreaks.

    ICP Associates, Inc., a national consulting company with the objective to provide quality products and services to healthcare facilities to facilitate their own infection control programs and initiatives, also offers a variety of free resources, educational material and Web links regarding infectious disease, transmission and control measures.