Crystal clear knowledge for decision making

By Cristina Roure 

Excellent health care is one in which patients, professionals and managers apply the best available knowledge in decision making. Only well-informed agents can take the most appropriate decisions for an effective, safe and efficient health system. We often think that the big problem of the system is the lack of money, and only devoting more resources will solve the problems, but lack of knowledge is much more worrying than it may seem at first glance.

Sir Muir Gray, Chief Knowledge Officer of the National Health Service (NHS), uses an analogy that I find very spot on: "It takes knowledge as crystal clear as the water we drink if we want to take the right decisions." But the current reality is very different because we drink from contaminated sources of knowledge.

Medical Practice: an honest wage for an honest job

"outcomes-based reimbursement works only in a limited sector of healthcare" http://t.co/XFFymLHA8i

— Dr. Luis Ramos Neira (@lramosneira) April 29, 2014

Dr. Luis Ramos is a very professional dedicated to networking. He defines himself as a quali -  epidemiologist. Well, his tweet brings us to a post in The Health Care Blog, signed by a Swedish family physician, Dr. Hans Duvefelt, who works in a town in Maine, on the east coast of the United States. It’s a short clear post, from which I have extracted the main ideas.

We're hearing now that doctors should be paid in accordance with the clinical results of their work and of course we’re not talking about parameters such as controlling blood pressure or glycaemia, but about death, strokes, heart attacks, amputations, hospital infections, etc. But the question is: How can we measure the patients degree of involvement now that there’s so much talk about them? Should the doctor charge less if his diabetes patient is not doing well despite his good work? Wouldn’t this model lead us to the selection of patients?

Nurses: (+) training (-) workloads = (-) mortality

A few months ago, Mireia Subirana, Director of Care at "Consorci Hospitalari de Vic" explained in a post the results of her doctoral thesis that can be summarized as: "more nurses and more training (in hospital wards) was associated with better clinical outcomes". Following this thread, The Lancet has just published the results of a retrospective observational study that has explored whether the nurses training levels and workload ratios could influence the mortality of patients admitted for medium complexity scheduled surgery.

It’s an important work undertaken in 300 hospitals in 9 European countries by surveying 26.516 nurses and analysing 422.730 hospitalization surgical episodes. Despite the expected methodological difficulties of a project of this nature, it can be considered as a rigorous study.

Low cost medicine "made in India"

By Josep Mª Monguet

On 25th February, the first building of the Health City hospital complex which plans to grow up to 2,000 beds and be accredited by the JCI, offer all kinds of advanced tertiary health services and even open their own university, was inaugurated in the Cayman Islands. But what really draws the attention towards all of this is the origin of the initiative, which is none other than innovation in the health business model from India. Between 2001 and 2012, Narayana Health, a project led by Dr. Devi Shetty evolved from a 300-bed hospital in Bangalore to an aggregate of 6,000 beds in 17 hospitals, 80,000 patients and 3,500 interventions per month. And now they have switched their antipodes to enter the global market, offering, via a one and a half hour flight from the United States, open-heart surgery, prosthesis or neurosurgery, for obviously very competitive prices.

Leadership: difficulties and challenges

Managers from National Health Service consortiums now seem an endangered species, according to the King's Fund. Politicians have demanded cuts and they have fought greatly so that their centres can maintain the required levels of care. The result: the leakage of first level managers disappearing from the public system.

The first reference documents, which has as its subtitle "No More Heroes" (the green one), describes the new leadership style beyond the mandatory compliance to the objectives imposed from above. It said that Managers who have an inside perspective are essential if we want to get the doctors, nurses and other health professionals to do their work with quality. The new leadership should not only correspond to the manager, the heroism no longer makes sense. Therefore, now we need to have leaders throughout the organization, leaders who are present in every corner of all processes and, above all, know how to involve professionals in the management of resources, but also know how to facilitate the participation of patients in the decisions that affect them.

End of life: how to avoid hospitalizations?

24% of GPs think that hospitalisations can be avoided in last 3 months of life: http://t.co/EyYCmrKNBP Proactive communication vital. #hpm

— Palliative Medicine (@PalliativeMedJ) abril 9, 2014

Many people are sent to hospital to be attended to during the clinical stage complications they suffer from in the last months of life. We are all aware that we’re not dealing with this issue very well and in addition we haven’t gone to great lengths to improve it. What do these hospitalizations bring? Could they be avoided?

Palliative Medicine magazine just published a timely survey addressed to Dutch family physicians in order to gain insights into their thoughts about hospitalizations during the end of life for their own patients. And the results are quite suggestive:

Colorectal Cancer: prevention strategies

Colorectal cancer is the third most common cancer among men and the second among women. Most of these cancers develop from adenomatous polyps in a period that can be ten years or more. This long progression offers enough time to adopt preventive strategies with reasonable levels of effectiveness in a context of a mucosa where the presence of polyps is fairly common, despite only some of them evolving toward malignancy.

Colonoscopy is a technique that has been proven effective in reducing mortality from colorectal cancer, but no one can ignore the difficulties of applying this technique extensively, given the low adherence to the calls and the high costs of the program, without forgetting the side effects inherent to the practice of colonoscopy. For this reason I thought it opportune the study lead by Dr. Enrique Quintero (Hospital Universitario de Canarias) and Dr. Antoni Castells (Hospital Clínic Barcelona) which compares, in a prospective clinical trial involving more than 50,000 calls, the practice of a one time colonoscopy with the analysis of a stool sample (with immunochemical test) every two years. The work has an expected 10-year follow-up, and aims to measure the impact in terms of deaths avoided, and although it is still evolving, New England has published a progress report.