Hospital dependent patients: new cataloguing

In an article published in the New England Journal of Medicine, "Goal Oriented Patient Care," Dr. David Reuben, a geriatric doctor of Ronald Reagan UCLA Medical Center, proposed cataloguing the concept of "hospital dependent patient" such as those patients who a generation before were doomed to die quickly but now, thanks to the combined effectiveness of well coordinated professional teams and availability of technology, their life can be saved but they are unable to return to the previous clinical situation and therefore they enter a state of hospital dependence caused by the same clinical performance that saved their lives. Essentially, we’re not talking about a new disease entity, since most of these patients coincide with the group of chronic complex and/or frail elderly patients.

According to Dr. Reuben, "hospital dependent patients" once hospitalized, can get temporary stabilization, and even an acceptable quality of life, provided they have intensive nurse care, specialists guard teams and adequate resources availability and technological monitoring.

How to spot a "hospital dependent patient"?

Hospital dependent patients’ clinical problems are labile, unstable and unmanageable in the community and, for this reason, their hospitalizations are not avoidable, and herein lies the interest of Dr. Reuben’s cataloguing work.

In contrast, clinical targets for "standard complex chronic patients" focus on community services. These are patients that, if the system is able to offer intense enough programs tailored to their needs, in theory, could avoid hospital readmissions which should be understood as system failures.

The genome price plummets: Good news?

What can laparoscopic cholecystectomy teach us about genomic testing? Read here to find out http://t.co/TBdTarqNDk

— Peter Ubel (@peterubel) 26 agost, 2014

Peter Ubel is a researcher at Duke University in North Carolina and author of "Critical Decisions" book. We already had a post mentioning Dr Ubel: "Teaching patients to make the timely question." Now, along with that tweet, he sent us to a post written by himself on the Forbes magazine blog which analyzes the impact of plummeting prices for the genome test.

Meaningful use of electronic medical records

If you want to know if something is serious in health policy, check whether a budget allocation has been reserved for its implementation. Therefore I consider relevant that in 2011, the US federal government started a long term incentive program (until 2020) for the adoption of electronic medical records (EMR). The program is called "Meaningful use" which could be translated as meaningful use of medical records. That is, it encourages not the investment in information systems but its use and is measured by various indicators grouped into 3 stages.

Earlier this year Botta and Cutler published "Meaningful use: floor or ceiling?" an article where the process of encouragement was studied from expert interviews and from data from implementing a survey of American Hospital Association. Well, according to this analysis, the "Computerised Physicians Order Entry" (computerized physician orders) increased their deployment when they were encouraged by the "Meaningful use" program and even went ahead in the use of barcodes for drug delivery, action that was not encouraged by the government program (see figure).

Overscreening: new excess data

Cancer Screening Rates in Individuals With Different Life Expectancies http://t.co/Kefm8bPEiQ

— JAMAInternalMed (@JAMAInternalMed) 21 agost, 2014

JAMA Internal Medicine has just published the results of a study from the National Health Interview Survey (NHIS) - US in the period 2000 to 2010. The study included 27,404 participants aged 65 years or more, and used a NHIS specific index to assess the risk of mortality to 9 years of life.

The conclusion is that a substantial proportion of US population with limited life expectations received screenings for prostate, breast and colorectal cancer. These results show that the overscreening is standard practice in the US. These practices, the study's authors relate, rarely produce any benefits to these population groups and instead, increase health spending and induce therapeutic overbearing from with complications arise.

This American study warns us that we need more professional and social debate, not only about the advantages and disadvantages of preventive practices in healthy people, but also about the limits of such practices in geriatric patients who already have their own clinical management difficulties.


Jordi Varela

Editor

Cancer: are the military metaphors appropriate?

military metaphors may harm patients. @bmj_latest column http://t.co/84KgmVb3VU

— Margaret McCartney (@mgtmccartney) agost 15, 2014

Many people are convinced that when someone close has cancer, they ought to encourage them to fight, but this tweet by Dr. Margaret McCartney, author of "The patient paradox", refers to an article published in the BMJ, defending a critical attitude to this position. The reason is simple: the moral struggle is not associated with an improved survival rate (Petticrew 2002).

Personal health data: a new treasure for science

It’s time to make disease give, not just take. Find out more. http://t.co/m3ebqiyi78 pic.twitter.com/gZlJ78QPgp

— PatientsLikeMe (@patientslikeme) juliol 16, 2014

At seeing a survey by the Institute of Medicine (IOM) one fact stands out: 94% of Americans who are diagnosed with a chronic disease and are also social network users would be willing to donate their data to encourage research thus helping other patients like them.

In this context, the website "PatientsLikeMe", the most developed patients social network in the world, has launched a campaign to encourage the donation of data, so I invite you to see this promotional video: "Your data has a heartbeat that gives life to medical research.”

More on Personal Health Budgets in the UK

Due to the opportunity of the subject, in this second post about the Personal Health Budget (PHB) British program, I want to raise three questions: a) how the PHB process is being approached, b) what do professionals think of it, and c) illustrating another true story (in the first PHB post I talked about the case of Roger, a patient with COPD):

The 7 steps of the PHB process (according to Nuffield Trust) are:

1. Individual needs evaluation for the candidate to enter the program.
2. Elaboration of an indicative budget.
3. Identification (according to the professional team) of personal health and wellness goals.
4. Development and approval of personalized plan (there is no other requirement apart from trust).
5. Flexible money availability: directly from the pocket, intermediaries or service payment.
6. Commissioning of services and necessary supports.
7. At least a yearly evaluation.

The National Health Service estimates that this year 55,000 people with chronic and degenerative diseases and complex health and social needs, could benefit from a Personal Health Budget.

What do the professionals involved in the pilot say: