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Patient engagement is the holy grail of health care

by STEVE WILKINS, MPH

 

For health care professionals, patient engagement is the holy grail of health care.  It is the key to patient adherence – a prerequisite to achieving better outcomes, fewer ER visits and hospitalizations and more satisfied patients.  It is easy to recognize an engaged patient – they do what their health care providers recommends …what their health care team knows what is right for them.

But doesn’t engagement depend upon your perspective?

In a earlier life I spent a lot of time looking at health behavior.  Among the many things I learned were the following:

• We all define health within the context of our own lives and in our own way
• We all are satisfied with different levels of health

Admittedly there are patterns of health behavior or archetypes which can be used to segment health populations.  One such archetype is characterized as 1) placing a high priority on achieving a high level of personal health, 2) being very proactive in terms of achieving and maintaining their above average health, and 3) having a moderate to high distrust of the medical professionals.

Health Enterprise Zones to target disparities in Maryland

By Meredith Cohn, The Baltimore Sun, 8:20 p.m. EST, January 16, 2012

Frustrated by Maryland’s high rate of health disparities, state leaders are proposing a new attack — one more commonly associated with economic development.

Gov. Martin O’Malley’s 2012-2013 budget will include funding to create Health Enterprise Zones, where doctors and community groups in areas with large health disparities, such as Baltimore, could add medical and support services for minorities. Tax credits and other financial incentives would be available to spur interest.

 The plan is designed to save lives and healthcare dollars, according to Lt. Gov. Anthony G. Brown, who last summer formed a work group on disparities led by Dr. E. Albert Reece, dean of the University of Maryland School of Medicine.

“Maryland has world-class hospitals, top medical schools and one of the highest rates of primary-care physicians per capita, and yet we continue to see disparities in health care and outcomes among Maryland’s racial and ethnic communities. It’s clear that a lack of access to primary care in many communities is a significant factor driving these disparities,” Brown said, adding that funding is in the governor’s budget proposal, which has yet to be released.

According to state and national data, the disparities are many: In Maryland, the infant mortality rate among blacks is almost three times that for whites, the incidence of new HIV infections among blacks is almost 12 times that of whites, and Hispanics are more than four times as likely not to have health insurance as whites.

Alleviating Suffering 101 — Pain Relief in the United States–from NEJM

Philip A. Pizzo, M.D., and Noreen M. Clark, Ph.D., N Engl J Med 2012; 366:197-199 January 19, 2012

Philip A. Pizzo, M.D., and Noreen M. Clark, Ph.D., have authored a perspective essay in Thursday’s issue of the New England Journal of Medicine asserting that the amount of needless suffering caused by both acute and chronic pain in the United States is a major, overlooked medical problem that requires improved education at multiple levels, stretching from the implementation of new public health campaigns to better training of primary care physicians in pain management. Dr. Pizzo is Dean of Stanford University’s School of Medicine and Dr. Clark is director of the Center for Managing Chronic Disease at the University of Michigan. They were chair and vice-chair, respectively, of an IOM committee that issued a report in June that found that more than 116 million Americans have pain that persists for weeks.

At UA, the link is here.

2011 Success Rates, Applications, and Investigators

Posted on January 13, 2012 by Sally Rockey on the NIH Office of Extramural Research

Well, the numbers for 2011 (fiscal year) are in. Here are a few facts about the applications and people we supported in 2011.

Overall success rates for research project grants fell compared to 2010.	18%
Success rates for new investigators were equal to established investigators submitting new applications.	15%
The representation of women NIH investigators remained the same as in 2010.	29%
Women’s success rates were equal to men for new applications.	15%
Our commitment to supporting the individual investigator remains strong, with R01s and R37s representing a significant percentage of all research grants.	60%
The average size of R01-equivalent grants increased slightly compared to 2010.	$408,594
The average size of a center grant fell by 6% compared to 2010.	$1,863,037
Number of institutional training grant applications continued to decline, from a peak in 2005.	686

130 Medical Schools & Research Facilities to Join Forces to Serve Veterans & Families

First Lady Michelle Obama Announces Major Coordinated Effort by America’s Academic Institutions to Combat PTSD & TBI

Richmond, Virginia) Today, as part of First Lady Michelle Obama and Dr. Jill Biden’s Joining Forces initiative, the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) committed to creating a new generation of doctors, medical schools, and research facilities that will make sure our heroes and their families receive the care worthy of their sacrifice.  Recognizing veterans, service members and their families’ dedication and commitment, 130 schools associated with the AAMC and AACOM pledged to leverage their missions in education, research, and clinical care to train the nation’s physicians to meet the unique health care needs of the military and veterans communities.

“I’m inspired to see our nation’s medical schools step up to address this pressing need for our veterans and military families.  By directing some of our brightest minds, our most cutting-edge research, and our finest teaching institutions toward our military families, they’re ensuring that those who have served our country receive the first-rate care that they have earned,” says First Lady Michelle Obama.

Together, the AAMC and AACOM are committing to improve the education in their medical schools, the research in their laboratories, and the clinical care in their hospitals to better address the health issues that military families face.  Specifically, these organizations are committing to:

• Train their medical students as well as their current physicians, faculty, and staff to better diagnose and treat our veterans and military families;
• Develop new research and clinical trials on PTSD and TBI so that we can better understand and treat those conditions;
• Share their information and best practices with one another through a collaborative web forum created by the AAMC; and
• Continue to work with the VA and the Department of Defense to make sure that everyone is providing the best care available.

Research Bought, Then Paid For

By MICHAEL B. EISEN in the NYT 

Berkeley, Calif.

THROUGH the National Institutes of Health, American taxpayers have long supported research directed at understanding and treating human disease. Since 2009, the results of that research have been available free of charge on the National Library of Medicine’s Web site, allowing the public (patients and physicians, students and teachers) to read about the discoveries their tax dollars paid for.

But a bill introduced in the House of Representatives last month threatens to cripple this site. The Research Works Act would forbid the N.I.H. to require, as it now does, that its grantees provide copies of the papers they publish in peer-reviewed journals to the library. If the bill passes, to read the results of federally funded research, most Americans would have to buy access to individual articles at a cost of $15 or $30 apiece. In other words, taxpayers who already paid for the research would have to pay again to read the results.

This is the latest salvo in a continuing battle between the publishers of biomedical research journals like Cell, Science and The New England Journal of Medicine, which are seeking to protect a valuable franchise, and researchers, librarians and patient advocacy groups seeking to provide open access to publicly funded research.

The bill is backed by the powerful Association of American Publishers and sponsored by Representatives Carolyn B. Maloney, Democrat of New York, and Darrell Issa, a Republican from California. The publishers argue that they add value to the finished product, and that requiring them to provide free access to journal articles within a year of publication denies them their fair compensation. After all, they claim, while the research may be publicly funded, the journals are not.

NEJM at 200 Launches Fascinating Medical Discoveries Timeline

Click on the image to browse the timeline!

Project Puts Records in the Patients’ Hands

By RONI CARYN RABIN

In an old “Seinfeld” episode, Elaine goes to see a dermatologist about a rash, and is left sitting on the table in the exam room, alone with her medical chart. She opens the folder and almost immediately makes a sour face.

“ ‘Difficult’?” she says, reading aloud.

Let’s face it: We’ve all tried to imagine what the doctor’s been scribbling during our visits, what is to be found in that intimate record of frailties and phobias that we never see, even though it is all about us.

“The medical record is information that really belongs to the patient, but it’s treated like a classified document,” said Susan B. Frampton, president of Planetree, a nonprofit organization based in Derby, Conn., that promotes patient-centered approaches to health care. “It’s symbolic of the power differential in health care.”

Patients have a legal right to their records, though access can prove difficult. What would happen if patients were encouraged not just to see their medical records but to take them home, study them and really own them?

A research collaboration called OpenNotes has set out to answer this question, publishing the first results of a study on physician and patient attitudes toward shared medical records last month in Annals of Internal Medicine. For patients, at least, this seems to be an idea whose time has come.

The goal, said Dr. Tom Delbanco, a principal investigator of the study, is to engage patients more fully in their own health.

A Little Sugar And A Human Touch Can Ease Preemies’ Pain

by NANCY SHUTE

Premature babies have to endure to a lot of painful medical procedures, from blood draws to throat suctioning. Something as simple as a few drops of sugar water can ease that pain, but many preemies don’t get that help. And adding the comfort of touch helps, too.

Preemies in three Swiss hospitals were given either sugar water, held tightly, or given both when they had heel sticks to draw blood during their first two weeks in neonatal intensive care units. The babies who got both sugar and an embrace called facilitated tucking suffered the least, compared to babies who got just sugar or who were just held.

Sugar alone worked better than holding alone, according to the study, which was published in Pediatrics. It’s the latest of many that have shown that it is possible to relieve pain, even in the very young and fragile. Most preemies aren’t good candidates for the pain-relieving drugs used in older children and adults. So it’s been a huge relief to parents to know that treatments without drugs can work.