Volunteering in the U.S. – 64.5 million points of light

In his 1989 inaugural address, George H. W. Bush invited Americans to volunteer – to become one of a “thousand points of light”.  America was listening! According to data from the U.S. Bureau of Labor Statistics, there were 64.5 million volunteers who provided service at least once between September 2011 and September 2012. Most volunteers put in time through a religious or education/youth service organization; however, 7.8% – or approximately 5 million individuals – provided service in a hospital or health care setting.

The report, available online, provides a number of statistical analyses:

• Demographics: age, gender, race/ethnic group, educational attainment, marital status, employment status, parents of children under the age of 18 (it makes a difference!)
• Hours of volunteer service provided: almost 6% of all volunteers reported 500+ hours of service in the year; the median was 50 hours
• Number of organizations for which one volunteers
• Type of primary organization for which one volunteers: civic/political/professional/international, educational/youth service, environmental/animal care, hospital/health care, public safety, religious, social/community service, sport/hobby/cultural/arts, other 
• Main volunteer activity: the greatest number (10.9%) collected, prepared, distributed, or served food
• How volunteers become involved: self-directed, asked by someone else (boss, relative/friend/co-worker, someone in the organization, etc.)

The summary portion of the report also includes historical data back to September 2008.

Source: U.S. Bureau of Labor Statistics.  Volunteering in the United States – 2012.  [press release]  February 22, 2013.  http://www.bls.gov/news.release/pdf/volun.pdf   Earlier reports (back to 2002) are available at http://www.bls.gov/schedule/archives/all_nr.htm#VOLUN.

Managing the machine: a QA program for robotic surgery

A framework for assessing outcomes of robotic surgery across multiple specialties was developed by The Ohio State University School of Medicine working with staff at The Ohio State University Medical Center’s Quality Improvement and Operations Department.  The initial groundwork for the new QA tool was based on a retrospective study of medical records for robotic surgery in multiple disciplines, including:

• Urology
• General surgery
• Cardiothoracic surgery
• Otolaryngology
• Gynecology

The framework, using the balanced scorecard model (a sample of which is included in the article), provides benchmark data for multiple measures, including:

• total volume (measured quarterly)
• length of stay (days)
• readmission rate at 30 days
• return to surgery rate at 90 days
• mortality
• complications (accidental puncture)
• conversion to open procedure

The QA framework also accounts for surgeon experience with robotic procedures, length of procedure – cut to close time, and total OR time.  The two latter measures can be used to assess both clinical quality and operating room efficiency.

Source: Gonsenhauser, John, and others.  Developing a multidisciplinary robotic surgery quality assessment program.  Journal for Healthcare Quality.  34(3):43-53, May/June 2012.  http://onlinelibrary.wiley.com/doi/10.1111/j.1945-1474.2012.00205.x/pdf

To boldly go where no medical device has gone before!

Rejoice all you Star Trek fans!  The race is on to produce the first fully functioning medical tricorder  – a handheld diagnostic device for those of you not familiar with the epic space adventure.  If a winner is declared, the Qualcomm Tricorder X Prize will be $10 million. 

Full details of the competition, as well as application forms, can be found on the website of the X Prize Foundation at http://www.qualcommtricorderxprize.org/.  The criteria are few, but challenging:

• The device must weigh less than 5 pounds (handheld, remember?)
• The device must be user-friendly (the intended audience is consumers, not health care professionals)
• The device must be able to accurately diagnose a set of 15 diseases independently (no input from any kind of health care professional or provider)
• The device must be safe to use (no chance of electric shock, chemical exposure, punctures, infection)

The goal of the competition is to inspire a technological breakthrough that has the potential to revolutionize health care access and delivery by putting the necessary tools in the hands of the patient – literally!

To quote another famous Enterprise captain – “Make it so!”

Source:  Page, D.  Beam me up, Scotty!  Hospitals & Health Networks.  86(6):37.  http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/06JUN2012/0612HHN_FEA_Wireless&domain=HHNMAG

X Prize Foundation.  http://www.xprize.org/

Busy ED flows around patients

Cambridge Health Alliance – a three-hospital system headquartered in Cambridge, MA – has re-engineered its emergency department services using a patient-centered care model that has led to increased efficiency, happier staff, and higher patient satisfaction scores.

The new model includes:

• Patient partners – non-clinical staff who greet incoming patients, gather necessary information (name, date of birth or Social Security number, nature of emergency), and then take them immediately to either an assessment room or into the main ED for immediate care
• Multiple triage nurses – instead of one nurse doing all triage, there are now multiple nurses who perform this function, as well as providing nursing assessments and initiation of care for those patients with less emergent conditions
• Registration on the go - registration staff come to the patient’s room  and complete the registration process while the patient is being assessed and/or treated

The results speak for themselves:

• For rapid assessment patients, the average length of stay has dropped from three hours to slightly more than one hour
• 97 percent of patients are in a room within 5 minutes of entering the ED
• 90 percent of patients are seen by a provider within 14 minutes of entering the ED

Dr. Sayah, ED director sums up his department’s paradigm shift: “The new culture is that the patient is in the room, and we are going to move around that patient.  The nurse will come in, the doctor will come in, the registration will come in, whereas before the patient was moving around us.”

Source: System-wide flow initiative slashes patient wait times in the ED, boosts volume by 25%.  ED Management.  24(6):61-64, June 2012.  Available for purchase from publisher’s website at http://www.newslettersonline.com/user/user.fas/s=6/fp=3/tp=3?T=open_article,50062141&P=article

Patient satisfaction scores comes home

Data from the Home Health Consumer Assessment of Healthcare Providers and Systems (HH-CAHPS) debuted on the Home Health Compare site - http://medicare.gov/homehealthcompare/search.aspx - on April 19, 2012.  Based on the results of a 34-question survey, the data are designed to help consumers make decisions about Medicare-certified home health agencies using both qualitative and experiential information.  Some of the questions include:

• When you started getting home health care from this agency, did someone from the agency ask to see all the prescription and over-the-counter medicines you were taking?   Yes     No    Do not remember  [question 5]
• In the last 2 months of care, did you and a home health provider from this agency talk about pain?   Yes    No [question 10]
• In the last 2 months of care, how often did home health providers from this agency treat you with courtesy and respect?  Never    Sometimes    Usually    Always  [question 19]
• When you contacted this agency’s office, how long did it take for you to get the help or advice you needed?  Same day    1 to 5 days    6 to 14 days    More than 14 days    I did not contact this agency  [question 23]

The official HH-CAPHS website is at https://homehealthcahps.org/Home.aspx, providing access to the survey in multiple languages, the protocols and guidelines manual, instructions on data submission, and other support material.

Night-shift intensivists’ impact on ICU patient mortality

A study published in the May 31, 2012 issue of New England Journal of Medicine examines the impact that night-shift staffing of ICUs by intensivists has on patient mortality.  The findings, based on responses to an ICU staffing survey and analysis of medical records from 25 hospitals representing 49 ICUs and over 65,000 patients, support the conclusion that for ICUs in which intensivists are not routinely used or consulted during the day shifts (low-intensity staffing), their presence on the night shift lowers patient mortality.  In those ICUs where intensivists are used on a 24-hour rotation (high-intensity staffing), the presence of intensivists during the night shift has no statistically significant impact on patient mortality.   

Source: Wallace, David J., and others.  Nighttime intensivist staffing and mortality among critically ill patients.  New England Journal of Medicine.  366(22):2093-2101, May 31, 2012.  http://www.nejm.org/doi/pdf/10.1056/NEJMsa1201918

More on intensivists: Campbell, Victoria.  Intensive enough?  New England Journal of Medicine.  366(22):2125-2125, May 31, 2012.  http://www.nejm.org/doi/pdf/10.1056/NEJMe1203772

New IOM report focuses on funding health improvement rather than financing health system reform

” . . . it is no longer sufficient to expect that reforms in the medical care delivery system (for example, changes in payment, access and quality) alone will improve the public’s health.”

The Institute of Medicine has issued the third and final report of a series on public health that focuses on how altering the fundamental physical and social environment will lead to improved health in the general population, an essential requirement of any effective reform of the system that delivers health care services.

For the Public’s Health: Investing in a Healthier Future addresses its thesis in four chapter:

• Introduction and Context
• Reforming Public Health and Its Financing
• Informing Investment in Health
• Funding Sources and Structures to Build Public Health

The committee responsible for the report also propose ten recommendations, among which are the following:

• Greater legislative/regulatory flexibility in the allocation of funds by state and local health agencies in pursuit of public health improvement initiatives;
• Reduction in the provision of clinical care services by public health agencies so that they can focus on the delivery of population-based services, such as nurse home visits and health promotion activities;
• Development of  a model chart of accounts for use by public health agencies to improve their tracking of funds and measuring program effectiveness;
• Doubling the current federal appropriation for public health, with periodic adjustments to ensure public health agencies’ ability to deliver a minimum package of services;
• Reallocation of state and local funds from paying for services currently reimbursed through Medicaid or state health insurance exchanges to financing population-based prevention and health promotion initiatives conducted by public health departments. 

Source: Institute of Medicine.  For the Public’s Health: Investing in a Healthier Future.  Washington, DC: National Academies Press, 2012.  Free online edition at: http://books.nap.edu/openbook.php?record_id=13268.

The two previous reports are also available online.

For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges.  2011.  http://www.nap.edu/catalog.php?record_id=13093

or the Public’s Health: The Role of Measurement in Action and Accountability. 2010.  http://books.nap.edu/openbook.php?record_id=13005

Faster than a speeding bullet: the growth in health expenditures since 1950

Victor Fuchs, Stanford University, has written a brief (5-page) article on the explosive growth in health care expenditures from 1950 to the present.  Fuchs positions this growth as “one of the most important economic trends in the United States in the post-World War II era” and supports that claim with some brief analysis and a couple of head-spinning comparisons:

• health care spending has gone from representing 4.6 percent of gross domestic product (GDP) in 1950 to more than 17 percent in 2009
• per capita expenditures (2009 adjusted dollars) has risen from $407 to $6,807 in the same time span
• out-of-pocket expenditures represented 56 percent of 1950 health expenditures; in 2009, they represented only 14 percent

Beyond the actual dollars being spent, Fuchs takes a quick look at the changes over time in the sources of payment and the health services being purchased, hospital operations, physician practice, and overall changes in the structure of the health care delivery system.

He ends by identifying some of the more pressing dilemmas facing anyone (or any political party) interested in successful reform, but points out the sad fact that, ” . . . every past prediction of a sustained slowing of the growth of health expenditures has been proved wrong.”  It makes one wonder if Sisyphus had it so bad after all.

Source: Fuchs, V.  Major trends in the U.S. health economy since 1950.  New England Journal of Medicine.  366(11):973-977, March 15, 2012.  Full text: http://www.nejm.org/doi/pdf/10.1056/NEJMp1200478

Buyers’ guide for outfitting bariatric services

Healthcare Purchasing News has put together a buyers’ guide targeted to bariatric services that includes 36 product categories and the names and websites for 64 companies. 

Source: 2012 bariatric product vendors.  Healthcare Purchasing News.  36(2):16-17, February 2012.  Full text at http://www.hpnonline.com/inside/2012-02/1202-BariatricChart.pdf

Patient-family councils – case study in person-centered care

Who: Catholic Health Initiatives

What: Patient-family advisory council (system-wide initiative)

When: Planning was initiated in 2009; implementation began in 2010 and has been completed

Where: Englewood, CO-based hospital system with 76 hospitals in 18 states

How: Read article, including side bar on “How CHI Rolled Out Its National Program”

Why: To support CHI’s philosophy of person-centered care -

• Personalization of care according to patient and family needs, preferences, and values
• Comprehensive care encompassing body, mind, and spirit
• Collaborative care that links patients and their families to providers

Source: Haycock, Camille.  Patient-family councils make the difference.  Health Progress.  93(2): 24-29, March-April 2012.  Full text at http://www.chausa.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=8147