Tuesday, August 24, 2010

Egg Safety and the Egg Recall

We find ourselves in the midst of a massive egg recall. Current estimates say that 500 million eggs have been recalled. The CDC is the place to go for the latest information on these recalled eggs and salmonella.

Foodsafety.gov also is a great resource with updated information. Here is a link to the FDA site on how to identify if you are in possession of any of the recalled eggs.

Food safety surveillance must be vigilant and people deserve to have access to reports, citations, and above all the ability to consume food that is safe from contamination. Who is to blame in all of this - governmental red tape, the food industry, the distributors, the FDA for lack of oversight? Politico has an article that suggests a slow moving Senate may be the culprit.

Will this latest recall affect how/where you purchase food?

Thursday, August 19, 2010

More on Patient Centered Care & Homes

Here is an op-ed piece that I wrote some time ago that unfortunately didn't get published. However, this blog is a great place to put it!

Patient-Centered Health Care

Patient centered. To the average health care consumer, the notion that they themselves are the main focus of the care received is a no-brainer. However, the reality that exists in health care today is quite the opposite. More often, interacting with the current health care system is often a deeply dissatisfying and frightening experience, fraught with errors, miscommunication and waste. As a community-based nurse practitioner for 10 years, I practice within the fragmented confines of an inefficient and costly system and know how this current system is too often harming people. Fundamental reform is needed. According to the Institute of Medicine, care is often delivered in silos producing poorly coordinated and overly complex care. The current healthcare system is fraught with opacity and is unnavigable for most of us. For example, oftentimes patients don’t know how much a procedure or office visit will cost.

I imagine a near Utopian health care system where a patient can complete registration forms just once, have their complete health record accessed from virtually any Internet connection, communicate with their providers at their convenience and have their care coordinated by a team of professionals whose main objective is to improve health outcomes, decrease costs and deliver patient-centric, evidence- based health care. Such a system is currently undergoing pilot studies known as the Medical Homes Demonstration Project.

The time and cost savings potential of these Homes are virtually limitless. Technology will play a major role within the Homes, allowing for health systems to engage in rapid learning, so common in other industries. For example, imagine visiting your health care home, and then reviewing your laboratory results online the next day while your health care provider explains the meaning of the results by phone or by instant message. Text message alerts can be used to remind you when it is time to take your medications or get a colonoscopy. More importantly, practices will be better able to track the outcomes of care they are providing and consumers will be easily able to compare health care homes for quality.

Patients who are members of a patient centered home will take far more responsibility for the direction of their care. Gone will be the days of asking for the latest and most expensive and largely unproven medication because of their fancy commercials. Patients will have the opportunity to hear and evaluate the evidence for their condition and will make informed decisions, just as when you go to an accountant or lawyer, who provide options and a cost-benefit analysis.

Continuity of care will also be a hallmark of the Home. Your team of providers will know you and your medical history. Visits to specialists, dentists, and other health care professionals will be coordinated and integrated into a single repository of your health data. Along with the team, you will make the important health decisions.

The Medical Homes Demonstration Project is an exciting model of team-based, coordinated, high-quality and cost-efficient care. While the initiatives in the model aren’t new, the collective sum is unlike anything we have today. We a model that is patient-centered and where the exchange of data is efficient, coordinated and examined so the optimal care is delivered for that individual, time and place. We also need to ensure that the foundations of the homes are sound. That is, the physicians and nurse practitioners guiding the care must be available to care for the many patients who will utilize this model. Finally, for true health reform all the stakeholders – patients, clinicians, lawmakers and insurers must be willing to work together. Every American should have a such a home.

Wednesday, August 18, 2010

Team Work

The NY Times recently wrote about pharmacists expanding roles on the health care team. This is one example of a concept who's time has come that has the potential to make a significant positive impact on health care outcomes. Conceptually, this makes sense since as we all know, health care doesn't just take place in hospitals or in private offices. Patients are constantly making choices about their health in their everyday actions such as choosing what and when to eat. Pharmacies are located in the communities where people live and work and having access to a health care coach or guide in the form of a pharmacist (or other professional) gives people the opportunity to discuss their options and perhaps make better every day health decisions.

Community health nurses have long known this as they visit patients in their homes and assess their living environment and offer recommendations that could eliminate safety hazards for partially paralyzed patients following a stroke for example. They have also spent countless hours teaching patients about their medications including how, when and where to take them. One of the biggest obstacles for home care nurses is the limited insurance coverage and restrictions that dictates how many visits a patient would receive (if any). Now the concept is taken to the next level by getting members of the health care team out into the community. This has been done for years by federally funded community health centers but now is gaining traction in the mainstream.

I believe the more access people have to health care providers, the better we can focus on disease management and wellness as long as patients are engaged in their own health. Perhaps constant reminders, visibility of providers and access could drive individuals to play a greater role in the provision of health care. However, the costs of this increased access remains unknown. Common sense would dictate that the greater access people have would increase utilization of services thus increasing costs. Maybe this is true under our current fee-for-service payment structure but we know that this structure is flawed. As new payment models are introduced that incentivize wellness, active patient engagement and a focus on evidence-based outcomes, we can finally move beyond the mindset that health care only takes place during a visit with a provider.

Finally, remember there is no "i" in team. A multidisciplinary approach is needed to have the right subject matter experts teaching, educating, treating and caring for patients. That means no "captain of the ship" or "ruler of the roost" - just a team of professionals partnering with patients to meet their health needs.

Tuesday, August 3, 2010


Nope, not a post on the dysfunction of the health care system, just on the wonderful New York State politics at play. Today, accidental governor Patterson vetoed a bill that had passed both NYS Senate and Assembly that would have allowed NPs to sign DNR orders.

There were apparently some language/technical issues with the Bill. However, the most disturbing piece here is the Governors complete and total lack of understanding what NPs do (no real surprise there). He was quoted,

"Finally, I am not convinced that this is an appropriate function to be carried out by nurse practitioners. Decisions of life and death should be made by physicians, not nurse practitioners.”

Not convinced?!? Didn't you just sign a bill that eliminated collaborative agreements between physicians and nurse midwives? (That would be life). Ever hear of hospice care? (That would be death). I wonder if he understands exactly who is spending time with hospice patients in their final days of life. It is the team of professionals largely comprised of nurses, NPs, and physicians. (For a wonderful read about hospice care, see this piece written by an NP colleague.) In times when some Governors are blazing the trail to reduce barriers to NP practice (think PA Governor Ed Rendell), we are literally stuck here in NY to maintain the status quo, all the while when they are crying that there aren't enough providers to care for patients.

Of course, I am waiting for organized medicine to claim victory on this one touting how New Yorkers will somehow be "safer" because NPs won't be able to sign the DNR (I predict they will paint a ridiculous picture where NPs would sign DNRs left and right and slowly kill off New Yorkers one by one - maybe thats one way to keep health care costs down!).

Dysfunction. Election day can not come soon enough so that New Yorkers will hold elected officials accountable for their incompetence and narrow-mindedness. Oh, and hopefully we'll have a budget passed by then too (the one that was due on April 1st - April Fool's Day - go figure).