Wednesday, May 12, 2010

Happy Birthday! Peel an Orange

A number of nurseries in the UK are trying something new for kids--no more birthday cake, or any sweets for that matter.  The elimination of the the age-old tradition of birthday cake is removed from children's diets as part of a program called the "Pre-school Nutrition Project," which is basically a program geared toward encouraging healthy eating.  It was set up by the Knowsley Borough Council and Chester University.  

I love this.  Stick a candle in an apple and I'm happy.  

But don't worry, birthday cakes and sweets are still allowed on the kids' birthdays--they just can't be eaten on-site.  The sweets will get sent home with parents, who can them decide on their own whether to allow their kids to indulge or not.  

Is this taking it too far?  Or is this a great idea to combat our overwhelmingly growing obesity problem and teach children healthy eating habits?  

Tuesday, May 11, 2010

Curative+Palliative=New Hospice?

Prior to health reform, Medicare (federal program for 65+ and disabled) only covered palliative (non-curative) care for individuals on Hospice care.  Hospice is both a type of care and a philosophy for terminally ill patients, focused on management and alleviation of pain symptoms and spending the end of one's life with friends and family in a manner of dignity and peace.  The focus is on quality of life, rather than lengthening duration of life, or providing cures, and occurs on one's home or a hospice facility.   

With health reform becoming law, Medicaid (state-federal program for the poor) must now provide both palliative care and curative care for children with terminal health conditions.  Additionally, Medicare is instructed to start approximately 15 demonstration projects around the US (rural/urban mix) to test this palliative and curative combination.  Basically, the demonstration projects will be 3-year programs allowing individuals to receive all currently covered Medicare services while simultaneously receiving hospice care.  If the demonstration projects show benefits (defined as the impact on patient care and quality of life) without increasing costs, this could become a new policy for Medicare.  It is listed as Section 3140 of the Patient Protection and Affordable Care Act (PPACA) (and its reconciled Healthcare and Education Reconciliation Act) and is called the Medicare Hospice Concurrent Care Demonstration Program.  

What do you think the outcome will be?  Will this combination of therapies work?  Will costs increase?  Does the addition of curative therapies confuse the point of hospice care (to end life peacefully and with dignity)? Will this make the end of life easier or more difficult for families? 

Wednesday, May 5, 2010

Robots & Quality Health Care

In yesterday's Wall Street Journal, John Carreyou talks about da Vinci (the robot, not the artist).  The da Vinci is a robot used to perform minimally invasive surgeries.  The machine costs between $1.4 million and $2.2 million and is manufactured by Intuitive Surgical.  It's operated by surgeons with joystick controls with the purpose of providing better visibility and greater flexibility and ease in surgeries.  

Tha da Vinci then is argued to be good for patients because leads to: less blood loss, smaller scars, and less infection.  Additionally, one study found da Vinci surgeries to cut hospital stays, thus reducing hospital costs by a third.  Sounds great, but what are the potential problems?

For one, if unexperienced doctors are performing these procedures, there could be harmful outcomes for patients.     

The da Vinci has been marketed as a technological advantage for small hospitals to be competitive with other hospitals.  One such hospital, Wentworth-Douglas Hospital, in Dover, New Hampshire, has been using the da Vinci for years.   The hospital has performed about 300 surgeries in 4 years.  As a comparison, individual robotic surgery experts, like Dr. David Samadi at Mt. Sinai, average 400-600 per year.  Now, Wentworth-Douglas hospital is under investigation for quality concerns with the robotic surgeries.  There have been some complications in surgeries, but the hospital also notes their da Vinci complication rates are below some recently published rates.

There isn't current data to compare the rates of complications across hospitals, comparing high-volume (high number of procedures in a year) to low-volume.  However, there is data on number of procedures and offsetting cots.  One recent study in the Journal of Urology said that doctors need to perform over 500 per year to offset costs of traditional surgery.

So how can we ensure that we can allow for technological innovation while ensuring consistently high quality medical care delivered to patients and keeping costs down?  If it takes continuous experience (i.e. high volume hospitals, specifically the physicians in the hospitals, performing the procedures frequently) to ensure top-notch quality, how do we ensure access to top quality to less-resourced areas?  Can we ensure equality in quality geographically?