Consulo Indicium - 1/30/20
Information for your Consideration…
Organizational Structure and Quality of Care – In case you missed it, there was an important article several weeks ago in the New England Journal of Medicine. The researchers studied the acquisition and consolidation of the hospital industry and its impact on quality of care in a project supported by the Agency for Healthcare Research and Quality (AHRQ). It’s obvious to all of us that over the last couple of decades, consolidation has been dramatic – and, continues on many fronts throughout the nation. This is the first research I’m aware of that asks the question: So, what is the impact on quality of care? The researchers used Medicare and Hospital Compare data for the period 2007 – 2016 on four measures, including: clinical process, patient experience, mortality and rate of readmissions. The results were telling!! Overall, there was a modest decline in quality following the consolidation on the patient experience, no significant change on the 30-day readmission or mortality analysis with only a “slight” improvement in the clinical process measure. Not much change and within the margin of error for “no impact”. In other words, the consolidation movement is all about the back-office and finance and not about the care delivery side of the equation. The results should tell us something and provide a path forward for making health care better – I would think…
Of Mice and Men – The mouse study has been used for many, many years as a precursor to human level research. Why? Over the years, we’ve learned that the mouse can effectively serve as a surrogate for the human in many different forms. So, I was quite taken by some new research coming out of the Wyss Institute for Biologically Inspired Engineering at Harvard University and Harvard Medical School (HMS). Using an adeno-associated virus (AAV) three longevity-associated genes were injected into the mouse cells as a gene therapy. The results were dramatic! The gene therapy completely reversed several age-related diseases which offered a strong suggestion that a systems-level approach to treating age-related diseases could improve overall health and lifespan. Even more important, that is not the approach we take toward treating age-related diseases at the present time. The focus of treatment is currently on a more “piecemeal approach” as described by the first author of the study, Noah Davidsohn. Rather than a piecemeal approach, the study suggests that a more holistic approach at the macro level might be a much more effective strategy for dealing with aging and promoting health in aged individuals. While reading the entire study is important for gaining a full understanding of the implications, certain genes that protect against obesity, Type 2 diabetes, heart failure and renal failure were used. The genes had both individual and synergistic effects on preventing the occurrence of the problems mentioned. For example, injection of the FGF21 (weight/diabetic gene) caused complete reversal of weight gain and Type 2 diabetes in obese, diabetic mice. The injection of that gene along with the sTGFβR2 (kidney atrophy prevention gene) reduced renal fibrosis by 75% in the mice. There were other examples cited as well in the study.
The PTSD Experience – Dealing with post-traumatic stress syndrome (PTSD) can be debilitating. We’ve known that for years. But, a new study was recently public in JAMA Surgery showing that a significant number of gunshot victims continue to experience symptoms of PTSD coupled with substance abuse even years after the incident. Individuals that had such incidents in their lives had an increased incidence of unemployment, alcohol and drug abuse, as well as PTSD symptomology. With more than 70,000 Americans surviving gun shootings every year, the long-term effects and the toll is much more massive than the initial numbers might indicate.
And, The Opioid Problem Continues – We are all well aware of the toll that opioids have taken on society, especially in the rural areas throughout the nation. In large measure, the rural areas have been affected due to the economic situation experienced across the nation in recent years with the deterioration of economic infrastructure and capacity. A new study just came out for the more urban areas of the nation noting the same phenomenon. One study highlighted the impact of the opioid crisis on communities where an automotive plant had recently closed. It revealed an 85% higher opioid overdose death rate in the counties where the closure had occurred after five years. A strong link between economic hardship, feelings of depression and fatal drug use were clearly correlated. In a separate study the efforts of the Food and Drug Administration’s (FDAs) to curtail the opioid crisis were called into question. In 2012, the FDA implemented a number of new strategies designed to reduce opioid use, including: medication prescriptive guidelines, safe prescribing education, and requirements for companies to report prescriber behavior and patient safety efforts. But, by 2017, no evidence could be identified which showed that the FDA’s initiatives had worked. Hmmm – maybe the FDA could not keep up with the few companies that were engaging in sales to physician offices and spreading inappropriate information on use…
And, Then – There’s Vaping – By now, most of us in the health care community have become aware of the significant problems with vaping. As a former smoker – I mean 4PPD as a young college-age student – when the vaping problem first raised its head, my ears perked up. I quit smoking at the ripe old age of 30 – and, boy am I glad I did!! Vaping – from an intuitive level of thinking – is just like smoking 4PPD. There isn’t much difference. Now two studies were recently presented at the American Heart Association’s annual meeting which revealed that vaping is potentially MORE dangerous to the heart than smoking. One of the studies found that vapers had high levels of LDL (unhealthy) cholesterol and low levels of HDL (healthy) cholesterol compared to non-smokers. A second study revealed that the ability of the heart to pump blood was markedly diminished both during exercise and rest for the vapers compared to the non-vapers. The data is piling up. Now, the FDA needs to take action…
The good news; however, was a report by the CDC that adult smoking in the USA has now reached a record low of 13.7%. The CDC Director, Robert Redfield, MD noted in the release that, “This marked decline in cigarette smoking is the achievement of a consistent and coordinated effort by the public health community and our many partners”.
