Issue 76 - Thursday 04 December 2008
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Articles
1. EDITORIAL.
By Grazier, Kyle L. Journal of Healthcare Management, Mar/Apr2008, Vol 53, Issue 2:p71-71
Abstract: The article discusses various reports published within the issue, including one by Dean Smith on the private and public responses to the problem of the medically uninsured and another by Sandy Lutz on the current trends and future implications of consumer-driven healthcare.
2. Interview with Lucian Leape, MD, HFACHE, Adjunct Professor of Health Policy, Department of Health Policy and Management, Harvard School of Public Health
Journal of Healthcare Management, Mar/Apr2008, Vol 53, Issue 2:p73-77
Abstract: An interview with Lucian Leape, professor of health policy at Harvard School of Public Health, in the U.S. is presented. Leape explains the reasons that motivated him to leave 20 years of clinical practice as a pediatric surgeon for a career that is centered on health policy. He also discusses the factors that hinder the significant progress toward reducing medical errors. Lastly, he offers details on incentives available for health care workers to promote safety as a priority.
3. The Uninsured in the U.S. Healthcare System.
By Smith, Dean G. Journal of Healthcare Management, Mar/Apr2008, Vol 53, Issue 2:p79-81
Abstract: The article presents an analysis regarding the 2006 social and economic surveys conducted by the U.S. Census Bureau that determined the insurance status of individuals in the nation. According to the 2006 Current Population Survey (CPS) there were 47 million individuals in the U.S. Meanwhile, the Agency for Healthcare Research and Quality, through its Medical Expenditure Panel Survey (MEPS) found that 50.4 million Americans were uninsured as of the first half of 2006. In conclusion, the number of individuals without insurance is growing.
4. What Do Consumers Want?
by Lutz, Sandy. Journal of Healthcare Management, Mar/Apr2008, Vol 53 Issue 2:p83-87
Abstract: The article reports on the findings of the 2007 PriceWaterhouseCooper LLP (PWC) Health Research Institute (HRI) survey regarding healthcare issues such as satisfaction of consumers' needs and their transaction capabilities in the U.S. The survey indicates that consumers are heavily using the web to research health information such as finding remedies and looking up price and quality information. According to the survey, convenience is driving payers and policymakers to rethink about primary care issues such as cost, workforce and healthcare quality.
5. Chief Nursing Officer Retention and Turnover: A Crisis Brewing? Results of a National Survey
By Jones, Cheryl B. Journal of Healthcare Management, Mar/Apr2008, Vol 53, Issue 2:p89-106
Abstract: Anecdotal evidence suggests growing concerns about chief nursing officer (CNO) dissatisfaction, intent to leave, and turnover. However, little evidence documents the magnitude of the problem or whether CNO turnover requires direct action. This article reports the results from the first phase of a three-phase study examining CNO turnover and retention in U.S. hospitals. CNOs were invited to complete an online survey to gather data about their experiences with turnover and to identify CNO retention issues. Our sample includes responses from 622 CNOs employed in hospitals and healthcare systems across the United States. Approximately 38 percent of the respondents reported having left a CNO position-13 percent within two years before the survey and 25 percent within five years before the survey. Of these, approximately one-quarter had been asked to resign, had been terminated, or had lost their jobs involuntarily. When asked about the context of their departure, a high percentage reported leaving their position to pursue another CNO position (50 percent)or for career advancement (30 percent); approximately 26 percent reported leaving because of conflicts with the chief executive officer. Of great concern is the finding that approximately 62 percent of respondents anticipate making a job change in less than five years, slightly more than one-quarter for retirement. Respondents clearly indicated that CNO turnover is a problem that requires attention. The knowledge gained from this study can be used by healthcare leaders to develop strategies and policies aimed at recruiting and retaining CNOs and easing the transition for CNOs and others in the organization when CNO turnover does occur. [ABSTRACT FROM AUTHOR]
6. Rural Hospitals and Spanish-Speaking Patients with Limited English Proficiency
by Torres, Myriam et al. Journal of Healthcare Management, Mar/Apr2008, Vol 53 Issue 2:p107-120
Abstract: Between 1990 and 2000, the Latino population in the United States increased by 61 percent, becoming the largest minority group. Language differences contribute to patient safety and access to healthcare concerns for limited English proficiency (LEP) Latinos. The objectives of this research were to determine the techniques rural hospitals use to accommodate Spanish-speaking LEP patients, to identify strengths and barriers to providing language services, and to describe local approaches to language assistance services. Surveys were mailed to 841 hospitals in 544 rural counties with moderate to high Latino growth rates between 1990 and 2000. A total of 319 rural hospitals responded. Nearly all rural hospitals reported having tools to help patients communicate language needs. The most commonly used tools include brochures, language identification posters, and language identification cards. Strengths were institutional support for language assistance services, staff willingness to use interpreters, and access to telephone language lines. Principal barriers included lack of funding for interpreters, lack of local language training programs, and lack of state agency support. Hospitals that serve counties with higher Latino population growth rates reported higher demand for services compared with those counties with smaller Latino population growth rates. Several innovative approaches were also identified. Various language accommodation resources, tools, and strategies are available for hospitals to help them serve LEP clientele. Hospitals should routinely review their policies and procedures for language assistance services to ensure compliance with federal and Joint Commission standards. [ABSTRACT FROM AUTHOR]
7. Board Engagement in Quality: Findings of a Survey of Hospital and System Leaders.
by H. Joanna Jiang et al. Journal of Healthcare Management, Mar/Apr2008, Vol 53, Issue 2:p121-135
Abstract: Hospital governing boards assume an important role in improving delivery of quality care in the hospital. More knowledge about the prevalence and impact of particular board activities can help them perform this role more effectively. This study draws from a survey of hospital and system leaders (presidents/chief executive officers [CEOs]) that was conducted in the first six months of 2006 with a total of 562 respondents. The survey contained 27 questions on various aspects of board engagement in quality. More than 80 percent of the responding CEOs indicated that their governing boards establish strategic goals for quality improvement, use quality dashboards to track performance, and follow up on corrective actions related to adverse events. The adoption of other practices was reported less frequently. Only 61 percent of the respondents indicated that their governing boards have a quality committee.The existence of a board quality committee was associated with higher likelihoods of adopting various oversight practices and lower mortality rates for six common medical conditions measured by the Agency for Healthcare Research and Quality's Inpatient Quality Indicators and the State Inpatient Databases. Hospital governing boards appear to be actively engaged in quality oversight, particularly through use of internal data and national benchmarks to monitor the quality performance of their organizations. Having a board quality committee can significantly
enhance the board's oversight function. Other potentially useful activities-such as board involvement in setting the agenda for the discussion on quality, inclusion of the quality measures in the CEO's performance evaluation, and improvement of quality literacy of board members-are currently performed infrequently. [ABSTRACT FROM AUTHOR]
8. American health policy: cracks in the foundation
by Nyman, J A. Journal of Health Politics, Policy & Law, Oct 2007, Vol 32 Issue 5:p759-83
Abstract: Much American health policy over the past thirty-five years has focused on reducing the additional health care that is consumed when a person becomes insured, that is, reducing moral hazard. According to conventional theory, all of moral hazard represents a welfare loss to society because its cost exceeds its value. Empirical support for this theory has been provided by the RAND Health Insurance Experiment, which found that moral hazard-even moral hazard in the form of effective and appropriate hospital procedures-could be reduced substantially using cost-sharing policies with little or no measurable effect on health. This article critically analyzes these two cornerstones of American health policy. It holds that a large portion of moral hazard actually represents health care that ill consumers would not otherwise have access to without the income that is transferred to them through insurance. This portion of moral hazard is efficient and generates a welfare gain. Further, it holds that the RAND experiment's finding (that health care could be reduced substantially with little or no effect on health) may actually be caused by the large number of participants who voluntarily dropped out of the cost-sharing arms of the experiment. Indeed, almost all of the reduction in hospital use in the cost-sharing plans could be attributed to this voluntary attrition. If so, the RAND finding that cost sharing could reduce health care utilization, especially utilization in the form of effective and appropriate hospital procedures, with no appreciable effect on health is spurious. The article concludes by observing that the preoccupation with moral hazard is misplaced and has worked to obscure policies that would better reduce health care expenditures. It has also led us away from policies that would extend insurance coverage to the uninsured.
9. Litigating the science of breast cancer treatment
by Jacobson, P D et al. Journal of Health Politics, Policy & Law, Oct 2007, Vol 32, Issue 5:p785-818
Abstract: Beginning in the late 1980s, many health insurers refused to cover high-dose chemotherapy with autologous bone marrow transplant (HDC/ABMT) for high-risk and metastatic breast cancer patients. Insurers denied coverage because there was no persuasive evidence of clinical effectiveness. In response, many women sued to compel coverage. After years of litigation and the expenditure of approximately $3 billion, randomized clinical trials (RCTs) showed that the procedure was no more effective and possibly more harmful than conventional therapy. To understand whether and how litigation contributed to the diffusion of the procedure, we conducted a series of case studies that examine the litigation tactics and strategies used by defense and plaintiffs' counsel. Despite the fact that HDC/ABMT lacked proven scientific effectiveness, insurance defense attorneys were unable to stop the procedure's diffusion. Plaintiffs' attorneys had a much easier and more sympathetic story to tell and were able to exploit vulnerabilities facing the defense.
10. The impact of the adoption of gag laws on trust in the patient-physician relationship
by Patel, M S and Chernew, M E. Journal of Health Politics, Policy & Law, Oct 2007, Vol 32 Issue 5:p819-42
Abstract: Physician organizations, policy makers, and patient advocates have expressed concern that health plans have contractually limited the freedom of physicians to communicate with their patients. In response, many states have adopted gag laws that limit the ability of managed care contracts to restrict patient-physician communication. We examine the impact of these laws on patient trust in the physician. We analyzed patients'ratings of trust in their physicians in states before and after adoption of gag laws. Individuals in states that had such laws throughout the study period were used as the comparison group. The analysis is based on a nationally representative sample of adults obtained from the 1996-1997 and 1998-1999 Community Tracking Study Household Surveys. After adjustment for patient characteristics, it was estimated that the adoption of gag laws had no statistically significant impact on trust in the physician for the average patient. However, the adoption of gag laws is estimated to have increased trust in the physician by a modest amount (25 percent of a standard deviation) for health maintenance organization (HMO) enrollees who did not have a usual source of care. Gag laws may assure HMO enrollees without a usual source of care that their physicians are free to speak candidly about treatment options. This does not necessarily imply that physicians are prohibited from speaking freely in the absence of such laws, but gag laws indicate concerns (justified or not) that patients have about unrestricted communication with their health care providers.
11. Medical malpractice reform and insurer claims defense: unintended effects?
by Ambrose, J M and Carroll A. Journal of Health Politics, Policy & Law, Oct 2007, Vol 32 Issue 5:p843-65
Abstract: In response to recent and past medical malpractice insurance crises, most states have implemented reforms meant to stabilize premiums and coverage availability. The importance of understanding whether these reforms implicitly affect the behavior and incentives of plaintiffs, attorneys, medical providers and malpractice insurers in the intended way is crucial to policy makers, if they are to achieve their goal. This study specifically examines the effect of reforms on the claims defense efforts of insurers, given that defense expenses account for approximately 30 percent of malpractice premiums. Using state data for the period 1998-2002, we regress claims defense expenses against a variety of reform variables. These include seven tort reforms (noneconomic damage caps punitive damage limits, attorney fee limits, modified collateral source rule, modified joint and several liability doctrine, mandatory pretrial screening, and statute of limitations) and two government-sponsored insurance mechanisms (joint underwriting associations and patient compensation funds). Claims defense expenses are found to be higher in the presence of noneconomic damage caps, punitive damage limits, and attorney fee limits-an unintended and counter productive effect of reform-but are lower with mandatory pretrial screening and patient compensation funds.
12. Sanctions and recidivism: an evaluation of physician discipline by state medical boards
by Grant, D and Alfred, K C. Journal of Health Politics, Policy & Law, Oct 2007, Vol 32 Issue 5:p867-85
Abstract: This article descriptively assesses how physicians are disciplined by state medical boards throughout the United States, drawing on a nationwide database of sanctions delivered during the period 1994-2002. We identify the frequency and severity of disciplinary actions, the offenses leading to actions, and the degree to which sanctioned physicians are subsequently sanctioned again in the future. The most significant finding is that there are a very large number of repeat offenders among physicians who have received board sanctions, indicating a possible need for greater monitoring of disciplined physicians or less reliance upon rehabilitative sanctions.
Journals - Table of Contents
13. From Nursing Times, Vol 104, No 46, 18 November 2008
NT COMMENT
13A. PCTs should ensure practice nurses are fully rewarded
NEWS
13B. Needlestick dangers neglected; Prime minister praises nurses; Queen's nurses key to NHS plans
13C. Work to rule threat over pay deal; NT Awards 2008: The Winners
13D. A real trooper remembered - Ms Monica Baly; Lords to decide if POVA breaches human rights; More graduates being employed
13E. Children's nurses upset at criticism; Productive Ward will drive up NHS quality; Call for trusts to protect children
CLINICAL NEWS
13F. Aggressive foot ulcer treatment cuts deaths; Safer sex ignored in middle age; Ovary transplant sparks concern; Probiotics trialed against C. difficile
13G. Genetic testing can aid heart disease prevention; Chemotherapy risks understated
NEWS ANALYSIS
13H. What happens when your trust is taken over?
OPINION
13I. Nurses have to behave professionally online
LISTEN UP
13J. Let's hear the good news about care homes
CAREER DILEMMA
13K. Dilemma [How can I combine my teaching and clinical skills in a way that will enhance my career?]
13L. Town planning can be a major health intervention
13M. Practice Nurses deserve more
13N. The 'Oscars' of nursing [Coloured photographs of the recipients of Nursing Times Awards 2008]
NT CLINICAL
13O. Raising awareness of stroke risk factors among women
13P. Exploring the anatomy and physiology of ageing [Part 8 - The reproductive system]
13Q. Erectile dysfunction and heart disease [1: Overview]
DEVELOPMENT
13R. Using telephone interpreters to communicate with patients
RESEARCH
13S. Promotion of a community culture in nursing research
13T. Urine screening for clients with learning disabilities
13U. Preventing constipation in critically ill patients
13V. Encouraging adolescents to seek continence help
CLINICAL LEADERSHIP
13W. Nurses take the lead in practice
14. From Canadian Nurse, Volume 104, Number 9, November 2008
PERSPECTIVES
14A. Artist's work honours - tradition of healing in the military
14B. Annual survey supports effective HHR planning
14C. New ethics resources released
14D. Capacity building in Southern Africa
SPECIAL FEATURES
14E. CNA's past presidents offer their perspectives on the role
14F. CNA's role in protection of the public reflects changing times
14G. Giving nurses a voice in patient safety
14H. A century of research in nursing human resources
14I. Community health nursing research - a retrospective
14J. Roles, research of resilience - the evolution of advanced practice nursing
Conferences, training and seminars
15. Study Health Sciences in Wellington - Masters in Health Sciences or specialist disciplines
University of Otago Wellington
More information: 04 385 5543 or 0800 80 80 98
Website: wwwuow.otago.ac.nz
Email: postgrad.wsmhs@otago.ac.nz
16. Primary Focus 3 - New Zealand made Primary Health Care. He tangata, he tangata, he tangata Conference 2009
Conference Themes:
- Health promotion and population health
- Evolution of primary health care and lessons learned
- Workforce and multi-disciplinary teams
- Focus on the patient
- Innovation and the future of primary health care
Date: Tuesday 24 - Thursday 26 February 2009
Venue: Westpac Stadium, Wellington
For further information: www.primaryfocus.org.nz
17. The 29th Annual Meeting of the Australian Neuroscience Society
Date: 27 - 30 January 2009
Venue: National Convention Centre, Canberra
More information: http://www.sallyjayconferences.com.au/ans2009/index.html
18. Research Synthesis for Policy and Practice
Date: 9 - 12 February 2009
Venue: School of Government, Pipitea Campus, Victoria University of Wellington
Theme: COMPASS (Centre of Methods and Policy Application in the Social Sciences) at The University of Auckland has invited Professor David Gough, University of London, to present this course on systematic reviews as part of their NZSSN Short Course 2009 Summer Programme.
More Information: http://www.nzssn.org.nz/pages/viewcourse.php?id=15&courseid=72
19. Introductory Analysis of Linked Data
Date: 9 - 13 February 2009
Venue: School of Government, Pipitea Campus, Victoria University of Wellington
Theme: Presented by Professor D'Arcy Holman, University of Western Australia. Organised by COMPASS (Centre of Methods and Policy Application in the Social Sciences) at The University of Auckland as part of their NZSSN Short Course 2009 Summer Programme. More information: http://www.nzssn.org.nz/pages/viewcourse.php?id=14&courseid=72
20. International Critical & Feminist in Health & Social Justice Conference
Date: 16 -19 April 2009
Venue: Auckland
Theme: This conference aims to provide a platform for the presentation and discussion of papers challenging societal perspectives and issues of social injustice within health. In Aotearoa New Zealand, the Treaty of Waitangi similarly challenges us to consider the principles of partnership, protection and participation of Maori and other indigenous peoples in our critique of health care. The focus of the conference is on fostering the interchange of ideas along these critical lines among consumers, policy analysts, practitioners, educators and researchers from all health and related disciplines.
More information: http://www.aut.ac.nz/schools/health_care_practice/centre_for_midwifery_and_womens_health_research/cfpnc2009.htm
21. Neuromuscular Alliance 50th Anniversary Conference, Window on Tomorrow
Date: 7 - 9 May 2009
Venue: Sky City, Auckland
Theme: A milestone event, this will be a worldwide cutting-edge exposition of the latest in science, medicine and research into neuromuscular conditions
More information: http://www.nma2009.org.nz/
News - National
22. Source of salmonella outbreak stumps officials
Christchurch Press - 04 December 2008
A national outbreak of a "potent" and rare type of salmonella has health officials puzzled.
http://www.stuff.co.nz/thepress/4781429a19753.html
23. National scheme has little impact on diabetics: study
NZ Herald - Thursday Dec 04, 2008
Control of blood sugar levels in Maori and Pacific diabetics showed little improvement in two years, despite their participation in the national "Get Checked
programme", a new study has found.
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10546463
24. GP college welcomes extra funding for trainees
NZ Herald - Thursday Dec 04, 2008
The Government will pay for an extra 25 doctors to start training as general practitioners from February, to help ease the GP shortage.
http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10546483
25. Concrete cancer hits hospital
Dominion Post - Thursday, 04 December 2008
"Concrete cancer" and a leaky reservoir are among several costly problems besetting Wellington Hospital after years of deferred maintenance.
http://www.stuff.co.nz/dominionpost/4781367a23882.html
26. Increased collaboration for health services
Otago Daily Times - 4 Dec 2008
Collaboration between Otago and Southland diabetes and endocrinology services is about to increase, with two Otago consultants soon to begin monthly outpatient clinics at Invercargill Hospital.
http://www.odt.co.nz/news/dunedin/34530/increased-collaboration-health-services
27. Surgeon failed to warn patient of risks
Dominion Post - 02 December 2008
A general surgeon could face prosecution for failing to explain surgical risks to a patient who later died
http://www.stuff.co.nz/dominionpost/4779820a6479.html
News International
28. Aid's lessons for Zambia's Young
The Guardian Weekly - Wednesday November 26th 2008
In southern Zambia, everyone knows someone who has died of Aids, says community worker Wilson Nyirenda. But he believes it's only by educating the young that organisations like his can bring about lasting change.
http://www.guardianweekly.co.uk/?page=editorial&id=831&catID=3
29. Bolivia's miracle of sight
The Guardian Weekly - Wednesday October 22nd 2008
Operation Miracle is a Cuban health programme that provides free eyecare to low-income patients around the world. The brainchild of Fidel Castro, it began in 2004 as a cooperative initiative with Venezuela and has since expanded to 33 countries. In Bolivia, South America’s poorest country, thousands of patients every year have their sight returned to them by Cuban doctors. Yanet Valdez Morales is one of them, a Cuban ophthalmologist whose life's mission is to bring light to the poor.
http://www.guardianweekly.co.uk/?page=editorial&id=774&catID=3
30. War against elephantiasis
The Guardian Weekly - Thursday October 16th 2008
One-fifth of the world’s population is said to be at risk from lymphatic filariasis, a painful and disfiguring disease that can wreck lives and cause sufferers to be shunned by society. Also known as elephantiasis, it enters the body via microscopic worms and causes severe swelling of the limbs, breasts and genitals. Dr Mwele Malecela, of the Global Alliance to Eliminate Lymphatic Filariasis (Gaelf), says that efforts by programmes like hers to treat the disease are proving to be successful.
http://www.guardianweekly.co.uk/?page=editorial&id=768&catID=3
