This article nicely highlighted the concerns with transitions in medical care and the use of 'medication reconciliation' in hospitals to track prescription medications. The most important point made was regarding the lack of a network between community providers and hospitals. In Rochester, a new network has been created, called RHIO, which links electronic medical records and allows physicians all over the region to access information. This is ideal in a city of Rochester's size, but how should we address the same problem in major metropolitan areas with much larger networks of providers? It seems that what methods we use now, such as medication reconciliation, has not been properly evaluated. In order to reduce medical errors, more HSR should be done on this important topic.
I really like the the idea behind this national scorecard because it helps us see which areas of the health care system are high functioning vs. deficient/dysfunctional.
This part of the article made a strong impression on me -- "...the need for a whole-systems approach, in which performance is measured and providers are held accountable for performance across the continuum of care" -- definitely rings a bell with the Meadows book that we read a couple weeks back. (Also makes me wonder if policymakers or politicians know/care about systems approach after watching some of the Republican candidates debate last night.)
The first two indicators that show "significant deterioration or no improvement" are "insurance and access" and "affordable care." Although my understanding of health care reform is still a work in progress, I'm looking forward to how it will help mitigate these two poor-performing indicators (along with others).
The National Scorecard on U.S. Health is an important tool. It points to the nation’s strengths and weakness which are keys to improvement. The fact that the U.S. ranked last out of the 16 industrialized nations in measures of mortality is disheartening but, other issues within the system point to how this can happen even in a nation with high health care expenditures and technology. The lack of access, inefficiency and inadequate preventative medicine are definitely contributing factors to preventable deaths. There is a lot of room for improvement in the system and being in the midst of health reform makes the measures outlined in the scorecard even more useful. Comparing the U.S. system to other industrialized nations is particularly useful because in many instances the U.S. system is far behind on key indicators. The recommendation that system improvement requires an “integrated system,” with a focus on improving the health of the whole population is a huge leap from the system today, which is fragmented and overly complex. Analysis of the system and comparison to other systems are both important but actually seeing the research translate into change will prove far more challenging with all of the different players in the health care system.
Our system can't even achieve the three objectives we set out to achieve (lower costs, increased access to care, increased quality). If this isn't a sign that an overhaul is needed, I don't know what is. ObamaCare might not even bring about the change we need...
I'm happy that we've managed to improve the quality of care the elderly receive. I hope to not upset anyone, but I wish we would focus more of our attention on the young and middle aged. They are the future of our country, and the elderly population is at the end of their life span. It makes sense that if we would focus more of our energies and time on those in the start of their lifespan, costs would be so much lower.
If only adolescents could vote! If only ALL middle aged people voted--then maybe we would have just as much power to influence the focuses of our health care system...
Although I agree in general to all of the above, I was also reading an article recently which discussed how cost has little to do with the actual quality of care achieved (I'll post the link when I find it). I'm not sure what the response to this idea would then be: do certain healthcare models produce a better quality of care? This makes sense, but at the same time, I would imagine that a certain model's success would also have to be attributed to the attitudes and goals of the people, too. For example, I've started working on a project for another class on the health care model in Switzerland: they spend less per capita than the United States, but more than most of the other countries in the EU (if not all of them). The citizens contribute more to their health insurance than in other countries, but their mandated basic insurance plan is comparable to a luxury, "Cadillac" plan in the United States. Plus, I think we have to recognize that providing care costs money, and insuring more people will cost more money, at least initially, because piecemeal approaches don't do much to change the overall system at play.
It’s interesting how much things can improve in areas that are “the focus of national initiatives”. Like the focus on controlling blood pressure. If health plans see this as their own responsibility (and publicly reported results help in taking this goal seriously by health plans) we can see a rapid progress. But of cause the progress is seen in measures of population that belongs to the plans. And those who do not have health insurance or do not have access to care due to other reasons did not benefit from “national initiative” simply because there is no entity who is responsible and who would care about the results. So it is not surprising that US ranks last out of 16 industrialized counties in mortality rates amenable to medical care. And the reason is the same - inequity of health care. With health care reform taking place I look forward to see improvement especially in areas that attributed to health care disparities.
I would like to comment on something Kyvaughn wrote above which I agree with completely. That is that more emphasis needs to be placed on the young and middle aged. Of course I would advocate for care based on need. Kyvaugn is right though that we need to especially focus on the future while respecting what has been accomplished in the past. I'm sorry that I can't find the source, but cost-benefit analysis has been done by age and it has shown that for every $1 spent on those 5 and under yields $1 or more in economic benefit. After 5 years of age we see economic loss. I will continue to look for the source.
This article nicely highlighted the concerns with transitions in medical care and the use of 'medication reconciliation' in hospitals to track prescription medications. The most important point made was regarding the lack of a network between community providers and hospitals. In Rochester, a new network has been created, called RHIO, which links electronic medical records and allows physicians all over the region to access information. This is ideal in a city of Rochester's size, but how should we address the same problem in major metropolitan areas with much larger networks of providers? It seems that what methods we use now, such as medication reconciliation, has not been properly evaluated. In order to reduce medical errors, more HSR should be done on this important topic.
ReplyDeleteI really like the the idea behind this national scorecard because it helps us see which areas of the health care system are high functioning vs. deficient/dysfunctional.
ReplyDeleteThis part of the article made a strong impression on me -- "...the need for a whole-systems approach, in which performance is measured and providers are held accountable for performance across the continuum of care" -- definitely rings a bell with the Meadows book that we read a couple weeks back. (Also makes me wonder if policymakers or politicians know/care about systems approach after watching some of the Republican candidates debate last night.)
The first two indicators that show "significant deterioration or no improvement" are "insurance and access" and "affordable care." Although my understanding of health care reform is still a work in progress, I'm looking forward to how it will help mitigate these two poor-performing indicators (along with others).
This comment has been removed by a blog administrator.
ReplyDeleteThe National Scorecard on U.S. Health is an important tool. It points to the nation’s strengths and weakness which are keys to improvement. The fact that the U.S. ranked last out of the 16 industrialized nations in measures of mortality is disheartening but, other issues within the system point to how this can happen even in a nation with high health care expenditures and technology. The lack of access, inefficiency and inadequate preventative medicine are definitely contributing factors to preventable deaths.
ReplyDeleteThere is a lot of room for improvement in the system and being in the midst of health reform makes the measures outlined in the scorecard even more useful. Comparing the U.S. system to other industrialized nations is particularly useful because in many instances the U.S. system is far behind on key indicators.
The recommendation that system improvement requires an “integrated system,” with a focus on improving the health of the whole population is a huge leap from the system today, which is fragmented and overly complex. Analysis of the system and comparison to other systems are both important but actually seeing the research translate into change will prove far more challenging with all of the different players in the health care system.
This is really unfortunate.
ReplyDeleteOur system can't even achieve the three objectives we set out to achieve (lower costs, increased access to care, increased quality). If this isn't a sign that an overhaul is needed, I don't know what is. ObamaCare might not even bring about the change we need...
I'm happy that we've managed to improve the quality of care the elderly receive. I hope to not upset anyone, but I wish we would focus more of our attention on the young and middle aged. They are the future of our country, and the elderly population is at the end of their life span. It makes sense that if we would focus more of our energies and time on those in the start of their lifespan, costs would be so much lower.
If only adolescents could vote! If only ALL middle aged people voted--then maybe we would have just as much power to influence the focuses of our health care system...
Although I agree in general to all of the above, I was also reading an article recently which discussed how cost has little to do with the actual quality of care achieved (I'll post the link when I find it). I'm not sure what the response to this idea would then be: do certain healthcare models produce a better quality of care? This makes sense, but at the same time, I would imagine that a certain model's success would also have to be attributed to the attitudes and goals of the people, too. For example, I've started working on a project for another class on the health care model in Switzerland: they spend less per capita than the United States, but more than most of the other countries in the EU (if not all of them). The citizens contribute more to their health insurance than in other countries, but their mandated basic insurance plan is comparable to a luxury, "Cadillac" plan in the United States. Plus, I think we have to recognize that providing care costs money, and insuring more people will cost more money, at least initially, because piecemeal approaches don't do much to change the overall system at play.
ReplyDeleteIt’s interesting how much things can improve in areas that are “the focus of national initiatives”. Like the focus on controlling blood pressure. If health plans see this as their own responsibility (and publicly reported results help in taking this goal seriously by health plans) we can see a rapid progress. But of cause the progress is seen in measures of population that belongs to the plans. And those who do not have health insurance or do not have access to care due to other reasons did not benefit from “national initiative” simply because there is no entity who is responsible and who would care about the results.
ReplyDeleteSo it is not surprising that US ranks last out of 16 industrialized counties in mortality rates amenable to medical care. And the reason is the same - inequity of health care. With health care reform taking place I look forward to see improvement especially in areas that attributed to health care disparities.
I would like to comment on something Kyvaughn wrote above which I agree with completely. That is that more emphasis needs to be placed on the young and middle aged. Of course I would advocate for care based on need. Kyvaugn is right though that we need to especially focus on the future while respecting what has been accomplished in the past. I'm sorry that I can't find the source, but cost-benefit analysis has been done by age and it has shown that for every $1 spent on those 5 and under yields $1 or more in economic benefit. After 5 years of age we see economic loss. I will continue to look for the source.
ReplyDelete