On Informing Families a Child has Died

I am sharing a moving piece by Naomi Rosenberg, an emergency room doctor at Temple University Hospital in Philadelphia, about telling a mother her child has died. It is hauntingly familiar; over the past 20 years as a pediatric emergency medicine physician, I have followed a sequence similar to the steps she describes in her piece. ItContinue reading “On Informing Families a Child has Died”

Waiting for perfect science on antimicrobial resistance is a dangerous excuse for policy inaction

A discussion paper newly released by the National Academy of Medicine–Antibiotic Resistance in Humans and Animals–marks the 40 year anniversary of the first definitive evidence  that antibiotic usage in livestock results in the direct spread of antibiotic-resistant bacteria to humans. In releasing the report, the authors pull no punches: Thus, we have known definitively for more thanContinue reading “Waiting for perfect science on antimicrobial resistance is a dangerous excuse for policy inaction”

AHRQ and CMS Public Reporting Measures Fail to Describe the True Safety of Hospitals

A new study from the Johns Hopkins Armstrong Institute for Patient Safety and Quality, published in the journal Medical Care, performed a systematic review and meta-analysis of two sets of safety measures used for pay-for-performance and public reporting The measures evaluated in the study are used by several public rating systems, including U.S. News and World Report’s Best Hospitals, Leapfrog’s Hospital Safety Score,Continue reading “AHRQ and CMS Public Reporting Measures Fail to Describe the True Safety of Hospitals”

Medical ecology: tending the microbiome

Today, the Obama administration announces the new National Microbiome Initiative, intended to create scientific tools, discoveries and training techniques related to the human microbiome, the 100 trillion microbes that live in the human body. Tending the human microbiome may help in the treatment of infections, as well as disorders that would seem unrelated to microbes, including obesity andContinue reading “Medical ecology: tending the microbiome”

Pay for performance penalties fail again

The Incidental Economist astutely deconstructs the assumptions leading to the failure of the nationwide Hospital-Based Purchasing Program’s pay-for-performance penalties to reduce 30-day mortality.  These assumptions include: 30-day mortality is the right outcome measure because it is feasible to measure 30-day mortality is a valid proxy for the quality of inpatient care delivered. As shown with readmissions based penalties and with other payContinue reading “Pay for performance penalties fail again”

The Minimum Wage and the Social Determinants of Mental Health

A new study in Health Economics shows a temporal association between Britain’s minimum wage law and substantially improved mental health of the low wage workers benefitting from the policy. Source: The Minimum Wage and the Social Determinants of Mental Health

Should Doctors Undergo Opioid Prescribing Risk Training?

Earlier this week, an advisory panel recommended that the Food and Drug Administration require doctors who prescribe painkillers s to undergo training aimed at reducing misuse and abuse of the medications. The New York Times notes: It is the second time since 2010 that an F.D.A. panel has recommended expanding safety measures for painkillers. But the trainingContinue reading “Should Doctors Undergo Opioid Prescribing Risk Training?”

What are the priority Emergency Department (ED) presenting conditions for which ED-based Shared Decision-Making should be most urgently developed?

An article in this week’s Wall Street Journal focused on the development and use of shared decision-making (SDM) tools in the emergency department (ED).  Decision tools can help engage patients in making decisions about their care, including decisions about which tests and treatments to pursue.  In the ED, relevant decisions are (1) decisions involving two similarly reasonable optionsContinue reading “What are the priority Emergency Department (ED) presenting conditions for which ED-based Shared Decision-Making should be most urgently developed?”

Fall in life expectancy for white Americans

Newly released 2014 data from the National Center for Health Statistics on life expectancy showed a worrisome decline in life expectancy for whites in the US, to 78.8 years in 2014 from 78.9 in 2013. The good news is that, in contrast, life expectancy increased by 0.2 years for the Hispanic population (from 81.6 toContinue reading “Fall in life expectancy for white Americans”

April no-fooling!

This week’s NY Times science section debunks several common misconceptions.  All are interesting reads: Misconception: Baby teeth don’t matter. I am leading with the one I hear most often at work. Dental caries (cavities) is the most common chronic illness of childhood, and this misconception is one reason why. (Actually: Neglecting baby teeth can set a childContinue reading “April no-fooling!”