0 A Watershed Year What 2013 Holds for the Patient Centered Medical Home PCMH

The savvy Jeff Levin-Scherz, who blogs over at Managing Healthcare Costs has responded to the Disease Management Care Blogs snarky "Prattling Pinheads of Pessimism" post on the topic of the Patient Centered Medical Home (PCMH). 

Hes not a nattering nabob of negativity or a prattling pessimistic pinhead, says he.  Hed like to be thought of as a skeptic seeking substantiation.   The DMCB wholeheartedly approves of the agreeable alliterative appellation.

2013 may well turn out to be the watershed decision year for the PCMH:

If theres no published peer-reviewed proof that it reduces health care costs, nabobs, pinheads, skeptics and policymakers will need to decide if no evidence of an impact on costs is the same as evidence of no impact on costs.

If the answer is no, THEN well then have to decide if the traditional "X causes Y" mathematical approaches to derive proof (such as a comparison of averages using standard power calculations and/or impact on expected or observeed trend) are equal to the task in a very "statistically noisy" environment involving complicated human beings.

If that answer is no, THEN well have to decide if reasonable and informed assessments of potential cost reductions, used by countless other businesses every day in other sectors of the economy, are good enough,

If that answer is no, THEN well have to decide if there is face value to the PCMH. This involves a contrast of any patient benefit versus its incremental cost.  If the benefit is worth the cost.....

THEN we may have to decide if consumers are willing to pay for it, or if health care costs will need to be cut elsewhere to pay for it.

Stay tuned!

0 The 3 Legged Stool of Telemonitoring The Device A Non Physician Professional and the Patient

Just when the Disease Management Care Blog has barely learned to control itself when its in the company of clueless electronic health record (EHR) techno-weenies, enter the equally intolerable "telemonitoring" enthusiasts. Their jargon-laced claims of pan-medical and cost efficacy is enough to give the DMCB a migraine.

Their bombast is easy to spot.  According to this new class of leprechauns, small wearable telemonitoring devices for blood pressure, temperature, breathing, heart rate, weight, calories, blood sugar, cholesterol, brain waves, nail length, eye-blinks and minutes spent in the bathroom upload the data to the doctor who, thusly armed with critical insights of well-being, can do more of their... doctor stuff like... give out some prevention and stomp out disease.

For the best example of how that is simply not true, the DMCB is reminded of this negative December 2010 heart failure symptom telemonitoring study that alerted the patients physicians about "variances."  The DMCB readership already knows that physicians are already busy and just dont have the time to fit one more task into their busy days.  Thats doubly true if the data is unfiltered and without any context.

Yet, while the DMCB is unwilling to hop aboard the telemonitoring train, that doesnt mean that this has nothing to offer.  In the DMCBs estimation, itll increase quality and probably lower costs if it is combined with two other key ingredients:

1) a non-physician professional being in the loop, who can a) monitor the information and b) contact the patient with significant variances and c) use a combination of clinical judgement and standing orders/protocols to guide a patient response (which, by the way, doesnt have to include seeing the physician).  An example is here.  Theyre usually nurses and they can be part of the Patient Centered Medical Home or as part of a population health management program (or both).

2) an empowered, engaged, enabled and educated patient who understands the "output" of the device and can respond autonomously, confidently and collaboratively.  While some readers may pooh-pooh the DMCBs unrealistic idealism, the DMCB has found that most patients are smarter than they are given credit for.  As far as the DMCB is concerned, if a patient can manage a telemonitoring device, they can usually deal with the non-physician professional and also have some insight about what the device is "saying."
   
The DMCB thinks of it as a three legged stool.  Having telemonitoring patients be 1) passive and 2) unsupported bystanders while their data uploads scramble their overburdened physicians workflows isnt health reform, it isnt cost saving and it isnt quality. 

Image from Wikipedia

0 Broccoli is Good for Breast Cancer Patient

Broccoli is Good for Breast Cancer Patient | Properties of broccoli for cancer has long been a concern of scientists. In a recent research note, broccoli and cabbage can also increase the life expectancy of breast cancer patients, and even delay the recurrence of cancer.

Research conducted in China on 5,000 women aged 20-75 years who were diagnosed with breast cancer found that those who often group cruciferous vegetables like broccoli, cabbage, or mustard, the risk of dying from breast cancer 62 percent lower. Among other benefits, the risk of disease recurrence is also 35 percent lower.

According to new research presented by Sarah Nechuta, a researcher from Vanderbilt Epidemiology Center in Nashville, Tenn.. "This study demonstrates that cruciferous vegetables contain bioactive compounds that may protect against breast cancer," he said.

Researchers claim that their findings are in contrast to previous research, because this time the findings look at the influence of the consumption of broccoli and cabbage family vegetables in patients who have been diagnosed with breast cancer.

The respondents in this study were women who took part in the Shanghai Breast Cancer Survival Study. The researchers interviewed volunteers over six months after being diagnosed to gather information about diet, lifestyle and clinical factors such as tumor stage. They were also asked about how many vegetables at 18 and 36 months after being diagnosed.

Results showed that women who consume broccoli 62 percent less likely to die from breast cancer during the study period of about five years less than women received vegetable intake. While the risk of recurrence was 35 percent lower among women who ate broccoli.

Researchers said the relationship a lower risk of death and cancer recurrence was even adapted by other factors, including soy and meat consumption, vitamin intake, physical activity, stage of cancer, income and education levels. On average, the women in this study ate approximately 3.5 ounces of broccoli family of vegetables a day.

Even so, Dr. Laura Kruper, director of the Women Health Center, City of Hope in Duarte, Calif., said, "These findings are very difficult to demonstrate cause and effect relationships." He added, need to do more studies in other populations and particularly in the long term to see the relationship between the two.

"I always tell my patients to limit alcohol (four glasses a week) and sugar, and eat more vegetables and less red meat consumption," said Kruper. Kruper added, alcohol and physical inactivity are the two factors known to increase risk of breast cancer. For more info about Breast Health

Source: Kompas