Category: Living Well Written by Michigan Chronicle Staff
ANN ARBOR—An improvement in the African-American infant mortality rate in Genesee County, Mich., can be attributed in part to a program that opened the eyes of many in the community to the challenges faced by African-American mothers, according to research led by a faculty member in the University of Michigan School of Public Health.
African-American infant mortality declined to a historic level in 2005 and has remained lower, following a series of tours designed to increase understanding of obstacles for expectant mothers in some of the most impoverished areas of Flint, Mich.
The Genesee County Racial and Ethnic Approaches to Community Health (REACH) program's "windshield" tours exposed some 1,000 physicians, hospital administrators and staff, faculty members, medical center residents, community partners and residents to the conditions that have contributed to poor maternal care.
"Local hospital staff members, especially medical residents, are from all over the world. They work long hours and commute to work by freeway, so they do not experience the same community conditions as many of their patients," said Daniel Kruger, research assistant professor at the U-M School of Public Health.
Kruger and REACH partners conducted pre- and post-tour surveys to measure participants' understanding of the issues mothers face and the conditions within the community, and to measure any changes that resulted from their increased knowledge.
The results are featured in an article published in the Journal of Primary Prevention.
The tours took place in areas where infant mortality was the highest, and participants noted such disparities as the lack of grocery stores, the number of abandoned and dilapidated buildings, a number of unsafe areas, the absence of police facilities, and unreliable transportation options.
Other research from the REACH project has shown that a deteriorated built environment predicts adverse birth outcomes, especially for African Americans, independent of traditional socio-demographic factors.
"We encourage everyone to have a healthy diet, but that is not easy when all that is in the neighborhood is fast food restaurants and convenience food at liquor stores," Kruger said.
After hearing about such difficulties, transportation officials created a new bus stop at a full-service grocery store at the city's edge.
Upon learning the barriers faced by expectant mothers in some of the most impoverished areas of the community, many of the participants reported adjustments in their health care practices, and several led advocacy efforts to encourage more change.
Health care professionals became more understanding about appointment tardiness and less hasty about canceling, local stores began to stock more produce and fresh food options, tobacco advertising was reduced due to advocacy efforts, and buses were rerouted and schedules became more reliable.
The project received funding from the Centers for Disease Control and Prevention REACH 2010 and REACH US grants.
U-M School of Public Health: www.sph.umich.edu
Daniel Kruger: www.sph.umich.edu/iscr/faculty/profile.cfm?uniqname=kruger
Genesee County REACH: www.gchd.us/Services/PersonalHealth/REACH
Last Updated on Friday, 21 June 2013 14:31
Category: Living Well Written by Mario Williams
Children had half as many emergency department visits if their primary care office had evening office hours on five or more days a week, according to new research from child health experts at C.S. Mott Children’s Hospital and Johns Hopkins University.
The new study was published online this month in The Journal of Pediatrics and will be presented at the AcademyHealth Annual Research Meeting.
“These findings are an important step in understanding where primary care practices and medical home programs can be most effective in making changes to enhance access,” says U-M pediatrician Joe Zickafoose, M.D., M.S., formerly a research fellow with the Child Health Evaluation and Research Unit at the University of Michigan C.S. Mott Children’s Hospital and now a health researcher with Mathematica Policy Research in Ann Arbor, Mich.
Primary care practices for children around the country are working on ways to make it easier for families to communicate with the practice to get advice and make an appointment. A key goal of these efforts is to help parents avoid the stress and expense of unnecessary emergency department visits, and extending office hours into the evening might be an effective way to do this, says Zickafoose.
Efforts around the country to improve health care for children have increasingly focused on the “medical home” as a model to make primary care practices more accessible, comprehensive, and focused on quality improvement. A central aspect of the medical home approach is to enhance families’ options for accessing their child’s primary care practice, including 24-hour phone advice, email or patient portal communication, same-day sick visits, and evening and weekend office hours.
The investigators found that many parents did not know whether enhanced access services were available in their child’s primary care office. Children whose parents reported that their offices had evening hours most nights of the week had half the number of emergency department visits compared to other children even after adjusting for factors such as health insurance and household income. But, only half of parents knew whether their child’s office was open after 5 PM.
Recent studies have shown that extended office hours seem to decrease emergency department use and some health care costs in adults, but no large studies have looked at practices for children.
The types of changes practices need to make to enhance access can be costly and time consuming, so information about the most effective changes could help practices decide where to commit their resources, Zickafoose says.
Data used in the study came from a national survey of parents. In the survey, parents were asked about characteristics of their child’s primary care practice, including 24-hour phone advice, email or patient portal communication, same-day sick visits, and evening and weekend office hours. They were also asked how many times they needed to take their child to the emergency department in the 12 months prior to the survey.
The investigators looked at the association between parents’ reports of the “enhanced access services” and the child’s emergency department visits, controlling for other factors that are frequently associated with emergency department use.
In this study, other enhanced access services, such as same-day sick visits, were not associated with the rate of emergency department visits.
“We hope that our study encourages parents and primary care practices to communicate more about when the office is open and when they can call for advice,” says Zickafoose, lead author of the study.
Last Updated on Wednesday, 19 June 2013 11:23
Category: Living Well Written by Mario Williams
When it comes to shopping for health care services, few publicly available tools help patients measure the best bang for their buck, according to a new study in the Journal of the American Medical Association (JAMA).
The federal government recently shone a light on health care prices by releasing hospitals’ charges for procedures and services – but that kind of information won’t likely help consumers trying to compare their care options, say authors of the study led by an expert from the VA Center for Clinical Management Research and the University of Michigan Health System.
A rigorous analysis of 62 publicly available state websites that aim to help patients to estimate or compare prices for health care services found that most sites only reported billed charges, not what patients were actually expected to pay.
The study also found that most websites focused on prices for in-hospital care, which patients often don’t have the luxury to plan ahead for. Meanwhile, sites rarely included prices for outpatient services like laboratory or radiology tests that are often predictable or less urgent, and therefore more shoppable. Experts also found that most patient resources didn’t provide information on quality of services alongside price information in situations where variations in price could be tied to differences in quality.
“There’s growing enthusiasm for improving transparency of prices for health services to help people be well-informed consumers and make better decisions about their care. The problem is that most of the information that’s out there isn’t particularly useful to the patients themselves,” says lead author Jeffrey T. Kullgren, M.D., M.S., M.P.H., health services researcher in the VA Center for Clinical Management Research and the division of general medicine in the U-M Medical School.
“As more Americans face high levels of cost-sharing in their insurance plans, it’s even more important to improve access to data that help them anticipate their out-of-pocket expenses and evaluate their options.”
People with chronic conditions who face high levels of cost-sharing would especially benefit from the ability to compare their out-of-pocket costs for different services, Kullgren notes. For example, a patient with diabetes who is enrolled in a high-deductible health plan may undergo several routine tests a year and has time to estimate and compare prices for those services ahead of time.
Most of the public websites analyzed, however, focused on reporting prices for in-hospital services that are often used to treat urgent, sometimes life-threatening conditions.
“Obviously if you have a heart attack or another emergency that sends you to the hospital, you’re not going to be researching prices of services ahead of time,” Kullgren says. “But if you know you’re due for a routine lab test, a radiology test, or an outpatient procedure that you will have to pay for, you often have time to assess the options. Unfortunately prices for those types of services are seldom available.”
Kullgren and his colleagues evaluated websites run by state-specific institutions such as state government agencies or hospital associations. The number of websites offering information on health care prices steadily rose from 2000-2012, and more than half of them launched after 2006.
Some sites, such as the New Hampshire HealthCost website, stood out as bright examples of how consumer-friendly data can be shared. The website allows patients to plug in their health insurance plan to receive a customized estimate of what certain health care services would cost them at different facilities in their community. But such instances are rare and often arise from specific state legislation that dictates the types of information that state governments collect from health care providers and publicly report, Kullgren says.
“We’ve definitely come a long way in increasing transparency about cost and quality for consumers in the last decade, but we’re still not reporting the key information patients need to maximize the value of their health care spending,” Kullgren says. “We aimed to identify opportunities for improvement so that we can better empower people to choose the care that’s right for them.”
Last Updated on Wednesday, 19 June 2013 10:14
Category: Living Well Written by Jackie Berg
The AMA overturns 2009 ruling and recognizes obesity as a disease today
More residents are aware of their cholesterol levels than their Body Mass Index (BMI), according to the Michigan Dept. of Community Health (MDCH).
Such ignorance cost the U.S. a whopping $344 billion in obesity-related health care costs annually, $200 billion of which could be prevented with increased education, awareness and treatment efforts detailed in a joint report issued by the United Health Foundation and the American Public Health Association and Partnership for Prevention.
Is obesity a social ill or a medical problem?
The American Medical Association (AMA) ended the debate with its decision to recognize obesity for disability status.
Its governing body, the House of Delegates, ruled against recognizing obesity in 2009 when the estimated health care costs associated with obesity hovered at $121 billion.
Skyrocketing obesity-related health care costs and conclusive medical studies supported the reversal, which is expected to spur better reimbursement for treating overweight individuals and support better health outcomes.
Doctors, meeting in Chicago for the AMA’s annual meeting, said such an endorsement will lead to greater investments and potentially health insurance coverage specifically for a diagnosis that someone is obese when there is a payment mechanism for evaluating and managing obesity, according to a Forbes post.
Not everyone agrees with the ruling, which divided AMA members.
Opponents worry that the decision will further encourage sedentary lifestyles and fatalistic behaviors. But the majority, including the nation’s largest healthcare providers, seems comfortable that the current reimbursement structure for obesity as a condition is adequate.
Even the IRS recognizes medical costs for the treatment of obesity among its eligible deductions.
Among those inevitable things in life, it appears that death and taxes remain. Scratch obesity off the list.
Last Updated on Wednesday, 19 June 2013 10:20
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