Category: Research

Coronavirus: We are all in this together

published date
March 20th, 2020 by

In this edition of #CareTalk, Carecentrix CEO John Driscoll and I discuss the impact of COVID-19 in the US and around the world.  John retracts his earlier claim that the feds are doing a good job, and we go on to discuss the fact that we’re all in this together, universal coverage is a sensible policy, science matters, and government can help.

We agree with Tony Fauci, who said, “If it looks like you’re overreacting, you’re probably doing the right thing,” and we also look for signs of hope on the horizon (or just over it).


By healthcare business consultant David E. Williams, president of Health Business Group.

Health disparities: You ain’t seen nothing yet

published date
January 22nd, 2020 by
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Welcome to the machine

A survey in the UK showed that the gap in health between rich and poor is widening. From the US perspective that comes as a bit of a surprise. After all, don’t the Brits have universal healthcare through the NHS?

But of course, social determinants of health such as diet, exercise, stress, access to transportation, and education play a bigger role in health than the healthcare system. With socioeconomic disparities widening, it serves to reason that health disparities will grow, too.

So where do things go from here? They probably get worse –that’s my guess. Current political and economic forces in the US, UK and elsewhere point toward an exacerbation of current gaps. And as climate change makes the world a generally harsher environment it’s the poor who will be more adversely affected by floods, fires, air pollution, etc.

But in a decade or two that will be nothing compared with the haves and have nots wrought by the advancement of medical technology. Expect the well off to increasingly invest in tools that let them get further ahead: for example cyborg inventions that augment intelligence, strength, vision, hearing and more. Not to mention artificial organs and genetic interventions to greatly extend life.

Will such modifications make people happy? Maybe not. But it will enable them to lord it over the rest of society to an increasingly greater degree.

Enjoy!

What gets measured gets done. So be careful what you measure!

published date
October 21st, 2019 by

When I read ‘Fear of Falling’: How Hospitals Do Even More Harm By Keeping Patients in Bed I was reminded of the old adage, ‘What gets measured gets done.’

In this video I lay out three solutions to the problem of overzealous pursuit of fall reduction:

  1. Keep the measure but change the target so we’re not aiming for zero falls
  2. Add a new measure of how much patients are getting up and walking
  3. Reduce the penalties for excessive falls

What do you think?

By healthcare business consultant David E. Williams, president of Health Business Group.

Noisy hand dryers – how to cope? Hint: Lower you hands

published date
July 25th, 2019 by
fullerton02
Noisemaker in chief
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Noise reduction nozzles. Anyone ever seen one of these in the wild?

Nora Louise Keegan, a 13 year old Canadian has generated great publicity with her recent article in Pediatrics & Child Health (Children who say hand dryers ‘hurt my ears’ are correct: A real-world study examining the loudness of automated hand dryers in public places).

She conducted a rigorous study to measure the peak loudness of dryers at two distances from the wall, both with and without hands in the dryer’s air flow. She measured the sounds at different heights, corresponding to the ear canal height of younger and older kids and of adult men and women.

I encourage you to read the article. It is brief and well-written.

When I saw the write-up in the Washington Post, I immediately remembered writing about this very issue back in 2013 (when the author was about 7 and starting to develop an interest in the topic).

In my post (Hand hygiene and hearing loss. Avoiding the tradeoff) I wrote:

I’m not so fond of the Excel Xlerator. Sure it’s powerful, but it’s also incredibly noisy. I have sensitive ears, and I’m not embarrassed to admit that when I’m exposed to a loud sound I cover my ears with my hands. But of course if I’m drying my hands I can’t use them to protect from the noise. The Xlerator is loud enough that I suspect it’s a threat to hearing. At the very least it’s so annoying that I bet some people skip hand washing to avoid using it. My gym has one of these beasts and after being bothered by it for a while I decided to research the noise level.

I didn’t do any original research but I found a paper by Jeffrey Fullerton and a colleague from an acoustical consulting firm and corresponded with Jeff about the subject. He told me that the airstream is a major factor in the noise level and advised me to lower my hands a foot or so below the nozzle , which helps make things quieter. This is the approach I use to this day, with some success –although sometimes the sensor doesn’t see my hands and it does take a bit longer to dry.

The new research by Keegan quantifies the difference made by placing hands in the airflow and also identified the Xlerator as the number one bad boy.

When I read the article I circled back to my original sources. The article I cited is gone (maybe the firm snuffed it when the author moved on) but the Acoustical Society of America still has a summary on its site.

My favorite tidbit is that there is (was?) a noise reduction nozzle for the Xlerator. Presumably the manufacturer understood there was a problem.

I’ve never seen one of these in use. Have you?

By healthcare business consultant David E. Williams, president of Health Business Group.

 

 

Experiencing Patient Experience results from MHQP

published date
January 28th, 2019 by

For the past 14 years, Massachusetts Health Quality Partners (MHQP) has published results of its primary care patient experience survey. The information is useful to the practices themselves as they seek to improve, and to health plans looking to evaluate their networks, improve member service, and pay bonuses to the best practices.

This year MHQP added an analysis of free text feedback to its analysis, to give practices more color on the scores.

The consumer-facing site, Healthcare Compass lets users view ratings for individual practices and compare up to three at a time. Users can click on the individual categories to learn what each one means, what patients can do, what doctors can do, and where to find additional resources. For example, the “what you can do” tab in the communications section includes suggestions to speak up if you want your doctor to make eye contact and to ask the doctor to repeat back what you just said.

I used the site to compare three practices I am familiar with and the results match up well with my perceptions.

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Comparing MD offices
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Click on the Harvey ball to see the underlying data

There is a lot to like about MHQP’s patient experience reporting including:

  • It provides validated information on key elements of practices, for both adult and pediatric
  • The site is easy to navigate. The information is communicated in plain English and with simple, intuitive graphics. For even more detail, you can click on the Harvey balls (I didn’t realize this at first) to get the detail behind the score.
  • Providers have responded to the feedback by improving performance in key areas over the years, including communications and care coordination
  • The bottom line “willingness to recommend” percentage provides a useful benchmark for comparing practices
  • For the first time this year, MHQP issued awards for the highest performing practices for adults and pediatrics and for each domain of care. You have to go to the MHQP site itself to see it, but you can bet the doctors know it’s there!

MHQP has built trust with providers and payers by working collaboratively with them and taking their sensitivities into account when publishing the performance data. Here’s how public reporting of survey results could expand, subject to the consent of providers and payers and additional funding:

  • Provide more prominence to the actual scores for the measures, rather than just a three-level Harvey ball (full, half full, empty) showing relative performance. The current approach obscures the fact that median scores for certain categories are much higher than others. For example, the mean score for pediatric practices on patient-provider communications is 97.3% compared with 50.3% for empowering patient self care. While we’re at it, it might also be nice to see the range of scores. Does everyone cluster around 50% for self care or do some practices get into the 70s or 80s?
  • Provide reporting at the level of the individual MD for measures where that’s relevant, e.g., “how well doctors communicate with their patients” and “how well doctors know their patients,” while keeping practice-level reporting for measures such as, “getting timely appointments, care, and information.” The challenge here is that it would require a much bigger budget to reach the needed sample size
  • Provide a synthesis of the qualitative comments
  • Provide ratings of specialists as well as primary care

The pushback will be that there are valid reasons to present the information as it is and that expanding will be cost prohibitive, but on the other hand it would make this reliable and validated information more likely to be used.

Congratulations to MHQP for its continued success in shining a light on patient experience and making useful information available to all the stakeholders in the Massachusetts healthcare system.


By healthcare business consultant David E. Williams, president of Health Business Group.