Tuesday, May 21, 2013

Health sites too complex, full of cliches: study

By Ivan Oransky
NEW YORK (Reuters Health) - The importance of health literacy hit home for Lisa Gualtieri when a Cambodian refugee diagnosed with cancer asked her to act as a patient advocate.
She played the role of a "salty tongue," a Cambodian expression that paints outspokenness in a positive light. But even though the patient's family was in the room when doctors took the time to answer every last question about test results and treatment options, the refugee's family would call Gualtieri hours later to review what doctors had said.
A new study, published Monday in JAMA Internal Medicine, suggests one potential reason for the family's confusion: Despite good intentions, many experts may be creating educational materials that are too difficult for patients and their families to grasp.
"Patients will often come to the office, and one of the first things they say to you, especially about technical information, they'll say that they've been on the Internet, and they'll quote one or two key phrases back to you," said study author Dr. Charles Prestigiacomo. "Unfortunately, the little soundbites, while accurate, may not be complete."
Prestigiacomo and his colleagues at the University of Medicine and Dentistry of New Jersey (UMDNJ) in Newark used a number of readability scales - including "simple measure of gobbledygook (SMOG) grading" - to test how challenging materials by 16 different medical specialty societies were to read.
The average reading level of the online materials by groups ranging from the American Society of Anesthesiologists to the American Psychiatric Association, fell anywhere from ninth grade to the sophomore year of college. (See one example here: http://bit.ly/10ItXRX.)
That's far above the fourth-to-sixth grade level recommended by the American Medical Association and by a number of U.S. government agencies such as the Department of Health and Human Services.
Those guidelines are based on the fact that the average American writes at 7th or 8th grade level, said Nitin Agarwal, a medical student at UMDNJ and another author of the study.
"We might not be cognizant of the population reading our articles, who might need something more simple," Agarwal told Reuters Health.
The current study's findings agree with those of previous work by some of the same researchers looking at patient education materials in individual specialties.
"Organizations often end up using jargon," said Gualtieri, who studies health communication at Tufts University in Medford, Massachusetts, but was not involved in the new research. They end up "using the language they're accustomed to as opposed to (the language) the people they're trying to reach are accustomed to using," she told Reuters Health.
"You have to think about reaching people where they are," she added.
Sometimes, according to Prestigiacomo, that means using analogies. "There are only so many ways you can describe an aneurysm," said the UMDNJ neurosurgeon, who tells patients such ballooning blood vessels are "like a blister on a tire."
"The problem is that it's not quite perfectly accurate," he said. "But sometimes we have to realize that simplifying it to an analogy may be the best way for patients to understand it."
When it came to the quality of the writing, obstetrics and gynecology really failed to deliver. Materials in that specialty had nearly six cliches for every 50 pages, and also "contained the highest total number of indefinite article mismatches (the improper use of "a" or "an")."
"You go from region to region in the U.S., people aren't familiar with what each cliche refers to," said Agarwal.
And in a sentence that might have unintentionally demonstrated the authors' point, they report, "The proportion of passive voice sentences used throughout resources ranged from 4% in family medicine to 27% in neurological surgery."
"Concise and to the point is the way to go for this sort of stuff," Agarwal said. Gualtieri recommended that those who produce such materials consider why people are coming to their sites, and what they're looking for. She echoed the authors' suggestion that such sites use pictures and videos.
"The organizations represented should be happy that people are at their sites," Gualtieri said. "It's high-quality, reliable information, there's a lot out there that isn't. If one of these organizations could read something like this, and say, ‘we're not doing everything we can for those who most read us,' that would be a lovely outcome from a study like this."
That's already happened. Prestigiacomo showed the results to one of the specialty groups whose patient materials were analyzed before publishing the paper, and the organization committed to rewriting them.
And the Cambodian man with cancer is doing well, Gualtieri said. "The treatment was successful."
SOURCE: http://bit.ly/13GdSBH JAMA Internal Medicine, online May 20, 2013.

Venrock Invests $10 Million In Medical Second Opinion Platform ConsultingMD



5/21/2013 @ 7:15AM

As chief of interventional radiology at Stanford Hospital specializing in blood clots in the leg, Lawrence “Rusty” Hofmann routinely got requests from patients around the world for a second opinion on a treatment or diagnosis. One patient from Australia was ready to mortgage her house to come see him in Palo Alto, Calif. Hofmann asked instead for her medical records and images—sent in PDFs and CDs, and referred her to a specialist in Melbourne.
Still, it wasn’t until two years ago, when Hofmann’s then 8-year-old son was struck with a rare blood disorder, that the radiologist realized how lucky he was to have easy access to the world’s top experts. “That galvanized everything,” says Hofmann. “My son wouldn’t have gotten the care he needed. I got frustrated with patients who come see me, and who received the standard of care—which is 10 to 12 years old; what you want is state of the art.”

In 2012, Hofmann formed ConsultingMD, a selection of 230 specialists culled from medical institutions such as Duke, UCSF, and Harvard, and considered experts in their field. He won’t disclose the number of cases the physicians have handled so far, but says that six out of ten cases resulted in a different treatment or diagnosis.
There are no numbers on the frequency of second opinions. Medicare might pay in some cases for another surgical opinion; same with health insurance companies. Patients may still feel uneasy about seeking the opinion of another physician, and when they do they’re typically motivated by disappointment, as some studies have shown. One thing is clear though, misdiagnoses are common, deadly, and costly. According to research by Johns Hopkins, over the past 25 years diagnostic errors accounted for nearly 29% of insurance claims at a cost of almost $40 billion, and more often resulted in death.
Medical centers such as Johns Hopkins, Cleveland Clinic, Partners HealthCare and MD Anderson offer second opinion services. Johns Hopkins charges $565 to review a case, and $250 to interpret an image. Rival WorldCare works with a consortium of hospitals that includes Duke, Mayo Clinic , and Partners; and Best Doctors boasts more than 53,000 physicians in its network.
“When you start throwing out numbers, you miss the point; we’re skeptical of large number games,” says Owen Tripp, ConsultingMD’s chief executive, and formerly chief operating officer of Reputation.com. For example, Hofmann is listed in Best Doctors’ roster, although the company never contacted him. ConsultingMD has contracts with its specialists, and covers them for malpractice. It pays them on a per case basis, from $400 to several thousand dollars, a rate they can determine.
ConsultingMD plans to make its money by offering its services to employers as a cost-saving tool, for a few dollars a month per employee. (Tripp won’t disclose amount, or the number of customers). ConsultingMD gathers the patient’s medical record, test results, and images in one file, and matches the patient with the right specialist—sometimes with the help of an algorithm. The start-up says it delivers a consultation within 48 hours—more or less what competitors promise. Venrock’s $10 million investment will help ConsultingMD expand its network. Partner Bryan Roberts who now sits on its board is one of only two health IT investors on the Midas List.
What if second opinions have the reverse effect of driving up costs? Says Hofmann: “It will lower costs, because experts know when to bring out the heavy guns, and when not to.”

Life Sciences Organizations to Discuss ACOs, Patient Engagement and Reimbursement at National Healthcare Conference

Published: May 20, 2013 
New Premier healthcare alliance supplier collaborative extends participant enrollment, focuses on emerging trends in healthcare
 — Life sciences organizations participating in the Premier healthcare alliance’s Healthcare Innovators Collaborative will meet face-to-face during a national healthcare conference in June.
The Healthcare Innovators Collaborative engages life sciences organizations in dialogue about ever-evolving healthcare delivery, measurement, financing and risk. Participants share knowledge from health systems nationwide that are implementing accountable care organizations (ACOs), as well as Premier research on care coordination, new payment models, resource utilization and more.
Premier’s Breakthroughs Conference and Exhibition, taking place June 11-14 in San Antonio, brings together leaders in healthcare from across the U.S. to share learnings and innovations. Healthcare Innovators Collaborative members will gather to discuss emerging trends in healthcare such as ACO implementation, patient engagement and the dynamics of reimbursement transition. Speakers include physician and integration leaders from alliance members AtlantiCare, H. Lee Moffitt Cancer Center and Research Institute, Integrated Solutions Health Network, Methodist Health System and Summa Health System.
Nine pioneering organizations specializing in pharmaceuticals, biotechnology, medical devices, laboratory and more have already joined the collaborative. These organizations recently participated in the collaborative’s first interactive session on emerging trends in accountable care.
The Healthcare Innovators Collaborative is led by a panel of experts, including representatives from the Institute for Healthcare Improvement, Premier executive leadership, and Premier members such as Saint Francis Health System.
The collaborative provides updated information on the latest healthcare reform topics, issues and legislation. Charter members have access to insights gained through Premier’s PACT™, QUEST®,and Bundled Payment Hospital and Health System Performance Improvement collaboratives. This includes information on:
  • Care delivery and integration changes;
  • New payment models;
  • Utilization;
  • Engagement and cost measurements;
  • Patient-centered medical homes;
  • Drug and device management;
  • Data warehousing; and
  • High-value care networks.
“Sharing best practices helps providers identify better ways to serve their communities,” said Wes Champion, senior vice president of Premier Performance Partners. “In the Healthcare Innovators Collaborative, life sciences organizations better support providers in this changing environment, finding new ways to collaborate and innovate together.”
Charter level enrollment in the collaborative is available on a limited basis until May 31.
For more information or to join the current charter members of the Healthcare Innovators Collaborative, please email scott_pope@premierinc.com.

About the Premier healthcare alliance, Malcolm Baldrige National Quality Award recipient
Premier is the nation’s largest performance improvement alliance of more than 2,800 U.S. hospitals and 93,000 other sites using the power of collaboration and technology to lead the transformation to coordinated, high-quality, cost-effective care. Owned by healthcare providers, Premier operates a leading purchasing network with more than $5 billion in annual savings. Premier also maintains clinical, financial and outcomes databases based on 1 in every 4 patient discharges. A world leader in measurably improving patient care, Premier has the largest performance improvement collaboratives in America, including one in partnership with the Centers for Medicare & Medicaid Services. Headquartered in Charlotte, N.C., Premier also has an office in Washington. https://www.premierinc.com. Stay connected with Premier on FacebookTwitter,LinkedIn and YouTube.

Read more here: http://www.heraldonline.com/2013/05/20/4876366/life-sciences-organizations-to.html#storylink=cpy

FDA brings patient engagement to drug, device approval process | EHRintelligence.com

FDA brings patient engagement to drug, device approval process | EHRintelligence.com

FDA brings patient engagement to drug, device approval process

Author Name Jennifer Bresnick   |   Date May 20, 2013   |  

Physicians aren’t the only ones placing an emphasis on getting patients engaged in their own care to encourage healthy choices and preventative medicine.  While the Food and Drug Administration (FDA) doesn’t have to worry about Stage 2 meaningful use requirements demanding a 5% engagement rate, the agency does play a critical role in patient care, and is working on allowing the public to be more involved with drug approval, medical device development, and regulatory processes before products ever hit the shelves.  With the launch of its new Patient Network website, the FDA invites patients to learn about the approval process, ask questions of senior administrators, and provide feedback on research and regulation processes from the comfort of their own keyboard.
The FDA has recruited and involved patient advocates for years, allowing them to attend meetings and learn about the development of pharmaceutical products and medical monitoring devices to focus their input and provide an important real-world perspective for the agency during its review procedures.  The new Patient Network site is intended to be an interactive tool to foster engagement, and “brings together, in one place, information that is important to patients, making it easier for them to find what they are looking for and to understand the significance of their findings.”
“This web site will open new channels of communication with the public,” says Dr. Margaret A. Hamburg in a blog post announcing the site launch.  “It will help patients and consumers better understand the process for determining whether medical products are safe and effective and encourage them to contribute their ideas and concerns about the development and regulation of these products.”
As the FDA plans to take a greater role in the regulation of mobile health devices and medical equipment, input from patients will become increasingly valuable as mHealth products and applications continue to skyrocket in popularity.  The agency plans to regulate high-risk apps used in conjunction with standard devices, and has been wrangling with opponents about a 2.3% excise tax on devices for more than two years.  Final guidance about the FDA’s involvement in mHealth regulation is expected soon.
The website will help give patients a voice by allowing them to comment on ongoing regulatory decisions, live chat with senior officials, become a patient representative, and submit questions or comments online.  The site “provides a new model for FDA to follow in making its inner workings transparent to the public,” Hamburg says. “It ushers in a new era of access and input for patients and consumers that will evolve with the needs of both communities.”