My lede:

Catheter-related bloodstream infections kill at least 30,000 patients in the intensive care unit each year, the Centers for Disease Control and Prevention estimates. About 250,000 hospital patients contract these infections annually, costing an estimated $9 billion in extra care.

Yet, within three months of implementing a simple set of interventions in 2004, more than 100 Michigan ICUs slashed their central-line associated bloodstream infection rates by 66%. The median infection rate dropped from 2.3 per 1,000 catheter days to near zero. The program, which focuses on using checklists of evidence-based interventions and changing hospital culture, was funded by the Agency for Healthcare Research and Quality.

The whole shebang.

My lede:

Scores of competing pay-for-performance programs using uncoordinated sets of quality measures have made it hard for physicians to earn health plan incentive payments and yielded little in the way of better patient care.

That is why hopes were high for the Integrated Healthcare Assn., a California quality collaborative whose P4P program drew the cooperation of the state’s seven largest HMOs and 225 medical groups representing 35,000 physicians. The health plans aggregated their data to capture physician performance more accurately, and everyone agreed on a common set of quality metrics.

From 2004 to 2007, IHA — operating the country’s biggest P4P program — paid out $203 million in bonus payments. But the quality breakthrough many expected has yet to arrive, according to a study in the March/April issue of Health Affairs, a leading policy journal (content.healthaffairs.org/cgi/content/abstract/28/2/517/).

The whole shebang.

My lede:

Three studies published in March highlighted the importance of improving physicians’ conversations with dying patients.

Previous studies have shown that the 5% of Medicare patients who die each year account for 30% of Medicare’s costs, with 78% of last-year-of-life expenses occurring in the month before death. But there may be a way to help reduce these costs, according a March 9 Archives of Internal Medicine study of 603 dying cancer patients at seven hospitals, oncology clinics and hospices.

The study found that patients who had conversations with their doctors about whether to focus on life extension or pain relief were more likely to die at home and spent less time in intensive care units, undergoing chemotherapy or on ventilators. Patients benefiting from talks with their doctors had a slightly better quality of life and survived just as long as those who did not have end-of-life-care discussions with physicians.

The whole shebang.

My latest story is a feature on the book, “Three Generations, No Imbeciles: Eugenics, the Supreme Court and Buck v. Bell,” about the 1927 U.S. Supreme Court decision that sanctioned sterilization of the so-called feebleminded.  The article includes three short book excerpts, a Q&A with the author and a slideshow.

The lede:

This first excerpt shows the flimsiness of the trial evidence that purported to prove the “feeblemindedness” of three generations of Bucks — grandmother Emma, daughter Carrie and infant granddaughter Vivian. It is what was used to justify sterilizing Carrie under Virginia’s eugenics law.

Red Cross nurse Caroline Wilhelm was new to Charlottesville, having moved to town the previous February to become county administrator of public welfare. She had little firsthand experience with Carrie apart from bringing her to Lynchburg on the train early in the summer. Her first comments clearly revealed the real reason that Carrie was sent to the Virginia Colony. Wilhelm explained that Mr. Dobbs [Carrie’s foster father] had reported to the welfare office that Carrie was pregnant and that “he wanted her committed somewhere — to have her sent to some institution.”

The whole shebang. Here is a 2007 story I wrote about the centennial of Indiana’s enactment of the world’s first eugenic sterilization law.

My lede:

A proposal to eliminate the medical ethics department at the University of Tennessee Health Science Center’s College of Medicine would deprive medical students of critical training, said bioethicists upset by the plan.

Experts said they had never heard of a medical school eliminating its bioethics program. The Liaison Committee on Medical Education says ethics must be taught, though it does not require a separate department.

The whole shebang.

My lede:

State legislators have reacted to the furor over the January births of octuplets conceived through in vitro fertilization by drafting bills to more closely regulate artificial reproductive technology.

The most aggressive bill, filed by Georgia Sen. Ralph Hudgens, would restrict to two the number of embryos a doctor could transfer during any IVF cycle in women younger than 40. The measure limits women 40 or older to three embryos. Octuplet mother Nadya Suleman, 33, told NBC’s Today that her physician transferred six embryos and two split.

The whole shebang.

My lede:

Since the 1999 second-degree murder conviction of Jack Kevorkian, MD, the Michigan pathologist known as “Dr. Death,” the assisted-suicide debate has shifted from criminal trials to whether doctor-aided deaths should be legally allowed.

Assisted suicide is now legal in Oregon, Washington and Montana. Meanwhile, Hawaii, New Hampshire and New Mexico are considering “death with dignity” legislation.

The late February arrests of four people for their alleged involvement in the helium-induced suicide of a Georgia man could hinder passage of physician-assisted suicide laws.

The whole shebang.

This one wound up on the front page. I think it’s a pretty good story. My lede:

The relationship between doctors and drug reps may never be the same again.

Pharmaceutical companies — battered by a sluggish drug pipeline, the looming loss of blockbuster patented drugs, an economy in recession and scrutiny of their relationships with physicians — are re-examining the value of sending drug reps into doctors’ offices. Detailers are struggling to grab a shrinking slice of physicians’ valuable time and attention while adjusting to new drug industry rules banning freebies such as pens and notepads.

The whole shebang.

My lede:

The National Quality Forum has endorsed 45 changes it said doctors and hospitals should make to reduce disparities and provide more culturally competent medical care. More than 22 million U.S. residents speak limited English, and 34 million were born in another country, according to the American Medical Association’s Ethical Force Program.

The NQF standards, adopted in late February, cover areas ranging from leadership and management systems to patient communication and health care work force diversity. A comprehensive approach is critical to improving the care that patients with low health literacy and different cultural expectations receive, said Winston Wong, MD, who co-chaired the committee that endorsed the best practices first developed by other health care organizations.

“One does not just go through a checklist and declare the organization as culturally competent,” said Dr. Wong, director of the disparities improvement and quality initiative at Kaiser Permanente in Oakland, Calif. “It needs to be a dynamic process.”

The whole shebang.

My lede:

If an electronic prescribing system pops up a medication safety alert but no doctor heeds it, does it ever sound the alarm?

That question appears more salient than ever, as research continues to show that the clinical decision support systems intended to protect patients from medication errors prove in some ways to be more of a hindrance than a help to doctors.

The latest example is a study of the electronic prescribing records of nearly 2,900 community physicians and other prescribers in Massachusetts, New Jersey and Pennsylvania. Nearly 230,000 times these doctors were warned about potential drug interactions, and 90% of the time they decided to proceed as if the alert had never appeared.

The whole shebang.

My lede:

The Washington State Dept. of Health has finalized rules implementing Initiative 1000, the Death With Dignity Act.

Voters approved the measure in November 2008, and the law took effect March 5. The rules are virtually the same as Oregon’s, where more than 340 patients have died with physicians’ help since 1998.

The whole shebang.

My lede:

Katie Couric’s on-air colonoscopy in 2000 was just one element of a larger awareness-raising effort that helped increase the colorectal cancer screening rate among eligible adults from about 25% a decade ago to 60%, according to 2008 data from the Centers for Disease Control and Prevention.

Yet experts have looked for ways to help primary care physicians push the rate even higher. Screening all eligible patients for colon cancer could prevent an estimated 75,000 cases annually through the timely removal of precancerous polyps, according to the American Cancer Society.

Now there is more evidence that time-squeezed doctors weighed down with recommending ever more preventive health measures need help getting patients screened.

A randomized controlled trial at Harvard Vanguard Medical Associates, a 14-site multispecialty group practice in eastern Massachusetts, found that mailing individualized screening reminders to patients worked better than using electronic medical records to alert physicians. The results from the study of 110 doctors and 21,860 patients were published in the Feb. 23 Archives of Internal Medicine.

The whole shebang.

My lede:

Teaching hospitals outperform other hospitals at saving patients who experience deadly surgical complications, but only if those patients are white.

That’s the finding of a study in the February Archives of Surgery that analyzed Medicare claims from 4.6 million patients at 3,270 acute care hospitals from 2000 to 2005. Patients at teaching and nonteaching hospitals experienced similar rates of surgical complications, but white patients at teaching hospitals were 17% less likely to die afterward.

Black patients had similar survival rates after surgical complications whether at teaching or nonteaching hospitals, even after adjusting for income.

The whole shebang.