On a mild, gray day in February, fatigue lined the face of Anthony Parish, a slight, 39-year-old man who has been through a lot. He had a cancerous portion of his lung removed and struggled with postoperative pain. Chemotherapy treatments caused abscesses in his mouth that ruined his teeth and repeatedly sent him to the emergency department for relief, delivered in the form of painkillers and antibiotics.

Despite his health problems, Parish voiced hope on that midwinter morning. His medical team had developed a plan to help alleviate his dental pain. By the end of the month, his infected teeth would be removed and replaced with dentures. He still has intermittent chest pain, but he is learning to cope with it.

Parish is one of about 950 patients identified by Spectrum Health System in Grand Rapids, Mich., as having used their hospital EDs 10 times or more during the previous year. These patients accounted for more than 20,000 total visits and at least $40 million in costs during that period. In November 2011, Spectrum launched the Center for Integrative Medicine, a $1 million multispecialty clinic modeled on a pilot program that slashed ED use by nearly 90%, to help patients like Parish address the source of the problems that keep bringing them back to the ED.

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The National Quality Forum in April added four “efficiency” measures that could be combined with quality metrics as part of the Medicare value-based purchasing plan set to start in 2015.

These metrics join four measures previously endorsed in January and represent the multistakeholder group’s first efforts to measure the intensity of medical services that the health system provides, as well as the total costs. The work is being done under contract with the Dept. of Health and Human Services.

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A group of Hawaii physicians is offering to write lethal prescriptions for terminally ill patients in a bid to test whether doctor-assisted suicide is allowed under state law.

Unlike Oregon and Washington, the only two states where writing such a prescription is explicitly allowed and regulated, Hawaii has no law authorizing physician-assisted suicide. Moreover, Hawaii Attorney General David M. Louie issued an opinion in December 2011 saying that manslaughter charges could be brought against physicians who write prescriptions with the intention of causing death.

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Medical ethics is often the stuff of esoteric academic debates and journal articles littered with $10 words. Now one of America’s most venerable bioethics think tanks is expanding its reach with a public TV special and a patient-focused website that addresses the ethical challenges of emerging medical technologies.

Genetic testing, assisted reproduction, children’s mental health and end-of-life care are among the issues addressed at The Hastings Center’s site, called “Help with Hard Questions.” The website was launched in March to coincide with the airing of an episode of the PBS program “NOVA” that was co-produced by the center and focuses on the brave new world of genomics. The program can be viewed online.

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Three decades after hospice emerged as the standard of care for terminally ill patients, the end-of-life treatments that palliative medicine physicians provide are frequently referred to as murder, euthanasia and killing.

More than half of hospice and palliative medicine physicians say patients, family members and even other health professionals have used those terms to describe care they recommended or implemented within the last five years, according to a nationwide survey of 663 palliative care doctors in the March Journal of Palliative Medicine.

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Less than half of U.S. states require hospitals to report surgical site infections, and only a fraction of these states have publicly posted the information for patients to use in deciding where to seek care, said a study published online March 2 in theJournal for Healthcare Quality.

Twenty-one states require reporting of infections acquired during surgical procedures such as coronary artery bypass grafts and hip and knee replacements. Only 14 of these states have so far posted any of the information publicly. Moreover, states differ on data collection procedures and risk-adjustment standards.

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Many state and local government agencies and health systems are not ready to coordinate the response to a disaster that overwhelms available medical resources and requires a shift in standards of care, said an Institute of Medicine report released in March.

In the event of a catastrophe such as pandemic flu that results in a shortage of ventilators, hard choices will have to be made about who gets the high-tech breathing help. Ethical and legal “crisis standards of care” should be triggered by predefined indicators of disaster, yet few states have taken action to implement such a process, said the IOM report.

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Recent outbreaks of vaccine-preventable diseases and a growing immunization opt-out rate are pushing physician organizations in California and Vermont to seek greater restrictions on exemptions from school-entry immunization requirements.

Every state allows exemptions for children with medical contraindications verified by a physician, and all but two states let parents with religious objections skip immunizing their children.

An additional 20 states allow exemptions based on parents’ philosophical or personal beliefs. Requirements for securing personal-belief exemptions vary by state but are often as easy as signing a form.

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The mortality rate for obese patients who regularly take sleeping pills is nine times higher than the death risk for similar patients who do not use the drugs, said a study presented at an American Heart Assn. scientific meeting in March.

Researchers examined the medical records of more than 34,000 patients treated in the Geisinger Health System in Pennsylvania. After controlling for sex, age, smoking status, alcohol use, marital status and ethnicity, the obese patients who took hypnotic medicines regularly — at least 132 pills annually — were 9.3 times likelier to die than patients with similar health who did not. Even obese patients who took 18 pills or fewer annually had a death rate eight times higher.

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Pharmaceutical companies have slashed their sales rep force by about 30% from a high of 105,000 five years ago, according to industry figures. And as the number of detailers has fallen, so, too, has another hallmark of pharmaceutical marketing: drug samples.

Drugmaker spending on the samples that drug reps leave behind in physician offices has gone down by 25% since 2007, said Cegedim Strategic Data, a global pharmaceutical market-research firm that surveys a rotating panel of 2,300 U.S. physicians to generate its industrywide estimates. In 2007, drugmakers spent nearly $8.4 billion on samples. That figure fell to about $6.3 billion in 2011, the most recent data available.

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Peter A. Goodwin, MD, a family physician who lobbied for passage of Oregon’s Death with Dignity Act, died March 11 after ingesting medication prescribed to him by a doctor under the law. He was 82.

Dr. Goodwin was diagnosed with the progressive neurogenerative disease corticobasal degeneration in 2006. He said in a recent online video that three physicians gave him a prognosis of less than six months.

“I’ve always accepted the idea that if push came to shove, and if I qualified for the [Death with Dignity Act], that I’d use the law,” Dr. Goodwin said in the video.

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Seven years after the federal government started publicly reporting hospitals’ performance on quality measures, evidence suggests that this transparency effort has not improved patient outcomes measurably.

The latest discouraging finding is in a study in the March issue of Health Affairs that analyzes death rates among Medicare patients with heart attack, heart failure and pneumonia in the five years before the launch of the government’s Hospital Compare website and in the three years afterward. Although individual hospitals’ compliance with quality metrics for these conditions was reported publicly, the effort reduced the odds of a heart failure patient dying within 30 days by only 3%. Heart attack and pneumonia patients saw no improvement in death rates, the study concluded.

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Many patients struggle to understand written health materials, as well as their physicians’ spoken instructions. Doctors can help their patients get the message.

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