JAMA. 2010;304(10):1116-1117. doi:10.1001/jama.2010.1301
Authors: Matthew P. Muller, Allan S. Detsky
“Public reporting of hospital performance has been proposed as a means of improving quality of care while ensuring both transparency and accountability. …In 2002, it was estimated that approximately 1.7 million hospital-acquired infections (HAIs) and 99 000 HAI-related deaths occurred in the United States each year. Hand hygiene is considered the most important strategy to prevent HAIs. Since 2002, an increasing number of US states have mandated public reporting of quality indicators related to HAI prevention; to date, none have included reports of hand hygiene compliance in their mandates. This Commentary suggests the need for caution…”
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Archive for category US Health Services
Improving Drug Safety
Sep 8
JAMA. 2010;304(10):1060. doi:10.1001/jama.2010.1284
Author: Mike Mitka
“Citing a record 1742 drug recalls in 2009, a 400% increase from 2008, Sen Michael Bennet (D, Colo) introduced legislation designed to enhance the ability of the Food and Drug Administration (FDA) and the pharmaceutical industry to ensure that medications are safe and effective regardless of where they are manufactured. The bill (S 3690 [http://thomas.loc.gov]), introduced August 3, would enhance the FDA’s ability to track and monitor foreign manufacturing sites and give the agency additional recall power and enforcement options, such as assessing civil penalties. …In addition, the bill would give the FDA new oversight of over-the-counter (OTC) drugs…”
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United States Court of Appeals of the Federal Circuit, decision 27 August 2010
“This case is one of approximately five thousand cases that have been filed under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 to -34 (“Vaccine Act”) in the Court of Federal Claims claiming a link between childhood vaccines and autism. The Special Masters created the Omnibus Autism Proceeding (“OAP”) to determine the relationship, if any, between vaccines and autistic spectrum disorders. Petitioners Theresa and Michael Cedillo seek compensation on behalf of their daughter, Michelle Cedillo (“Michelle”). Their case is a part of the OAP proceeding. The Cedillos alleged that the measles-mumps-rubella (“MMR”) vaccine together with thimerosal-containing vaccines (“TCVs”) caused Michelle to suffer from various medical conditions, including autism.”
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Health Affairs, 29, no. 9 (2010): 1697-1705, doi: 10.1377/hlthaff.2010.0038
Authors: Megan Sandel, Mark Hansen, Robert Kahn, Ellen Lawton, Edward Paul, Victoria Parker, Samantha Morton, and Barry Zuckerman
“Health care is undermined when patients don’t receive the benefit of laws intended to address social determinants of health, such as housing and food. Medical-legal partnerships, which now exist in more than 200 clinical sites in the United States, integrate lawyers into health care to address legal problems that create and perpetuate poor health. This paper describes how such medical-legal partnerships can change clinical systems—for example, by adding legal form letters to electronic health records to help low-income patients rectify substandard housing conditions.”
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Health Affairs, 29, no. 9 (2010): 1578-1584, doi: 10.1377/hlthaff.2010.0146
Authors: J. William Thomas, Erika C. Ziller, and Deborah A. Thayer
“In this paper we present the costs of defensive medicine in thirty-five clinical specialties to determine whether malpractice liability reforms would greatly reduce health care costs. Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.”
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Health Affairs, 29, no. 9 (2010): 1585-1592, doi: 10.1377/hlthaff.2010.0135
Authors: Emily R. Carrier, James D. Reschovsky, Michelle M. Mello, Ralph C. Mayrell, and David Katz
“Physicians contend that the threat of malpractice lawsuits forces them to practice defensive medicine, which in turn raises the cost of health care. This argument underlies efforts to change malpractice laws through legislative tort reform. We evaluated physicians’ perceptions about malpractice claims in states where more objective indicators of malpractice risk, such as malpractice premiums, varied considerably.”
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The Flaws In State ‘Apology’ And ‘Disclosure’ Laws Dilute Their Intended Impact On Malpractice Suits
Sep 7
Health Affairs, 29, no. 9 (2010): 1611-1619, doi: 10.1377/hlthaff.2009.0134
Authors: Anna C. Mastroianni, Michelle M. Mello, Shannon Sommer, Mary Hardy, and Thomas H. Gallagher
“Apologies are rare in the medical world, where health care providers fear that admissions of guilt or expressions of regret could be used by plaintiffs in malpractice lawsuits. Nevertheless, some states are moving toward giving health care providers legal protection so that they feel free to apologize to patients for a medical mistake. Advocates believe that these laws are beneficial for patients and providers. However, our analysis of “apology” and “disclosure” laws in thirty-four states and the District of Columbia finds that most of the laws have major shortcomings. These may actually discourage comprehensive disclosures and apologies and weaken the laws’ impact on malpractice suits. Many could be resolved by improved statutory design and communication of new legal requirements and protections.”
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Strange Deathbedfellows
Sep 6
The Hastings Centre Report, Vol. 40, No. 5, September – October 2010
Author: Linda Ganzini
“In 1998 I was hired by a local health care system to evaluate the mental health of enrolled patients who requested lethal prescriptions under Oregon’s newly implemented Death with Dignity Act. …Since then, I have been privileged to interview more than fifty Oregonians who requested legalized, physician-assisted death, as well as their family members, physicians, and hospice providers. These people prize independence, autonomy, self-sufficiency, and control. They want to leave this world in the driver’s seat, and they anticipate a dying process that is incompatible with this goal.”
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Telegraph, By John Bingham, 4 September 2010
“Women in some areas are being denied access to the treatment altogether while others are facing new restrictions which appear to flout national guidelines. One in five local Primary Care Trusts (PCTs) said they had cut the number of IVF procedures they had funded over the past three years, the study by the health magazine, Pulse, found.”
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ABC News, By Ray Sanchez, 3 September 2010
“A decision by a Fox affiliate in California’s capital to broadcast what is believed to be the first paid ad for a medical marijuana dispensary has caused hardly a stir, according to the station general manager and the advertiser.”
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