Study examines Mercury in vaccines

• Author: Health Informer
• Filed under: Health News
• Date: Oct 31,2009

The injectable, multi-dose H1N1 vaccine contains the mercury-based preservative thimerosol to reduce risks of bacterial contamination.

The presence of thimerosol has once again raised concerns whether there are risks posed to children when the tiny amount of mercury contained in thimerosol is included in a vaccine. In a recent issue of the Journal of Pediatrics, however, a team of scientists supported by the National Institutes of Health reported findings that should alleviate those concerns.

The researchers, led by author Michael E. Pichichero, MD, Director of the Rochester General Research Institute, Rochester General Hospital, Rochester, NY evaluated levels of mercury in the blood of the smallest children — prematurely born and low birth weight infants after they received a dose of a childhood vaccine containing thimerosol. They found the levels of mercury were exceedingly low.

The issue of administering vaccines containing mercury has been controversial because at very high levels mercury is known to cause organ damage (brain/kidneys). Consequently in 2001, as a precaution, at the prompting of the American Academy of Pediatrics, the Centers for Disease Control, and the Food and Drug Administration, the use of thimerosol in childhood vaccines was reduced or eliminated.

However, after examining the evidence the Institute of Medicine issued an opinion that an association between thimerosol exposure and autism was not supported by the evidence. Nevertheless the contention that mercury in vaccines causes autism continues to be debated. The newly released multi-dose, injectable H1N1 Influenza vaccines contain the preservative thimerosol and thimerosol is 50% ethyl mercury, which has sparked a renewed debate on the safety of administering this new influenza vaccine.

The purpose of the study was to find out how much mercury from a vaccine containing thimerosol stays in a child’s body,” said Dr. Pichichero. “What we found was that blood mercury levels before vaccination were often detectable, even at a level similar to many children after the vaccination. By just breathing the air, mothers were passing to their unborn infants some slight amounts of mercury. The mothers did not eat fish that contains mercury, so in the United States and other countries where fish is consumed by pregnant women the levels of mercury would be presumably even higher. After the babies were given vaccines containing thimerosol, their blood levels of mercury did rise to very low levels and then fell rapidly to baseline levels by day ten after the vaccination.”

Since thimerosol has been largely removed from vaccines in the US since 2001, this study of 72 newborn infants was conducted at the Hospital Durand in Buenos Aires, Argentina. In Argentina, like many countries of the world, vaccines are purchased through sources supported by the World Health Organization and the WHO has rejected the notion that thimerosol in vaccines is unsafe. This is the third and final study by Dr. Pichichero and his colleagues that tested mercury levels following the injection of vaccines containing thimerosol. Previous studies were conducted on term newborns, and on 2-and 6-month old infants. In those studies, the researchers also found the mercury levels in the vaccinated children were very low and quickly returned to pre-vaccine levels, usually within three to seven days. In 1999, when the first concerns about thimerosol in vaccines was raised, it was presumed that the ethyl mercury in thimerosol would behave in the same manner as methyl mercury in fish after ingested. The three NIH-supported studies clearly refuted that idea.

Dr. Pichichero and colleagues concluded that with this latest data, it is time to recognize that the risk of exposure to thimerosol in vaccines is minimal to non-existent. “The H1N1 vaccine is safe and should be given to those at risk as recommended by the US Centers for Disease Control,” Dr. Pichichero said.

Source: Rochester General Health System

New study finds significant inconsistency with how diabetes quality of care is measured

• Author: Health Informer
• Filed under: Health News
• Date: Oct 30,2009

Recent survey reflects 146 measure definitions – including 21 for hemoglobin A1c NCDP calls for harmonization of measurement

The National Changing Diabetes® Program (NCDP) announced today results of a study that found extraordinary variety in the measurement of clinical processes critical to optimal diabetes management such as blood pressure and glucose levels.

In the study, Quality Measurement in Diabetes Care, published today in Population Health Management, researchers at Thomas Jefferson University’s Jefferson School of Population Health, Philadelphia, reported 146 distinct measures for 31 medical outcomes – a quilt of measurements that healthcare providers say is complex, disjointed and cumbersome. In the study, the authors note that “although the broad array of existing measures creates valuable opportunities to quantify, benchmark, and improve a wide range of clinical processes and outcomes, providers and other stakeholders report that the broad scope of activities lacks clarity.”

An increasingly common strategy for improving care and adherence to treatment guidelines has been periodic performance assessments of doctors, health systems, and health plans. Several organizations provide such assessments, and the Centers for Medicare and Medicaid Services includes diabetes measures in its doctor-incentive initiatives to encourage improved medical care and promote public reporting of performance data. However, according to the study authors, “currently, the environment is characterized by hundreds of measures that frequently do not conform completely with key facets of measure selection, data sources, and standards for defining high-quality care. Clinicians report dissatisfaction when they encounter mixed messages regarding testing and screening schedules or target goals for key outcome indicators.”

For the study, the Jefferson research team searched the National Quality Measures Clearinghouse, a comprehensive database maintained by the Agency for Healthcare Research and Quality, and reviewed diabetes measures created by national organizations and institutions. The researchers categorized measures by medical procedure, such as managing medication and performing foot exams; health status indicators such as cholesterol and blood pressure levels; and other types of assessed care, such as patient self-management.

The team also conducted interviews between July and October, 2008, with leaders from the organizations who use and develop quality measures, along with other stakeholders in the quality measurement community.

“We found a measurement system that is both redundant and inconsistent, with many different measures assessing the same clinical indicators,” says Dr. Nash, one of the study’s authors and Dean of the Jefferson School of Population Health. “Methods and assessment goals vary among different organizations, as do, in some cases the sources of data (for example, patient or health plan level data) making uniform standards more difficult to achieve.”

Doctors aren’t alone in grappling with these challenges, researchers say. According to the study, large employers and policymakers are also struggling to understand which measures are most appropriate for their quality initiatives. Ideas proposed by the authors for reconciling different quality measures include: development of a “comprehensive” measure set, which would focus on measuring indicators that are most significant for diabetes care, such as glucose, blood lipids, and blood pressure; and use of a “composite score,” that would combine a range of indicators and generate a single score.

“This study demonstrates that current measurement of diabetes care quality is far too complex and disjointed, and at the same time lacking in a number of key areas, particularly at the population level,” says Dana Haza, senior director of NDCP.

The study also found significant gaps in quality measures, including a lack of population-based or epidemiologic measures. In addition, much of the current focus is on patients who are employed and insured, which ignores “millions of Americans and may not accurately reflect the overall state of diabetes care,” the researchers write. Patient perspectives, access to care, or efforts to identify and advise those with pre-diabetes, those at high risk of developing the disease, are also not commonly measured.

The research was sponsored by the National Changing Diabetes® Program, a diabetes leadership initiative established by Novo Nordisk to drive health systems change at the national and local level. About 24 million Americans have diabetes and health experts say that number could double in the next 20 years. With direct and indirect costs associated with diabetes and pre-diabetes estimated at $218 billion in the U.S. in 2007, much effort has gone into developing practice guidelines that improve care and patient outcomes.

“Streamlining and harmonizing existing measures is an important challenge that must be addressed to encourage wider use of performance assessment,” the researchers conclude. Haza adds that a clearer understanding of the state of diabetes quality measurement is “an important step toward improving their usefulness, and addressing gaps in quality assessment.”

Source: National Changing Diabetes Program

Top 10 business mistakes made by physician practices

• Author: Health Informer
• Filed under: Health News
• Date: Oct 29,2009

Many medical practices are struggling. Shifting reimbursements are a significant factor, but many are making basic business mistakes, according to Andrew Graham, MBA, President of Clinic Service Corporation.

Here are the top reasons practices struggle, said Graham.
1. No business plan. A practice’s strategic plan needs to include goals for revenue generation, customer service, performance and operational processes, and innovation measures.
2. Poor understanding of customer flow. A practice should retain two-thirds of its patients annually. Practice managers need to discover which managed care contracts feed them patients and which doctors send referrals.
3. Revenue cycle confusion. Doctors are typically reimbursed within 30 days. Based on a predictable flow of payments, practice managers should be able to predict cash flow. It might be time for a revenue analysis.
4. Performing procedures that are unprofitable. No one is suggesting doctors perform only treatments that pay best. Medicine is first a humanitarian calling. However, it does not make business sense to focus a practice on an unprofitable sector either. Practices need to code patient visits consistent with the level of care provided and consider whether they are wasting time bundling codes.
5. Unfavorable Payer Contracts. A good place to start this exploration is with a discussion with a practice’s billing company.
6. No marketing plan. Many physicians will spend thousands on phonebook ads, but more savvy doctors understand the Internet can play a big role in their success. Medical marketing firms can be helpful here.
7. Poor office culture. A healthy workplace culture is critical to a practice’s success. Step one is to define the practice’s mission and communicate that mission to all staff.
8. Not hiring help. Doctors today are confronted by fiscal, technological, managerial and communications challenges. Hiring specialists to help is a no-brainer.
9. No staff training. Doctors are required to “sharpen the saw” frequently. It may be time to apply that education mindset to the physician’s staff too.
10. Poor location. Having a poor location can sink all but the most sought after specialists. Many physicians will say they are hunkered down within their current space. They should reconsider. Changing location could be the spark they need.

Source: Clinic Service Corporation

CSMS issues results of health disparities survey

• Author: Health Informer
• Filed under: Health News
• Date: Oct 29,2009

First Connecticut research to examine how physicians care for patients from diverse racial, cultural and ethnic backgrounds

Connecticut physicians believe they could be providing better care to patients of diverse racial, cultural and ethnic backgrounds if they had training that was more accessible, according to the results of a survey released today by the Connecticut State Medical Society. “Providing Medical Care to Diverse Populations” is one of the first studies of its kind to seek physician input in helping reduce disparities in health care. The statewide survey of Connecticut physicians from 17 specialties was conducted from April to July through a grant from the Connecticut Health Foundation.

The findings indicate gaps in physician education programs that highlight cultural competency:

– Fewer than 2 in 5 physicians received some kind of cultural diversity education in medical school or residency.
– 70% of physicians were not aware of educational programs in this area that are available to them today.
– Physicians working in small practices, the setting that describes more than 80% of Connecticut physicians, were less likely to have received training in cultural literacy. Those working in hospital or medical school settings were the most likely to have had formal training in cultural awareness.
– Physicians ages 55-64, and those whose practices were mostly White, gave themselves lower ratings for providing culturally appropriate care.
– Women physicians were significantly more likely to provide interpreter services and patient-education materials in other languages.

In addition, the physicians surveyed identified patients’ health insurance status as the greatest barrier to referrals. Forty-three percent called it “a big problem.”

“The results of our survey tell a sobering story about our ability to communicate with patients, which is the foundation of the physician-patient relationship,” said Kathleen A. LaVorgna, MD, president of CSMS. “The good news is that we can have an immediate impact on this situation by providing the kind of cultural awareness education physicians want and need.”

CSMS is developing materials to educate physicians and office staff, working closely with national organizations dedicated to this issue. It plans to provide patient outreach materials through patient rights groups. A recent state mandate requires cultural diversity training for medical license renewal; CSMS hopes to assist in developing the curriculum so the end result is valuable for physicians. Near the conclusion of the two-year grant, CSMS will survey physicians again to measure progress in improving cultural competency.

Robert Aseltine, PhD, professor in the Division of Behavioral Sciences and Community Health and Director of the Institute for Public Health Research at the University of Connecticut Health Center, contributed to the report.

Source: Connecticut State Medical Society