Laura Landro - The Wall Street Journal
Even healthy people worry about the quality of care they can expect to receive when they become ill. Will a cancerous tumor be spotted early enough? Will hospital staff move fast enough to save my life? What is the worried-looking doctor scribbling in my chart?
Health-care innovations aren't limited to drugs and devices. Experts increasingly are adopting new ways to treat patients that studies show are better at healing the sick, preventing disease, improving patients' quality of life and lowering costs. Here are 10 innovations that took root in 2012 and are changing the care patients will get in 2013.
Doctors Are Adopting a Better Bedside Manner
Hospitals increasingly have a new focus: keeping patients happy. Surveys sent home after a hospital stay are asking patients to rate everything from whether nurses and doctors seemed attentive to their concerns to how clean their room was. The institutions are putting doctors, nurses and other employees through customer-service training, hiring "patient experience" consultants and designating staff ombudsmen to handle complaints. The moves follow prodding from Medicare, which now ties payments in part to how patients feel they were treated. The changes, though, benefit all patients.
Heart Attacks Are Being Treated Faster
Speed is of the essence in surviving a heart attack, and in many cities now treatment starts before the patient reaches the hospital. Emergency medical technicians perform electrocardiograms and transmit results wirelessly to the emergency room. New guidelines from the American Heart Association and the American College of Cardiology aim to quickly restore blood flow when an artery is blocked, the most severe type of attack known by the acronym STEMI. Guidelines call for balloon angioplasty and stents as preferred treatments for STEMI, and clot-busting drugs as a stopgap measure. Also recommended: Chilling the patient in cases of cardiac arrest, a practice that reduces subsequent brain injury. In new research, survival rates were higher among cardiac-arrest patients who received CPR longer—a median of 25 minutes versus 16 minutes. For patients, the message is: Don't delay calling 911 when you have symptoms, and avoid going to the hospital in a private car.
ERs Are Getting Better at Handling Medical Mysteries
A growing number of hospital emergency rooms are opening observation units to keep an eye on patients who show up with complaints that can't be quickly or conclusively diagnosed. This reduces crowding in harried ERs. It also allows emergency staff to closely monitor at-risk patients and conduct tests more quickly and cheaply than by admitting them as an inpatient to a hospital room.
You Can Finally See What Your Doctor is Writing About You
Patients who have access to the notes their doctor makes about them are more likely to understand their health issues, recall what the doctor told them, and take medications as prescribed, according to a trial program called Open Notes initiated by several big hospitals and now spreading across the country. Although patients have the right to view doctors' notes, these often aren't included in patient requests for medical records and doctors don't make it easy to see them. In the Open Notes trial, some patients picked up errors. Other patients became more diligent about follow-up actions that eliminated the need for additional office visits, says Thomas Delbanco, a physician at Beth Israel Deaconess in Boston and lead investigator of the study.
Health Apps Are More Sophisticated
Rather than just count calories and monitor exercise, new apps take on more serious concerns. "Is it Contagious?" from the Nemours Foundation has information on some 85 childhood infections and conditions, including info on when to seek immediate medical care. An app from the Centers for Disease Control and Prevention enables searches of health information. Carolinas Medical Center has an app to calculate the risk of pain and discomfort after hernia surgery. MyIBD, from Toronto's Hospital for Sick Children helps those with irritable bowel disease track symptoms and food intake. The nonprofit Pew Research Center says some 19% of smartphone users have at least one health app on their device.
Tests for Colon Cancer Are Less Arduous
Colonoscopy is the gold standard for detecting colon cancer. Yet millions of people who should have one don't, whether out of distaste for the laxative prep regimen or fear of the procedure. Alternatives include a "virtual" colonoscopy, using CT scanning to examine the colon. A new version of the fecal occult blood test analyzes stool samples gathered at home to find polyps, abnormal growths that can become cancerous. Randomized controlled trials have shown the technique reduces colon cancer death rates. Kaiser Permanente mails test kits to its Northern California patients and gets 3,000 samples a day. If test results are positive, colonoscopy is advised.
Talk of Dying Gets a Little Less Daunting
Families and patients are getting help with one of the most difficult care decisions: When to stop invasive and costly treatments and focus on a dignified and comfortable pathway to the end of life. A program known as POLST—Physician Orders for Life-Sustaining Treatment—has been adopted in a growing number of states. It offers a template doctors and patients can use to discuss and record which types of care patients want and which they would rather forgo. Another program, the Conversation Project, created by writer Ellen Goodman, is a way to help people talk about these issues with loved ones around the kitchen table. A starter kit, available free online, helps map out how to think about what matters most, such as being able to recognize family members, and how to talk to family about tough care decisions.
The Hospital Is Less Likely To Make You Sick
The problem of hospital patients who contract potentially fatal infections has dogged providers for years. Medicare has stopped paying to treat some infections acquired in the hospital.A breakthrough came in September with news that a program in 1,100 intensive care units in 44 states reduced the rate of a deadly hospital bloodstream infection by 40% over four years. The remedy seems simple: Doctors and staffers follow a checklist of routine precautions, including washing hands and removing catheters from patients as soon as possible. Peter Pronovost, the Johns Hopkins patient safety expert who oversaw the program, estimated it has saved more than 500 lives and $34 million and will lead to more programs to reduce harm.
Robots Are Helping Your Surgeon
In a growing number of medical schools and hospitals, trainees and staff are learning procedures on lifelike electronic robots that bleed, have seizures, and give birth—all while simulating emergency complications. that requireCare providers practice critical thinking and decision-making under pressure, "without risking the well-being of actual patients," says George Halvorson, outgoing chief executive of Kaiser Permanente. A robot named Noelle can simulate a birth emergency while the multitalented SimMan has the ability to present realistic human responses to heart attack, stroke or respiratory distress. Studies show that simulation leads to enhanced teamwork and crisis-management skills of health-care providers.
Vetting a Hospital Gets Easier
Data on hospital quality and safety has been available online for some time, but not in a very user-friendly way. This year, the Leapfrog Group, a coalition of public and private purchasers of employee health coverage, graded hospitals, from A to F, based on measures of patient safety. Some hospitals got poor grades and took issue with the methodology, which was subsequently altered slightly. Leapfrog CEO Leah Binder says it is "the toughest standard-bearer and provides the most complete picture of a hospital's quality and safety." The list of 1,200 hospitals, released Dec. 4, ranks only 89 of them as top facilities. Patients can use a free website or a mobile app to compare hospitals based on overall safety or based on selected procedures such as heart bypass surgery. A research team at Johns Hopkins' Armstrong Institute for Patient Safety and Quality will provide scientific guidance in future.
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