Aaron Carroll talks to Dr. David Haas about gestational diabetes. You may know that women can develop diabetes during pregnancy, and may know that their blood sugar and insulin return to normal shortly after giving birth. What you may not know is that this condition is associated with a host of negative outcomes. Insulin treatment during pregnancy can impact the growth of the baby in utero. Experiencing gestational diabetes is also associated with a huge increase in risk for developing type II diabetes later in life. So, what can we do about this?
The Healthcare Triage podcast is sponsored by Indiana University School of Medicine whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research and patient care.
IU School of Medicine is leading Indiana University’s first grand challenge, the Precision Health Initiative, with bold goals to cure multiple myeloma, triple negative breast cancer and childhood sarcoma and prevent type 2 diabetes and Alzheimer’s disease.
Available wherever you get your podcasts! Including iTunes.
Dan Skovronsky, President of Lilly Research Laboratories and Chief Scientific Officer for Eli Lilly and Company gives us a peek into the drug discovery and development process specifically focused on Alzheimer’s detection and research.
The Healthcare Triage podcast is sponsored by Indiana University School of Medicine whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research and patient care.
IU School of Medicine is leading Indiana University’s first grand challenge, the Precision Health Initiative, with bold goals to cure multiple myeloma, triple negative breast cancer and childhood sarcoma and prevent type 2 diabetes and Alzheimer’s disease.
As always, you can find the podcast in all the usual places, like iTunes and Soundcloud.
This month, Aaron is talking to Dr. Rafat Abonour about multiple myeloma. Multiple myeloma is a cancer that forms in white blood cells, and Dr. Abonour tells Aaron about how the disease affects patients, and the cutting edge of research into treatments. And we get a nice story about biking.
The Healthcare Triage podcast is sponsored by Indiana University School of Medicine whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research and patient care.
IU School of Medicine is leading Indiana University’s first grand challenge, the Precision Health Initiative, with bold goals to cure multiple myeloma, triple negative breast cancer and childhood sarcoma and prevent type 2 diabetes and Alzheimer’s disease.
As always, you can find the podcast in all the usual places, like iTunes and Soundcloud.
Our guest this month is Dr. Bernice Pescosolido, who is a medical sociologist at Indiana University. Dr. Pescosolido studies the environments, neighborhoods, and connections that contribute to patients’ identities, and looks how this social fabric works or doesn’t work for some people. Particularly, Dr. Pescosolido studies the rising suicide rates in the United States, and tries to track the pathways that have led victims to suicide. She also studies what kind of social factors contribute to how patients come into contact with (or don’t manage to engage with) the medical system.
The Healthcare Triage podcast is sponsored by Indiana University School of Medicine whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research and patient care.
IU School of Medicine is leading Indiana University’s first grand challenge, the Precision Health Initiative, with bold goals to cure multiple myeloma, triple negative breast cancer and childhood sarcoma and prevent type 2 diabetes and Alzheimer’s disease.
As always, you can find the podcast in all the usual places, like iTunes and Soundcloud.
This week, your host Dr. Aaron Carroll welcomes NYT best-selling author (and Healthcare Triage executive producer) John Green to the show. John and Aaron discuss mental health, the ills of the social internet, and answer your questions.
Yes, THAT John Green. Go listen. You can find the podcast in all the usual places, like iTunes, Soundcloud, or even on YouTube.
To improve the quality of care we need accountability, and one way to get it is documenting what clinicians do. This stuff matters: Checklists have saved thousands of lives.
But you can have too much of a good thing. On EconTalk, Russ Roberts interviews Leonard Wong, a retired military officer and a professor at the US Army War College. Wong and Stephen Gerras have written a paper describing the moral challenge experienced by military officers faced with high burdens of regulatory compliance. Like medicine, the military has a complex mission with life and death stakes, using tools that change constantly and are inherently unsafe. The military cultivates intensive safety disciplines that have, for example, reduced aviation fatalities per mile flown by many orders of magnitude.
To build an effective military and protect servicemen and women, the military sets many requirements. Officers must ensure that their units meet these requirements, and they have to certify conformity with these requirements with a signed report or checklist.
The problem is that there are now so many requirements that it is impossible to meet them. Moreover, the Army is in effect a zero-defects culture; failure to complete requirements disqualifies you from promotion.
Wong argues that as a result, officers are falsely documenting completion of requirements that either have not been met or that they have never inspected. This means that potentially important tasks are not getting done, and that nobody knows which things are not getting done. Perhaps more importantly, the professional norm of integrity is being undermined.
People in health care should study this in detail. My view is that the burden of documentation and compliance for health care providers is comparable to the burden on the military. Here are David Blumenthal and J. Michael McGinnis:
The budding enthusiasm for performance measurement, however, has begun to create serious problems for public health and for health care. Not only are many measures imperfect, but they are proliferating at an astonishing rate, increasing the burden and blurring the ability to focus on issues most important to better health and health care. Measures of the same phenomenon also vary in specification and application, leading to confusion and inefficiency that make health care more expensive and undermine the very purpose of measurement, namely, to facilitate improvement. Not uncommonly, a health care organization delivering primary care to a typical population is asked to report and collect hundreds of measures aimed at dozens of conditions.
In some ways, the situation in health care is worse than the military. The military has a single chain of command, but medicine has many bodies issuing standards, many of them redundant. Blumenthal and McGinnis illustrate their point with this Figure:
The Proliferation of Measurements.
So what do we do? What we shouldn’t do is give up the concepts of accountability or documentation.
But critics of excessive standardization have an important point. Clinicians are not automatons following recipes. They have to optimize their time by prioritizing from an indefinitely long list of tasks that could potentially benefit patients. Therefore any requirement that constrains clinician choice has an opportunity cost in terms of the other things that she might do for her patient. Ideally, before setting a standard we should compare the benefit that can be achieved by implementing the standard against that opportunity cost.
My sense is that most people engaged in quality research and improvement are aware of this tradeoff. But it isn’t addressed in any serious way.
We can’t even begin to address this problem unless the people setting standards look at the total burden of documenation and compliance. Blumenthal and McGinnis argue that what we need are “core metrics”, defined as
a parsimonious set [of measures] that provides “a quantitative indication of current status on the most important elements in a given field, and that can be used as a standardized and accurate tool for informing, comparing, focusing, monitoring, and reporting change.” [Core metrics should be] outcomes oriented, reflective of system performance, and meaningful and have utility at multiple levels of the health care system.
We can’t measure everything about medical practice, so we need consensus on a minimum set of requirements that are feasible to measure and maximally affect practice.
Specifying that minimum set is an enormous and challenging task. But it’s critical for the long run success of quality improvement and the preservation of the virtue of integrity in medicine.
Obviously these podcasts will not be weekly. We’ll strive for a more sustainable “occasional” one. Anyway, in the podcast below, we discuss electronic medical records. We’re sorry to say, it’s rather depressing. Here are some relevant links to prior posts:
Aaron and Austin discuss competitive bidding and, at the end, how it relates (or not) to Mitt Romney’s Medicare reform plan. More competitive bidding links are in the FAQ. Prior posts on Romney’s plan are here, here, and here. As always, you’ll find more podcasts in the archive.
Last week, the US Preventative Services Task Force recommended against routine screening for prostate cancer. Like their recommendations for mammograms in 2009, this one has stirred up a bit of controversy. We discuss it in the podcast below. For more on prostate cancer screening and treatment, see the FAQ entry. For more on our podcasts, see the podcast archive.
Programming note: Due to scheduling conflicts, there will be no podcast this Friday. We hope to post the next one on October 28.
Austin and Aaron are participants in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com.
12/06/2019
Tiffany Doherty
