institute of medicine


The CEO Checklist For Better Medical Care

(IOM -- The CEO Checklist)

Checklists are all the rage in medicine these days.

The simple concept — that a short, well-crafted list of basic but critical items can help focus even the most accomplished doctor and improve care — was pioneered by Dr. Peter Pronovost, of Johns Hopkins and popularized by Dr. Atul Gawande, the New Yorker writer and surgeon at Brigham & Women’s Hospital. Gawande wrote about checklists for surgery, among others. And recently, a study came out on an effective, World Health Organization-backed checklist for childbirth.

Today, the Institute of Medicine releases a new paper: A CEO Checklist for High-Value Care , written by 11 hospital chiefs, among them Gary Gottlieb, the president and CEO of Partners HealthCare System, Inc.

But a surgical checklist, which includes things like identifying the patient and surgical site and making sure all the sponges are accounted for after an operation, may be simpler and more practical then establishing a “culture of continuous improvement — commitment to ongoing, real-time learning,” which is #2 on the CEO’s Checklist.

Indeed the IOM paper notes: “The strategies in this Checklist are not, of course, of the “one-and-done” variety. Rather, the items we present here are elements that must become core components of an organization’s DNA.”

But if an institution’s DNA actually does evolve, care improves, according to these CEOs, and costs decline as certain wasteful practices are eliminated.

For instance, the paper notes two examples involving Partners:

1. Partners HealthCare’s Connected Cardiac Care Program (CCCP) is a home monitoring program for heart failure (HF) patients at risk for hospitalization. CCCP’s core components are care coordination, education, and development of self- management skills through the use of telemonitoring. Patients use home monitoring equipment to submit weight, blood pressure, heart rate, and symptoms on a daily basis.
• Better care: 51 percent reduction in HF hospital readmission; 44 percent reduction in non-HF hospital readmission
• Lower costs: More than $10 million in savings to date ($8,155 per patient)

2. Partners participated in a 3-year demonstration project to test strategies to improve the coordination of high-cost Medicare patients. To help primary care physicians manage these patients, case managers were integrated into primary care practices. Case managers developed personal relationships with enrolled patients and worked closely with physicians to help identify gaps in patient care, coordinate providers and services, facilitate communication (especially during transitions), and help educate patients and providers.
• Better care: 20 percent reduction in admissions; 13 percent reduction in ED visits
• Lower costs: $2.65 saved for every $1 spent; 7 percent net savings for each patient in the program

Physician’s Group Denounces IOM On Health Coverage, Says Financial Conflicts Abound

Physician’s For A National Health Program, a group that advocates a single-payer health system, yesterday charged that the influential Institute of Medicine’s recommendations for “essential” health coverage under the new national health law are “skimpy” and biased and could “cause much suffering” for patients.

In response to the accusations, detailed in a letter sent to U.S. Health and Human Services Secretary Kathleen Sebelius, a spokesperson for the IOM, Christine Stencel, wrote this in an email message:

The committee’s report lays out the solid rationale for each of its recommendations and speaks for itself. We invite all interested people to download a free electronic copy and read it to see exactly what it said in terms of balancing coverage and cost.

Here’s the full news release from the national physician’s group:

More than 2,400 doctors, nurses and health advocates denounce Institute of Medicine’s health coverage recommendations

IOM panel ‘riddled with conflicts of interest’ in violation of agency’s own guidelines, signers of protest letter charge

In a letter sent to Secretary of Health and Human Services Kathleen Sebelius and posted on the Internet today, more than 2,400 physicians, nurses and other health advocates condemn the recommendations of an Institute of Medicine (IOM) committee regarding the “essential benefits” to be mandated under the 2010 federal health reform law. Continue reading

Report: Vaccines Don’t Cause Autism, Only Rarely Have Serious Side Effects

Experts conclude that vaccines are mostly safe, but that won

By Karen Weintraub
Guest Blogger

A federal report released today concludes that the health benefits of childhood vaccines vastly outweigh the rare chance of serious side effects. But the report will likely do little to allay the fears of a minority of parents who believe, despite scientific evidence, that vaccines are linked to disorders such as autism.

The problem, as the researchers themselves admit, is that it’s impossible to prove a negative – that vaccines don’t ever cause autism, for instance. Plus, the new report is an analysis of 1,000 existing studies on vaccines, so it puts existing information in context rather than adding new data to the debate.

Those who raise concerns about vaccines say that new research is needed to look at whether the shots can cause problems in subgroups of children – perhaps groups that are too small to have been picked up by existing studies.

Still, the 635-page report concludes that common childhood vaccines are extremely safe and effective at preventing measles, mumps rubella, tetanus, diphtheria, pertussis, polio, chicken pox, flu, meningitis, hepatitis and human papilloma virus, which can cause cancer.

“We have a lot of evidence that vaccines save lives and avert a lot of suffering,” Dr. Ellen Wright Clayton, the chairwoman of the panel that wrote the report, said in a news conference today. “The side effects we’re talking about here are really relatively rare – because it’s hard to find them when you look at a general population. The majority of the ones we found are either short-term or readily treated.” Continue reading

With Over 100 Million Sufferers, Making Pain Relief A National Priority

“This report is huge for all the patients who suffer in severe, chronic pain and aren’t taken seriously; for the doctors who don’t learn nearly enough about the basic biology of pain in medical school, particularly the ways in which acute pain turns into chronic pain; for the researchers who are trying to develop new, non-opioid drugs to combat chronic pain; and for insurers and policy makers who often still don’t grasp that chronic pain is a disease, not just a symptom of something else, and that patients need the whole works – better drugs, more empathic doctors, better insurance coverage and, most important, the knowledge that when they say they are in pain, they should be believed.”

That’s the word today from Judy Foreman, nationally syndicated health columnist and long a widely respected Boston Globe reporter. Judy is on the pain beat these days. She’s author of the upcoming book “A Nation in Pain – Healing Our Biggest Health Problem,” and she’s in Washington, D.C. today for the release of a major Institute of Medicine report on pain.

Here’s the Institute of Medicine’s official description of its new plan, titled “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.”

Chronic pain affects an estimated 116 million American adults—more than the total affected by heart disease, cancer, and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the IOM in examining pain as a public health problem. Continue reading