Rethinking as a Game

Quality is the new watchword in health care, it is what we are looking for - and more what we are trying to measure. Drugs, equipment, hospital services, care delivery - all are now questioned, as we seek to measure it to their advantage, and justify their costs.
The idea of ​​using metrics to evaluate the quality of make sense, but only if we can trust the metrics themselves. Otherwise, we risk an updated version of the party always craniometry, systematized false precision that focuses on easily measurable parameters (such as head circumference), which can not represent meaningful indicators for the assessment that we really after (ie, intelligence).
The good news is that the science of testing, the development of evaluation tools has improved over time. We are now better able to recognize the qualities and characteristics of good tests - and to see where they are likely to miss.
We are also getting more comfortable with demanding robust evaluation tools. For example, the FDA approach puts patients reported exceptional results (and appropriate) focus on the assessment tool selected, and demands that they show the features before. On their results
Unfortunately, a critically important area within our health care system, such as the escape depth review is seems to have the way out the expertise of the service providers generally and certified.
Whether you're an X-ray technician, a physical therapist, a nurse or a surgeon, you are required to pass through a maze of costly certification exam. These tests, already considerable assume even greater importance as the health system still sees them as proxies for quality. Certification may be required for employment and admission privileges, and often impact on the reimbursement rate for healthcare providers.
All this makes perfect sense - provided that the certification tests themselves are solid.
Unfortunately, the world of the workforce in the health certification remains a bit like the Wild West, as medical organizations and professional societies certification testing approach with greatly varying degrees of severity - and usually little to no transparency.

Paradox

Everyone, including this blog writer who has been touting the virtues of the great discoveries of data already or will soon be in the electronic health record (EHR), are available, which heralds the learning health [1, 2]. It is sometimes unbridled enthusiasm that the data collected in the clinical systems, perhaps combined with the research data, such as gene sequencing, will supply us easily knowledge about what works in health care and as new treatments [3, 4] are developed. The data is unstructured? No problem, just use natural language processing [5].
I honestly must share in this enthusiasm, but I also know that it can be alleviated, or at least at a dose of reality. In particular, we must remember that our great and data analysis algorithms only get us so far. If we have poor underlying data, the analysis may end up misleading us. We must be careful to problems of data incompleteness and inaccuracy.
There are all sorts of reasons for a lack of data in EHR systems. Probably the most important is that those data, ie, physicians and other clinicians, you usually give it for reasons other than the data analysis. I've often said that the clinical documentation may be what stands between a busy clinician and home for dinner, so he or she charting terminate before the end of the work day.
I also know many doctors, whose enthusiasm for the entry of correct and complete data is tempered by their view of the input data as a black hole. That is, they give the data in but never derive its benefits. I like to think that most doctors would be an opportunity to look at the aggregate view of their patients in their practice and / or patient, the outliers in a measure or another to enjoy identify. But a common complaint I hear from doctors is that the data collection priorities are more attempt by the hospital or clinic to maximize their refund than to support clinicians in better patient care driven ..

Disruption

Disruptive conduct. This is a thing now? I was told that this is just a kind of guide-I, it was a market is dynamic.

Hmmm ...

What it takes to be a "disruptive" to be leader?

Does it talk like a pirate in explaining how the company will be cutting benefits?

Does it try to dress like Ali G and, to imitate him, but only to raise a WASP accent?

I guess it does ... But that's the easy part.

Job No. 1 disruptive in leading a true market economy: FIND HIDDEN and fertilize the rage at the STATUS QUO that within ALL OF U.S. IS. Find it in yourself and feed and then find it in the other and pull it with you to work.

I am constantly looking for change in my personal life. For example, I just bought a Tesla. My other car is a 1983 Land Rover. Why? As in 1983, you do not need to sell vehicles with a seat belt dinger and airbags in the front seats Andd because Tesla is the first attacker disruptive automotive manufacturers. Past the fetal stage in my life I have to feed them. I hate the established automotive industry! I'm trapped in a small number of culturally (and sometimes financially) bankrupt brands that have an interest in the fight against overregulated morass that restrictions have lost.

Healt İnsurance

A staple of the conservative critique of universal coverage is that having health insurance does not equal access. The corollary is that the. Already assured access to care from doctors and hospitals willing to take care of them to a non-profit basis and of "safety net" institutions

This argument is not new, after he made years before the Affordable Care Act became law. In 2007, said the Council for Affordable Health Insurance, that "universal coverage is not timely access":

"One of the false assumptions behind the push for universal coverage is that everyone has access to medical care. During the first appear, start within a short time to grow, the waiting time and start the access and quality, as the government limits decrease health care financing. Moreover, do the uninsured access to care ... some of which are free or at reduced cost in public hospitals. would be better with insurance coverage, but the uninsured can get care and want. "

Writing for the libertarian Cato Institute, Michael Tanner argues similarly that "health insurance does not mean universal access to health care., In practice many countries promise universal coverage but ration care or have long waiting lists for treatment."

Dr. Marc Siegel, a physician, takes the argument even further, blogging in the National Review that he instruct not only to the government health insurance for all objects, but rather the idea of ​​health insurance:

"The individual mandate is the glue that holds together from Obamacare shoehorning in young, healthy people who do not know .. the health insurance for the sick and elderly, who do not pay, but an even bigger problem than the mandate lies in the cumbersome insurance itself Obamacare will be much worse by the number of people who are insured extended, the procedures and other objects (such as contraception) covered, and is the expansion of government involvement in making it all. "

(I find it ironic that many conservatives, the Obamacare because they advocate contradict result in more people getting health insurance for converting Medicare to defined contribution program, where the government is you-you it-to buy a voucher for private health insurance ! guess)

But let's get back to the main argument: that health insurance does not equal access to care, and that the insured care anyway.

It's true that health insurance companies must ensure not only access-you enough doctors to take care of patients, for one thing, but the evidence also clear that without health insurance is consistently associated with less access and poorer outcomes.

Here's what the Institute of Medicine noted in his landmark 2009 report, "America's Uninsured Crisis: Consequences for Health and Health Care":

"A robust body of well-designed, high-quality research provides conclusive results about the harms of being uninsured and to gain the benefits of health insurance for children and adults. Despite the availability of some safety net services, there is a gap between the health needs people without health insurance and access to effective health care. This gap results in unnecessary illness, suffering and even death. "

What's with those long waiting times for care in countries that have universal coverage? Well, there's more waiting for elective surgery in some of them, but the United States does not compare very favorably even when measured on elements such as access to family doctors and eliminating it because of the cost.

In 2011, the Commonwealth Fund report and chart pack compares U.S. health care system with eight other countries (all in some form of universal coverage have), and found that that was U.S. second worst waiting time to get an appointment when them sick, third last in always care after hours without an emergency room, and had the highest proportion of people who reported that because of the cost, she did not get medical care, not fill a prescription or skipped medical test, treatment or follow-up.

Leadership-Candidates

The National Journal reports that the jobs and the deficit is likely to dominate today night presidential debate, but the most important deficit in the absence of leadership candidates to unsustainable health care spending, not the federal budget. But before you blame Governor Romney and President Obama, first look in the mirror: Politicians do not just need the voters about the victim to lower health care costs, because we would vote them out of office if they did.

Today's 90-minute debate on domestic issues only. The first 45 minutes on the economy to be followed by 15-minute segments on health care, the role of the state and over. But even though his health is only 15 minutes to get fame, you can not really talk about the other issues without health spending. Because when you solve the health care spending problem, you solve the deficit and improve the economy. And controlling health expenditure see basic questions, such as the candidates and the general public, the government's role and approaches to regulation. Problem is that we will not allow the voter to either President Obama or Governor Romney to us. The truth about health issues because we do not know what they have to say, although we lament the lack of plain language of politicians

Because that's what an honest answer to the question: "What should the United States do to health care costs and access?" would sound like:

"The simple fact is that we can not afford our health care system. It is too expensive, even though there are millions of us leaving without health insurance. My opponent and I disagree on how best to reduce spending, but it is not a contradiction that health spending come down soon, by a large crowd, and in a way that none of us like.

Here's why: health care spending is the largest single cause of our exploding budget deficit and debt. We can not balance the budget without, how much we spend on Medicare and Medicaid. As our population ages, is Medicare, the. More and more people, even if we are less young people they support with their taxes Yes, all of us pay into Medicare during our lifetime, but much more from him in return, as we put into it.

An average-wage worker pays $ 60,000 in Medicare in their working years, but will receive $ 170,000 in benefits, if a man, $ 188,000, when a woman. The rest comes from our adult children, but there is not enough of them to pay for the many millions of baby boomers' I'm not talking about my generation without massive tax increases on them. Or we can borrow the money to throw us into more debt, debt that will be passed on to our children.

Our health care system provides excellent support for many of us, and we are the global leader in medical progress and innovation. But millions of us do not get a good access to care. Forty-six million have no health insurance. And we know that people without health insurance delay always requires care, and many of them suffer from more serious diseases or die from diseases that could have been prevented with better access. And the rest of us end up paying for their care. One thing that we have both together (pointing to the other candidates), is that we both signed cover laws for most Americans, remain formidable in Massachusetts and at the national level through Obamacare, but we and our country, whether national divides Law should be implemented, improved, or repealed, and if canceled, what would replace them.

Remember!

Freaked Facebook users around the world this week, when rumors spread that some of their private messages now appeared in public. (We do not blame them, it is angry-you certainly do not want your father saw late-night messages to your hookup buddy.) Be But after reviewing the reports, the social network said there were no signs of previously private content published, and many people back down to their demands.

What happened? Facebook networks were intimate at the time, so some people were wrong remember how loose they were even with the exchange of personal data. In other words, human memories were in a very different context than when they were recalled, first a new study in the Journal of Neuroscience may explain why saved. "'.

During the three days of experiments, researchers at Northwestern University, asked people to learn the locations of the objects on a computer screen, then you remember the next day, and a third day.

All the wrong people, the objects placed on the second day and the third day while 70 percent of the internships were closer on day two internships, not the starting point. The wild part? The people gave off neural signals that a new memory card is in the specified brain also suggested if it was wrong.

If you recall a memory card, there is a possibility that your brain creates a different memory of that call, says Donna J. Bridge, Ph.D., the study's lead author and a postdoctoral fellow at Northwestern's Feinberg School of Medicine. If the details are confusing (as in something reminiscent in a different environment, mood or time), a false memory could become part of this original memor

New Cares in New Congress

Three months ago a contribution argues that America's primary care associations, organizations and members of groups have splintered into tightly-focused specialties. Individually and collectively, they have proven unable to withstand decades to the attack on the basic services of other health interests. The article concluded that the primary care accumulate a new, more comprehensive organization and requires the use of energy to be focused policy influence in favor of the primary health care needs.
The intention was to strengthen rather than displace the 6 different societies - The American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), the Society for General Internal Medicine (SGIM), the American Academy of Pediatrics (AAP) the American Osteopathic Association (AOA), the American Geriatrics Society (AGS) - which currently divide the primary care physician membership and dilute its influence. Instead, would convene a new organization and galvanize practitioners in ways that increase their power. It would also reach and embrace other primary care groups - for example, mid-level clinicians and primary care practice organizations - by weight and resources, and reflects the fact that primary care is always a team-based undertaking.
We came to believe that a single organization would not be serviced. Feedback on the article suggested that a number of units required to have achieved a workable design