Tag Archives: npr

With state funds gone, Okla. dental programs still serve needy

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for the local NPR StateImpact outlet, Logan Layden looks at how dental programs for the needy are coping in the absence of state funding. In the 2010 state budget crisis, Layden writes, “Funding for several programs, including Dentists for the Disabled and Elderly in Need of Treatment, was totally eliminated.”

Among those was Oklahoma’s D-Dent, which provides a sort of superstructure that takes care of logistics and tests in order to allow dentists to donate their work to the needy and elderly. Since the cuts, the statewide program has gone from supporting about 800 patients a year to about 600. They no longer get state funds, though they still rely on the health department for most of their referrals, as well as a little moral support.

“We here are entirely supportive of this program,” Jana Winfee, Chief of Dental Health Services the Department of Health, said. “They have our support, just no funds.”

For more on NPR’s StateImpact project and a list of current participants, check out their lab.

Project looks at problems in how deaths are investigated

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The results of a yearlong joint investigation of the American autopsy system by ProPublica, Frontline and NPR show that problems in the death investigation system throughout the country have led to innocent people being sent to prison, “allowed the guilty to go free and left some cases so muddled that prosecutors could do nothing.” When autopsies aren’t done, diagnostic errors go undetected and opportunities to learn more about medicine are lost.

One story of patient rights and legal wrangling sports the remarkable headline “Why Can’t Linda Carswell Get Her Husband’s Heart Back?” It hinges, among other things, on the simple fact that “Even though the Institute of Medicine has reported that medication errors affect an estimated 1.5 million patients per year, it is not typical to conduct toxicology tests as part of clinical autopsies. They are routine in forensic autopsies.”

Another piece takes a broader view, exploring the reasons behind and consequences of the fact that autopsies are performed on only about one in 20 patients who die in hospitals when, 50 years ago, the rate was one in two.

Hospitals aren’t required to perform autopsies – the Joint Commission hasn’t included autopsy rates in its accreditation process since 1971 – and neither Medicare nor private insurers reimburse hospitals for the procedures, which Allen found cost about $1,275 each. The implications of these financial disincentives, combined with related factors such as some physicians’ confidence that new diagnostic tools such as MRIs and CT scans provide such accurate results that they obviate the need for postmortem work, are far-reaching.

Diagnostic errors, which studies show are common, go undiscovered, allowing physicians to practice on other patients with a false sense of security. Opportunities are lost to learn about the effectiveness of medical treatments and the progression of diseases. Inaccurate information winds up on death certificates, undermining the reliability of crucial health statistics.

Furthermore…

A 2002 review of academic studies by the federal Agency for Healthcare Research and Quality found that when patients were autopsied, major errors related to the principle diagnosis or underlying cause of death were found in one of four cases. In one of 10 cases, the error appeared severe enough to have led to the patient’s death.

Other stories in the project report that suspicious deaths of the elderly are rarely investigated and that the deaths of children “pose special technical challenges for forensic pathologists.”

Watch the full episode. See more FRONTLINE.

Some fear DSM update opens door for exploitation

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

On All Things Considered, NPR’s Alix Spiegel looks to the past and future to ferret out the potential drawbacks and benefits of the expanded psychiatric diagnoses proposed in the upcoming revision of the American Psychiatric Association’s Diagnostic and Statistical Manual.

dsm-iv

Photo by Richard Masoner via Flickr

Spiegel begins with the forceful perspective of Allen Frances, the man who edited the last update of the DSM. From Frances, Spiegel pulls a few cautionary tales of the unintended consequences of changing DSM entries.

The first? Aspergers.

It’s a disease that needed to be diagnosed, Frances says, but it’s now massively overused because of the unforeseen “unintentional incentive” created by schools that offer greatly expanded educational resources to children diagnosed with Aspergers.

“And so kids who previously might have been considered on the boundary, eccentric, socially shy, but bright and doing well in school would mainstream [into] regular classes,” Frances says. “Now if they get the diagnosis of Asperger’s disorder, [they] get into a special program where they may get $50,000 a year worth of educational services.”

Another cautionary tale? Bipolar disorder. The last DSM revision made it a far easier diagnosis to get. In essence, this easier diagnosis opened a gaping door in medicine, one which pharmaceutical companies quickly muscled through.

“Drug companies got indications for treating bipolar disorder,” Frances says. “Not just with mood stabilizers, but also with the newer antipsychotic drugs. And they began very intensive ubiquitous advertising campaigns. So the rates of bipolar disorder doubled. And lots of people got way too much antipsychotic and mood stabilizing medicines. And these aren’t safe drugs.”

For the other side of the story, Spiegel spoke to a psychiatrist who argued that broadening diagnoses means that fewer of the mentally illl go undiagnosed, and that diagnoses are delivered earlier than they would be otherwise. Furthermore, he believes that adding illnesses to the DSM will spark research and investment toward treating those ilnesses.

UK’s Dartmouth-esque atlas yields familiar results

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Writing for NPR’s health blog, Christopher Weaver looks at the NHS Atlas of Variation in Healthcare, which is similar to our Dartmouth Atlas. While they don’t have an interactive map up yet (they promise one will come next year), it has generous helpings of maps and graphs. The full PDF comes out to 100 pages and 19mb.

The most and least surprising thing about the NHS atlas? That, despite vastly different health care systems, it yields much the same results as the American version. I’ll let Weaver explain:

Before you blame … inconsistencies on America’s money-driven health system, take a look at Britain’s effort to anglicize the Dartmouth work: Doctors in some areas such as the college town of Oxford do one type of hip replacement at rates up to 16 times greater than in places like London, according to a November atlas by the National Health Service.

The British atlas is surprising because “doctors are not by and large paid on a fee for service basis in the NHS,” Angela Coulter, director of global initiatives for the Dartmouth Atlas-associated Foundation for Informed Medical Decision Making, said at a Salzburg Global Seminar session this week. “It illustrates the fact… that doctors tend to favor the treatments they’re trained to provide,” even when money isn’t a factor. Most British doctors get salaries rather than payments for each procedure like their American colleagues.

Related

For more European health news, see AHCJ’s Covering Europe initiative.

Boomers line up for Medicare Part D plans

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In a Morning Edition piece, NPR’s Kelley Weiss manages to hit all the highlights of this year’s Medicare Part D open enrollment period. With millions of Baby Boomers hitting the system and reform provisions shaking up Part D and Medicare Advantage, it’s one of the livelier open enrollments in recent years. Also, one of the most confusing. If you prefer text, see the Kaiser Health News roundup of open enrollment coverage, which emphasizes previews and explainers.

Open enrollment, or the period during with the over-65 set can make changes to their Medicare plans, began Nov. 15 and ends Dec. 31. As you’ll learn from Weiss, the period has pushed seniors and caregivers into a sudden six-week crash course in federal insurance policy.