Contributing editor to Politico Magazine and former health care editor-at-large, Politico, Commonwealth Fund journalist in residence and assistant lecturer at Johns Hopkins Bloomberg School of Public Health.
Advocates in three conservative states – Utah, Idaho and Nebraska – are trying to get Medicaid expansion on the ballot in November.
Organizers in Utah already have submitted signatures, which are now being verified. They have surplus signatures so odds are that they will make it. According to an article by Dylan Scott of Vox, a recent poll by the Salt Lake Tribune and the University of Utah found 62 percent of Utah voters support the ballot initiative. Continue reading →
Historically the suicide rate in rural states has been higher than in urban ones. According to the most recent national data available, Alaska has the highest rate, at 24.6 suicides per 100,000 people. Next comes Wyoming (23.3), followed by New Mexico (21.1), Montana (21.0) and Nevada (20.2). Idaho ranks 6th, at 16.5. Suicide is the second-leading cause of death for Idahoans aged 15-34. Only accidents rank higher.
Farnham focuses on the Gem State, where suicide rates are rising alongside unemployment and related economic hardship. In addition to economic factors, including cuts to Medicaid funding, and a regional lack of resources for the initial diagnosis of mental illness, local experts point to demographic and cultural factors.
Kim Kane, executive director of Idaho’s Suicide Prevention Action Network in Idaho says other factors explain the high rate of suicide in western mountain states. One is the greater prevalence of guns: In 2010, 63 percent of Idaho suicides involved a firearm, compared with the national average of 50 percent.
She and Garrett also say the West’s pride in rugged individualism can prevent people from seeking help. Their feeling, says Kane, is that they ought to be able to pull themselves up by their mental bootstraps. Idaho is the only state not to have a suicide-prevention hotline.
David Leonhardt, writing for New York Times Magazine, profiles Brent James and Intermountain Healthcare, the hospital network he helps oversee. Idaho native James has turned the Utah- and Idaho-based network into a world leader using data to make positive changes to medical outcomes. James’ basic process is based on the idea that if there’s variation in treatment, then that variation will produce varied outcomes. He and his people track that variation and those outcomes, “identify variation and then figure out which treatments have not been working.”
Leonhardt’s carefully choreographed piece at once runs deep into Intermountain, and wide across the entire health care reform debate, illuminating how evidence-based medicine works and addressing criticism of it. A few highlights:
Electronic medical records make James’ work much easier, and much more effective.
Simply presenting doctors with a well-considered default choice, whether it be electronically or in the form of a pre-written prescription they must choose to either sign or discard, can have a significant positive effect on outcomes.
Intermountain’s statistics are impressive and numerous. One example: “A protocol for dealing with one broad category of pneumonia cut its mortality rate by 40 percent over several years.”
Dartmouth Atlas father John Wennberg called James’ work “the best model in the country of how you can actually change health care.”
Intuition, a cornerstone of medical decision-making, has its place but rarely outperforms data-based decision-making.
Not every implementation of evidence-based medicine will work. It must be done right. This involves heavy administrative oversight and a careful persuasive approach to dealing with physicians.
Intermountain’s pioneering work is often rewarded by a hit to the bottom line as their hospitals reduce the need for costly (and profitable) additional procedures.