Tag Archives: utah

Coincidence leads to remarkable transplant story

Last month, Salt Lake Tribune reporter Heather May was following a family as they waited for the liver donation that would ensure their 13-month-old daughter’s survival. The infant’s mother, Liz Badger, struggled with the unavoidable fact that the donor her daughter so desperately needed would likely be somebody else’s dead child.

At the same time her co-worker, Erin Alberty, was reporting on a 12-year-old girl, Ashley Maynard, on life support. That child’s mother hoped she would slip away in such a manner that her organs could go on to save as many other children as possible.

That’s when, as the reporters watched from the sidelines, the two stories came together. It’s a deep look at transplants, donors and ethics made possible by luck and thorough reporting. For an inside-the-newsroom look at how it all came together, I e-mailed May. Here’s her response:

After reading Liz Badger’s blog, I wanted to write a story about one family’s experience waiting for a transplant, never imagining the story we would get.

I started following the Badger family Jan. 5 — which happened to be the day that Ashley was struck by a car, though of course we didn’t know that until later. So I was with Liz as she spoke about waiting for another child to die as Ashley was in the hospital.

I was with the Badgers during their weekly doctor’s appointment while Ashley was literally down the hall on the same floor in the hospital, again, unknown to us.

On Jan. 14: Liz called me to say they were headed to the hospital for the transplant. Hours later, Ashley’s father called our newsroom to tell Erin Alberty that his daughter was going to be taken off life support and would become an organ donor. Erin had not been following the family, but the paper had written a brief about Ashley having been hit a week earlier while waiting for the bus. Her father called to update the paper about her condition.

At that point, the paper figured that Ashley was going to be LuLu’s donor, but we couldn’t ethically link the two families. I considered attending the funeral with Liz and James with their permission. But after consulting with an ethicist at Poynter, the paper decided I shouldn’t go: We couldn’t tell Ashley’s family that the reason we wanted to attend was because we thought Ashley was likely LuLu’s donor and that we wanted to watch as the families met.

Later, I got permission from Camie to talk to Ashley’s doctors about Ashley’s care. I recreated the hospital and funeral scenes from interviews. I was there when Camie met LuLu for the first time.

Survey looks at use of leftover pain meds

One in five people in Utah have been prescribed pain medication in the past year, according to new figures from the Morbidty and Mortality Weekly report from the Centers for Disease Control and Prevention.

While the survey only takes into account the use of pain medications in Utah, the CDC notes that “This percentage is comparable to the 18.4% of insured persons aged ≥18 years who reported receiving a prescription for opioids in a national study in 2002.”

The report says that deaths in Utah as a result of  “poisoning by prescription pain medications” increased nearly 600 percent from 1999 to 2007.  It also looks at the problem of leftover medication and people using medications not prescribed to them:

An estimated 72% of respondents who were prescribed an opioid had leftover medication, and 71% of those with leftover medication kept it; during the same period, 97% of those who used opioids that were not prescribed to them said they received them from friends or relatives.

The state has set out some recommendations for health care providers aimed at reducing the availability of unused medications.

The data comes from the Behavioral Risk Factor Surveillance System, an on-going telephone survey system that collects information about health risk behaviors, preventive health practices and health care access. Utah is apparently the first state to include pain medication questions in the BRFSS, “although Kansas added a module of questions regarding chronic pain in 2005 and 2007 with one follow-up question asking how the pain was treated.”

Utah tests hybrid bundled payment system

The Salt Lake Tribune‘s Lisa Rosetta explains Utah’s new bulk payment pilot program, which aims to drive down costs by paying participating physicians flat rates for delivering babies and managing diabetes. In a departure from previous systems, the Utah hybrid will still include mini-reimbursements on a per-procedure bases, primarily to prevent instances of undertreatment. For another primer on bundling, see this post.

Here’s Rosetta’s explanation of the diabetes management program:

Highway signs in the Beehive State. Photo by jimmywayne via Flickr.

Doctors treating diabetics will be paid a monthly retainer fee, giving them the flexibility to innovate. If a patient would be better served by calling them at home to make sure they are taking their medications, or checking their blood glucose regularly, for example, doctors can do that without worrying about whether the insurance company is going to pay.

If a patient has problems — say a diabetic ends up in the emergency room for a preventable complication — the doctor’s monthly retainer fee goes down.

Additionally, doctors will be paid a “mini” fee for service so they aren’t discouraged from providing care.

The mini fee was instituted because of lessons learned from a similar experiment in the 1990s, in which a simple flat fee encouraged undertreatment of patients by cost-conscious hospitals.

Pregnancy will work a little differently, Rosetta said:

Doctors caring for pregnant women will be paid differently. They’ll continue to receive one large, bundled payment after the patient delivers, as they do now; the difference is they’ll be paid the same whether it’s a vaginal delivery or cesarean section. Doing so removes any incentive a doctor may have to perform a section, which costs more, but doesn’t discourage it if it’s necessary.

A number of hospitals, doctors and insurers have already signed on for the pilot project. Organizers hope it will be up and running by early 2010. In future versions, they hope it evolves to the point that it is “rewarding cost-effective choices by consumers, and recognizing employers that actively engage workers in healthy behaviors and value-based health care choices.”

NYT Mag takes deep look at data-driven medicine

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.