Indiana numbers show preventable errors down
The Indianapolis Star’s Daniel Lee reports that, according to the state’s newly released 2009 numbers, preventable medical errors are down in Indiana. There were 94 reported errors last year, down from 105 each in 2007 and 2008.
Part of the decline can be attributed to the health department’s Indiana Pressure Ulcer Initiative, which appears to have helped bring bed sore occurrences down 33 percent from 2008.
The initiative, which began in June 2008 and runs through September, focuses on improving hospitals’ systems for assessing risk factors for patients developing bed sores. Efforts have included in-person and online prevention training for hospital personnel.
The real story is the Indiana error numbers, which are wonderfully extensive. They’re broken down by condition (28 different serious errors), location and specific facility.
Related
- More on medical errors
- Record crowd hears from Dennis Quaid, Elizabeth Edwards
- Tip sheet: A road map for covering your local hospital’s quality
Conference presentations
- Arrogance without accountability? Where is the media? [Peter Pronovost | Watch an excerpt of his keynote address]
- The National Healthcare Reports, Ernest Moy
- How a Hospital Failed a Boy Who Didn’t Have to Die, Helen Haskell
- Citizens for Patient Safety, Patty Skolnik
- MRSA Survivors Network, Jeanine Thomas
- Improving patient safety through health information technology
AHCJ articles
- Medical misconnections: Patient-safety problems [About the project | Contest questionnaire]
- Experts discuss benefits, dangers of telemedicine
- Hospital patient safety initiatives borrow from transportation industry
- Specialty hospitals, surgery centers call 911 in emergencies
- Reporter documents surgical errors through public records
Gays excluded from clinical trials
Thanks to an awards announcement from the National Lesbian & Gay Journalists Association, we just noticed Jen Colletta’s story in the Philadelphia Gay News about the exclusion of gays from clinical trials. Colletta won an Excellence in News Writing Award. The exclusion of gays in clinical trials is an issue that hasn’t received much mainstream attention, apart from a letter from Colletta’s sources in NEJM, a write-up by Ed Silverman and a story in The Philadelphia Inquirer.
According to Colletta, the data behind the story grew out of a chance discovery by researchers at the Fox Chase Cancer Center in Philadelphia.
“We review all the different trials that are proposed here, and they don’t necessarily open here, but a lot of them are multi-center trials so we do look at them. And I saw that we had been looking at a number of clinical trials that explicitly excluded gay people, and they didn’t necessarily open at Fox Chase, but I started to become more attuned to this and realized that this is a bigger, national issue,” (Brian Egleston, assistant research professor of biostatistics at the center) said.
The researchers analyzed trials listed in the ClinicalTrials.gov database, maintained by the National Institutes of Health and the Food and Drug Administration.
In particular, Colletta reported, homosexuals are excluded from studies about couples, especially those dealing with erectile dysfunction, which are often related to treatments for prostate cancer. It’s entirely normal for a drug trial to have exclusion criteria, but an oversight in NIH regulations mean that the exclusion of homosexuals, unlike exclusion along racial lines, can be implemented arbitrarily.
In the mid-1990s, Congress mandated that NIH establish a set of guidelines that would prevent it from excluding minorities, such as women and African Americans, from federally funded clinical trials unless there was a significant reason. There are currently no such rules regulating the inclusion of LGBT individuals.
The distribution of exclusionary studies is particularly interesting. To put it in perspective, here’s a quick visualization of the data put forth in the NEJM letter:
Mass. won’t post hospitals’ death rates
Filed under: Health data, Hot Health Headline, Public records
The Boston Globe’s Liz Kowalczyk reports that, two years after it was first proposed by a consumer group, the Massachusetts Health Care Quality and Cost Council has decided it won’t publish hospital-wide mortality rates. The problem, it seems, is the lack of an accurate, universal method of computing such numbers.
Health and Human Services Secretary Dr. JudyAnn Bigby, who heads the group that made the decision, said current methodology for calculating hospital-wide mortality rates is so flawed that officials do not believe it would be useful to hospitals and patients and could harm public trust in government.
It appears, Kowalczyk writes, that general hospital mortality rates just aren’t “ready for prime time” quite yet.
The council convened an expert panel, which worked with researchers to evaluate software of four companies for measuring hospital mortality. The problem was that researchers came out with vastly different results when they used the various methodologies to calculate hospital mortality between 2004 and 2007 in Massachusetts, and they could not tell which company’s results — or if any — were accurate.
AHCJ pushes for access to publicly funded research
Filed under: Government, Health data, Health journalism, Public records, Studies
The strong public interest in “direct, free and full text access to research articles” prompted the Association of Health Care Journalists to send comments to the House Oversight and Government Reform committee.
The letter [PDF] was in support of full-text access to the fruits of publicly-funded research to members of Congress considering H.R.5037 – Federal Research Public Access Act of 2009. One section of that bill would require researchers who receive funding from federal agencies to provide free online public access to final peer-reviewed manuscripts or published versions as soon as practicable, but not later than six months after publication in peer-reviewed journals.
While AHCJ did not take a position on the specifics of the bill, the group highlighted the strong public interest in “direct, free and full text access to research articles,” noting that for journalists to be able to provide readers and audiences with accurate and comprehensive reporting, they need to be able to see the full details of research reports, not merely the highlights contained in abstracts or news releases.
“The fundamental principle at issue is the public’s right to examine both the evidence produced by research studies and the methods employed by researchers. When the researchers are supported by taxpayers, the public’s claim is even stronger,” AHCJ’s statement read in part.
The statement took note of the concerns of some publishers who fear the mandate could cut into their income, while also pointing out that other publishers already provide free online access to the full text of research articles within six months of publication.
Related:
Bill would require public access to research
Investigating, localizing salmonella outbreak
Filed under: Health data, Health journalism, Hot Health Headline
As some of you may have noticed, there’s an egg recall going on. It all began when the CDC’s PulseNet monitoring program noticed a fourfold jump in the number of salmonella cases being reported, which spurred investigations around the country. This jump is evident in the graph below. Don’t be fooled by the dropoff at the end, it has more to do with the reporting process than with an actual decrease in the number of salmonella cases (which clearly isn’t happening).
Image courtesy of the Centers for Disease Control and Prevention
Health officials then traced it all back to a man outlets love to describe as a sort of rogue Iowa egg magnate and his Wright Country Eggs (satellite view?).
As we stand now, the tainted eggs could have been distributed through any number of channels, but constitute a tiny fraction of the national egg supply.
For reporters digging into this national recall story, or looking to localize it to their coverage area, AHCJ has a strong archive of foodborne illness resources.
Start with a classic, the AHCJ article “Fatal Food: A study of illness outbreaks ,” in which Thomas Hargrove details SHNS’ massive investigation into the nation’s food safety monitoring system. Not only is Hargrove’s how-to instructive, his actual findings are useful examinations of state and local food safety systems around the country.
For your own investigation, look at Mining NLM databases: PubMed, Medline and more and the rich set of resources in the sidebar to Hargrove’s story.
If you’re looking for solid numbers and the most up-to-date national context, see Covering Health’s recent post on the CDC’s lates foodborne illness data, as well as our examination of 2009 foodborne illness rates.
Other relevant Covering Health posts include:
Schneider: FDA lacks resources to keep food safe
CDC assembles rogues gallery of food bugs
Private food auditors didn’t stop outbreaks
Lax oversight, complex supply chains aid outbreaks
Heisel’s ‘Doctors Behaving Badly’ goes viral
Filed under: Health data, Health journalism, Hot Health Headline, Member news, Nursing
As anybody who follows the Reporting on Health blog knows, William Heisel’s virtual roadshow of physician background research has been gaining ridiculous amounts of steam lately. His Doctors Behaving Badly brand has taken on a life of its own, propelled by a Google Map he put together to place his findings into geographic context.
View Doctors Behaving Badly in a larger map
That geographic context has become the focus of his investigation, as Heisel has turned what was once a quirky little recurring item into a systematic, state-by-state way into how the public can check up on disciplined (or otherwise problematic) doctors. He’s almost reached the halfway point, and he’s reached some interesting conclusions. My favorite is that he doesn’t think states that have terrible sites with which to check up on doctors are being malicious, they’re just bad at making websites.
I think the problem lies in poor website design. A board starts with a simple site that allows people to see if a doctor has a valid license. Then that same board adds scanned documents from its disciplinary files, but instead of linking these two things together, it puts them in completely different parts of its site. When the board gets around to adding malpractice information or criminal histories, it layers those on top, too, instead of fully integrating them.
The effect is a stratified system of information that lets patients think their physicians have a clean history when, in fact, their records are simply too hard to find.
Heisel recently appeared on Fox News to explain what he’d found thus far.
On the whole, Heisel’s effort helps illuminate the power of my favorite online reporting tool: The progressively investigated database.
EPA changes would improve public access to data
Filed under: Government, Health data, Health policy, Hot Health Headline
A recent OMB Watch story covers the EPA’s latest attempt to leverage the Toxic Substances Control Act to make it easier for the public to access chemical data and harder for manufacturers to hide health and safety related information behind the “trade secrets” label.
Fire and emergency response personnel practice techniques for hazardous materials containment and removal. (CDC photo)
The key is the expansion of the Inventory Update Reporting rule, which requires companies to report toxic substances over a certain weight threshold. According to OMB Watch, the Bush administration bumped this threshold from 10,000 to 25,000 pounds, and decreased reporting frequency from every four years to every five years.
The proposed rule lowers or eliminates thresholds for reporting and increases reporting frequency, moves that should provide the public with more information on more chemicals. The amount of a chemical manufactured at a facility in any given year fluctuates widely. … EPA’s proposed rule would require a manufacturer to submit information on a chemical if the volume exceeds the 25,000-pound threshold for any year since the previous submission. The agency is also proposing to return the reporting frequency to every four years rather than every five. Additionally, EPA is proposing requiring all reporters to submit data on the processing and use of the chemicals. The current program requires such reporting only for chemicals manufactured or imported over 300,000 pounds.
The manufacturers would use EPA-provided software to report their chemical inventory – currently, most manufacturers submit paper reports. The paper reports take years to process and the data-entry process introduces extra error into the system.
Another proposed change would require reporting of a number of valuable pieces of information, such as yearly production volumes, more specific chemical names and numbers to ensure the correct chemical substances are identified, and the approximate number of workers exposed to the chemicals.
Furthermore, manufacturers currently can label just about anything as “confidential business information,” the new rules would place annual limits on the practice and require manufacturers to justify any such designations.
The Society of Environmental Journalists wrote about the issue back in March and included a link to a report [PDF] from the EPA’s Inspector General, as well as other coverage.
Missouri data disclosure details infection fight
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public health, Public records, Studies, Tools
Missouri law requires hospitals to disclose infection rates for intensive care and certain surgeries. It doesn’t keep that data around for long, but St. Louis Post-Dispatch reporter Jim Doyle still managed to review data from 2005 to 2009.
Robots sanitize an ICU room by spraying hydrogen peroxide vapor into the air at St. John’s Mercy Medical Center.
He found that while numerous local hospitals lagged behind national infection rates, most were improving. A story that could have been a dire assessment of health care-associated infections instead became (mostly) a profile of local hospitals’ drive to cut down on the transmission of such infections. He doesn’t draw a clean line between the state’s monitoring and increased anti-infection efforts, but it’s tempting to read between the lines.
Doyle’s second installment continues the theme, discussing the aggressive, nonstop effort that is required to contain drug-resistant bacteria. Measures range from checklists to room-enveloping antibacterial vapors.
Missouri’s disclosure laws are an important step toward infection fighting, Doyle found, but their narrow definition allows hospitals some wiggle room and may miss serious systemic issues. Speaking of systemic issues, I highly recommend Doyle’s sidebar on why Missouri infection data is so hard to keep around.
CDC releases 2007 foodborne illness numbers
In the latest Morbidity and Mortality Weekly Report, the CDC has released the 2007 numbers on foodborne illness in the United States. Norovirus (39 percent) was the most common culprit, followed by Salmonella (27 percent). In terms of illnesses caused, poultry led the way, followed by beef and leafy greens. In the majority of the 1,097 reported outbreaks of foodborne illness, no agent was identified – a fact the CDC attributes to the small scale of many of those outbreaks. Here’s a breakdown of what investigators managed to find:
Those looking to dig a little bit deeper into the numbers should consult this four-page PDF, which breaks it all down by contaminant, food, number of outbreaks and number of illnesses caused.
Resources for covering food safety
Tip Sheets
- Lifting the shroud: Using multiple-cause-of-death data
- FDA Reform: The Time Has Come (Nancy Donley presentation)
- Why Is It So Difficult to Prevent Foodborne Illnesses? (Michael Doyle presentation)
- Reporting on the intersection of health and the environment
- Fatal Food: A study of illness outbreaks
Websites
- Center for Infectious Disease Research & Policy
- Outbreak Alert! Database
- Center for Food Safety and Security Systems
- FoodRisk.org
Related
- Recent stories and studies on foodborne illnesses
- Video study finds risky food-safety behavior more common than thought
- Airlines delay testing of onboard water
- A selection of stories about a 2008 salmonella outbreak
- Private companies, not the FDA, increasingly perform food safety inspections
Tougher concussion rules from high school assn.
The National Federation of State High School Associations has released tougher rules about removing players with potential concussions from the field. The initial release outlines the changes:
Photo by Les_Stockton via Flickr
The previous rule directed officials to remove an athlete from play if “unconscious or apparently unconscious.” The previous rule also allowed for return to play based on written authorization by a medical doctor. Now, officials are charged with removing any player who shows signs, symptoms or behaviors consistent with a concussion, such as loss of consciousness, headache, dizziness, confusion or balance problems, and shall not return to play until cleared by an appropriate health-care professional.
The Tampa Tribune’s Mary Shedden and Katherine Smith reported on how the change would affect Florida high school football and on how implementations of the new rule vary from district to district.
Language in the new rule is vague, stating a player can’t return until cleared by a “health-care representative.” In Hillsborough and Pinellas counties, players will need a doctor’s clearance, but Pasco officials may interpret the rule to include medical officials who were at the game, said Phil Bell, Pasco’s supervisor of athletic programs and facilities.
The best-known guidelines for returning to the game come from a sports medicine expert consortium in Zurich. It recommends athletes gradually return to activities, from light aerobic activity to noncontact drills to game day. Each step takes a minimum of 24 hours, and if symptoms return, an athlete must revert to the previous step.
Texas, Oregon and Washington have state laws mandating when players should be taken off the field; many other states rely on their athletic associations to format such rules. With the school year and football season getting under way, this would be a good time for reporters to check on the policies at local schools. Read more about concussions, including some recent reports and Congressional testimony.
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
- Reporting on the intersection of health, environment
- Tip sheet: Covering cuts to Medicare reimbursements
- Briefing: Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
