Archive for: February 2010

Simplifying the Legal System: Philip K. Howard at TED 2010

Feb 25, 2010, 9:44 AM, Posted by RWJF Blog Team

Philip K. Howard, Founder & Chair of Common Good – a Pioneer Grantee – gave an engaging talk at TED 2010 on four ways to simplify the legal system. We encourage you to listen to the talk and then pop back over here and let us know what you think about his ideas.

You can also read more from Howard on RWJF’s Health Reform Galaxy Blog.

Death Toll from Hospital-Acquired Infections Higher than AIDS, Guns or Traffic Accidents�Costs Astronomical

Feb 24, 2010, 10:27 AM, Posted by RWJF Blog Team

Since 2006, sepsis and pneumonia, two common conditions caused by largely preventable hospital-acquired infections (HAIs), have killed 48,000 patients and have cost the health care system a staggering $8.1 billion – this according to a new study in Archives of Internal Medicine by researchers at Extending the Cure.

To put this in perspective: the death toll from avoidable pneumonia and sepsis is higher than that from traffic fatalities. It's more than three times higher than that for AIDS, and roughly twice as much as annual deaths from firearms.

The study is the largest nationally representative study to date – Ramanan Laxminarayan, Anup Malani and colleagues analyzed 69 million discharge records from hospitals in 40 states – and the findings are generating a lot of buzz.  Patients who developed sepsis after surgery stayed in the hospital 11 days longer and the infections cost an extra $33,000 to treat per person – what’s worse is nearly 20 percent of those patients died as a result of the infection. While patients who developed pneumonia after surgery stayed in the hospital an extra 14 days, cost an extra $46,000 per person to treat and 11 percent died as a result of the infection.

HAIs frequently are caused by microbes that defy treatment with common antibiotics. Co-author Malani said, “These superbugs are increasingly difficult to treat and, in some cases, trigger infections that ultimately cause the body’s organs to shut down”.

Another interesting implication is that Medicare’s decision to not reimburse hospitals by preventable so-called “never” events is not having much of an impact when it comes to HAIs.  In a case of misaligned incentives, the study suggests that penalties may not be a sufficient deterrent to motivate stronger infection control if hospitals knowingly misclassify infections to avoid penalties.  It also may be that problems documenting the infections prevent adequate enforcement. Even if the Medicare rules were fully effective, though, it wouldn’t matter…according to the NPR blog, “in an analysis that's not in the published paper, the authors looked at how many deaths could be averted each year…The answer: Fewer than 100.”

Check out other coverage from ABC News, the Wall Street Journal Health Blog and NPR’s Marketplace.

If you are interested in seeing what else Extending the Cure is working on, make sure to check out their blog and twitter account. 

'Tis a Gift to be Simple

Feb 22, 2010, 9:50 AM, Posted by Paul Tarini

George Whitesides, a chemist and the Flowers University Professor at Harvard, gave an elegant talk on simplicity at TED.  Whitesides asserted that simple things have four qualities:

  • They are predictable and reliable;

  • They are cheap;

  • They have a high value-to-cost ratio; and

  • They are stackable, that is you can combine them to build more complicated things.

The lowly transistor is a simple thing.  It’s also the building block of modern electronic devices.  Transistors enabled computers which enabled the internet which enabled, well, you get the picture. The point here is that simple things have emergent properties, that is, they enable complex systems to arise out of simple interactions. The next point is that you can never predict what results or complex systems will emerge when you stack a bunch of simple things together, snowflakes included.

What he’s talking about, clearly, are simple physical things.  But it led me to two thought experiments I’d like some help with…the first: identify two or three simple things that could be combined to create some novel product, service, or experience that would significantly improve health and health care. 

The second: can you deconstruct a complex aspect of our health care system and identify its most simple parts as a first step in re-thinking how things get done?

Benchmarking Progress in Health IT

Feb 17, 2010, 4:08 AM, Posted by Steve Downs

Being at TED last week led to some interesting conversations about data, health and the progress of health IT.  One conversation in particular stuck with me – a computer industry executive pointed out that the pace of innovation in the computer industry is orders of magnitude faster than in the health IT industry.  Orders of magnitude.  As in 10, 100, 1000 times faster.  A bold claim.  But then think about some of the advancements shown at TED:

- Microsoft’s integration of Photosynth and Sea Dragon technologies to create a Virtual Earth experience where you can now do a street level fly through of a city neighborhood and see the facades of the buildings around you.  And where there are web cams, seamlessly integrate live video into the view.

- A voyage through the Digital Universe, which is about what it sounds like – extending the Virtual Earth/Google Earth experience to all known objects in the universe.

- Google’s demo of an image recognition feature where the presenter took a photo of a postcard of a hotel with the Nexus One and Google (the omniscient Google – not the company) returned the name and address of the hotel.  And speech-to-speech translation through the Nexus One as well.

- John Underkoffler’s prototype interface in which people can gesture toward a screen to “pick up” a document, then walk across the room and drop the document onto the screen of a different computer.

 

When you step back and think about it, it’s truly extraordinary.  The gap between sci-fi and ship dates is closing rapidly.  Magic abounds.

So where are we with health IT?  Progress to be sure.  Pockets of excellence.  But as best as I can tell, we’re still struggling with threshold challenges around data exchange, interface design, workflow and deployment at scale.  I’m still processing all this and I’m probably missing something, so I’d really like to hear from people on this question – is the pace of innovation in health IT really that much slower than in the computer and software industries?  If so, then the implications for how we think about the integration of IT into health care are really serious.

The Need for More Randomized Controlled Trials in U.S. Social Policy Interventions?

Feb 17, 2010, 3:45 AM, Posted by Deborah Bae

Esther Duflo, a development economist at MIT, gave a thought-provoking talk at TED on using randomized controlled trials to study the impact of anti-poverty interventions in developing countries. Instead of trying to answer the big, controversial question, “Does (international monetary) aid work?” Duflo tries to answer smaller, local questions that provide insight to the big question.  For example, mosquito nets are highly cost-effective for preventing malaria, but they’re not being used widely.  Duflo wanted to know why and whether cost had something to do with it.  Are poor villagers more likely to use mosquito nets if they have to buy them (at a low, subsidized price) versus getting them for free?  Her research showed it’s more effective to give the nets away for free. 

What’s most appealing about Duflo’s research is that she’s able to show what works (or doesn’t) and she can back it up with data.  Randomized controlled trials are the gold standard- for example, the 1971 Rand Health Insurance Experiment is still cited today, yet, they’re not extensively conducted on U.S. social policy interventions (with the exception of education) primarily due to cost, ethical issues, and complexity of the research design.  Knowing what works would ensure that scarce funds are directed towards those policies that have meaningful, lasting impact to improve the lives of millions of people.

Duflo’s talk raises some important questions: When is appropriate to conduct randomized controlled trials in U.S. social policy?  Should we conduct more randomized controlled trials in health and health care to understand which interventions work and to invest in? Or are randomized controlled trials too controlled, localized, unrealistic and infeasible?