Delivering hospital-level care at home, hope for change in med ed, and what unrest in Baltimore has to do with health

April 30, 2015

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Moving medical care out of the hospital setting is emerging as an efficient, convenient and cost-effective way to care for patients with certain diagnoses, while protecting them from well-documented hospitalization harms. In a New York Times article, Daniela Lamas, MD, highlights hospital-affiliated programs where patients are offered hospital-level treatments in their homes. These may include IV meds and X-rays or scans, as well as regular provider visits. Not surprisingly, these at-home “hospitalizations” are yielding shorter recovery times, with patients no more likely to be readmitted or return to the ED because of complications. Another program, this one in nursing homes, also offers its residents treatments that once only took place in hospitals. Again in The New York Times, writer Paula Span describes how certain residents are receiving care like infusions for antibiotics and diuretics so that they don’t have to be transferred to hospitals, thereby averting falls and stubborn infections that the elderly may be prone to. At present, for many hospitals, it is not clear how to pay for these creative at-home “hospitalizations,” since they don’t fit cleanly into Medicare’s fee for service system. But hospitals with their own health plans may not be limited, and neither are certain nonprofit nursing homes that have philanthropic support.


In a JAMA interview marking the beginning of his tenure, newly appointed Surgeon General Vivek Murthy said he would focus on critical public health issues like improving nutrition, mental health, and curbing gun violence. That focus is especially relevant this week, as protests have engulfed West Baltimore and drawn attention to health challenges associated with urban poverty. Mass unemployment, lead exposure, drug abuse, a pattern of over-incarceration and abusive policing are common in cities across the country, and too often social policy choices serve to entrench rather than alleviate them. Around the country, laws have been passed criminalizing homelessness and even prohibiting charities from feeding people in public. In contrast, in Los Angeles, Mitch Katz, MD’s health department is pushing “housing first” strategies to help improve health for this vulnerable population. Murthy has an opportunity not just to improve public health, but to set an example for all physicians. The role of health professionals in advocating for patients isn’t limited to the exam room. The duty to advocate extends to all of the social circumstances that affect patients’ health, and by extension, the health of their communities.


As the medical system evolves to address different challenges, medical training is evolving alongside it. In Forbes, medical students Allan Joseph and Karan Chhabra note changes in the new MCAT. The updated test will emphasize social science, interpreting evidence, and other skills as well as knowledge of biology and chemistry. Hopefully the test will encourage would-be doctors to pursue a broader perspective on the world, and perhaps encourage more social science or humanities-minded students to consider careers in medicine. Many medical schools, too, are rethinking their curricula to reflect the importance of non-medical forms of social support and involve students to help patients with social and behavioral health issues. Many of these reform ideas were on display at the Beyond Flexner conference earlier this month. However, humanistic innovations in medical education may still encounter significant resistance, especially when they start encroaching on basic science courses.



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Financial harm


End-of-life care


Dr. Oz




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