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It seems counterintuitive and more than a little uncomfortable to be writing about end-of-life care during a time when millions are giving thanks for all they have in life. But it is that inability to talk about and realistically face death that often contributes to poor end-of-life care.

Data released last week from the Dartmouth Atlas Project is telling: one in three Medicare cancer patients spent at least part of their final month of life in the hospital or an intensive care unit. Six percent of these elderly cancer victims were still receiving chemotherapy two weeks before they died. In some parts of the country, more than 16 percent of these terminal patients were subjected to intensive procedures like endotracheal intubation, feeding tube placement or CPR.

Some may think this a tribute to the determination of these patients to fight until the end or at least a credit to the choices we have in our health care system. But, as the Dartmouth study notes, for frail, elderly patients, and any patient with advanced cancer, research has shown these treatments have limited or no benefit. In terms of quality of life, this is lack of compassion that can border on cruelty.

“The well-documented failure in counseling patients about their prognosis and the full range of care options, including early palliative care, leads many patients to acquiesce to more aggressive care without fully understanding its impact on the length and quality of life,” said David C. Goodman, M.D., lead author of the study. That failure also leads to billions of dollars in needless health care spending.

As for choice, there are better ones, like hospice. In Iowa, 69 percent of the patients in the Dartmouth study received hospice care, compared to about 50 percent in the nation overall. With more patients directed toward hospice, fewer die in the hospital – only about 25 percent in Iowa (compared to about 32 percent for the nation).

It is good news that Iowa is on the right track in terms of providing end-of-life care (in Mason City, only 7 percent of the study group died in the hospital, the lowest rate in the nation).  This is on par with other Dartmouth studies that show Iowa’s hospitals are much more consistent about providing the right care at the right time. But the studies also show there is notable variation within Iowa, just as there is across the nation and even among the country’s most renowned academic medical centers.

So, while Iowa can be grateful this Thanksgiving for having one of the best health care systems in the nation, there is room for improvement, including getting better at caring for patients who are close to death.  As Dartmouth researcher Elliott Fisher, M.D., concluded:

“These findings highlight important opportunities to improve the care of patients with serious, life-limiting illness. Patients and families must understand that they have choices – and that it is critical to have early discussions with their physicians about what most matters to them. Physicians and hospital leaders must also recognize that they have much to learn – and that serious inquiry into their current practices can help make sure that we are providing all the care that our patients want and need, but no more.”

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Featuring hospital and health care headlines from the media and the Web.

Iowa News

Nobel winner in economics will study health care systems in Iowa, Indiana, Colorado
Indiana University Professor Elinor Ostrom, the 2009 Nobel Prize winner in economics, will head a research team looking at Cedar Rapids and three other locations that have comparable health care systems. The systems’ share a reputation for delivery of Medicare services at the nation’s lowest costs and highest positive outcomes. (Grand Junction Daily Sentinel)

Study says Iowa does a good job in end of life cancer care
A study by Dartmouth College shows Iowa does better than the rest of the country when it comes to providing end-of-life care to cancer patients, including one north Iowa hospital was at the top of the list. Iowa’s hospice enrollment rate of 70 percent was one of the highest in the study, which showed 42 percent hospice enrollment for New York, 47 percent for California. (Radio Iowa)

Where you live=how you die
At 241-bed Mercy Medical Center-North Iowa in Mason City, palliative care staff members credit their region’s success to a variety of factors including supportive administration, a long history of focusing on end-of-life care, and a holistic approach to treating patients. And, according to W. David Clark, a palliative medicine physician at the hospital, people in the region are trusting and appreciate the plain, straight talk that comes with palliative care. (Modern Healthcare)

Endowment continues prenatal research
Christina Campbell researches the role of diet and nutrition of expectant mothers in disease prevention through the Blossom Project, in which she partners with Mary Greeley Medical Center in Ames. Campbell and the medical staff record women’s activity levels and collect blood samples at 18 and 35 weeks of pregnancy and from their babies’ umbilical cords following delivery, to test for nutrients. (Ames Tribune)

Dinner is by invitation — to all
What Nancy Broer and some of her friends in Onawa discovered when they decided to invest their time in creating a dinner for the community was that it was easier said than done. Folks associated with Burgess Health Center stepped forward to assist. (Sioux City Journal)

Inaction on medical errors draws fire in Iowa
Declaring that special interests have taken over state government, one of Iowa’s top regulators is criticizing the Iowa Hospital Licensing Board for blocking public disclosure of hospital errors that threaten patient safety. The Iowa Department of Inspections and Appeals has been trying for several months to persuade the Hospital Licensing Board to approve a measure requiring hospitals to make public so-called “never events.” (Des Moines Register)

U.S. News

Independent hospitals unite under ‘shared services,’ prepare for ACOs
Some hospitals and health systems are striving to reduce costs and prepare for accountable care organizations by banding together in shared service arrangements. Such arrangements allow independent organizations to share functions like recruitment and alignment of physicians, health information technology, group purchasing and revenue management, says Rob Betka, a consultant at Catalyst Management Advisors in Grand Rapids, Mich. (Becker’s Hospital Review)

Growing National Nurses United union steps up strikes
National Nurses United, the largest nurses union in the country, has helped organize strikes or threatened them this year at hospitals in California, Pennsylvania, Maine, Michigan and Minnesota. The Oakland, Calif.-based union has tapped into concerns of registered nurses worried about losing jobs at a time when hospitals and health-care organizations are under enormous pressure to cut costs. (Washington Post)

Some states weight unthinkable option: ending Medicaid
Elected and appointed officials in nearly a half-dozen states, including Washington, Texas and South Carolina, have publicly thrown out the idea. Wyoming found that Medicaid accounts for 63 percent of the state’s nursing-home revenue. The idea of abandoning Medicaid as a solution is so extreme that even proponents don’t expect any state will follow through, but officials are floating the discussions because dire budgetary pressures have forced them to at least look at even the most drastic options. (Wall Street Journal)

12 hospital and health system goals for 2011
“In 2011, just like we have this past year, Iowa Health System (IHS) will continue to lead efforts to improve the quality of care through innovation in delivery and cost efficiencies,” said Bill Leaver IHS CEO. He adds the system will focus on three key areas: reimbursing healthcare providers for adding value to the healthcare delivery system, supporting high quality care to the system’s communities and remaining fiscally viable as a driving economic force. (Becker’s Hospital Review)

As hospital system expands, patient advocates worry
Sutter Health’s gleaming $618 million Mills-Peninsula Medical Center, scheduled to open here in February, is filled with doctor- and patient-friendly features. Although Sutter executives say these developments will improve patient care, some analysts and patient advocates worry about the growing leverage the nonprofit hospital system has in negotiating rates paid by insurers, employers and patients. Sutter already is the priciest health system in California. (National Public Radio)

ER visits fall for tots after cold, cough medicines pulled
The number of babies and toddlers who go to the emergency room because of cough and cold medicines fell by more than 50 percent after manufacturers stopped selling products labeled for children under 2, a study shows. Manufacturers agreed to pull over-the-counter cough and cold products for those ages in October 2007 because of concerns about safety and effectiveness. (USA Today)

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Featuring hospital and health care headlines from the media and the Web.

Iowa News

Sumner lays plans for new hospital
Mary Wells, CEO of Community Memorial Hospital, announced the capital campaign kickoff as organizers and lead donors gathered in support of “The Heart of Your Community.” Wells explained “The Heart of Your Community” fund-raising campaign is part of a $17.4 million project to build a 51,850-square-foot facility just south of the current hospital along Highway 93 on the western edge of the city. (Oelwein Daily Register)

U.S. health benefit costs increased by 6.9 percent
Among Iowa employers that responded to the survey: 34 percent said they will shift costs to their employees next year by raising deductibles, co-pays or out-of-pocket maximums. Additionally, 28 percent said they will increase employees’ share of premium contributions, and 18 percent will increase employee cost sharing in some other way. Fourteen percent offered a consumer-directed health plan with an account feature (health reimbursement account or health savings account) in 2010. (Des Moines Business Record)

Blank hospital president recovering from cancer surgery
David Stark, president and chief operating officer of Blank Children’s Hospital, is recovering at home after surgery last week for colon cancer. Stark, 39, was recently diagnosed with an advanced stage (stage IIIC) of colon cancer. He is planning to return to work in the next couple of weeks, he said through a hospital spokeswoman. He will undergo several rounds of chemotherapy over the next few months. (Des Moines Register)

U.S. News

A hospital chief’s tough task in tough times: cut costs, improve quality
Judy Rich is a bundle of energy, ideas – and worry. Since she became president and CEO of the Tucson Medical Center in 2009, she’s had to face the impact of an economic recession that hit Arizona health care particularly hard. Now, as she leads the largest hospital in southern Arizona, she’s trying to adjust to a decrease in the number of paying patients, state cutbacks in health spending and a slew of changes from the new health law. (Kaiser Health News)

Health care law is unconstitutional, Republican Senators tell court
Requiring people to purchase health care “oversteps the bounds” of the U.S. Constitution, 32 senators said today in the filing in federal court in Pensacola, Florida. The U.S.’s arguments in favor of the law are “harming the Constitution’s framework by allowing the federal government to overreach its enumerated powers and invade the legitimate province of the states,” wrote the senators, including Republican leader Mitch McConnell. (Bloomberg)

Health industry cool to complete repeal of new law
But while a large majority of GOP voters told exit pollsters they strongly support the idea of starting from scratch on the health overhaul issue, major players in the health care industry — usually strong Republican allies — are a lot less enthused about the idea. “No one has said what this bill would be replaced with,” said Richard Umbdenstock, president and CEO of the American Hospital Association. (National Public Radio)

Hospitals take steps to improve
Every hospital is committed to providing patients with the right care at the right time in the right setting. Their mission is to build healthy communities, both one patient at a time and through communitywide initiatives. Rather than punishing hospitals for their efforts to improve, we should encourage them to continue to work together to develop new and better tools to deliver the safest possible care. (USA Today)

Quality of care in Minnesota is all over the map
The first state-mandated report on quality of medical care in Minnesota shows that clinics and hospitals vary dramatically in how well they treat patients — even on something as basic as children’s colds. The report, which was two years in the making, gives consumers an inside look at how 520 individual clinics and 133 hospitals performed on a series of quality measures, from asthma to pneumonia care. (Minneapolis Star Tribune)

Medicare panel backs $93K cancer drug Provenge
The Centers for Medicare & Medicaid Services will make a final decision on the drug in March, and a positive ruling would make the drug available to tens of thousands of seniors diagnosed with prostate cancer. Most analysts expect Medicare to pay for the drug, giving drugmaker Dendreon Corp. a blockbuster product worth up to $2 billion in sales per year. (USA Today)

In California, facing down a family physician shortage
In the latest in a series on health reform, Betty Ann Bowser reports from California on what’s being done to inspire medical students to address a shortage of primary care doctors. (PBS NewsHour)

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Featuring hospital and health care headlines from the media and the Web.

Iowa News

Ottumwa hospital builds promise to grow
“We need more physicians in the community, and that’s one of the reasons the board chose (to sell to) RegionalCare,” said Dr. Ted Haas, an Ottumwa Regional Health Center board member. Tuesday morning, board members, hospital employees and members of the public gathered behind the ORHC emergency room parking lot, where two new medical office buildings are going. (Ottumwa Courier)

Scotland Yard detectives tour St. Luke’s Child Protection Center
A specially trained unit of Scotland Yard in London uses a team approach to bring forensic science and law enforcement together to conduct sexual assault investigations and to provide victims with support. Detectives from the unit shared their skills and experiences this week during a conference with local educators, law enforcement and hospital staff. (Eastern Iowa News)

Iowa Health coat drive collects 1,525 items
The Iowa Health-Des Moines employee volunteer program’s “Giving Warmth Coat Drive” collected 1,525 warm clothing items for central Iowans in need. The coat drive was held in conjunction with Des Moines Area Community College, KCWI-TV, Gold’s Gym and Community Choice Credit Union. (Des Moines Register)

U.S. News

U.S. patients have more access to specialists, less to primary care
A new international survey finds that U.S. consumers report greater access to specialty health care but also have a tougher time seeing a doctor on the day they need help and in paying their medical bills than consumers in many other developed nations. Americans visit doctors and specialists more readily than some other countries, such as Canada and France, according to the survey, which was conducted in 11 countries last spring for the Commonwealth Fund. (Kaiser Health News)

Average health insurance deductible now $1,200
Close your eyes and take yourself back to 2005 for a minute: George W. Bush had his second inauguration, “Star Wars: Episode III–Revenge of the Sith” was burning up the box office and health-insurance deductibles were only about $770. But in 2010, the average deductible for PPOs, the most common employer-provider health plan, hit a whopping $1,200. (Wall Street Journal)

Medicare opt-out provision triggers scope-of-practice debate
Within the last nine years, 16 states have opted out of a federal rule requiring physician supervision of certified registered nurse anesthetists administering anesthesia medication at Medicare-participating hospitals. Governors and nursing groups from the 16 states say taking the exemption enables them to provide anesthesia services in communities that have a hard time attracting physicians, and without the higher cost of an anesthesiologist. (American Medical News)

Nurses’ role in the future of health care
Like crew members frantically moving deck chairs, policy makers, medical center administrators, third-party payers and even doctors and patients have remained focused on one thing: the physicians. In all the discussions about adjusting the number of medical schools and training slots, rearranging physician payment schedules and reorganizing practice models, one group of providers has been conspicuously missing. The nurses. (New York Times)

Deficit panels go where politicians won’t
Two bipartisan plans for reining in the federal debt have been tossed onto the national stage in the past week, after a campaign season in which President Obama and Congressional Republicans separately promised to act but offered few specifics. The two plans suggest why: Each proposes substantial cuts to spending across the board and an end to popular tax breaks for individuals and corporations after 2012. Those are not the kind of promises that candidates generally make. (New York Times)

Patients hurt by economy, doubtful about health care overhaul
The Harvard School of Public Health asked people with heart disease, diabetes, and cancer whether they had difficulty paying their medical bills or managing their illnesses. About a third of heart patients and diabetes patients and a fifth of cancer patients said they had to use up most or all of their savings to pay medical bills, co-payments, or other fees. The same proportion of patients also said the poor economy has hurt their health. (Boston Globe)

Mayo Clinic taking cancer treatment to a new level
The Mayo Clinic said Tuesday it plans to build the state’s first proton beam therapy center for cancer patients — an investment of $188 million that will provide an emerging form of radiation therapy delivered with massive machines that stand nearly three stories tall. Currently, fewer than 10 medical centers in the U.S. offer the proton beam therapy, which proponents say is a more precise form of radiation with fewer side effects. (St. Paul Pioneer Press)

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Recently, Mercy Medical Center-Des Moines in collaboration with Air Methods, Bell Helicopter and the Federal Aviation Administration (FAA) unveiled its newest Mercy One air ambulance equipped with state-of-the-art navigation equipment. This technology will enable pilots to fly in more inclement weather situations than ever before.

“We miss about 240 flights a year due to the fact that the weather minimums are such that we can’t fly,” said Dan Keough, director of emergency transport services at Mercy. “We feel that with this new technology being state-of-the-art and the first of its kind in Iowa, we will recapture at least 20 percent of those weather misses that we currently have now.”

After testing is complete, Mercy plans to use its hospital as the first location to deploy Mercy One but soon after will include landing sites at Clarke County Hospital in Osceola, Mercy Medical Center-Centerville, Monroe County Hospital in Albia as well as a non-hospital based helipad being built in Stuart.

Dan Keough and Dennis Cochran, Mercy One Program Manager, Mercy Medical Center-Des Moines sat down with IHA to discuss the new Mercy One helicopter and the impact it’s likely to have across the health care industry.

Click here to view all the photos taken at the Mercy One media annoucement event.

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