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(From time to time, the blog features recipients of the IHA Iowa Hospital Heroes Award.  These outstanding hospital employees come from across the state and work at hospitals of every size.  They exemplify the courage, caring and community focus that are at the center of the hospital mission in Iowa.)

profile-photo-smallHospitals are the place to go when you break a bone, need surgery or have a baby; hospitals are not as well designed to heal the emotional and mental needs that many of our patients also bring with them.   Social Worker Maggie Martinez is the person that Buena Vista Regional Medical Center in Storm Lake turns to when patients need more assistance than medical training can provide.

Maggie is known to come in at any hour, vacation days and holidays to assist with those patients with mental or social needs.  She spends countless hours on the phone seeking out various resources that patients need after they are discharged from the hospital.  Physicians often make comments that she “ensures our patients are not lost once they leave the hospital.”

About a year ago a mentally disabled man with a chronic illness was admitted to the hospital.  He lived in an unsafe environment and had no family to help.  Maggie helped to secure a nursing home bed.  To accomplish this, she traveled to the man’s home and spent many hours on the phone with a judge, physicians and nursing homes.  She even accompanied him to the nursing home the day he was discharged because he was so frightened.  He remains living there today in a safe, clean environment he calls home.

Hero_MaggieM_8-2013-008smallRecently she dealt with a troubled teen whose parents could no longer handle and multiple programs and agencies would not accept. Maggie spent countless hours and days with this patient.  With persistence, she found a program that would accept the teen.

Maggie’s presence helps not only the patients but all the staff dealing with difficult situations. Our hospital employees are often involved with difficult cases that impact them emotionally.  The staff does what they need to do in each situation to provide the best outcome and experience for the patient and their family.  Maggie is crucial to making sure our staff learns how to deal with their own emotions regarding the event, enabling staff to provide the best care to patients.

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The additive manufacturing movement will provide form along with function.

The additive manufacturing movement will provide form along with function.

Johannes Gutenberg would be astounded at what is now possible as the world has progressed far beyond anything he might have imagined when he first printed the Bible on his movable type press.  That’s because the practice of putting ink to paper was mastered and made obsolete in the last several decades and humanity is now moving forward with the next step in the evolution – printing three-dimensional objects.

Lifelong fans of Star Trek would interject at this moment and say that this movement is more akin to replication than printing.  That’s because these sci-fi aficionados began dreaming of this day ever since they saw Captain Picard utter, “Tea…Earl Grey…Hot,” to a wall-mounted machine and suddenly a piping beverage would appear before him out of thin air.

3-D printing, or “additive manufacturing,” as it’s more commonly referred to, still primarily uses molten plastic, so it’s a long way from such the Star Trek scenario.  However, the possibilities it’s yielding are still remarkable, to say the least.  Some say this is the beginning of a new industrial revolution where consumers will eventually cease purchasing objects but rather buy the digital blueprints to create those objects (or their components) at home using 3-D printing machines.  Alas, while this probably won’t make your Ikea furniture any less confusing to assemble, this scenario is already in the early stages of realization, even within the realm of health care.

Take for example a young child who, by way of a tragic affliction or accident, has lost a leg. In the current prosthetic environment, these implements are not made to fit the patient, rather it’s quite the opposite and still remains an expensive ordeal despite years of discomfort and chronic joint and back issues that can be caused as a result.

Through additive manufacturing, that child is now able to have custom prosthetics crafted to fit his or her body and then have new versions of the implement scaled as the child grows.  In the case of a hand prosthetic, different hand positions can be crafted to enable the patient to do things that were previously accomplished using more arcane-looking attachments like hooks and claws.

But even further down the rabbit hole lies a couple of advancements that may seem even more like science fiction but are already nearing a state of practical use. The first is 3D-printed organs and organ tissue which companies like Organovo are already manufacturing. While still somewhat in the development phase, 3D-printed organ tissue has potential to revolutionize transplants by offering “off-the-shelf” organs and eventually eliminating the often heartbreaking wait and disappointment of donor organs and donor lists. One other anticipated practical use of 3D-printed organs is in pharmaceutical drug testing using actual human tissue, thus yielding more accurate results than previously possible with 2-D cell cultures or animal testing.

And it’s not only organs that are coming off the press, but food as well. This has obvious humanitarian implications as 842 million people in the world are suffering from hunger. Organizations such as Meals from the Heartland, which benefit largely from volunteers (one of IHA’s favorite volunteer activities every year) and donations, could soon be directly benefitted from such an advancement.

And here at home, the U.S. Army is currently considering 3D-printed food as an alternative to the current “meals ready to eat” for feeding its troops. For now, the menu hasn’t ventured beyond the “paste and gruel” varieties, so odds are we won’t see Gordon Ramsay popping a blood vessel over poorly rendered gourmet 3D food any time soon, but we all had to learn to cook ramen once before we could move up to tiramisu.

All of these facets of additive manufacturing as well as some you might not expect will be discussed by Kendall Joudrie, founder and CEO of Thinking Robot Studios, as part of a track of sessions examining innovation at this year’s IHA Annual Meeting, October 7-9 at Veterans Memorial Community Choice Credit Union Convention Center in Des Moines.

Don’t feel ashamed if all of this techy goodness finds you in a geeky mood and asking iPhone’s SIRI for “Tea…Earl Grey…Hot.” The outcome won’t readily quench your thirst, but she’ll still come back with a number of great places around downtown Des Moines where you can hoof it to.

 (photo credit: Melissa Ng,

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It’s becoming more and more apparent that the struggle to expand insurance coverage in Iowa through Medicaid was well worth the effort.  As these pages have recently noted, coverage is up and uncompensated care is down in both Iowa and other states that expanded Medicaid.  That trend has impacted more than medical care and finances; it has helped smooth Iowa’s mental health system reform and contributed to Iowa ranking as best in the nation for children’s health.

In other parts of the nation, the positive impacts are also being documented, including actual lives saved.  In Massachusetts, which adopted insurance expansion in 2006, a study published last spring determined that mortality declined almost 3 percent relative to control counties in the four years after the state’s health expansion was rolled out.  Mortality related to health care-amenable conditions fell by 4.5 percent.

As IHA’s successful campaign stated and restated in 2013: coverage matters.

medicaid-mapUnfortunately, it also matters for the 24 states that have so far turned their backs to Medicaid expansion (though a few are on the fence).  An Urban Institute survey found that the uninsured rate among adults under 65 had declined by 6.1 percentage points in states that expanded, compared with only 1.7 percentage points in those that didn’t.

The situation in these states has put hospitals in peril.  Carolinas HealthCare System, which has some 900 care locations including 7,640 licensed beds in North and South Carolina, reported an astounding 53 percent drop in earnings.  Had North Carolina expanded Medicaid, it would have covered 500,000 additional people and brought an additional $413 million to the state.  Meanwhile, Fitch Ratings had this blunt assessment: “We expect providers in states that have chosen not to participate in expanded Medicaid eligibility to face increasing financial challenges in 2014 and beyond.”

What’s more, many of these states, by many measures, were among the least healthy in the nation long before the Affordable Care Act (ACA) became law.  Look at the Kids Count Survey which Iowa led and you will see Louisiana, Alabama, Mississippi and other far-southern states struggling with every sort of children’s health issue, from low-birth weight babies and infant mortality to childhood immunization rates and the number of children struggling with mental health issues.  Amazingly, seven of the 10 states with the highest uninsured rate (for total population) are not moving forward with Medicaid expansion.

On top of all this, the United States Court of Appeals for the District of Columbia Circuit ruled last week that ACA does not allow the federal government to offer financial assistance to people buying insurance in states not running their own insurance marketplaces.  If that ruling stands (keep in mind another federal court ruled the subsidies are fine), it could mean that millions of residents in 36 states, including Iowa, would lose access to insurance through ACA.

Having expanded Medicaid, Iowa remains well-positioned for the future.  However, many states (including four of the six bordering Iowa) have declined the offer, leaving millions of Americans even more on the fringes of the health care system.  In that way, ACA has fallen short as a national solution for providing health care access to uninsured Americans.

The need remains – in fact, it has only become greater.  The question is, given the unexpected curves and bumps thrown in front of ACA’s otherwise admirable progress, what can or should be done to get states that have been left behind back on track?  Furthermore, how will their lack of progress impact states like Iowa that have done the right thing and continue to make great strides in providing high-quality, high-value health care?

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Visiting HoursThe concept of patient-centered care has long recognized the value of each patient’s family and friends as an integral part of both the healing process and wellness in general.  It’s arguable that this support system is as important as the care services themselves.

With that in mind, many hospitals in Iowa and around the nation have done away with “visiting hours” and replaced them with 24/7 visitation policies that are presented something like this:  “We encourage family and friends to be with their loved one while in the hospital.  We view family and friends as our partners in the patient’s care and we support their presence and participation in the patient’s caretaking and decision-making, but only to the extent that the patient would like.”

Visiting hours may be as ancient as hospitals themselves – or maybe not, since early hospitals depended greatly on family members as caregivers.  More likely, visiting hours are a lingering contrivance of “modern” medicine and professionalization of providers, ostensibly designed to benefit the patient but able to hang on because of staff preferences.

With a greater focus on patient-centeredness and safety, the necessary involvement and encouragement of “care partners” has been duly recognized.  By reducing fear and anxiety, they support the healing process.  By serving as scribes and advocates, they increase understanding (for both providers and patients) and help reduce the likelihood of errors or readmissions.

In a 2014 Health Research & Educational Trust survey of U.S. hospitals, about 58 percent of hospitals report that they have a policy or guidelines that exist across all units in the hospital that facilitate unrestricted access to the patient by families or partners in care, according to patient preference.  This is good news for patient-centeredness, but there is clearly still work to be done.

For the majority of hospitals that have set aside restrictions, perhaps the next step is to formally eliminate the concept of “visitors.”  Some hospitals have done this by transforming their visitor policies and developing an official “welcoming policy.”

One of the leaders in this development has been Contra Costa Regional Medical Center (CCRMC), a public hospital in Martinez, California.  The hospital’s website explains the policy:  “We have implemented a new Welcoming Policy to make the hospital accessible 24 hours a day to family and loved-ones of those receiving care in the medical center.  Recognizing that family and loved-one presence supports safe and high quality care, we have worked over the last year to replace our ‘visitor policy’ with this Welcoming Policy.”

Implementing the policy was a rigorous process at CCRMC that involved physicians and nurses as well as front-line staff, security personnel, patients and families.  Anna Roth, the hospital’s CEO, noted that a 24/7 welcome policy is not without boundaries; safety, security and patient preference remain priorities. The hospital is tracking the policy with data; since implementation, more than 5,000 after-hours (8 p.m.-7 a.m.) “welcome moments” have been recorded with zero complaints.

Roth explained, “Our old policies treated family members like visitors, until we realized that we are the visitors in people’s lives, not the other way around.  This was a huge cultural shift, and one that the staff here was courageous enough, bold enough and caring enough to undertake.”

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A toddler gets his heart checked at Monroe County Hospital & Clinics in Albia.

A national survey that each year measures major trends affecting children’s well-being ranks Iowa as the top state for health and in the top three overall.

The 2014 Kids Count Data Book released this week by the Annie E. Casey Foundation lists Iowa No. 1 for health, third place for children’s economic wellness and third overall. The survey compares data from 2005 to 2012, the most recent year that statistics are available.  Iowa also moved up from seventh place to third in the nation for overall children’s well-being.

Four indicators were used to measure the health of those up to 19 years old:  low-birth weight babies, children without insurance, child and teen deaths per 100,000 and teenage abuse of alcohol and drugs.

From the Quad-City Times:

Marcus Johnson-Miller, who works in the early childhood program run by the Iowa Department of Public Health, pointed to the state’s efforts to encourage better care for low-birth weight babies.

In the past year, the state has worked on a regional system that pairs up low-birth weight babies with the hospitals that can best care for them.

In other words, he said, “High-risk deliveries are now done at the facilities that can handle the high-risk babies.”

Further, the state is examining ways to ensure that women carry their babies to full-term, or 40 weeks, he said. The rate of early elective deliveries in Iowa has at least stabilized or gone down slightly, he said.

Actually, Iowa hospitals have been working diligently to reduce the number of early elective deliveries – and with great success.  Reports from the Iowa Healthcare Collaborative show these deliveries have been reduced by more than 90 percent.

Iowa hospitals do constant work to keep children healthy, from providing free bike helmets to teaching babysitting classes to helping parents properly install child seats in their cars. Hospitals also help sponsor “safety fairs,” like this one in Vinton and this one in Iowa City.

Hospitals also work hard to make sure children are properly immunized, as the Times noted:

To Dr. Louis Katz, Iowa’s lofty ranking is because of the hard work done by many public health workers.

Katz, the longtime medical director of the Scott County Health Department, mentioned the many screening and immunization programs now available, saying that they are central to good health and finding potential medical problems early.

One example is the Flu-Free Quad-Cities initiative of Genesis Health System that offered free inoculations to almost 10,000 schoolchildren in Scott, Clinton and Rock Island counties last year.

Finally, another big reason Iowa’s children are healthier than others is insurance. The Kids Count data shows only 4 percent of Iowa children were uninsured – almost half the national average. As the Des Moines Register reported:

Iowa has long had some of the lowest uninsured rates in the nation. Marcus Johnson-Miller, who oversees early childhood programs for the Iowa Department of Public Health, noted that state officials have aggressively worked in the past few years to let parents know about options such as Medicaid and Hawk-I. The publicly subsidized insurance plans are for children from poor or moderate-income families. Johnson-Miller said the Hawk-I enrollment efforts have been supplemented this year with expansion of other types of insurance under the Affordable Care Act. The rate of uninsured children has probably declined even further since 2012, he said.

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