Study indicates risk of fatal birth defects is higher in counties with mountaintop-removal coal mining

"Children born in counties home to mountaintop coal mines had a 26 percent higher risk of suffering" a fatal birth defect "compared to ones born in non-mining regions," according to a new study, Dan Vergano of USA Today reports. The study, led by health economist Melissa Ahern of Washington State University in Spokane, will appear in the upcoming Environmental Research Journal. (Map shows counties with coal mines in 1996-2003, with "mountaintop" mining counties in darker gray)
Air and water pollution from mountaintop mining led Ahern and her colleagues "to look for health effects on infants" in West Virginia, Kentucky, Tennessee, and Virginia, Vergano writes. The researchers found birth defects in mountaintop mining areas were elevated above non-mining areas in six of seven categories, including heart, lung and gastrointestinal. Because of an already established connection between poverty and birth defects, the researchers then "controlled for social factors such as smoking, drinking, mother's education, race and other poverty-related factors" and found a 26 percent increased risk of fatal birth defects in mountaintop-mining counties, Vergano reports.

A spokesman for the National Mining Association "suggested adding more demographic factors to the study might remove the elevated birth defects," Vergano writes, then quotes environmental and pediatric-health expert Lynn Goldman of George Washington University as saying "It isn't proof of cause and effect" and paraphrases her: "Because the study is the first of its kind, public health researchers will need to reproduce the study results to feel confident it has uncovered a real link, she cautions. Further studies will be needed to show how exposures in mountaintop mining communities could lead to more birth defects." (Read more)

Several Kentucky hospitals overdo CT scans, despite cost, risk

Despite the risk of exposing patients to more radiation and the fact that radiologists say it is very rarely necessary, Medicare outpatients are regularly receiving two CT scans on the same day at 12 Kentucky hospitals, according to analanysis of Medicare data by The New York Times, which produced a handy interactive map, a segment of which is copied here. To use the actual map, click on the map below.

Though only 5.4 percent of hospitals nationwide scan a patient's chest twice on the same day, nine Kentucky hospitals are double-scanning at least 15 percent of the time and three are doing it more than 30 percent of the time, accoding to data for 2008. Figures for 2009, which are expected to be similar, are due out next month from the federal Center for Medicare and Medicaid Services.

Clark Regional Medical Center in Winchester has the highest rate, double scanning 43 percent of the time. Monroe County Medical Center in Tompkinsville double scans 34 percent of the time, followed by Pineville Community Hospital at 32 percent.

Other Kentucky hospitals that are double scanning at least 15 percent of the time include: Clinton County Hospital, Albany, 30 percent; Paul B. Hall Regional Medical Center, Paintsville, 25 percent; Harlan Appalachian Regional Healthcare Hospital, 24 percent; Norton Hospitals, Louisville, 23 percent; Westlake Regional Hospital, Columbia, 23 percent; Spring View Hospital, Lebanon, 20 percent; Methodist Hospital Union County, Morganfield, 19 percent; T.J. Samson Community Hospital, Glasgow, 18 percent; and The Medical Center at Bowling Green, 18 percent.

There are two types of CT scans, one that uses iodine contrast to monitor blood flow and one that does not. In rare circumstances, performing both scans — each with a separate charge — could help spot a tumor, said Dr. Michael J. Pentecost, a radiologist and Medicare consultant. While doctors may opt to double scan to get the most information on their patient possible, experts say being so thorough is rarely necessary, particularly given the added cost to the system and the exposure to radiation for the patient.

As Kentucky's numbers indicate, double scanning happens more often at small, community hospitals, where treatment can involve transferring patients to larger facilities. Nationwide, 200 hospitals administered double scans more than 30 percent of the time.

The Medicare agency released the data last year to hospitals "to show how they performed relative to each other and to encourage more efficient, safer practices," Walt Bogdanich and Jo Craven McGinty of the Times report. "The Medicare agency believes hospitals can and should do more to change physician behavior ... The federal agency plans to use other, similar measurements to rein in what it considers to be unjustified — and potentially dangerous — medical procedures." (Read more)

Monday, June 27 is National HIV Testing Day

Kentuckians are being encouraged to find out their HIV status on Monday, June 27, National HIV Testing Day.

About 1,700 Kentuckians were diagnosed with HIV between Jan. 1, 2005 and Dec. 31, 2009. About 1 in 3 Kentucky adults under the age of 65 have been screened for HIV, the Foundation for a Healthy Kentucky notes. Christian, Hopkins and McLean counties have the highest rate of HIV testing, with 45 percent of adults being tested. Montgomery County has the lowest rate at 24 percent. For more county-specific information, click here.

The earlier that HIV is discovered, the better the treatment works, but early detection is not commonplace in Kentucky. By the time they are tested for HIV, 30 percent of Kentuckians already have full-blown AIDS. Though at one time 100 percent of Kentuckians infected with HIV died within five years, now 82 percent are alive after the same time period.

Kentucky ranks 19th in the country for the number of people who have the HIV infection that leads to AIDS. "Health officials say that at least one new HIV infection is discovered each day in Kentucky," Mary Meehan of Lexington Herald-Leader recently reported. National HIV Testing Day was founded by the National Association of People Living with AIDS in 1995. To find a testing site, click here.

Signups due tomorrow for nutrition workshops June 29-July 1

Tomorrow is the deadline to register for two affiliated workshops that will focus on school nutrition and the overall health of Kentucky children. The Coordinated School Health Institute will focus on how schools and communities can work toward creating healthier schools. The Growing Healthy Kids in Kentucky workshop will address how to create healthy, hunger-free communities.

The CSHI event is June 29. The Growing Healthy Kids gathering is June 30 and July 1. Both events will be at the Marriott Griffin Gate Hotel in Lexington. All school staff, community organizations, parents, dietitians, nurses, school food service staff, journalists and any stakeholder in the health of Kentucky children are welcome.

The CSHI workshop will cover topics focusing on fitness, staff wellness, school health services, mental health, school nutrition and Medicaid managed care. It is presented by the Foundation for a Healthy Kentucky.

The two-day Growing Healthy Kids event will address physical activity, farm-to-school success stories, local foods, the Let's Move initiative, Kentucky Proud, breastfeeding, worksite wellness and culinary arts programs. It is sponsored by the Kentucky Dietetic Association.

Click here to register online. The cost for both events if $205. For more information, click here.

New immunization rules for children take effect July 1

Starting July 1, Kentucky will have new immunization requirements for infants, toddlers and schoolchildren, including age-appropriate pneumonia vaccine for children up to 5 years of age and meningitis vaccine for entry to the sixth grade.

Additional requirements include a second dose of varicella vaccine for students going into kindergarten and sixth grade; one dose of tetanus-diphteria-acellular pertussis vaccine for students going into sixth grade; and a second dose of measles-mumps-rubella for children by the time they turn 6.

The new regulations bring the state more in keeping with recommendations by the Centers for Disease Control and Prevention and with national pediatric standards. For more information about the Kentucky Immunization Program, click here. For a story from The Associated Press, click here.

Rural emergency rooms frequented by the poor and uninsured

A new report from the federal Agency for Healthcare Research and Quality shows that low-income adults accounted for 56 percent of the 8 million rural emergency room visits in 2008. In nonrural hospitals, low-income adults accounted for only 30 percent of emergency room visits. According to the report, 44 percent of adult visits to rural emergency departments were paid for by Medicaid, were uncompensated, or billed to uninsured patients. Only 31 percent were paid for by private health plans. In nonrural hospitals, 37 percent of adult visits were paid for by private health plans, and 42 percent were paid for by Medicaid, uncompensated or billed to uninsured patients.

Emergency business is mainly just that for rural hospitals. Only 8.3 percent of rural emergency department visits resulted in a hospital admission, compared to 16 percent of non-rural emergency department visits.

The report also noted the lack of rural hospitals with trauma-level emergency departments. Nationally, only 2.4 of rural emergency departments held any level of trauma designation. Among non-rural emergency departments, 35.5 percent had a trauma designation. Read more here.

In Kentucky, approximately 75 of the state's 130 hospitals are in rural areas, according to the Kentucky Hospital Association. The state has been working to improve its trauma system and will soon begin designating level IV trauma centers in some of the state's smallest hospitals, said Dick Bartlett, emergency preparedness and trauma coordinator for the Kentucky Hospital Association. Already, Marcum & Wallace in Irvine and Livingston Hospital in have met requirements for the designation and will be certified, once the state approves the new level IV designation. (The national report focused on levels I-III; in Kentucky, level I-III are certified by the American College of Surgeons.)

The new designation is part of an effort by Kentucky to improve trauma care statewide. Having a level IV trauma center means better trauma care for Kentuckians injured in rural areas, Bartlett said. "It improves your potential for survival," he said. These hospitals have committed to providing certain levels of staffing, including a board-certified emergency room physician, and to following protocols to quickly decide whether a patient can be treated at their facility or if a patient should be transported to another, higher-level facility.

A map showing Kentucky's current trauma hospitals and those hospitals seeking trauma certification is available here.

The urge to merge hospitals is driven by health care reform

Mergers that are creating large hospital groups in Kentucky are part of a national trend being driven in part by last year's health-care reform law.

There are three key reasons for this, according to Barton Walker, a North Carolina attorney with McGuireWoods, who specializes in health care mergers. Reform is decreasing revenues, increasing costs, and rewarding integration among providers, Walker said during a webinar last fall. Because the federal government is rewarding hospitals that can demonstrate quality -- and measuring quality takes investment -- larger organizations are better poised to take advantage of the changes, he said. Fior more from Leigh Page of Becker's Hospital Review, click here.

On Tuesday, the University of Louisville's hospital and its James Graham Brown Cancer Center joined with Jewish Hospital and St. Mary's HealthCare in forming a system to be led by the parent of Lexington-based St. Joseph Health System. The partners announced that their boards had approved a merger that would combine the three health care groups. The merger plan was announced last November, about the same time that the University of Kentucky and Norton Healthcare announced a similar plan that was fleshed out last week.

The system including U of L will be the largest hospital group in Kentucky. It will be led by Denver-based Catholic Health Initiatives, which owns St. Joseph and is a partner in Jewish and St. Mary's. The group will hold 10 of the 18 seats on the new organization's board in return for an investment of $620 million in the new system.

The new group must be approved by regulators and Catholic Church officials, a process that could take up to a year. It brings together hospitals, clinics, specialty institutions, home health agencies and satellite primary care centers, where more than 3,000 academic and community physicians work. “We will be increasing access to basic and advanced health services,” said Bob Hewett, a long-time St. Joseph board member who will be the first chair of the system’s community board of trustees. "That will lead to improving the health not only of individual patients, but of entire communities.” For more from The Courier-Journal, click here.

Despite the glowing appraisals and the promises of improved health care from of the proposed merger, some fear that the merger may mean less health care access. According to a story in Monday's Courier-Journal, members of the Louisville Board of Health are worried that the merger may interfere University Hospital's mission to care for the poor. In addition, the members are worried that the new merger may reduce access to reproductive services, as some Catholic hospitals limit their reproductive services. Hospital officials responded that there was no need for such worries, and U of L President James Ramsey told cn|2 Politics that the reproductive servcie would be provided at outpatient facilities.

UK finally wins $20 million grant to translate medical research into action at the bedside and in the field; now 'a member of the club'

The University of Kentucky announced Tuesday that the National Institutes of Health had awarded it $20 million over five years to help move research discoveries from the laboratory to the bedside. The grant, one of the largest research awards in the university's history, will support the UK Center for Clinical and Translational Science.

The grant, which UK had sought for five years, will support research to apply or trnslate discoveries into practical applications. “Translational research, often referred to as 'bench to bedside,' means turning laboratory findings into preventions, treatments and cures for patients through collaborations across academic units with interdisciplinary research teams,” said UK President Lee T. Todd Jr.

UK Executive Vice President for Health Care Michael Karpf told the Lexington Herald-Leader that, in addition to provide funding, the grant acknowledges UK's excellence in translational research. "This grant is recognition by the NIH that we are one of the places," Karpf said. (Read more)

The grant could mean better care for patients, not only in the UK hospital. Dr. Philip Kern, left, director of the center, told Mike Wynn of The Courier-Journal that it will affect community engagement, information management and direct patient care. "One focus of the community-based research involves improving the delivery of treatment for patients who don't receive the health care they need, Wynn reports, quoting Kern: “That is probably the one form of research that will impact Kentuckians most quickly.”

Wynn notes that 60 universities have received such grants, and writes, "The university would have lost any prospect of ranking among the top 20 research institutions without Tuesday's grant and recognition, said UK Provost Kumble Subbaswamy." (Read more)

Until now, the center has had to compete with other university units for funding. Now it will have a stready stream of money, and that goes beyond the grant, because some grant opportunities are open only universities with such continuing grants, and that usually gives each of them anotrher $2 million a year, Kern said. "This gives us much greater stability," he said. "There will be opoportunities that will come down the pike because we are now a member of the club."

The grant will help research both at the UK hospital and in the field. Patients involved in research must have beds dedicated to that purpose, to make sure the hospital has room for regular patients, and that requires not only dedicated space, but funding, Kern said.

He said one example of the type of field research that the grant can support is a project being run by Dr. Nancy Schoenberg, right, in Letcher County, using faith-based organizations to find the best ways to help individuals and community groups fight obesity.

The grant will also help UK partner with other schools, especially those in a new Appalachian translational science network. Kern said Schoenberg and a colleague at Ohio State, which is in the network, have already received a pilot grant for a community-based project to leverage social networks to increase colorectal cancer screening in Appalachia. For a description of the project, click here.

Cities' efforts to combat obesity get state, national attention

The efforts of two Kentucky cities to slim down made news this week. On Monday, The New York Times ran a story about Louisville's programs to encourage healthy eating and physical activity in an attempt to combat obesity. On Tuesday, the Lexington Herald-Leader ran a short story about the move to healthier snacks at two public pools. (Eric Crawford, sports columnist for The Courier-Journal, notes in a blog post, partly about his own weight issues, that Men’s Health magazine says Lexington ranks No. 25 in fatness nationally, while Louisville is No. 51.)

The Times story describes Louisville's eight-year effort to combat obesity by establishing bike lanes, creating pocket parks, and making sidewalks wider and safer. The effort involves multiple city agencies and grants from the Robert Wood Johnson Foundation and the Centers for Disease Control and Prevention. The results are hard to measure, sort of like a new dieter on a scale, reporter Stephanie Strom writes: "Successes on one front are countered by setbacks on another, and signs that the needle has moved overall are slight and mostly anecdotal."

Former Louisville Mayor Jerry Abramson, who started the initiative, told Strom that the impetus to reduce the city's obesity rate was economic. “For businesses, a healthy work force is more productive and less costly, so it became a competitiveness issue,” he said. “Every city was offering tax incentives, every city was offering real estate deals but not every city had the weight problem we do.”

The Herald-Leader article focuses on menu changes at two park pools' snack stands. The new menus include options like fresh fruit, grilled chicken, and yogurt. The change is a joint effort of the city Parks Department and the Tweens Nutrition and Fitness Coalition in Lexington to encourage healthier eating. As Coalition Chairman Anita Courtney told the Herald-Leader, "Concession stands are like pantries for kids in the summer. What they are stocked with is what they'll eat."

Data on hospital-acquired infections, other conditions online

The federal Centers for Medicare and Medicaid Services (CMS) has posted information about hospital-acquired conditions on its website, and The Courier-Journal not only has a story about it today, it has an easily searchable database of Kentucky hospitals.

This is not information that the Kentucky Hospital Association or the American Hospital Association wants online, at least in its current form. “You have to look at the totality of the care. And these little snapshots that CMS wants to pick out are very misleading,” KHA Senior Vice President Nancy Galvagni told C-J reporter Patrick Howington. She said the data don't allow for differences between hospitals, such as specialities, that may cause higher rates of acquired conditions.

However, Doug Leonard, president of the Indiana Hospital Association, told Howington that the industry needs to “embrace transparency. Sometimes we don't like the results of that, but I think transparency is good for us and good for the public.” Dr. Kevin Kavanagh of Somerset, chairman of the nonprofit group Health Watch USA, "said the data's greatest value may be to help hospitals spot areas that need improvement, rather than to help patients choose between hospitals," Howington writes. "In fact, a hospital shown as having a high complication rate 'may be the safest hospital to go to, because they were under pressure to get the problem corrected.'" (Read more)

The conditions tracked are trauma such as falls, infections from catheters, bedsores, poor blood-sugar control for diabetics, foreign objects left in bodies, air or gas bubbles in blood vessels, and transfusions of the wrong blood type.

Partnership between UK and Norton extended, further defined

They still haven't agreed on how to spell "health care," and don't do it as we do, but the partnership announced last November between UK HealthCare and Norton Healthcare to implement stroke, cancer, transplant, obesity, obstetrics and heart initiatives has been extended and further defined.

"We have worked to identify opportunities for collaboration to improve the access and quality of care for Kentuckians close to their homes while making sure that patients with the most complex medical issues receive the care they need without have to leave the state," said Stephen A. Williams, Norton's president and CEO.

The partnership will establish and extend stroke and obesity education programs; expand teaching programs for UK medical students so they can do a rotation at Norton hospitals; and establish a transplant and specialty clinic in Louisville. Research initiatives in obesity and cancer are also part of the collaboration.

All of the work being done is meant to target what outgoing UK President Lee Todd calls "the Kentucky uglies," the state's most troubling and chronic health issues. According to Business Lexington, Kentucky ranks 15th nationwide in deaths per 100,000 caused by stroke or related disease. Kentucky is in the top five for cancer incidence and leads the country in lung cancer. In 2009, Kentucky's obesity rate was the fourth highest in the country and cost the state about $1.3 billion in health costs. And there is a shortage of obstetricians in the state, with as many as 71 of the state's 120 counties without an obstetrician. (Read more)

Legislators question if Medicaid is ready for managed care

"State lawmakers on Thursday questioned whether the state has the resources and expertise to oversee moving the $6 billion Medicaid program to private, for-profit managed care companies," Beth Musgrave of the Lexington Herald-Leader reports.

Staff of the Interim Committee on Program Review and Investigations, chaired by Republican Sen. Jimmy Higdon of Lebanon, left, reviewed reports and found state Medicaid staff did not adequately analyze their current program to determine if there were savings or if there were waste and abuse. These reports "quite frankly, have us concerned that the cabinet is not fully prepared" to switch to and monitor managed care by July 1, as per the deadline, Higdon said.

In testimony, officials with the Cabinet for Health and Family Services told lawmakers they do feel they have the expertise to handle managed-care contracts. Neville Wise, acting Medicaid commissioner, said part of the contract monitoring will be done by an independent contractor. He did not say the cabinet would be ready to implement managed care by July 1.

Sen. Vernie McGaha, R-Russell Springs, also asked cabinet officials how they will assess whether managed-care organizations save the state money once they are implemented en masse. The cabinet could not determine if the only managed care organization already in place, Passport Health Plan in the Louisville region, saved the state money. That was one of the weaknesses pointed out in a highly critical audit by state Auditor Crit Luallen.

Moving to managed care is the centerpiece of Gov. Steve Beshear's proposal to fill a $166 million gap in the Medicaid budget. Senate President David Williams, R-Burkesville, says he is unconvinced. Williams is running against Beshear for governor in the Nov. 8 election. (Read more)