Rural states with declining immunization rates have increasing incidence of whooping cough

In the state that once had the highest immunization rate, Vermont's medical community is not so proud of anymore. Fewer people are vaccinating their children in the nation’s most rural state, reports Dr. Wendy Mahoney, a private practioner in the state. But Vermont isn't alone. Stories about declining immunization have come in from across rural America, Mahoney writes in the Daily Yonder, and they "come in the midst of a pertussis outbreak the likes of which Vermont has not seen in years, if ever." Pertussis is whooping cough.

Mahoney says she can find one reason for the recent outbreak: a new law in her state, like some in other rural states, that allows parents to exempt their children from required vaccinations "because of a personal, moral, or other belief." Mahoney says many rural residents use the exemption, which she finds hard to fathom in the face of scientific advances that prove that vaccination has ended smallpox, wiped out polio in most of the world, and controlled measles, rubella, tetanus, diphtheria, influenza type b and other infectious diseases.

The top map shows the estimated percentage of children enrolled in kindergarten who have been exempted from receiving one or more vaccines in the 2011–12 school year. Comparison with the other map shows that states with large numbers of exemptions are those where whooping cough is making a comeback. (Centers for Disease Control maps)

A comparison between states with low vaccination coverage rates and those reporting higher numbers of whooping cough cases shows some, though not consistent, overlap. (Read more)

Association of Health Care Journalists' reporting fellowship application deadline is Nov. 9

The Association of Health Care Journalists is offering fellowships for reporting on health care performance to journalists who wish to pursue a significant year-long reporting project related to the U.S. health care system. It can be local or national in scope -- or a little of both, according to materials included with the announcement, which suggests a topic could be "an aspect of the Patient Protection and Affordable Care Act playing out in your community or subject specialty, or the impact of particular evidence-based treatments on health outcomes, or an analysis of a health care organization’s performance, using public data sets."

Newsrooms for which the fellows work need to commit to publish or air their work. Freelancers will also need to have that commitment from a news source. Guidance is provided by AHCJ fellowship leaders through seminars on health care systems, conference calls and email consultations. The fellowship covers the cost of attending the seminars and conferences, and a project allowance is available. Application deadline: Nov. 9, 2012. (Read more)

Here are some examples of the work done by those awarded fellowships in 2012:

• The New Goliaths: The 2010 health law was designed to lower costs. Yet hospitals merging seems  to have upped the price of care.
  
• Nothing to Smile About: The number of dentists is shrinking. 
  
• In Praise of Price-Fixing:  Maryland may have found an answers to health care inflation. 
  

CaldWELL County group campaigns for smoking ban

A committee dedicated to the wellness of Caldwell County, which makes the most of the county's name, is pushing for a smoking ban. The CaldWELL Committee's internal acronym stands for Wellness Education through Local Leadership, and members did some of that Tuesday when the group asked the county Fiscal Court for an ordinance banning cigarette smoking indoors in public buildings. The group was joined by representatives from the local health department, housing authority, Extension office, law enforcement, education, emergency services, mental health, senior services and other public and private agencies, reports Jared Nelson of The Times Leader.

The committee has been collecting survey data from residents about their health perceptions and needs. Their request to the fiscal court is a direct result of that data, said Allison Beshear, health educator and public information officer with the Pennyrile District Health Department. In Caldwell County, about 27 percent of adults are identified as smokers. That number is down from 34 percent reported in the results of a 2008-10 survey. The Times-Leader is behind a paywall. To credit an account, go here.

Infections, other safety issues plague hospitals, maybe more so when nursing is cut; here's a good series on it

The Centers for Disease Control has reported that nearly 1 million patient-safety incidents, including infections that patients acquired in hospitals, occurred among Medicare patients over the years 2006, 2007, 2008. In all, the incidents -- which represented 2.3 percent of Medicare admissions -- were associated with $8.9 billion in costs. One of every 10 patients involved died as a result, the "HealthGrades Patient Safety in American Hospitals" study reported.

Financially squeezed hospitals should be careful about reducing nursing staff, because the fewer such staff they have, the more likely they are to have a patient-safety incident, says Kevin Kavanagh, a Somerset doctor and board chairman of Health Watch USA, in "Moving Healthcare Quality Forward with Nursing-Sensitive Value-Based Purchasing," an article in the Journal of Nursing Scholarship. Kavanagh explains that research has shown that adverse events in hospitals and any subsequent mortality "are highly dependent on nurse staffing levels and skill mix." He cites studies in which nurse staffing levels were a clear indicator of whether or not patient-safety accidents or "sentinel" events occurred. (Examples of "sentinel" events include falls, pressure ulcers, urinary tract infections, postoperative infections, pneumonia, upper gastrointestinal bleeding, shock and cardiac arrest.)

Kavanagh's article notes that nursing is at serious risk from being cut in cost-driven healthcare delivery systems. He is quick to point out the dangers and financial costs of making that cut. (To read the study, go here.)

So, how to report on this issue? In 2011, The Las Vegas Sun revealed that during the second half of 2009 area hospitals had reported 44 preventable hospital injuries or hospital-acquired infections when, in fact, those facilities had experienced 342 such events. That revelation led the paper's staff to take on the issue of hospital accountability in an award-winning five-part series, "Do No Harm: Hospital Care in Las Vegas." When all was said and done, the newspaper not only unearthed repeated incidences where the hospitals' own records did not reconcile with what they reported to the state, but showed lawmakers and health-care professionals how to properly disclose the incidence of patient infection and accidents. Their work eventually forced Nevada lawmakers to pass legislation that requires hospital records in two of the state's largest counties to be transparent, consumer-friendly and readily available on the state's Health and Human Services Department website. (To read their remarkable work, go here.)

Health Watch USA will host its annual conference in Lexington on Nov. 9 at The Four Points Sheraton, 1938 Stanton Way. Cost is $35 including lunch. Over 6 hours of continuing education credits have been approved for doctors, nurses, physical therapists, occupational therapists and human resource managers  For more information or registration, go to www.healthconference.org.

Medicaid managed-care firm files suit, alleging the state's rush job resulted in unreliable financial information for bidders

Medicaid managed-care company Kentucky Spirit alleges in a lawsuit filed Monday that Gov. Steve Beshear so hurriedly privatized the service last year that he gave incorrect cost information to the bidders. The company said it relied on the bad information and thus has lost $120 million since its work began a year ago.

John Cheves of the Lexington Herald-Leader reports that Kentucky Spirit had hoped that it could let its contract terminate a year earlier than scheduled without paying the damages that Health and Family Services Secretary Audrey Haynes has now said the state will pursue. Cheves writes that Kentucky Spirit says they relied on a "data book" -- what managed-care companies used to estimate costs in their bids -- prepared by the accounting firm PricewaterhouseCoopers. (Read more)

Wellness programs looking good as business investments

Businesses should like these numbers a lot: Invest $1, get $3 back. That's the latest math on the return on employee wellness programs and experts are saying that may just be the start for the financial returns they can expect from targeted prevention efforts. Mark Green of The Lane Report writes that no less of an expert than Dr. William Frist of Nashville -- doctor, policy specialist, former U.S. Senate majority leader and venture capitalist -- has said: “No question in my mind, if we are to invest a dollar to have the greatest value in terms of outcome and results, we should put that dollar in prevention and wellness."

Frist, reports Green, "is a strong advocate of wellness -- as a business practice to adopt and a business sector to be in. Individual doctors, hospitals and the entire healthcare industry need to get involved, he said." Frist broke down for Green what factors most determine how long someone lives: “The numbers break down 30 percent genetic, 5 percent environmental, 15 percent socioeconomic, which is surprising to a lot of people, and then 40 percent behavioral: wellness, prevention. And then what is left (10 percent) is who your doctor is, what hospital you go to, what your emergency room is.” Those numbers  are important to Frist because to impact longevity healthcare spending over time, he said, resources should be on the 40-percent sector: behavior, wellness and prevention. Think smoking programs, weight loss, exercise, nutrition, seatbelt use. (Read more)

Opportunity for news stories: New federal rules mean all nonprofit hospitals must do a community health needs assessment

It's long been the rule that nonprofit hospitals have had to provide charitable benefits to their community in order to keep their nonprofit status. That's no small matter, given that 60 percent of the nation's almost 3,000 hospitals are nonprofits and those tax benefits equal $12.6 billion annually. The benefits those hospitals provide have usually come in form of care for those unable to afford it, but it's unclear how, and how much, hospitals spend on community benefits has led to increased oversight by the Internal Revenue Service and Congress.

This year, there's a new kink for nonprofit hospitals and one that is important to every community those hospitals serve -- and a golden opportunity for every news outlet that reports on them. The Patient Protection and Affordable Care Act requires each nonprofit hospital to conduct a community health needs assessment, which must include a wide variety of community stakeholder input, prioritize needs, and eventually, when completed, be made widely available to the public. As explained by the Robert Wood Johnson Foundation, the assessment does more. It "offers an opportunity for the entire community to work together to collectively improve health." Participants can include health systems, health departments and other government agencies, community organizations, employers, the faith community, the United Way and other non-profits, local funding organizations, academic institutions, and other community leaders.

To read the issue brief and find more resources about the benefit and programs associated with it, go here.

Breast cancer awareness: Testing urged, guidelines explained, misconceptions explored

Women with BRCA1 and BRCA2, the
genes most commonly involved in breast
cancer, have up to an 80 percent chance
of getting the disease.

October is Breast Cancer Awareness Month. Although Kentucky's breast cancer rate is slightly lower than the nationwide rate, almost 600 women die every year from breast cancer in the Commonwealth. The American Cancer Society predicts approximately 3,160 new cases of breast cancer will be diagnosed in Kentucky this year. Early detection and prompt treatment can significantly reduce suffering and death from the disease.

According to the Cabinet for Health and Family Services, all health plans serving Kentuckians must, by law, cover mammograms. Medical guidelines strongly recommend that women older than 40 have annual mammograms and women younger than 40 with a family history of breast cancer should also have regular screenings. Through local health departments, the Kentucky Women's Cancer Screening Program provides breast cancer screenings, mammograms and Pap tests to eligible women in every county. During the 2011 fiscal year, KWCSP provided breast cancer screenings to 14,212 women. Services are provided to low-income women through the Kentucky Department for Public Health. Those women must be uninsured with incomes less than 250 percent of federal poverty guidelines.  For more information about breast cancer or screening services, call your local health department.

There are many misconceptions about the risks of developing breast cancer. Genetics, of course, is a well-documented factor but lifestyle issues have gotten a lot of talk. So what's true? Wendy Chen, MD, MPH, a breast cancer expert at Dana-Farber Cancer Institute in Boston, a principal teaching affiliate of Harvard University, tackles some of the more common questions here:

1) Soy may increase the risk of breast cancer returning.
False. Chen, who was part of a study that looked at over 9,500 American and Chinese breast cancer survivors who ate soy every day, says that eating soy may be linked to a lower risk of recurrence of breast cancer.

2) Alcohol consumption can increase the risk of breast cancer.
True. Dana-Farber researchers found that women who consume one alcoholic drink a day may increase their risk for breast cancer.  Chen and her colleagues analyzed data from over 105,000 women in the Nurses’ Health Study. Those who consumed three to six glasses of wine a week were 15 percent more likely to receive a diagnosis of breast cancer. Those who drank fewer than three drinks a week had no increased risk.

3) Fertility treatments increase a woman’s risk of breast cancer.
False. According to a recent study from the National Institutes of Health, ovulation-inducing fertility treatments like Clomid and follicle stimulating hormone (FSH) do not significantly increase a woman's risk of developing breast cancer.

4) Wearing deodorant can increase the risk of breast cancer.
False. According to the National Cancer Institute, there is no conclusive research linking underarm deodorants to breast cancer.

5) The bigger the baby the bigger the risk of getting breast cancer.
Possibly true. “This is a tough one because the research is still evolving,” says Chen. "But the latest research shows that women who have larger babies have more than twice the risk of developing breast cancer than mothers who give birth to smaller infants. Researchers say that having a heavier baby may create a hormonal environment in pregnancy that could lead to the future development of breast cancer. They found that during pregnancy in women who have heavier babies, the ratio of estrogen to anti-estrogen is unusually high. The greater the level of estrogen, the higher the risk of breast cancer. However, Chen emphasizes, women who have larger babies should not panic. There is definitely a need for further research.” (Read more)

Northern Kentucky group forms in response to what some consider 'epidemic' of heroin use in their area

Ashel Kruetzkamp with a vial of Naloxone
HCl, used to treat those who overdose
on heroin. (Photo by Patrick Reddy)

Heroin use is reaching such high levels in Northern Kentucky that experts are calling it "a plague." The problem is so dire that local agencies are coming together to form the Northern Kentucky Heroin Impact and Response Workgroup.

Cincinnati Enquirer reporter Terry DeMio reports that the group includes leaders from St. Elizabeth Healthcare, law enforcement, addiction treatment programs, the Northern Kentucky Chamber of Commerce and those who have been impacted by heroin. The goal of the group is “to fight, treat and prevent the destructive force of heroin in our community,” said Dr. Jeremy Engel, a family doctor with St. Elizabeth Physicians, Bellevue. Engel spearheaded the effort based on his belief that heroin use in the area has hit “epidemic” levels.

Engel points to first nine months of 2012 when St. Elizabeth Healthcare treated 311 heroin overdose patients in the emergency rooms of its five hospitals. For the same time period in 2011, the heroin overdoses presented in those emergency rooms numbered 186. With help from the chamber, St. Elizabeth Healthcare and others, Engel is forming the task force under the NKY Vision 2015 umbrella. (Read more)

One of Humana's plans to get 5% more in Medicare payouts under bonus plan that rewards proof of preventive care

The Courier-Journal reports that Louisville-based Humana Inc. will get 5 percent more in Medicare payments and the highest rating for one of its health plans under a government program that is likely improving care for the elderly, according to an analysis. The program provides bonus payments to insurers that limit "how many members are readmitted to the hospital after a discharge, increasing the amount of preventive care and getting acceptable ratings on patient satisfaction surveys, among other criteria," according to the report. Separate analyses by the consulting firm Avalere Health LLC and the nonprofit Commonwealth Fund conclude that the bonus system, created by the 2010 Patient Protection and Affordable Care Act, is working. It has since been modified by the Obama administration to allow for bigger payments to more plans.

Obamacare is unpopular in nine swing states, but not when the law is described without that label

Party labels affect what rural voters think about the Patient Protection and Affordable Care Act, according to the latest National Rural Assembly and Center for Rural Strategies poll of rural voters in nine swing states in the presidential election, reports Bill Bishop of the Daily Yonder, which the center publishes.

When asked if they approved or disapproved of the "Affordable Care Act, sometimes called Obamacare," 60 percent of rural voters said they opposed the law, and 34 percent said they favored it. Without reference to "Obamacare," voters were asked if they approved or disapproved of the law, which "would give states the opportunity to extend Medicaid coverage to cover more low income families with health insurance, with the federal government picking up 90 percent of the costs," and 45 percent said they approved, while 42 percent disapproved.

Bishop concludes that partisanship is the culprit for such results. "Partisanship overwhelms issues in today's politics," he writes. "Voters are willing to change their beliefs -- even their religious affiliation ... in order to stay with their political tribe." (Read more)

UK study definitively shows that meth labs proliferate in state's counties where pseudoephedrine sales are high

A University of Kentucky research study published in the Journal of the American Medical Association this week shows a direct correlation between pseudoephedrine sales and methamphetamine production in Kentucky counties. Pdeudoephedrine, the main ingredient in Sudafed and similar decongestants, is the key feedstock for meth labs. The General Assembly further limited its sale this year.

“We find that counties where more pseudoephedrine is sold, more methamphetamine lab seizures are reported. Even though Kentucky requires pseudoephedrine sales to be tracked electronically, in real-time, the per-capita sales in some counties appear to be aberrant. Our results indicate a 565-fold variation in pseudoephedrine sales between counties. It is highly improbable that demand for pseudoephedrine in these counties is solely due to cough/cold/allergy,” explained Jeffrey Talbert, director of the College of  Pharmacy's Institute for Pharmaceutical Outcomes and Policy.

The other authors of the study are College of Pharmacy faculty members Karen Blumenschein and Trish Freeman, staff member Amy Burke, and Arnold Stromberg of UK’s Department of Statistics. For a copy of their report, click here.