Posts Tagged ‘Brigham and Women’s Hospital’

US News Names New Hospital as Best

Monday, July 23rd, 2012

Massachusetts General Hospital or Mass General is No. 1 for the first time, according to the US News & World Report Best Hospitals rankings. It marks the end of a 21-year run for Johns Hopkins that started in 1991, the year after U.S. News began publishing Best Hospitals.

When Mass General was founded, James Madison was President, Napoleon was Emperor of France and the Juliana, the first ever steam-powered ferryboat, began operation.   Only Pennsylvania Hospital (1751) and New York–Presbyterian Hospital (1771) are older. The fact that Mass General hasn’t taken the top spot before may come as a surprise to some, given its pedigree: It was the original teaching affiliate and flagship of Harvard Medical School; it remains the largest hospital-based research program in the United States, with an annual research budget of more than $400 million; and is renowned in such specialties as diabetes & Endocrinology, Ear, Nose & Throat, Neurology & Neurosurgery, Ophthalmology, Orthopedics, and Psychiatry.

The 950-bed medical center each year admits about 48,000 inpatients and handles nearly 1.5 million visits in its outpatient programs at the main campus and satellite facilities. It also delivers more than 3,600 babies annually. It is now the largest non-government employer in the city of Boston, with more than 19,000 employees, including a nursing staff of 2,900. In addition, its 3,600-member medical staff includes physicians, dentists, psychologists, podiatrists, residents and fellows.

MGH is owned by Partners HealthCare, which was formed by MGH and Brigham and Women’s Hospital in 1994. MGH is also a member of the consortium which operates Boston MedFlight.

Living Solo Can Be Hazardous to Your Health

Monday, June 25th, 2012

Living to a ripe old age may depend on a person’s relationship to family, friends and community, according to research that finds lonely older adults are more likely to die sooner than their more socially active peers.  Lonely people who are 60 and older tend to have a 45 percent higher risk of dying over the next six years, according to research in the Archives of Internal Medicine.  Another study showed that people who live alone and had heart disease were 25 percent more likely to die from the illness.

Approximately one in seven Americans live by themselves.  The first study to examine the link between social isolation and death points to the importance of addressing psychosocial needs along with medical ones in improving the health of older adults, according to Carla Perissinotto, a study author.  “We cannot continue to ignore the other things that are happening in people’s lives,” said Perissinotto, an assistant professor of medicine and geriatrics at the University of California San Francisco.  “If we turn a blind eye to what our patients are experiencing at home, we may be missing a place to make a difference in someone’s health.”

The lonely people studied were more likely to have limited mobility and greater difficulty performing basic tasks like grooming and cleaning.  Approximately 25 percent of lonely people were likely to develop trouble compared to 13 percent who weren’t lonely.  While the connection between well-being and friendships isn’t new, the latest findings look specifically at people who self-identified as lonely, regardless of how extensive their social network.  “It’s about connectivity,” Carla M. Perissinotto said.  “Someone can have multiple social contacts but still somehow feel that they’re not connecting.”

One study followed nearly 45,000 people aged 45 and older who suffered from heart disease or had a high risk of developing it.  Those who lived alone were more likely to die from heart attacks, strokes, or other heart complications over a four-year period than people living with family or friends, or in some other communal arrangement.  The risk was highest in middle-aged people, just 14 percent of whom lived alone. Solo living increased the risk of heart problems and early death by 24 percent among people ages 45 to 65, and by only 12 percent among people ages 66 to 80.  And there was no association at all in people age 80 and older, a group in which living alone is widespread.

Additional research is needed to confirm the findings, but it may not be a bad idea for physicians to ask heart patients about their living situation, said senior author Dr. Deepak L. Bhatt, M.D., a cardiologist at Brigham and Women’s Hospital, in Boston.  Living solo “could be a little red flag that a patient may be at a higher risk of bad outcomes,” Bhatt said.  But living alone could impact health in more immediate ways.  For example, people who live along may skip their medications or ignore the warning signs of heart trouble, according to Bhatt.

Bhatt notes that patients who live alone should never ignore changes that might be a sign of health problems.  “Many times people just adapt to their circumstances.  Perhaps just lower your threshold a little bit and realize it’s better to call (the doctor) than not to call.”  That might not be the entire story.  “Other mechanisms by which living alone could increase cardiac risk have to do with possible social isolation and loneliness, and these are more challenging to fix,” he said.

According to Emily M. Bucholz, M.P.H., a medical student and doctoral candidate at Yale University, “Living alone, in and of itself, could stand for many different things.  Does it mean you lack companionship?  Or is it that there is no one there to help you out with medications?  Does it have to do with mobility or nutrition?”

Writing in Time, Alice Park notes that “Loneliness can be detrimental in many ways, some of which are biological and some of which are more behavioral.  Feeling isolated can trigger changes in brain chemicals and hormones that can increase inflammation in the body, for example, which can exacerbate conditions like heart disease and arthritis.  Loneliness may also lead to other problems — poor sleep, depression, a disinterest in one’s own healthcare — which can in turn contribute to disability and early death.  Which is why the researchers were particularly concerned over another finding — many of the elderly who said they felt lonely were not actually living alone.

Rather, they were married or living with family members.  That suggests that the size of a person’s social network isn’t the only measure of loneliness, and that studies that look only at the number of people’s contacts may miss an entirely separate factor that can have a significant impact on health, said Perissinotto.  ‘I think that from a public health and policy level, we are doing a disservice by not asking (people) about their subjective feelings of loneliness.  We focus on their diabetes control and treating their hypertension, but are we missing something that may be more distressing to patients and have more of an impact on their health?’”

Loneliness is a common source of suffering in older persons,” according to the study’s authors.  “We demonstrated that it is also a risk factor for poor health outcomes including death and multiple measures of functional decline.  Assessment of loneliness is not routine in clinical practice and it may be viewed as beyond the scope of medical practice.  However, loneliness may be an important predictor of adverse health outcomes as many traditional medical risk factors.  Our results suggest that questioning older persons about loneliness may be a useful way of identifying elderly persons at risk of disability and poor health outcomes.”

Healthcare: Saving Lives or Prolonging Suffering?

Thursday, August 12th, 2010

There is a cacophony of voices in the media talking about healthcare reform, but it’s more heat than light.  That why Atul Gawande’s most recent article in The New Yorker is so important. Boston-based Brigham and Women’s Hospital general and endocrine surgeon Gawande examines how the trend to prolonging life is one of the reasons behind soaring healthcare costs.Is healthcare saving lives or prolonging suffering?  Everyone needs to read this.

According to Dr. Gawande in Letting Go, “Twenty-five percent of all Medicare spending is for the five percent of patients who are in the final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.  Medical spending for a breast-cancer survivor, for example, averaged an estimated $54,000 in 2003, the vast majority of it for the initial diagnostic testing, surgery, and, where necessary, radiation and chemotherapy.  For a patient with a fatal version of the disease, though, the cost curve is U-shaped, rising again toward the end – to an average of $63,000 during the last six months of life with incurable breast cancer.

The big question Gawande poses is thus:  What are we getting in return?  “Patients who were put on a mechanical ventilator,” Dr. Gawande continues, “given electrical defibrillation or chest compressions, or admitted, near death, to intensive care, had a substantially worse quality of life in their last week than those who received no such interventions.  And, six months after their death, their caregivers were three times as likely to suffer major depression.”

Dr. Gawande notes that in one study, “Researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure.  Surprisingly, they found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer.  Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months.  The lesson seems almost Zen:  you live longer only when you stop trying to live longer.”

In one case Dr. Gawande describes, “Aetna decided to let a group of policy-holders with a life expectancy of less than one year receive hospice services without forgoing other treatments.  A patient like Sara Monopoli (who was diagnosed with terminal lung cancer at the age of 34) could continue to try chemotherapy and radiation, and go to the hospital when she wished – but also have a hospice team at home focusing on what she needed for the best possible life now and for that morning when she might wake up unable to breathe.  A two-year study of this ‘concurrent care’ program found that enrolled patients were more likely to use hospice:  the figure leaped from 26 percent to 70 percent.  That was no surprise, since they weren’t forced to give up anything.  The surprising result was that they did give up things.  They visited the emergency room almost half as often as the control patients did.  Their use of hospitals and I.C.U.s dropped by more than two-thirds.  Overall costs fell by almost a quarter.”

“Positive Deviants” Will Revitalize the Healthcare System

Tuesday, June 30th, 2009

The solution to America’s healthcare crisis might just lie in deviant thinking.  This is the message of Dr. Atul Gawande, this year’s commencement speaker at the University of Chicago’s Pritzker School of Medicine.  Gawande is a general and endocrine surgeon at Brigham and Women’s Hospital in Boston, an associate director of their Center for Surgery and Public Health, an associate professor at the Harvard School of Public Health and at Harvard Medical School.

050102_Gawande_Atul_3.jpgHis concept of positive deviants identifies those communities and physicians who discover innovative ways to reduce costs and improve care  to deliver better outcomes.

Gawande cites a nutritionist who spent his career attempting to reduce hunger in Vietnamese villages.  This man asked villagers to identify which families had the best-nourished children to determine a “positive deviance” from the norm.  The answer was that those children’s mothers did not act in accordance with accepted village wisdom had the best outcomes.  Rather, they fed their children even when they had diarrhea; fed them several small meals daily rather than one or two large ones; and fed their children foods that others considered low class but were nutritious such as sweet potato greens.

In the American healthcare system, the positive deviants resist the tendency to view patients primarily as revenue streams – but as human beings.  Rather, these physicians deliver high-value healthcare without focusing too strongly on their practices’ bottom lines; they neither over-treat nor under-treat their patients with extraneous but profitable tests and procedures.

To quote Gawande, “Look for those in your community who are making healthcare better, safer and less costly.  Pay attention to them.  Learn how they do it.  And join with them.”