Monday, 29 June 2015

Complex Chronic Patients: UK progress in funding

Director of King'sFund, Chris Ham’s tweet, takes us to Sam Everington’s article in The Guardian, about new experiences of financing (commissioning) towards community services deployed to address chronic complex patients in their own homes, even in episodes of clinical exacerbations, and thus avoiding likely unwise hospitalizations.

Monday, 22 June 2015

Chronic Models: the Wagnerian keys

Chris Ham, King's Fund Director, interviews Edward Wagner, Director Emeritus of MacColl Center for Healthcare Innovation Group Health Research Institute and promoter of the chronic patients care model (Chronic Care Model or CCM). As I think it is worth it, I decided to share a transcript summary of the conversation. It will not disappoint you.

Ham: How did you come up with the idea for CCM?

Wagner: From my own clinical practice. For me it was frustrating to see how well prepared and well-meaning physicians, when they had to deal with caring for chronic patients, failed to achieve good results, while we were starting to have evidence that by doing things differently, patients could better understand what was happening to them and could improve clinical outcomes. And for this reason I thought we had to share this evidence with the doctors.

Monday, 15 June 2015

Surgical Checklist: a challenged guarantee

The tweet from Dr. Elvira Bisbe ​​warns us that New England has sprung a surprise: a study in Ontario, deployed in 101 hospitals and more than 200,000 cases revealed that the application of a surgical checklist doesn’t significantly reduce complications nor mortality.

Monday, 8 June 2015

Palliative chemotherapy: an oxymoron?

An oxymoron is a figure of speech which consists in using contradictory terms in conjunction. In this case: chemotherapy and palliative care. From US data it’s well known that between 20 and 50% of patients with advanced cancer receive chemotherapy 30 days before death. I think these figures are impressive and even more so after reading the results of the work conducted by Professor Wright of Harvard Medical School. This is an ample view of over 386 patients with advanced cancer who averaged 4 months of life after entering the study. In this group it was noticed that patients who were treated with chemotherapy in the last months of life were more likely to receive towards the end of their life inappropriate clinical performances such as cardiac resuscitation or mechanical ventilation or to end their days in the intensive care units.

The American Society for Clinical Oncology (ASCO) believe that the disappearance of palliative chemotherapy would be a true "Triple Aim": better life quality for patients, fewer unwanted effects and lower costs, although the great difficulty with this issue, according to ASCO, lies in deciding when it’s time to stop treatment.

Monday, 1 June 2015

More participation, better policies?

Elena Torrente @etorrente

“For us [the Athenians legislators], the debate is not a stepping stone towards action, but the first step essential to taking any wise decision.” – Pericles

I read this quote in the book “És la política, idiotes!” by Professor of Political Science Quim Brugué where he firmly defends politics and the need for collective decisions in politics. Right now when political disaffection prevails, this is an interesting book to say the least that points to an issue that for me is paramount: Intelligence is always collective.

Nowadays, in the era of social networks where we can share knowledge and contribute ideas, interesting debate has never been so easy. But, how about in the area of public policy? Is collective intelligence taken into consideration when they design it? Does it make sense to do it?