Secretary Sebelius Highlights Two New Reports on Health Care Quality, Says Improving Quality is Key Component of Health Reform

At a speech before the United Nurses of America's 12th National Nurses Congress, Secretary Kathleen Sebelius today discussed two new HHS reports on the quality of health care in America and challenged hospitals to work to reduce health care associated infections. Published by the Agency for Healthcare Research and Quality, the annual 2008 National Healthcare Quality Report and 2008 National Healthcare Disparities Report indicate that patient safety measures have worsened and that a substantial number of Americans do not receive recommended care. Upon issuing the reports, Sebelius also announced the availability of $50 million in Recovery Act resources to fight health care associated infections and improve patient safety.

"Today's reports show why we can't wait to enact comprehensive health reform," said Sebelius. "The status quo is unsustainable and we cannot allow millions of Americans to continue to go without the care they need and deserve."

The reports found:
* 40 % of recommended care is not received by patients.
* Only 40% of diabetic patients received three recommended diabetic preventive exams in the past year, and this rate has not improved over time.
* Only half of obese adults and children are given advice to exercise more and eat a healthy diet.
* Seven out of ten adults with mood, anxiety, or impulse disorders received inadequate treatment or no treatment at all.
* Disparities in health care persist. Minority patients receive disproportionately poor care compared to Caucasian patients. At least 60 percent of quality measures have not improved for minorities compared to Caucasians in the past six years.
* One in seven hospitalized Medicare patients experience one or more adverse event.
* Patient safety measures have worsened by nearly 1% each year for the past 6 years.
* Central line associated blood stream infections (CLABSIs) strike hundreds of thousands of patients each year.

Patient safety has declined in part because of this rise in health care associated infections (HAI), infections that patients acquire during the course of their stay in a healthcare setting, such as a nursing home or a hospital. HAIs are among the top ten leading causes death in the United States, and drive up the cost of health care by up to $20 billion per year.

Sebelius today announced that the Department of Health and Human Services plans to make $50 million in grants funded by the American Recovery Act available for states to help fight healthcare-associated infections (HAI). HHS plans to make $40 million available through competitive grants to eligible states to create or expand state-based HAI prevention and surveillance efforts, and strengthen the public health workforce trained to prevent HAIs. HHS is also allocating $10 million in grants to states to improve the process and increase the frequency of inspections for ambulatory surgical centers.

"Healthcare-associated infections can make illnesses worse, further debilitate patients who are already struggling and sometimes lead to death," said Sebelius. "Through the funding provided by the Recovery Act, we can help prevent these infections and improve the quality of care for all patients."

Sebelius also called on hospitals across America to commit to reduce Central Line Associated Blood Stream Infections in Intensive Care Units by 75 percent over the next three years. Research indicates that these infections strike hundreds of thousands of surgical patients and the percentage of patients acquiring these infections has steadily increased over the past six years.

Sebelius challenged hospitals to make use of a proven patient-safety checklist that can significantly and dramatically reduce the rate of these life-threatening infections.

"Patients expect to get better in a healthcare facility, not worse" added Sebelius. "The Recovery Act money will help protect patient safety, but we need hospitals to do more. Today, I'm challenging hospitals to take basic steps to fight infections that are weakening our health care system and threatening patient safety."

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Atlanta's Ranking Falls with a Breath of Fresh Air

GFP Note: Atlanta's ranking dropped from number 4 in 2008 to number 9 in 2009 as America's most challenging place to live with asthma.

St. Louis Named Top Asthma Capital

/PRNewswire/ -- St. Louis, MO, is ranked as the No.1 Asthma Capital – the most challenging place to live with asthma in the U.S.(1,a,1) – according to the Asthma and Allergy Foundation of America (AAFA), which conducted the study. This ranking was determined based on an analysis and scoring of 12 factors in the 100 largest U.S. metro areas.(1,b,5) St. Louis was ranked No.1 this year in part due to worse than average scores in crude death rate due to asthma (2.2%), higher than average pollen counts over the previous year and the lack of “100-percent" public smoke-free laws, which many other large cities are enacting.(1,a,1)

St. Louis topped the study after being ninth last year (2,a,1) due to a variety of factors, including poor air quality and a rise in the percentage of uninsured residents (2,a,1). It is interesting to note, however, that the prevalence of asthma, both estimated and self-reported in this city decreased slightly over the last year.(1,a,1; 2,a,1)

In 2008, Knoxville, TN, ranked No.1 (2,b,1) but moved to the number seven spot in 2009 (1,b,1) because both the estimated and self-reported prevalence of asthma decreased, and reported pollen levels were lower than the national average, among other factors. (1,b,1) Of note, all of the top 10 Capitals scored “below average” with regard to whether these cities embraced “100-percent” public smoke-free laws.(1,d,1) The complete rankings with detailed data for each city can be found at www.asthmacapitals.com.

For six years, AAFA has scientifically researched and evaluated conditions in the largest metropolitan areas in America and ranked them based on quality of life for people with asthma in each city. The Foundation reviews 12 factors: Crude death rate (CDR-recorded metro area deaths from asthma) for asthma; the estimated prevalence of adult and pediatric asthma; risk factors, such as air pollution, pollen counts and public smoking bans; and medical factors, such as the number of asthma medications used per patient and the number of asthma specialists in the area.(1,e,5)

“For the last several years, I have seen an increase in the severity of asthma in our patients and how their life is affected by it,” (1,a,1;2,a,1) said Mario Castro, MD, MPH, Professor of Medicine and Pediatrics, Washington University in St. Louis. “The lack of a smoke-free public environment for our patients with respiratory problems, especially asthma, (1,a,1) in St. Louis is appalling. Our return to the No. 1 Asthma Capital ranking is very concerning news for St. Louis asthma patients and physicians.”(1,a,1) Asthma, if left uncontrolled, can result in serious consequences.(3,a,1) In fact, sudden asthma episodes account for an estimated 1.8 million emergency room visits (3,b,4) and nearly 500,000 hospital admissions (3,c,4) each year in the United States.

AstraZeneca sponsored this research to better understand the environmental factors and health policies that impact people with asthma, specifically around asthma control. For the last 20 years, AstraZeneca has helped millions of people manage their respiratory conditions through discovery and development of asthma medications.

“Although St. Louis was found to be a particularly difficult place for people with asthma to live, asthma triggers are present in every American city,” says Mike Tringale, AAFA's Director of External Affairs. “There is no way for asthma patients to escape their disease,(4,a,1) but no matter where they live, patients can work with their physicians to find ways to effectively control their symptoms.” (5,a,1)

“We hope this survey ranking encourages asthma patients everywhere to talk to their doctors about how to avoid asthma triggers and about effective asthma control,” said Dr. Castro. “While asthma may not be curable, (4,a,1) it can be kept under control by following an asthma action plan that may in some cases include a controller treatment, as prescribed by a physician.” (6, a, 1;6,b,1)

Top 2009 Asthma Capitals

The top 10 Asthma Capitals for 2009, considered to be the most challenging places to live with asthma, are:
1.St. Louis, MO
2.Milwaukee, WI
3.Birmingham, AL
4.Chattanooga, TN
5.Charlotte, NC
6.Memphis, TN
7.Knoxville, TN
8.McAllen, TX
9.Atlanta, GA
10.Little Rock, AR(1,d,1)

References:
1.2009 Allergy Foundation of America Asthma Capitals study results. Available at www.asthmacapitals.com. Accessed on 1/22/09.
2.2008 Allergy Foundation of America Asthma Capitals study results. Available at www.asthmacapitals.com. Accessed on 1/22/09.
3.Centers for Disease Control. “Asthma Prevalence, Health Care Use and Mortality, 2003-2005” Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/ashtma03-05/asthma03-05.htm. Accessed 1/22/09.
4.Asthma and Allergy Foundation of America. “Asthma Facts and Figures.” http://www.aafa.org/display.cfm?id=8&sub=42. Accessed 1/22/09.
5.Asthma and Allergy Foundation of America. “Asthma Overview Prevention.” http://www.aafa.org/display.cfm?id=8&cont=9. Accessed 1/22/09.
6.National Heart, Lung and Blood Institute. “How Is Asthma Treated and Controlled?” http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_Treatments.html. Accessed 1.22.09.

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Health Care Policy with New Administration, Congress to go Beyond Insurance Debate

President-elect Obama and Congress will undoubtedly wrangle with health care in 2009, but the action will go beyond the debate over health insurance coverage, according to a Georgia State University public health professor.

Reform will also encompass public health measures, prevention efforts, beefed-up regulatory enforcement, and investment in health care technology, said Russ Toal, associate professor and Distinguished Fellow in Health Policy at Georgia State.

“I want to be quick to note that there is much that can be done without expenditure of money. And much of it can be done quickly,” said Toal, who gave his remarks Nov. 5 Public Health Grand Rounds lecture. “Public health is far broader than health insurance matters.”

Even in the face of difficult financial times, the government can take measures to improve health care in the United States, including the improvement of health-related regulatory enforcement by agencies like the Occupational and Safety Hazards Administration, the Food and Drug Administration and the Environmental Protection Agency.

Peeling back the laws passed in recent years which make it harder for people to declare bankruptcy — an option considered by many who face huge medical debts — would also help, Toal said.

Prevention and education programs are essential in addressing chronic illnesses which run up health care costs, while changing rules which forbid the federal government from negotiating drug prices could reduce increasing costs for prescriptions, he added.

Other public health efforts which might be addressed next year include raising the federal excise tax on tobacco products — which has been done in several states to help discourage tobacco use — as well as improving nutrition labeling laws on food products.

However, parts of the debate will include the discussion of expense — including health insurance for the uninsured, as well as increased military health care expenditures, Toal said.

Health insurance is also a component of the policy debate, and Obama proposes a version of the health care plan enacted by former Massachusetts Gov. Mitt Romney that allows those with employer-provided insurance to remain in their plans, while giving those without insurance a chance to purchase subsidized coverage from a pool of private insurers. Proposals also include enacting “re-insurance” for people who face extremely high, catastrophic costs.

Getting any measures passed, though, requires policymakers and politicians to go through intense legislative wrangling.

When the 111th U.S. Congress and President-elect Obama take their oaths of office in January 2009, one party will control both the legislative and executive branches. But this does not mean that a new administration will be able to get all of its proposals through quickly, Toal said.

Not all Democratic senators will agree to certain proposals, and Republicans will maintain enough seats to allow for filibusters — a legislative maneuver which can let a minority party stymie or kill legislation.

And just as with this year, health care was a top campaign issue in the 1992 election, when Democrats took control of both the executive and legislative branches. That led many in public health to believe that reform would happen under the Clinton Administration, but Toal said reform was stymied by a commission that took 10 months to produce a 1,300-page bill that got nowhere.

“I hope that President-elect Obama understands that he needs to strike quickly,” Toal said. “The new administration must move to put people in place quickly, and send a message to those throughout the federal government about what we must do, and that people will be held accountable.”

Overall, Toal said that with a new administration, there could be a new spirit of service not seen since the Kennedy Administration, leading more people — including Georgia State health sciences students — to work for the public good, even though the hours are often long and the pay much lower than in private industry.

“The impact of a revitalized and energized work force cannot be underestimated,” he said.

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