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From all of us at Pioneering Ideas, thank you so much for participating in the blog and in the work of the Pioneer Portfolio, and we wish you very a happy holiday season.
We're taking a few days off for the holidays ourselves, but will be back early in the new year. We're looking forward to continuing our conversations with you then!
At the end of every year, David Colby, RWJF’s Vice President of Research and Evaluation puts together “the list”- ten articles from the Foundation’s top research and evaluation projects that had a real impact in the policy arena, helped shape the Foundation’s thinking and work, or stood out in other ways during the year.
This year, the work of Pioneer grantee, Extending the Cure, made it to the list.
We’ve spoken about Extending the Cure before on the blog. Paul Tarini introduced Pioneer’s work with its parent, Resources for the Future, back in March, highlighting the innovation involved in treating antibiotic resistance as an economic problem. Ramanan Laxminarayan was a guest blogger later that month and wrote about Extending the Cure’s analytic process. And then Laxminarayan’s colleague Eili Klein joined us just a few weeks ago to describe the actual findings that made it to the “top ten” list.
Extending the Cure’s staff, and their research to understand trends in staph and MRSA infections, and the risks of antibiotic resistance, have generated a lot of excitement both in the field and here at the Foundation. We expect their voice will be a key one as the conversations around MRSA and hospital-acquired infections continue to unfold.
Check out David’s list – it is an impressive collection of work and it will certainly offer some fascinating conversation starters for all of your holiday parties!
Thanks to Lygeia Ricciardi for the following...
"Many of the posts on the Project HealthDesign blog directly or indirectly address the topic of privacy, which is of course a core issue concerning PHRs specifically and the electronic exchange of health information generally. If you haven’t already seen it, take a look at the Project HealthDesign E-primer, The Need to Know: Addressing Concerns about Privacy and Personal Health Records. It gives a good overview of the privacy landscape in this context, touching on topics including pending legislation and ethical issues.
Regarding ethics, Ken Goodman (who heads up Project HealthDesign's efforts to better understand the ethical, legal and social implications of future PHR directions) explores the implications of defining privacy as a “human right”—if our society does so, we free ourselves from a great deal of debate about protecting it. But where would the boundaries of such a right lie? The E-primer poses some difficult policy questions, such as whether health information collected by a patient in a PHR should be treated differently from medical record information under current regulations."
This E-primer asks how consumers may regard issues of privacy, security and control of their health data in an age of smarter PHR systems, and how policies and norms may shift as a result. Will people be willing to share personal health information in order to gain greater efficiencies in their everyday lives? We do it all the time now with personal banking and finance info. Another question - how will the Myspace and Facebook generation treat the disclosure of personal health specifics in this era of all-about-me online identity?
Thoughts?
After my laptop gave out on a long flight to San Diego last week, I caught up on some reading. Wired offered an intriguing article about the failure of network-centric warfare in Iraq. The article described the basic concepts underlying the Pentagon’s approach of network-centric warfare.
The central idea is that an IT-enabled, highly networked force, that can communicate instantly in a peer-to-peer fashion can have the information it needs, when it needs it, to make rapid decisions. Such a force – that can pinpoint targets with breathtaking accuracy and eliminate them with air strikes within minutes – could overwhelm much larger, less technologically advanced forces. The article provided examples: small Special Forces teams defeating Iraqi Army units outnumbering them by as much as 500:1, a decrease in the time from target identification to target elimination from 3 days in the first Gulf War to under 10 minutes in the current conflict.
But then it goes on to discuss how this strategy, while highly effective in overrunning Saddam’s army, was entirely inappropriate for the years of fighting the insurgency that followed. The fascinating insight from the article was that the network-centric strategy failed because it excluded the most important nodes, or sources of information, from the network: many of the US troops on the ground, local policemen, Iraqi army officers, and tribal leaders. The counter-insurgency strategy that has apparently had some success in Iraq involves much more of a low-tech, messy, patient, trust-building social network approach.
So now let’s consider health IT, where we hear discussions of a nationwide interoperable network of electronic health records that could give clinicians the information they need, when they need it, to make the right clinical decisions.
In the same way that network-centric warfare is remarkably good at killing the enemy (as opposed to persuading the enemy not to be an enemy), network-centric health care (as so often envisioned) might be remarkably good at caring for acute conditions, where relatively little independent patient compliance is required (e.g., show up for surgery, adhere to a short course of medications), but for the messy world of chronic disease – perhaps not so much. In the same sense that in Iraq the network didn’t benefit from its most important participants, one could argue that network-centric healthcare, by not more deeply engaging the patient, fails in the same sense.
Which brings me to the meeting to which I flew. The Markle Foundation convened about 100 people to talk about key health IT issues (see David Kibbe’s post at the Health 2.0 blog for an insightful report on the meeting). At the meeting, Jamie Heywood gave a presentation of his site, PatientsLikeMe, which pulls together data from patients with ALS, Parkinson’s, MS, and HIV/AIDS. They’re getting extensive self-reported data about how each disease is progressing in different people, the symptoms they’re experiencing, the medications and treatments that people are taking, and the effects that they’re having.
Their numbers have grown to the point that they have more participants than most clinical trials on any of these diseases and they offer patients a very different body of information about their disease than what they’ll find in the literature. It’s the street intelligence: the day-to-day understanding of what’s really going on at the ground level in the war (in this case) against certain chronic diseases.
So to me, the parallel is striking: just as it is now with some hindsight that one can understand the flaws of the network-centric warfare strategy in Iraq, it would seem that a network-centric health system needs to move sooner rather than later to figure out how to incorporate the vital information assets that each person brings to the network.
Eili Klein, of Pioneer grantee Resources For the Future, is lead author of an article in the most recent issue of Emerging Infectious Diseases on hospitalizations and deaths in the U.S. caused by Methicillin-Resistant Staphylococcus Aureus, or MRSA. We asked Eili to comment on the article, its findings and their implications, and he responded:
Recently, it has been impossible to turn on the news without seeing another report about MRSA, an antibiotic-resistant form of a common bacterial infection. It was a feature on CBS’s 60 Minutes, and the subject of countless local news reports that the so-called “superbug” had become rampant in high school locker rooms and caused serious illness and some deaths in elementary school-aged kids.
While news coverage of local events has been extensive, there had been, until recently, a lack of data at the national level to assess the magnitude of the problem and its trend. My colleagues and I at Extending the Cure, a project of Resources for the Future, have just published a study that finds that resistance to drugs traditionally used to treat MRSA has increased significantly.
Based on data compiled from national records of hospitalizations and resistance, our study showed that the number of people hospitalized with MRSA infections more than doubled, from 127,000 to nearly 280,000, between 1999 and 2005. We also found that as many as 17,000 people infected with MRSA die each year.
In addition to this steady growth in the number of infections found among hospital patients, we also found a dramatic increase in the rate of minor skin and soft tissue infections – often looking like pimples or boils - commonly caused by another strain of MRSA that is generally acquired in the community.
This new infection pattern suggests that as the epidemic of drug-resistant infections in hospitals continues unabated, more and more MRSA infections requiring hospitalization also are being transmitted in the community.
Our study is the first to examine recent trends in staph and MRSA infections. In combination with a recent report in the Journal of the American Medical Association that provided a detailed snapshot of MRSA’s impact in 2005, this research suggests that the problem of MRSA should be a national priority.
Of particular interest to us at Extending the Cure is the potential for MRSA to increase the pressure on our waning antibiotic arsenal; treatment of MRSA, after all, requires the use of antibiotics of last resort like vancomycin, and the prospect of MRSA developing resistance to this drug is scary, indeed.
It is for reasons just like this that we at Extending the Cure recommend incentive-based policy solutions that engage all parties with a stake in the continued existence of effective antibiotics. In the specific context of hospitalizations involving antibiotic-resistant infections, policies might include not only increasing surveillance and reporting but also making this information more widely available and linking hospital reimbursements to successful outcomes from infection control programs. Our research on MRSA, its growth and spread and the risk it poses, only reinforces the need to take action.
Last week, New York Times reporter Tara Parker-Pope explored the consumer appeal and health benefits of active games. The Wii and Fisher Price's Smart Cycle are some of the hottest sells this holiday season. Learn why, after the jump, in the full article, for your reading pleasure.
Continue reading "Active Games - A Less Intentional, More Effective Workout?" »
