Spend enough time with Larry Smarr and, chances are, he’ll invite you to step inside his colon.
Like more than a million Americans, Smarr has inflammatory bowel disease. Unlike most, he also runs a cutting-edge institute replete with reams of ultrafast computers, crack graphics programmers, a towering wall of digital screens and a pitch-black virtual reality cave — all the better to summon up a digital 3-D version of himself that he calls “Transparent Larry.” Among its features is a larger-than-life replica of his colon that includes every nook, cranny, and section of inflamed tissue.
Smarr, 69, is a physicist widely recognized for his work on creating the national network of campus supercomputers that evolved into today’s internet. Now, he runs a futuristic institute called Calit2, housed on the University of California campuses in San Diego and Irvine, that works to advance a host of fields, including medicine. For the last decade, he’s been turning technology on to himself to quantify his body’s most intimate workings, with no clear idea where the experiment might lead.
Image Credit: Jurgen Schulze, UC San Diego
It has recently been reported that financial pressures within the NHS in the UK are leading some CCGs (Clinical Commissioning Groups) to consider limiting joint replacement procedures in the hospitals within their areas by 12% for hip and 19% for knee arthroplasties respectively. They will do this by treating only cases where the “patient’s pain and disability should be sufficiently severe that it interferes with the patient’s daily life and/or ability to sleep”, using the patient’s Oxford Hip Score as a determining factor.
There has been criticism of the proposal from orthopaedic surgeons, both from a financial as well as a clinical perspective. Grant Shaw, Consultant Orthopaedic Surgeon at the Alexandra Hospital in Portsmouth, UK acknowledges that “joint replacement surgery is an expensive and complex, invasive operation with significant risks” but he is adamant that these are far outweighed by “the huge potential benefits for the patient.” He says “In order to realise these benefits the surgery has to be done at the right time and for the right reasons for each individual patient.”
Image Credit: materialise
The starting point for achieving value in any health care system is to measure outcomes. Although this can present leadership challenges related to shifting strategy, culture and operations, it certainly isn’t rocket science. There are hundreds of provider organizations the world over that have already implemented outcomes measurement, and this number increases every week. Regardless, many providers still believe that measuring outcomes is too difficult to do.
Through regular interaction with our global network of value innovators, we at the International Consortium for Health Outcomes Measurement (ICHOM) have developed a 10-step implementation “blueprint” that any provider can follow. Of course, there is no one-size-fits-all solution for measuring outcomes, and all providers must make specific tweaks in order to make it work for them. However, all must take similar steps, traverse similar challenges, and build similar infrastructures to facilitate outcomes measurement.
By Jason Arora, Jan Hazelzet & Maarten Koudstaal | Harvard Business Review
Get in, get a new knee, go home.
As treatments get less invasive and recovery times shrink, a new kind of hospital is cropping up — the “bedless hospital.”
They have all the capabilities of traditional hospitals: operating rooms, infusion suites, and even emergency rooms and helipads. What they don’t have is overnight space.
“It reduces cost, and it reduces the risk of infection,” said Dr. Akram Boutros, CEO of MetroHealth System, which just opened a $48 million bedless hospital near Cleveland that he expects will serve about 3,000 people in the first year. “People go home to a less-risky environment, where they tend to get better faster.”
The growth in outpatient healthcare is a fundamental shift in US medicine. MetroHealth, which gets part of its funding from taxpayers and serves a large Medicaid population, has expanded outpatient visits from 850,000 to 1.2 million in the last four years, a 40 percent increase.
There’s an exceedingly simple way to get better health care: Choose a better hospital. A recent study shows that many patients have already done so, driving up the market shares of higher-quality hospitals.
A great deal of the decrease in deaths from heart attacks over the past two decades can be attributed to specific medical technologies like stents and drugs that break open arterial blood clots. But a study by health economists at Harvard, M.I.T., Columbia and the University of Chicago showed that heart attack survival gains from patients selecting better hospitals were significant, about half as large as those from breakthrough technologies.
That’s a big improvement for nothing more than driving a bit farther to a higher-quality hospital.
By Austin Frakt | The New York Times
Janet Prochazka was active and outspoken, living by herself and working as a special education tutor. Then, in March, a bad fall landed her in the hospital.
Doctors cared for her wounds and treated her pneumonia. But Prochazka, 75, didn’t sleep or eat well at Zuckerberg San Francisco General Hospital and Trauma Center. She became confused and agitated and ultimately contracted a serious stomach infection. After more than three weeks in the hospital and three more in a rehabilitation facility, she emerged far weaker than before, shaky and unable to think clearly.
She had to stop working and wasn’t able to drive for months. And now, she’s considering a move to Maine to be closer to relatives for support. “It’s a big, big change,” said her stepdaughter, Kitty Gilbert, soon after Prochazka returned home. “I am hopeful that she will regain a lot of what she lost, but I am not sure.”
Many elderly patients like Prochazka deteriorate mentally or physically in the hospital, even if they recover from the original illness or injury that brought them there. About one-third of patients over 70 years old and more than half of patients over 85 leave the hospital more disabled than when they arrived,research shows.
At a time when health care spending seems only to go up, an initiative in California has slashed the prices of many common procedures.
The California Public Employees’ Retirement System (Calpers) started paying hospitals differently for 450,000 of its members beginning in 2011. It set a maximum contribution it would make toward what a hospital was paid for knee and hip replacement surgery, colonoscopies, cataract removal surgery and several other elective procedures. Under the new approach, called reference pricing, patients who wished to get a procedure at a higher-priced hospital paid the difference themselves.
By Austin Frakt | The New York Times