Pain control, communication could be better, patients say
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Excerpts from the Globe's blog on the Boston-area medical community.
Most patients are satisfied with the care they receive in hospitals, but the quality of pain control and instructions they get when they leave could be improved, a New England Journal of Medicine study of national patient satisfaction surveys shows. Boston ranked sixth among large local regions.
Harvard researchers gathered data from more than 2,400 hospitals whose performance rating, as judged by patients, was released in March on the government's Hospital Compare website. Patients answered questions on communication with doctors and nurses, and the quality of nursing care as well as pain management and discharge instructions.
Almost a third of patients in the country gave low marks to pain management, and a fifth felt the same about communication. Hospitals whose patients ranked them highly were also more likely to score well on specific measures of care, such as heart attack treatment.
The more nurses per patient, the higher patient satisfaction, the researchers said.
Pharmalot blogger Ed Silverman helpfully quotes Candice Bergen's character Shirley Schmidt:"A famed Harvard psychiatrist helped fuel the recent boom in antipsychotics for kids. Turns out he personally took over $1.6 million from drugmakers over the past seven years," she says to a jury. "He also failed to report this income to the university, by the way. How can this be?"
Dr. Joseph Biederman of Harvard Medical School and Massachusetts General Hospital is widely regarded as influential in the rise in bipolar diagnoses among children. US Senator Charles E. Grassley has investigated Biederman and two of his colleagues for not disclosing all the payments they received from companies that made the medications they researched and recommended.
Harvard declined comment.
Researchers writing in the online edition of Health Affairs were watching for "crowd-out," or the effect state-subsidized insurance would have on whether businesses would continue to offer benefits on their own. The Massachusetts healthcare law, enacted in April 2006, included both a program to pay the bills for low-income residents and to assess an annual penalty of $295 per employee on businesses that decided not to offer insurance.
A spring survey companies show that 79 percent of businesses with three or more workers are offering insurance, up from 73 percent a year ago. Most employers think the new healthcare law is "good for Massachusetts." Fewer companies - 29 percent this year compared with 36 percent last - thought the healthcare law was a financial burden - although almost half of larger businesses were frustrated by paperwork they must file with the state.
The authors, led by Jon R. Gabel of the National Opinion Research Center at the University of Chicago, wrote. "For the moment, health reform has met or exceeded expectations with regard to the employer community."
Researchers analyzed the health records of more than 18,000 high-risk children 11 to 17 years old who got their medical care at Harvard Vanguard Medical Associates and their insurance from Harvard Pilgrim Health Care. Their illnesses included asthma, heart disease, immune-suppressing disorders, sickle cell anemia, and diabetes.
From 1992 through 2002, influenza immunization rates in this group rose from 8 percent to 15 percent, despite being recommended for vulnerable children for more than a decade, according to the study in this month's issue of Pediatrics. High-risk children who contract the flu are hospitalized two to four times more often than healthy children who get it.
"This was even worse than what we suspected," lead author Dr. Mari M. Nakamura of Children's Hospital Boston and Harvard Medical School said in an interview. "We also were surprised. It wasn't because these adolescents weren't coming in for visits, but because they had missed opportunities when they had come in."
ELIZABETH COONEY
