Posts Tagged health

Can We Overhaul Our ‘Broken’ Health Data System?

Can We Overhaul Our ‘Broken’ Health Data System?

COLUMBUS, Ohio – Our system for protecting health data in the United States is fundamentally broken, and we need a national effort to rethink how we safeguard this information, according to three experts in data privacy.

“Data scandals are occurring on a regular basis, with no end in sight,” said Efthimios Parasidis, a co-author of the NEJM article and a professor at the Ohio State University’s Moritz College of Law and College of Public Health. “Data privacy laws for health information don’t go far enough to protect individuals. We must rethink the ethical principles underlying collection and use of health data to help frame amendments to the law.”

Parasidis wrote the article with Elizabeth Pike, Director of Privacy Policy in the Office of the Chief Information Officer at the U.S. Department of Health and Human Services; and Deven McGraw, chief regulatory office at Citizen, a company that helps people collect, organize and share their medical records digitally. Previously, McGraw was Deputy Director for Health Information Privacy at the Office of Civil Rights in the U.S. Department for Health and Human Services, and Acting Chief Privacy Officer at the Office of the National Coordinator for Health Information Technology.

Parasidis said a process analogous to the Belmont Report would be a good blueprint to follow today. The Belmont Report is one of the leading works concerning ethics and health care research. Its primary purpose is to protect subjects and participants in clinical trials or research studies. This report consists of three principles: beneficence, justice, and respect for persons.

The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research produced the 1979 Belmont Report, which resulted in Congress passing laws to protect people who participated in medical research.

“Indignities in human subjects research compelled the government to create a commission to propose ethical guidelines for new laws. We are experiencing a rerun of what was happening then, with the scandals involving use of health data now rather than the use of human subjects,” Parasidis said. “We need an equivalent response.”

Currently, the Health Insurance Portability and Accountability Act (HIPAA) is the main law protecting the data of patients. But it doesn’t apply to many of the new companies and products that regularly store and handle customer health information, including social media platforms, health and wellness apps, smartphones, credit card companies and other devices and companies.

“All of this data held by digital health companies raises a lot of ethical concerns about how it is being used,” Parasidis said.

For example, some life insurers are offering contracts that have policyholders wear products that continuously monitor their health, and the information can be used to increase a customer’s premiums.

Most regulations require only that consumers be notified about how their information is used and give their consent.

“That system doesn’t work. Very few people read the notice and most people just click agree without knowing what they’re agreeing to,” he said.

So how can health data privacy be fixed?

One idea would be to establish data ethics review boards, which would review projects in which health data are collected, analyzed, shared or sold, according to the authors of the NEJM article.

Parasidis said such boards could function as safeguards required in both public and private settings, from university medical centers to private life insurance companies.

These boards could consider the benefits and risks of the proposed data use and consider policies governing data access, privacy and security. Members could include project developers, data analysts and ethicists, as well as people whose data would be collected.

“Right now, everything is about compliance. Companies and institutions check the boxes, fill out the forms and don’t really think about whether they’re doing the right thing,” Parasidis said.

“Deliberations about use of health data should take the ethical obligations to individuals and society into account. The law should mandate that this occurs.”

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National Health Survey Underway in Marengo County

National Health Survey Underway in Marengo County

The National Health and Nutrition Examination Survey (NHANES), the most comprehensive survey of the health and nutritional status of the U.S. population, is underway in Marengo County through April 20. This is an “invitation-only opportunity” in which randomly selected participants will receive a free and comprehensive health and nutrition evaluation. Respondents will be compensated for their time, travel and other expenses of up to $125.

“We encourage every eligible resident who has been selected for the survey to agree to participate,” said Alabama Department of Public Health’s Southwestern District Administrator Chad Kent. “All information collected is confidential, as required by law. If you are chosen, you will have been contacted by letter.”

A team of health professionals, nutritionists and health technicians ask respondents to first participate in a health interview in the respondent’s home followed by a health exam in the NHANES mobile examination center. Professionals will have a photo ID badge from the Centers for Disease Control and Prevention. While no medical care is provided directly, a report on physical findings is given to each participant along with an explanation from survey medical staff. All information collected in the survey is kept confidential and privacy is protected.

“NHANES serves as the nation’s ‘health check-up,’ by going into communities to collect health information throughout the country. The survey provides a wealth of important data about many of the major health and nutritional issues affecting the country,” according to the National Center for Health Statistics (NCHS) Director Jennifer H. Madans.

All counties in the United States have a chance to be selected for the NHANES, and Marengo County was one of the 15 counties chosen to be part of this initiative. NHANES provides important data on public health problems from a national perspective. Each year, 5,000 residents across the nation have the chance to participate in the latest NHANES, conducted by the NCHS, part of the Centers for Disease Control and Prevention.

“For the most part, people are very receptive,” George Dixon, study manager, said. “We may ask for some demographic information to determine if any people in the household are selected. We assist participants with transportation and even babysitting if needed.”

NHANES has had a prominent role in improving the health of all people living in the U.S. for the past 55 years. Public health officials, legislators and physicians use the information gathered by NHANES to develop sound health policies, direct and design health programs and services, and expand the health knowledge for the nation. NHANES findings provide critical health-related information on a number of issues such as obesity, diabetes and cardiovascular disease. In addition, NHANES data are used to produce national references and are used to create standardized growth charts for pediatricians across the country.

The comprehensive data collected by NHANES impact the everyday lives of the population of all ages, on everything from air quality to the vaccinations given by doctors, to the low fat and “light” foods now routinely offered in grocery stores.

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HHS Proposes New Rules to Improve Interoperability of EHI

HHS Proposes New Rules to Improve Interoperability of EHI
Could new innovations in technology promote patient access and make no-cost health data exchange a reality for millions?

The U.S. Department of Health and Human Services (HHS) has proposed new rules to support seamless and secure access, exchange and use of electronic health information. The rules, issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would increase choice and competition while fostering innovation that promotes patient access to and control over their health information. The proposed ONC rule would require patient electronic access to this electronic health information (EHI) be made available at no cost.

“These proposed rules strive to bring the nation’s health care system one step closer to a point where patients and clinicians have the access they need to all of a patient’s health information, helping them in making better choices about care and treatment,” said HHS Secretary Alex Azar. “By outlining specific requirements about electronic health information, we will be able to help patients, their caregivers, and providers securely access and share health information. These steps forward for health IT are essential to building a health care system that pays for value rather than procedures, especially through empowering patients as consumers.”

CMS’ proposed changes to the health care delivery system support the MyHealthEData initiative and would increase the seamless flow of health information, reduce burden on patients and providers, and foster innovation by unleashing data for researchers and innovators. In 2018, CMS finalized regulations that use potential payment reductions for hospitals and clinicians to encourage providers to improve patient access to their electronic health information. For the first time, CMS is now proposing requirements that Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans in the Federally-facilitated Exchanges must provide enrollees with immediate electronic access to medical claims and other health information electronically by 2020.

In support of patient-centered health care, CMS would also require these health care providers and plans to implement open data sharing technologies to support transitions of care as patients move between these plan types. By ensuring patients have easy access to their information, and that information follows them on their health care journey, we can reduce burden, and eliminate redundant procedures and testing thus giving clinicians the time to focus on improving care coordination and, ultimately, health outcomes.

“Today’s announcement builds on CMS’ efforts to create a more interoperable healthcare system, which improves patient access, seamless data exchange, and enhanced care coordination,” said CMS Administrator Seema Verma. “By requiring health insurers to share their information in an accessible, format by 2020, 125 million patients will have access to their health claims information electronically. This unprecedented step toward a health care future where patients are able to obtain and share their health data, securely and privately, with just a few clicks, is just the beginning of a digital data revolution that truly empowers American patients.”

The CMS rule also proposes to publicly report providers or hospitals that participate in “information blocking,” practices that unreasonably limit the availability, disclosure, and use of electronic health information undermine efforts to improve interoperability. Making this information publicly available may incentivize providers and clinicians to refrain from such practices.

ONC’s proposed rule promotes secure and more immediate access to health information for patients and their health care providers and new tools allowing for more choice in care and treatment. Specifically, the proposed rule calls on the health care industry to adopt standardized application programming interfaces (APIs), which will help allow individuals to securely and easily access structured and unstructured EHI formats using smartphones and other mobile devices. It also implements the information blocking provisions of the 21st Century Cures Act, including identifying reasonable and necessary activities that do not constitute information blocking. The proposed rule helps ensure patients can electronically access their electronic health information at no cost. The proposed rule also asks for comments on pricing information that could be included as part of their EHI and would help the public see the prices they are paying for their health care.

“By supporting secure access of electronic health information and strongly discouraging information blocking, the proposed rule supports the bi-partisan 21st Century Cures Act. The rule would support patients accessing and sharing their electronic health information while giving them the tools to shop for and coordinate their own health care,” said Don Rucker, M.D., National Coordinator for Health IT. “We encourage everyone – patients, patient advocates, health care providers, health IT developers, health information networks, application innovators, and anyone else interested in the interoperability and transparency of health information – to share their comments on the proposed rule.”

Policies in the proposed CMS and ONC rules align to advance interoperability in several important ways. CMS proposes that entities must conform to the same advanced API standards as those proposed for certified health IT in the ONC proposed rule, as well as including an aligned set of content and vocabulary standards for clinical data classes through the United States Core Data for Interoperability standard (USCDI). Together, these proposed rules address both technical and health care industry factors that create barriers to the interoperability of health information and limit a patient’s ability to access essential health information. Aligning these requirements for payers, health care providers, and health IT developers will help to drive an interoperable health IT infrastructure across systems, ensuring providers and patients have access to health data when and where it is needed.

For a fact sheet on the CMS proposed rule (CMS-9115-P), please visit: https://www.cms.gov/newsroom/fact-sheets/cms-advances-interoperability-patient-access-health-data-through-new-proposals

For fact sheets on the ONC proposed rule, please visit: https://healthit.gov/nprm

To receive more information about CMS’s interoperability efforts, sign-up for listserv notifications, here: https://public.govdelivery.com/accounts/USCMS/subscriber/new?topic_id=USCMS_12443

To view the CMS proposed rule (CMS-9115-P), please visit: https://www.cms.gov/Center/Special-Topic/Interoperability-Center.html

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CMS Announces New Medicaid Opportunity to Expand Mental Health Treatment Services

CMS Announces New Medicaid Opportunity to Expand Mental Health Treatment Services

The Centers for Medicare & Medicaid Services recently sent a letter to State Medicaid Directors outlining existing and new opportunities for states to design innovative service delivery systems for adults with serious mental illness and children with serious emotional disturbance. The letter includes a new opportunity for states to receive authority to pay for short-term residential treatment services in an institution for mental disease for these patients. CMS believes these opportunities offer states the flexibility to make significant improvements on access to quality behavioral health care.

Medicaid is the single largest payer of behavioral health services, including mental health and substance use services in the U.S. By one estimate, more than a quarter of adults with a serious mental illness rely on Medicaid. About 10.4 million adults in the U.S. had an SMI in 2016, but only 65 percent received mental health services in that year. Serious mental health conditions can have detrimental impacts on the lives of individuals with SMI or SED and their families and caregivers. Since these conditions often arise in adolescence or early adulthood and often go untreated for many years, individuals with SMI or SED are less likely to finish high school and attain higher education, disrupting education and employment goals.

“More treatment options for serious mental illness are needed, and that includes more inpatient and residential options. As with the SUD waivers, we will strongly emphasize that inpatient treatment is just one part of what needs to be a complete continuum of care, and participating states will be expected to take action to improve community-based mental health care,” said Health and Human Services Secretary Alex Azar. “There are effective methods for treating the seriously mentally ill in the outpatient setting, which have a strong track record of success and which this administration supports. We can support both inpatient and outpatient investments at the same time. Both tools are necessary, and both are too hard to access today.”

CMS currently offers states the flexibility to pursue similar demonstration projects under Section 1115 (a) of the Social Security Act, regarding substance use disorders (SUDs), including opioid use disorder. To date, CMS has approved this authority in 17 states, where it is already improving outcomes for beneficiaries. For example, early results in Virginia show a 39 percent decrease in opioid-related emergency room visits, and a 31 percent decrease in substance-use related ER visits overall after implementation of the demonstration. With this new opportunity, CMS will be able to offer a pathway forward to the 12 states who have already expressed interest in expanding access to community and residential treatment services for the full continuum of mental health and substance use disorders. About a quarter of individuals with SMI have a co-occurring SUD.

States participating in the SMI/SED demonstration opportunity will be expected to commit to taking a number of actions to improve community-based mental health care. These commitments to improving community-based care are linked to a set of goals for the SMI/SED demonstration opportunity and will include actions or milestones to ensure good quality of care in IMDs, to improve connections to community-based care following stays in acute care settings, to ensure a continuum of care is available to address more chronic, on-going mental health care needs of beneficiaries with SMI or SED, to provide a full array of crisis stabilization services, and to engage beneficiaries with SMI or SED in treatment as soon as possible. States are encouraged to build on the opportunities for innovative service delivery reforms discussed in the first part of this letter and summarized below in order to achieve these milestones and goals.

Through this demonstration opportunity, federal Medicaid reimbursement for services will be limited to beneficiaries who are short-term residents in IMDs primarily to receive mental health treatment. CMS will not approve a demonstration project unless the project is expected to be budget neutral to the federal government.

States will also be expected to report information detailing actions taken to achieve the milestones and goals of these demonstrations as well as data and performance measures identified by CMS as key indicators of progress toward meeting the goals of this initiative.

In addition to the 1115 demonstration opportunity the letter also describes strategies under existing authorities to support innovative service delivery systems for adults with SMI and children with SED, that address the following issues:

  • Earlier identification and engagement in treatment, including improved data-sharing between schools, hospitals, primary care, criminal justice, and specialized mental health providers to improve communications;
  • Integration of mental health care and primary care that can help ensure that individuals with SMI or SED are identified earlier and connected with the appropriate treatment sooner;
  • Improved access to services for patients across the continuum of care including crisis stabilization services and support to help transition from acute care back into their communities;
  • Better care coordination and transitions to community-based care; and
  • Increased access to evidence-based services that address social risk factors including services designed to help individuals with SMI or SED maintain a job or stay in school.

CMS announced this new demonstration opportunity following the publication of the Medicaid Managed Care proposed rule. States identified key concerns in the 2016 final rules limitation regarding 15-day length of stay for managed care beneficiaries in an IMD. CMS did not propose any changes to this requirement at this time; however, CMS is asking for comment from states for data that could support a revision to this policy. Meanwhile, this new demonstration opportunity will give interested states the ability to seek federal authority to have greater flexibility to pay for residential treatment services in an IMD as part of broader delivery system improvements.

For more information, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd18011.pdf

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Largest Pediatric Study Shows Obesity Increases Asthma Risk in Children

Largest Pediatric Study Shows Obesity Increases Asthma Risk in Children

ORLANDO – Ten percent of pediatric asthma cases could be avoided if childhood obesity were eliminated, according to research led by Nemours Children’s Health System. The research, published in Pediatrics, the journal of the American Academy of Pediatrics, reported on the analysis of medical records of more than 500,000 children. The study is among the first to use the resources of PEDSnet, a multi-specialty network that conducts observational research and clinical trials across eight of the nation’s largest children’s health systems. PEDSnet is funded by the Patient-Centered Outcomes Research Institute (PCORI), a government-supported nonprofit.

“Pediatric asthma is among the most prevalent childhood conditions and comes at a high cost to patients, families and the greater health system. There are few preventable risk factors to reduce the incidence of asthma, but our data show that reducing the onset of childhood obesity could significantly lower the public health burden of asthma,” said Terri Finkel, M.D., PhD, Chief Scientific Officer at Nemours Children’s Hospital in Orlando and one of three Nemours researchers participating in the study. “Addressing childhood obesity should be a priority to help improve the quality of life of children and help reduce pediatric asthma.”

In this retrospective cohort study design, researchers reviewed de-identified data of patients ages two to 17 without a history of asthma, receiving care from six pediatric academic medical centers between 2009 and 2015. Overweight or obese patients were matched with normal weight patients of the same age, gender, race, ethnicity, insurance type, and location of care. The study included data from 507,496 children and 19,581,972 encounters.

In their analysis, the researchers found that the incidence of an asthma diagnosis among children with obesity was significantly higher than in children in a normal weight range and that 23 to 27 percent of new asthma cases in children with obesity are directly attributable to obesity. Additionally, obesity among children with asthma appears to increase disease severity. Being overweight was identified as a modest risk factor for asthma, and the association was diminished when the most stringent definition of asthma was used. Other significant risk factors of an asthma diagnosis included male sex, age of under 5 years old, African-American race, public insurance.

With 6 to 8 million cases of pediatric asthma previously reported in the United States, the study’s data suggest that 1 million cases of asthma in children might be directly attributable to overweight and obesity and that at least 10 percent of all U.S. cases of pediatric asthma might be avoided in the absence of childhood overweight and obesity.

“This is the first study of its kind, looking at obesity and the risk of developing asthma entirely in a pediatric population, and is made possible through the PEDSnet data collaboration,” said Finkel. “The PEDSnet collaboration brings the power of Big Data to pediatric research and medicine – as well as the expertise to structure the data and understand how to extract the most meaningful points.”

Several limitations of the study are noted, including the retrospective design using electronic health data, which prevent the researchers from drawing absolute conclusions regarding the causal nature of the association between obesity and asthma. Additionally, while the study includes data from a large, geographically diverse population of children, rural children may be underrepresented in the study results.

The research team hopes in the future to use PEDSnet’s capabilities to continue to gain new epidemiologic insights into the relationship between pediatric obesity and asthma, including measures of lung function, comorbidity, and medication data. Each PEDSnet member institution is able to map its own data onto the common data model, creating an enormous resource across the network with the power to produce findings relatively quickly.

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National Rural Health Day is Nov. 15!

National Rural Health Day is Nov. 15!

National Rural Health Day is an annual observance that emphasizes the importance of rural America and promotes the need for accessible, high-quality health care. National Rural Health Day falls on the third Thursday in November each year and recognizes the efforts of those serving the health needs of over 60 million people across the nation.

The Alabama Department of Public Health’s Office of Primary Care and Rural Health (OPCRH), the Medical Association, the Alabama Family Practice Rural Health Board, the Alabama Hospital Association, the Alabama Primary Health Care Association and the Alabama Rural Health Association are proud to recognize the innovation, quality of care, and dedication of health professionals and volunteers in the state during National Rural Health Day 2018.

This year, Dr. Peter Strogov of Fort Payne, one of Alabama’s many fine health professionals, has been selected as a “Community Star” for his many contributions to health care in rural communities. The annual “Community Stars” publication honors and gives a personal voice to rural people, providers, advocates and communities across the country. His story will appear in the 2018 edition that will be available on the https://www.PowerofRural.org website, the official hub for National Rural Health Day and the Power of Rural movement, beginning Nov. 15.

Rural health care professionals, hospitals, county health departments, and clinics are dedicated to providing health care in Alabama’s 54 rural counties, which are home to almost 2 million people. These rural communities have unique health care needs and challenges, including the distance to the nearest health care facility. In addition, these counties have a population that is generally older, and with health conditions that require a greater need for health care.

Rural hospitals are the economic foundation of many rural communities, but they are being threatened with declining reimbursement rates and disproportionate funding levels that make it more difficult to serve their residents. The OPCRH is dedicated to addressing these issues through a number of programs, such as the following:

  • Loan repayments for physicians, dentists and other health care professionals through the National Health Service Corps
  • No-cost recruitment of physicians using a national recruitment and retention database
  • Adoption of telehealth services to bring distant health care to the local community
  • Designation of physician and dental shortage areas for federal assistance programs
  • Assisting rural clinics in becoming certified to receive enhanced medical payments

In addition, OPCRH works closely with rural hospitals and safety net providers to identify problems and provide needed technical assistance and resources. More than 150 health care providers are presently working throughout the state under programs administered by the office, dispersed among the state’s 138 community health centers, 106 rural health clinics, and other providers. The OPCRH’s services are available to any rural health care organization that is dedicated to providing accessible, high-quality health care to its community.

Gov. Kay Ivey has issued a proclamation encouraging citizens to recognize the valuable services of rural health practitioners on this day.

To learn more, visit http://alabamapublichealth.gov/ruralhealth/

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Call It Quits Nov. 15! Join the Great American Smokeout!

Call It Quits Nov. 15! Join the Great American Smokeout!

Smokers who want to quit tobacco can use their fingers to dial for free help instead of lighting up a cigarette. On Thursday, Nov. 15, the Great American Smokeout challenges smokers and vapers to take the first step by quitting for the day or making a plan to quit for good.

Callers in Alabama can dial 1-800-QUIT NOW (1-800-784-8669) to reach the AlabamaDepartment of Public Health’s Tobacco Quitline. Enrollment in the free program can provide the caller an individualized quit plan, counseling from certified tobacco treatment specialists, and up to eight weeks of nicotine replacement therapy (NRT) patches if the caller is medically eligible and enrolled in the program.

In Alabama, 20.9 percent of adults are smokers compared to the national rate of 17.1 percent, according to the Centers for Disease Control and Prevention’s (CDC) 2017 Behavioral Risk Factor Surveillance System. Smoking is the number one cause of preventable death and disease in the nation and kills more than 8,600 adults in Alabama each year. Annually, the state spends more than $1.88 billion in health care costs directly caused by smoking.

“Tobacco use doesn’t just harm the smoker,” said Julie Hare, ADPH Tobacco Prevention and Control Program’s cessation manager. “Secondhand smoke can cause adverse health effects for anyone exposed.” CDC’s Tips from Former Smokers national advertising campaign which shows the cost for patients living with a tobacco-caused disease and the effect on their families has inspired thousands of Alabamians to call the Quitline for help, she said.

Tobacco users and vapers can also register for services online at quitnowalabama.com. The Quitline is open from 6 a.m. to midnight seven days a week.

Medicaid callers are offered Quitline counseling but are referred to Medicaid’s program to obtain their medications. “Medicaid pays for a full course of any of the seven Food and Drug Administration-approved medications to help quit tobacco,” Hare said. “Smokers who want to quit should ask their private insurance carrier about medication coverage,” she said. “Under the Affordable Care Act, tobacco cessation is required to be covered as a preventive service.”

Hare said other ways to reduce smoking include the adoption of comprehensive smoke-free policies in cities. Some 32 Alabama cities have adopted smoke-free ordinances that prohibit tobacco use in workplaces, including restaurants and bars. At least half of those ordinances include e-cigarettes, she said.

The American Cancer Society has sponsored the Great American Smokeout since 1975.

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Speak Out! Don’t Allow Suicide to Take Another Physician’s Life.

Speak Out! Don’t Allow Suicide to Take Another Physician’s Life.

Did you know cancer was the most common cause of death among residents? Suicide was the second-leading cause of resident death — and the most common cause of death among male residents. A 2015 review of studies estimated 22 to 32 percent of resident physicians in the U.S. suffer from depressive symptoms and multiple studies have shown that residency training places physicians at risk for mental illness and suicidal thoughts.

Monday, Sept. 17, is National Physician Suicide Awareness Day, organized by the Council of Emergency Medicine Residency Directors (CORD), in collaboration with AAEM, ACEP, ACOEP, EMRA, RSA, RSO and SAEM to annually dedicate the 3rd Monday in September to remind physicians and other health care workers that suicide can be prevented and resources are available.

“Medicine is a calling, and the practice of medicine can be a very stressful career,” said Medical Association Executive Director Mark Jackson. “Alabama’s physicians care for thousands of patients each year, but they may not always stop to take care of themselves when they need it most. Physicians have a multitude of options designed just for them when they feel they are reaching a breaking point, and that’s where we can be a lifeline.”

While estimates of the actual number of physician suicides vary, literature has shown that the relative risk for suicide being 2.27 times greater among women and 1.41 times higher among men versus the general population. Each physician suicide is a devastating loss affecting everyone – family, friends, colleagues and up to 1 million patients per year. It is both a very personal loss and a public health crisis.

Help is available for physicians who feel they need assistance. The Alabama Physician Health Program is a confidential, effective, first-line resource for physicians and other medical professionals with depression and other mental health issues. Physicians may contact the APHP at (800) 239-6272 or email staff@alabamaphp.org.

 

Additional Resources

Let’s Talk About Physician Burnout

Physician Suicide

Medical specialties with the highest burnout rates

Suicide Is Much Too Common among U.S. Physicians

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STUDY: Doctor Burnout in Small Practices Is Dramatically Lower Than National Average

STUDY: Doctor Burnout in Small Practices Is Dramatically Lower Than National Average

Physicians who work in small, independent primary care practices — also known as SIPs — report dramatically lower levels of burnout than the national average (13.5 percent versus 54.4 percent), according to a study led by researchers at NYU School of Medicine published online July 9 in the Journal of the American Board of Family Medicine. The findings indicate that the independence and sense of autonomy that providers have in these small practices may provide some protection against symptoms of burnout.

Physician burnout is a major concern for the health care industry. It is associated with low job satisfaction, reduced productivity among physicians, and may negatively impact the quality of care. Multiple national surveys suggest that more than half of all physicians report symptoms of burnout.

Research on physician burnout has focused primarily on hospital settings or large primary care practices. The researchers say that this is the first study that examines the prevalence of burnout among physicians in small independent primary practices — practices with five or fewer physicians.

Researchers examined data collected from 235 physicians practicing in 174 SIPs in New York City. The rate of provider reported burnout was 13.5 percent, compared to the 2014 national rate of 54.4 percent. A 2013 meta-analysis of physician surveys conducted in the United States and Europe found that lower burnout rates were associated with greater perceived autonomy, a quality and safety culture at work, effective coping skills, and less work-life conflict.

“Burnout is about the practice culture and infrastructure in which primary care doctors work. So the obvious question is: what is it about the work environment that results in low burnout rates in small practices?” says Donna Shelley, MD, professor in the Departments of Population Health and Medicine at NYU Langone Health, and the study’s senior author. “It’s important to study the group that’s not showing high burnout to help us create environments that foster lower burnout rates. The good news is that a culture and systems can be changed to support primary care doctors in a way that would reduce the factors that are leading to burnout.”

How the Study Was Conducted

Researchers analyzed data as part of the HealthyHearts NYC (HHNYC) trial, which is funded by the Agency for Healthcare Research and Quality’s (AHRQ) EvidenceNOW national initiative. AHRQ is a division of the U.S. Department of Health and Human Services. The HHNYC trial evaluates how practice coaching or facilitation helps SIPs adopt clinical guidelines for the treatment and prevention of cardiovascular disease.

Each physician answered a multiple choice question with response options indicating various levels of burnout. Options ranged from no symptoms of burnout to feeling completely burned out and questioning whether or not to continue practicing medicine. The question was validated against the Maslach Burnout Inventory, a nationally recognized measure that identifies occupational burnout. Physician respondents were categorized as burned out if they checked one of the last three options in the multiple choice question.

As part of the HHNYC trial, physician respondents were also asked a number of questions about the culture of their practices. The tool used specifically measures “adaptive reserve,” or a culture where individuals have opportunities for growth and the ability to learn from mistakes by talking and listening to each other. Physicians who described this kind of culture in their practice reported lower levels of burnout. According to Dr. Shelley, practices, where employees feel they are included in decisions and have control over their work environment, are referred to as having “high adaptive reserve.”

Dr. Shelley is careful not to minimize the challenges faced by physicians working in solo practices or SIPs. She cites that even though burnout rates are lower, many of these practices are struggling financially, and many of these physicians are on-call all of the time.

“The more we can understand what drives low rates of burnout, the more likely it is that we’ll find solutions to this problem,” says Dr. Shelley. “The hope is that our research can inform ways for larger systems to foster autonomy within practices so that there is space to carve out a work environment that is aligned with doctors’ needs, values, and competencies.”

Dr. Shelley lists a number of the study’s limitations. Since the findings are representative of physicians working in small practices in New York City, the study does not capture burnout rates in other cities across the country. It is also possible that the researchers underestimated the number of hours worked by physicians, since hours worked is associated with burnout. Dr. Shelley also cited the lack of data linking physician burnout to patient outcomes.

In addition to Dr. Shelley, study co-authors include Nan Jiang, PhDCarolyn Berry, PhD; and Gbenga Ogedegbe, MD, MPH, of NYU School of Medicine; Chuck Cleland, PhD, of NYU Rory Meyers College of Nursing; and Batel Blechter of Johns Hopkins University.

The research was supported by the Agency for Healthcare Research and Quality (AHRQ).

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