Leaderboard ad

Monday, July 21, 2014

Choosing the Right Hospital

Depending on several factors, including your geographic area and your insurance plan, you could have a broad or narrow number of hospitals to choose from. Additionally, you choice of hospital could also hinge upon where your personal physician has hospital privileges.

However, if you ever have to change insurance plans, you might have a choice of plans that don’t include your preferred hospital on their provider lists. There’s a chance you might never use the hospital benefit, but it’s important to make the right choice in case you ever do.

Hospital Ratings

The official hospital site can tell you a lot about the services they offer, the doctors they have on staff, and other things associated with their brand. Unfortunately, these don’t often have patient-centric information. In fact, Becker’s Hospital Review indicates that there are only 10 top hospital websites with patient-centric information.

Ratings by an independent evaluator, like Consumer Reports and The Agency for Healthcare Research and Quality, are the best way to evaluate future hospitals. These companies evaluate patient-centric factors like patient experience and outcomes, hospital practices, their safety score, and heart surgery.

Patient Experience: 

The patient experience rating reports the likelihood that patients would recommend this hospital to others. It is based on a government survey of patients across the country and includes such criteria as pain control, room cleanliness, room quietness, staff helpfulness, and communication with nurses and doctors.

Patient Outcomes:

The patient outcomes rating reports how well hospitals prevent hospital-acquired infections, and how many patients have to be readmitted within 30 days of being discharged, based on data that the hospitals submit to state or federal agencies.

The patient outcomes rating also measures surgical mortality rates – including mortality from post-surgical complications, like deep vein thrombosis – and medical mortality rates, based on Medicare patients admitted for heart failure, heart attack, or pneumonia.

Hospital Practices

The hospital practices rating is based on the number C-sections performed at the hospital and the appropriate use of scanning.

The C-section rates in the US are considered too high and the American College of Obstetrician and Gynecologists have guidelines for preventing unnecessary C-sections. The C-section measurement uses state-based billing data and calculates to calculate the score.

Appropriate use of scanning refers to the number of CT scans performed twice on a patient – once with dye and once without. These double scans have been deemed unnecessary and also potentially dangerous because they expose patients to extra radiation. The appropriate use of scanning measurement uses billing data submitted to CMS to calculate the score.

Safety

The safety rating refers to multiple categories regarding patient and hospital safety many of which overlap with the previously listed ratings. The criteria for the safety rating include: hospital acquired infections, mortality, patient-medical staff communications, readmission rates, and appropriate use of scanning. Some rating systems may pull this information from the patient outcome and hospital practices scores, or they may have a separate data collection system.

Heart Surgery

The heart surgery rating is based on coronary bypass procedures and aortic valve replacements. Both categories measure patient survival rates, and the rate of post-surgical complications. The coronary bypass category also rates used the best surgical technique, which improves long-term survival, and it rates whether or not patients received the correct medications before and after surgery.

Some rating services might require you to have a subscription to access hospital rating information. However, some insurance companies can also provide hospital ratings to both current and potential customers.

This is a blog post by Nancy Evans.

Wednesday, July 16, 2014

Vital Signs and the Brain

Vital signs are an important measure of basic bodily functions and are part of most physical examinations. The main vital signs typically reported are body temperature, blood pressure, pulse (heart rate), and respiratory rate (breathing rate). Vital signs fluctuate throughout the day but a significantly high or low deviation from normal indicates the presence of some type of medical problem or situational stressor.

Many times, these medical problems or stressors are relatively mild and can be easily managed or treated. Sometimes, however, abnormal vital signs can indicate a problem with the brain or spinal cord.

Although many people may think that vital signs are solely controlled or influenced by the heart , blood vessels, and lungs, it may surprise you to know the brain plays a major role in regulating vital signs. For example, core body temperature is largely regulated by the preoptic area of the anterior (front) hypothalamus (see picture below). The brain communicates to the rest of the body through the spinal cord and vice versa, which establishes an important and continuous feedback loop.


Another area you will see in the above image and below is the brainstem. The brainstem is an area in the lower part of the brain that connects to the spinal cord. The brainstem consists of three parts: the pons, midbrain, and medulla (from top to bottom).


The brainstem contains structures that regulate arousal and the most basic of life functions such as breathing rate. More specifically, there is an area in the pons and medulla that contains special nerve cells that regulates blood pressure control. This area is known as the lateral tegmental area and is located towards the back of the brainstem. The pons, medulla, and spinal cord also contain nerve cell projections that help regulate breathing rate and temperature control.

But wait, you say, I thought that part of the hypothalamus was involved in temperature control. It is, but there are actually multiple areas within the brain and spine that help regulate vital signs. As another example, there is a group of nerve cell bodies known as the solitary nucleus of the medulla that helps regulate heart rate, breathing rate, and blood pressure by sending messages through other parts of the brainstem and spinal cord.

For this reason, the solitary nucleus is also known as the cardiorespiratory nucleus. This nucleus is a good example of the feedback system that takes place between the brain and spinal cord. That is, in addition to sending out information, the solitary nucleus receives information from special sensory receptors located in major blood vessels that are excited by stretching of blood vessels. The stretching generates a nerve impulse that results in information being communicated to the brain.

This basic tutorial shows the importance of the brain for vital sign functions. The next blog entry on this topic will discuss types of damage to the brain and/or spinal cord that can cause abnormal vital signs.