October

Instead of the ER: Paramedics making house calls to chronic patients.

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Emergency rooms — which can cost patients thousands of dollars each visit — have become the primary source of medical care for the uninsured and people with chronic illnesses.

A Minnesota health care provider is testing a new program in the hopes of reducing ER admissions and keeping people healthier: they’re sending paramedics on house calls to some of the area’s sickest patients who might otherwise end up in the ER.

The need for such out-of-the-box solutions is clear. In the last year, one in five Americans went to the ER at least once for an estimated 130 million visits. The cost of all those ER visits is staggering, considering that the price for treating some of the most common conditions can range from an average of $750 all the way up to $73,000.

“We don’t screen for insurance at the door,” said Dr. Joey Duren, an emergency physician with North Memorial Healthcare System in Minnesota. “So in our country now, a big thing is that the emergency department is a safety net for people who don’t have insurance.”

Patients with chronic conditions like asthma and diabetes can spiral out of control without regular monitoring and land in the ER multiple times in a single year. The number of repeat patients is often staggering; some of whom visit dozens of times each month, according to North Memorial’s chief medical officer, Dr. Kevin Croston.

“What’s really the biggest cost in health care are the chronic conditions where there are readmissions to the emergency department,” Duren said. “We realized we needed to create care that stopped that.”

That’s where house calls from the community paramedics came in. Since the program began last October paramedics have made more than 1,000 home visits, at a fraction of the cost for a trip to the ER. Although North Memorial doesn’t have data yet on the savings, officials believe the program will help reduce admissions.

“The role of this community paramedic is helping people get on top of their chronic disease processes so they aren’t getting so sick that they need to come to us in the emergency department,” Duren explained. “We’re controlling their diseases so they can be handled in an outpatient setting versus having to come here or be admitted to the hospital for multiple days because they’ve gotten so far behind in their insulin for their diabetes or their COPD has gotten out of control.”

Chris Anderson is among the first group of paramedics who were specially trained to make house calls. He quickly recognized the value of those home visits.

“It’s when you get to spend more time with [patients], you get to find out what’s going on, what’s truly bothering them, what they need the most help with,” Anderson said.

The house calls have been a life-saver for folks like 65-year-old Victoria Denbleyker, who suffers from multiple, hard-to-manage chronic conditions, like diabetes, congestive heart failure, and rheumatoid arthritis—problems that used to routinely send her to the ER.

With doctors, Denbleyker said, “you don’t have that much time to really talk to them, even if you get the maximum amount of time, which is half an hour. Sometimes there are too many things going on. “

Without consistent monitoring, Denbleyker’s condition can rapidly descend into the danger zone.

“My system can change in a heartbeat,” she said. “I never know what is coming next. So the fact that they know what is going on with me means a lot.”

The Minnesota project started last October. To figure out which patients might benefit from the program, the hospital searched for anyone who had used the ER nine or more times in a year.

Nine was “the number we had to land on for our own survival mode,” said North Memorial’s Croston.

Think that’s a lot?

“We’ve had some patients that were here 23 times in a month,” he said.

Croston said, “readmission rates are down for us as a health system, and that’s largely due to the fact that we’re intervening once they leave the hospital or once they leave the emergency department.”

Barb Andrews, who runs the program, says it’s a new way of thinking about health care.

“It gives us, as paramedics, an opportunity to be proactive rather than reactive,” she said. “The community paramedics empower [patients] to be able to manage their own health better in the home.”

And ultimately, she said, that can “keep them out of the hospital, keep them out of the nursing home.”

Novartis announces positive clinical trial results for novel H7N9 vaccine.

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  • 85% of subjects immunologically protected after receiving second dose of investigational cell culture vaccine when combined with proven MF59® adjuvant

  • Vaccine now in large scale production highlighting rapid response capability of novel FDA licensed cell culture technology

  • 135 confirmed cases and 45 deaths from H7N9 virus since emergence in March according to the World Health Organization.

Novartis announced today interim results from a Phase 1 clinical trial with its proprietary cell culture vaccine for the H7N9 avian influenza virus involving 400 healthy volunteers (18-64 years of age). The data shows 85% of subjects achieved a protective immune response after two doses of the 15 ug MF59 adjuvanted vaccine. Only 6% of subjects achieved a protective response when given two doses of the 15ug un-adjuvanted vaccine. The full data set from the trial will be submitted to a peer-reviewed journal for publication in the near future. 

The vaccine was produced utilizing full-scale cell-culture manufacturing technology, an alternative technology that can significantly accelerate vaccine production versus traditional egg-based methods.[2] Cell-culture technology utilizes a well-characterized mammalian cell line rather than chicken eggs to grow virus strains.[3]

“This rapid response underscores our leadership position in pandemic preparedness” said Andrin Oswald, Division Head, Novartis Vaccines. “Thanks to our investments into innovative production technologies and adjuvants, we are now able to offer a protective solution for a potentially deadly pandemic virus within a few months after the emergence of the H7N9 virus.”

Reports of H7N9 infection first emerged in China in March 2013. Novartis, along with its partners at the Craig Venter Institute, first synthesized the viral strain several days after it was shared with global researchers by the Chinese Centers for Disease Control. Novartis then produced clinical trial lots, began clinical trials in August, and initiated large-scale production in its Holly Springs (NC), USA and Marburg, Germany facilities in October.

Statement on Breast Cancer Awareness Month.

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The Honorable Kathleen Sebelius is the 21st secretary of the Department of Health and Human Services, which includes NCI. Secretary Sebelius released the following statement to mark Breast Cancer Awareness Month.

In October, during National Breast Cancer Awareness Month, we remember those who have lost their lives to breast cancer, and those who are battling it now, by recommitting ourselves to their fight and spreading the word of the importance of prevention and early detection.

Despite significant advances in treatment and prevention, breast cancer remains the second leading cause of cancer death for women in the United States. However, because of the Affordable Care Act, it’s a new day for women’s health and the fight against breast cancer.

President Proclaims October National Breast Cancer Awareness Month

The White House has issued a Presidential Proclamation designating October National Breast Cancer Awareness Month. As the federal government’s leading funding institution for cancer research, NCI supports a wide range of research to improve breast cancer prevention, detection, and treatment. NCI also funds research on follow-up care for the growing number of breast cancer survivors.

We know that the chance of successful treatment is highest when breast cancer is detected early. While not a perfect tool, mammogram screenings are key to early detection. Yet, only about 75 percent of women aged 40 or older have had a mammogram in the last 2 years. If we could boost that number to 90 percent, thousands more lives could be saved. But budgets are tight, and even moderate copays can deter many women from getting those important screenings.

Because of the Affordable Care Act—the health care law signed by President Obama 2 years ago—many private health plans and Medicare now cover mammograms and certain other preventive services with no copays or other out-of-pocket costs. This means that women can get the potentially life-saving services they need to detect breast cancer before it spreads, without worrying how a copay would affect their family budget. Last year, more than 6 million women with Medicare got a free mammogram.

Under the health care law, other services to help prevent breast cancer are also covered, such as a well-woman visit—at no additional cost—so women have the opportunity to talk to their doctor about their health care needs, their personal risk for breast cancer, and their best options to reduce their risk. The Affordable Care Act gives women, not insurance companies or the government, control over their health care.

Women also have new rights and protections under the law against insurance company abuse. If diagnosed with breast cancer or another illness, women cannot have their coverage taken away when they need it the most simply because of a mistake made on paperwork. And beginning in 2014, it will be illegal for insurers to discriminate against anyone with a pre-existing condition, such as breast cancer.

The health reform law is also helping women who are going through costly breast cancer treatment by preventing insurance companies from imposing lifetime dollar caps on coverage. This means that women fighting breast cancer can focus on their health, their families, and living their lives, and not worrying that their insurance will run out while they still need treatment.  

We have made substantial progress in reducing the burden and toll of breast cancer on American women and their families. Initiatives under the Affordable Care Act, along with ongoing research, are making real differences in the lives of American women and their families.

Kathleen Sebelius
Secretary 
U.S. Department of Health and Human Services

Selected Federal Breast Cancer Resources

Source: NCI