Oral cancer kills one American every hour, largely due to late detection.  It used to be known as a disease of older men with histories of heavy smoking or drinking. But today’s oral cancer victim is often younger and female. Oral cancer among people in their 40’s nearly doubled from 1973-2004, and researchers think they know why.

The human papillomavirus (HPV), long known as the primary cause of cervical cancer, turns out to be an equal-opportunity killer, causing oral cancer in men as well as in women. Oral cancer strikes three times as many Americans as cervical cancer, and kills twice as many per year. As reported recently on ABC TV’s Good Morning America, 39% of today’s oral cancer cases stem from HPV infection.

ABC showcased the new face of oral cancer: Theresa Dillon, a 38-year-old mom with no history of tobacco use was diagnosed with Stage II oral cancer on her tonsil. The cause? The HPV virus.

Johns Hopkins researchers, writing in the February issue of the Journal of Clinical Oncology, reported that the sexually transmitted HPV virus causes as many cancers of the upper throat as tobacco and alcohol combined. Oral sex is the likely method of transmission. They said the incidence rate for HPV-related oral cancers among males has been rising steadily for three decades.

“Every sexually active adult may be at risk for oral cancer,” says Dr. Omer Reed, Phoenix-based dentist and international dental practice consultant, “but no one should have to suffer, let alone die, from this disease.” Reed says dentists across the U.S. and Canada offer a 3-minute, totally painless exam called ViziLite® Plus that has been clinically proven to help dentists detect abnormal tissue, including pre-cancerous and cancerous lesions. After a patient rinses with a special solution, the dentist examines the mouth with a light stick that illuminates abnormalities. Suspicious areas are marked with a temporary dye called TBlue® for follow-up.

As Ms. Dillon said on Good Morning America, “People think the face of oral cancer is a 70-year-old man who’s been chewing tobacco and drinking whisky all his life. The face of oral cancer now is me, a young woman, healthy, non-smoking, fit.”

“An oral cancer exam should be a key part of every adult’s annual dental check-up,” says Dr. Reed.

A change in lifestyle can make all the difference for a patient who is at risk for cardiac disease, but behavioral changes are often not sustained over the long-term. Community Cardiovascular Hearts in Motion, with incorporation of the Wellness Record, is attempting to change that.

Community Cardiovascular Hearts in Motion (CCHIM) is a program serving people with heart disease and those at risk of developing it. With three community locations in the Halifax/Dartmouth area, CCHIM provides a multidisciplinary program – including components of nutrition, exercise, and risk factor management – to patients who have been referred to the clinic by their family physician.

“We were interested in learning whether an online tool could complement our program,” explains Dr. Nicholas Giacomantonio, Program Medical Director. “The Wellness Record provided a tool for our patients to track and improve their behaviour while giving the Hearts in Motion team an opportunity to better monitor patients and provide guidance and support between clinic visits.”

Though previous links have been suggested between online behaviour tracking and sustainable behaviour modification, the results were startling. In a typical intervention program, it is estimated that 30% of patients will stop exercising after six months and the majority will revert to previous eating habits, losing many of the benefits gained during the program. The addition of the Wellness Record helped counteract this trend. After three months, patient groups using the Wellness Record reported a change in their LDL of -8.9% and a change in weight of -2.5%. After six months, patient groups using the application reported a change in their LDL of -14.6% and showed a weight loss of 6.0%.

Not only did patient health continue to improve after leaving the clinic, but the results of patient groups using the Wellness Record far out performed patient groups who did not have access to the application.

“By encouraging people to track their activity and establish personal goals, the Wellness Record reinforces behaviour change,” says Wanda Firth, Program Manager. “The fact that we are continuing to see such results months after patients have left the program demonstrates the potential of online self-management – especially when used in conjunction with a clinical program.”

HealthGrades announced today that Yahoo! has selected the company as the exclusive provider of physician and hospital quality information for Yahoo! Health. HealthGrades’ physician quality reports and hospital ratings will be integrated into a variety of Yahoo! Health consumer health tools, including a new Yahoo! Health Physician Directory.

“Providing Yahoo! Health with HealthGrades content is a valuable opportunity for our company to provide millions more Americans with the critical information they need to choose the best quality medical care for themselves and their loved ones,” said Kerry Hicks, HealthGrades Chief Executive Officer.

Yahoo! Health will incorporate HealthGrades data into a new search-driven directory that will leverage numerous Yahoo! technologies and applications. The new physician directory will offer detailed physician and care provider pages, insurance coverage information, ratings and reviews from other users, comparable physician charts and health-focused Yahoo! Answer and Yahoo! Group modules.

“We are pleased to announce Yahoo! Health users will have access to HealthGrades trusted and independent health care quality information,” said Michael Yang, Yahoo! Health vice president and general manager. “Our goal is to empower individuals to make the best health decisions for themselves and their loved ones, and in teaming with HealthGrades, we can provide our customers with an easy-to-use physician directory that will offer detailed and trusted information at their fingertips.”

Through HealthGrades, millions of consumers access trusted quality information on more than 700,000 physicians and 5,000 hospitals nationwide, including consumer ratings on doctors and prescription drugs. HealthGrades operates the Web’s ninth most-trafficked ad-supported healthcare sites, according to comScore’s September rankings (with recent merger and acquisition activity taken into account), averaging more than 11 million visitors per month.

A new placebo-controlled study in 410 patients suffering from mild to moderate Alzheimer’s disease or vascular dementia has demonstrated the efficacy of EGb 761. Like the majority of dementia patients encountered in everyday clinical practice, the patients in the study suffered from both cognitive impairment and neuropsychiatric symptoms such as depressed mood, anxiety, irritability or aggression. During the observation period of 24 weeks, EGb 761 improved both cognitive functioning and neuropsychiatric symptoms of the patients significantly.

This study confirms that EGb 761 improves cognition as well as neuropsychiatric symptoms and activities of daily living. This not only benefits the patients themselves but in addition provides significant relief to the care-giving relatives.” says Prof. Ralf Ihl, a leading German geriatric specialist and president of the European Associaton of Geriatric Psychiatry. „This is important because it gives care-givers extra respite and some much needed time for themselves.”

The randomized, double-blind study included 410 outpatients who received either a once-daily dose of 240 mg of the patented Ginkgo biloba extract EGb 761 or a corresponding placebo. The primary outcome measure in the cognitive domain was the change in the total score of the SKT test battery, an internationally and cross-culturally validated measure to test cognitive performance in dementia. In the neuropsychiatric domain the Neuropsychiatric Inventory (NPI) was applied. Secondary outcome measures included scales to test the improvement or deterioration of daily activities, quality of life and the distress experienced by caregivers.

The patients treated with EGb 761 improved throughout the study with a significant advantage of 1.7 points (Alzheimer’s disease) and 1.4 points (Vascular dementia) in the SKT. On the NPI score an advantage of 3.1 points (Alzheimer’s disease) and 3.2 points (Vascular dementia) was observed for the patients receiving EGb 761. Similar improvements were found in all other outcome measures. EGb 761 was also very well tolerated with comparable adverse event rates in both treatment groups.

Under current law, spending on Medicaid is expected to substantially outpace the rate of growth in the U.S. economy over the next decade, according to a new annual report released today by the Centers for Medicare & Medicaid Services (CMS).

The report projects that Medicaid benefits spending will increase 7.3 percent from 2007 to 2008, reaching $339 billion and will grow at an annual average rate of 7.9 percent over the next 10 years, reaching $674 billion by 2017. That compares to a projected rate of growth of 4.8 percent in the general economy.

HHS Secretary Mike Leavitt presented the report today at the fall meeting of the National Association of State Budget Officers (NASBO).

“This report should serve as an urgent reminder that the current path of Medicaid spending is unsustainable for both federal and state governments. We must act quickly to keep state Medicaid programs fiscally sound,” Secretary Leavitt said. “If nothing is done to rein in these costs, access to health care for the nation’s most vulnerable citizens could be threatened.”

Although the CMS Office of the Actuary regularly produces 75-year projections of Medicare expenditures for the annual report of the Medicare Board of Trustees, the report released today is the first annual fiscal report on Medicaid.

The Medicare Trustees Report provides detailed information on the past and estimated future financial operations of the Hospital Insurance and Supplementary Medical Insurance Trust Funds. This new annual report on Medicaid contains analysis of past program trends and projections of Medicaid expenditures and enrollment for the next 10 years only. Future reports will expand on content to include longer-range projections and more extensive analysis.

Medicaid is a federal/state partnership program that provides health care to certain low-income people and is one of the largest payers for health care in the United States. For both federal and state governments, Medicaid is the largest source of general revenue spending on health services. Notably, Medicaid is the largest source of general revenue spending for health care for both the Federal government and the states.

This growth rate compares to spending projections for Medicare of 7.4 percent per year through 2017. Medicaid benefits spending over the next 10 years is projected to be $4.9 trillion. These amounts are in addition to that spent by federal and state governments on the State Children’s Health Insurance Program (SCHIP).

At this rate, Medicaid growth is projected to slightly exceed growth in overall health care expenditures, which is projected by CMS actuaries and economists to increase by 6.7 percent per year over the next 10 years, or over twice the rate of general inflation. Additionally, Medicaid’s share of the Gross Domestic Product (GDP) is projected to reach about three percent in 2017. The combined share of GDP spending for Medicare and Medicaid is projected to be 6.9 percent by 2017.

As a partnership program, both states and the federal government pay for services to Medicaid beneficiaries. The federal government matches state expenditures based on a formula that yields subsidies ranging from 50 percent to as high as 83 percent. The average federal medical assistance percentage is 57 percent.

However, even with federal support, states report they are struggling to meet their share of expanding Medicaid costs. State spending on Medicaid has remained relatively stable as a share of states’ budgets, averaging about 20 percent from 1995-2007. However, some states such as Maine are already spending as much as 31 percent of their budgets on Medicaid, according to NASBO.

NASBO is projecting that state spending on Medicaid will increase by 4.4 percent from 2008 to 2009. NASBO says such an increase would be more than four times the rate of growth in the average state general fund.

“High and increasing Medicaid spending clearly leaves states less able to fund other state priorities,” said Acting CMS Administrator Kerry Weems. “This new financial report confirms that America’s health care system faces significant fiscal challenges.

”As a nation we must tackle the difficult job of bringing health care costs under control and assuring that our health care dollars are buying the highest quality, most efficient health care services.”

Other findings from the report include:

• Average Medicaid enrollment is projected to increase 1.8 percent to 50 million people in 2008.
• During the next 10 years, average enrollment is projected to increase at an average annual rate of 1.2 percent and to reach 55.1 million by 2017.
• The estimated average cost of a person covered by Medicaid in 2007 is $6,120; however, per-enrollee spending for non-disabled children ($2,435) and adults ($3,586) was much lower than that for aged ($14,058) and disabled beneficiaries ($14,858), reflecting the differing health status of these groups.
• Medicaid represented 14.8 percent of all health care spending in the United States in 2006.
• Medicaid is projected to grow as a share of the federal budget from 7.0 percent in 2007 to 8.4 percent by 2013.

For the more than 8.5 million individuals relying on Social Security Disability Insurance (SSDI) or awaiting a decision on their application for benefits, the 5.8 percent cost of living adjustment (COLA) increase in Social Security payments for 2009 will certainly ease concerns, according to Allsup, a provider of Social Security disability, financial and healthcare-related services to people with disabilities. While the COLA has not been this high in more than 25 years, Allsup believes beneficiaries will not be overly optimistic about the increase.

“The Social Security COLA is tied to the annual increase in the Consumer Price Index, which takes into account the rate of inflation for the goods and services people buy. The 5.8 percent COLA increase simply reflects that the costs of these items have increased by that amount,” said Paul Gada, Allsup’s personal financial planning director.

Starting in 1975, automatic benefit increases, or COLAs, have been applied to Social Security benefits. The Bureau of Labor Statistics’ Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) for the third quarter of the previous year is used to set the following year COLA. For the quarter ending Sept. 30, 2008, the CPI-W was 5.8 percent.

“The Social Security cost of living adjustment isn’t about getting ahead. At best, it’s about keeping up. Even that is going to be tough, as people have already experienced higher living expenses this year with no sign of that letting up near-term,” said Gada.

However, Gada notes there are steps that people relying on SSDI can take to help better control escalating costs.

“It’s very difficult when your income is fixed, but your expenses are not fixed and generally just seem to be increasing,” said Gada. “But the first step is to honestly assess your financial situation.”

According to Gada, this involves creating a budget to track what you spend monthly and your monthly income. The next step is identifying ways to increase the money that comes in and decrease the money that goes out. For many individuals this means getting a handle on major sources of debt.

Pay Down Credit Card Debt

National credit card debt per credit card borrower increased 8.6 percent to $1,717 in the second quarter of 2008, compared to the same period 2007, according to a study by TransUnion.

If you have credit card debts, your goal should be to pay off high interest credit cards or consolidate them to save on interest charges,” explained Gada.

Allsup offers a free Credit Card Roll Down calculator to help people see how they can roll down credit card debt, in addition to a Personal Debt Consolidation calculator.

Refinance or Get Mortgage Help

About 19 million Americans now spend at least 30 percent of their income on housing, a figure that the government considers to be financially burdened, based on an Associated Press analysis of the U.S. Census Bureau’s 2007 American Housing Survey (AHS) released in September. People who have high interest rate mortgages or are having difficulty paying their mortgage should investigate refinancing to get lower monthly payments.

“The current housing climate combined with the credit crisis has many people fearful that they won’t be able to qualify for refinancing. However, it’s more important to recognize that if you are having difficulty paying your mortgage, you need to get help as soon as possible,” said Gada. “Banks do not want to own homes, so contact your lender; the sooner you do this, the more likely it is you will have alternatives.”

The U.S. Department of Housing and Urban Development (HUD) provides many resources to help homeowners with refinancing and avoiding foreclosure as well as provides a list of HUD-Approved Housing Counseling Agencies. Allsup also offers a free Refinance Interest Savings calculator to help people see the potential savings.

Make Sure Healthcare is Covered

A third significant source of expense for individuals with disabilities is healthcare costs. According to a study released last month by the Center for Studying Health System Change, nearly one in five Americans had problems paying medical bills in 2007. The share of people with low income facing medical bill problems was significantly higher at 32 percent.

Because many individuals with severe long-term disabilities are unable to work, they are more likely to be low income, Gada noted. However, people with long-term disabilities cannot afford to be without some plan to cover health-related costs on an ongoing basis.

COBRA coverage through their former employer is one option for initial coverage. Medicare is available to most individuals with disabilities only 24 months after qualifying for SSDI benefits.

People with disabilities who are eligible should examine all their Medicare options, including traditional Medicare (Parts A and B) with supplemental insurance (Medigap) and prescription drug (Part D) coverage, as well as Medicare Advantage plans. This should include looking at the costs and available healthcare coverage under the various scenarios, Gada said. For example, due to pre-existing conditions, people with disabilities often are not able to get supplemental coverage. This means that if they are enrolled in traditional Medicare only, they are likely to have high out-of-pocket expenses.

Medicare Advantage plans, on the other hand, combine basic traditional Medicare coverage with the added security of having supplemental insurance. Many of the available plans also provide prescription drug coverage and offer other services, such as vision and dental care, which are not part of traditional Medicare. At the same time, a participant’s overall out-of-pocket costs tend to be much lower under a Medicare Advantage plan. Meanwhile, pre-existing conditions are generally not an issue when enrolling in a Medicare Advantage plan, so almost anyone eligible for Medicare can benefit from such plans.

“When you are on a fixed income, one of the most important things is minimizing unexpected costs,” said Gada. “So it’s important to look for health insurance that can provide the coverage you need while minimizing surprises.”

Allsup provides online resources and a comprehensive service for comparing Medicare and Medicare Advantage programs. Some individuals may qualify for state-run Medicare Savings Programs for people with limited income and resources as well as drug assistance programs run by pharmaceutical companies.

Additional Resources for Controlling Costs

For individuals finding it difficult to make ends meet, Gada urges them to seek out financial assistance programs. This includes federal, state and local government programs available to help those with disabilities or low incomes, as well as privately funded programs.

The government sponsored financial assistance programs available to low-income individuals include:

• Help paying heat, electricity, telephone and water bills
• Support for energy-efficient home upgrades
• Reduced public transportation fares
• Property tax credits
• Food stamps
• Free meals for children attending school, including summer months
• Food pantries offering free monthly food packages

“Anyone struggling during the current economic environment can see some benefits from taking a closer look at their options,” Gada said. “The COLA increase is a benefit for recipients, but individuals and their families also should recognize that they can take additional actions to improve their existing finances.”

Angioblast Systems announced this week a successful initial safety results following commencement of the world’s first clinical trial to use allogeneic adult stem cells obtained from an unrelated, universal donor to treat patients with congestive heart failure.

The multi-center Phase 2 trial is examining the safety and effectiveness of three different doses of the company’s proprietary allogeneic, “off-the-shelf,” universal donor Mesenchymal Precursor Cells (MPCs) injected by catheter into damaged heart muscle of patients with congestive heart failure.

Safety data from the first seven patients enrolled in the trial by Angioblast at medical centers in Arizona, California, and Minnesota were presented today at the Transcatheter Cardiovascular Therapeutics (TCT) Conference in Washington D.C.

Dr. Nabil Dib, Director of Cardiovascular Research for Chandler Regional and Mercy Gilbert Medical Centers in Arizona, reported that no adverse events had occurred in any of the first seven patients following the catheter procedure.

The placebo-controlled trial of Angioblast’s Revascor MPC cell therapy will randomize up to 60 patients suffering from congestive heart failure, including those with non-ischemic cardiomyopathy, to either implantation with allogeneic adult stem cells or standard of care in a 3:1 ratio.

Angioblast’s Revascor adult stem cells are delivered to damaged areas of the heart by a minimally invasive cardiac catheterization procedure performed under local anesthesia while the patient is awake. Patients undergoing the procedure are released from the hospital within 24 hours.

Dr. Dib said: “We hope that the stem cells will increase the potential for myocardial repair and restoration of heart function. Angioblast’s Revascor cells are a well characterized, pure population of MPCs. These cells, obtained from a healthy young adult donor, are isolated, expanded and cultured to produce treatments potentially for thousands of patients.”

According to company founder, Professor Silviu Itescu, “Heart failure remains a major cause of hospital admissions and patient deaths. Based on studies to date, our Revascor™ MPCs have the potential to make a significant impact in patients with heart failure and to address this major clinical need.

“This Phase 2 clinical trial is an important step toward our entry into this vital and growing market,” Professor Itescu said.

The nervous system and the immune system have something in common. Each has evolved to react quickly to environmental cues. Because the nervous system is able to detect some of these cues—say, a characteristic odor signaling a pathogen’s presence—at a distance, it sometimes can sense trouble earlier than the immune system, which has to wait until the pathogen invades the organism.

So it makes sense that the two systems might talk to one another. Stanford University School of Medicine geneticists have shown that, indeed, they do.

In a study to be published online Oct. 14 by the journal Nature Immunology, Man-Wah Tan, PhD, assistant professor of genetics and of microbiology and immunology, and postdoctoral scholar Trupti Kawli have shown that a change in the secretion patterns of nerve cells in the minuscule soil-dwelling worm, Caenorhabditis elegans, induces a change in the worm’s susceptibility to a bacterial pathogen, Pseudomonas aeruginosa. In humans, P. aeruginosa is an important pathogen among cystic fibrosis patients and can cause pneumonia.

Importantly, the Stanford investigators have nailed down the connection between the two systems. They identified a particular molecule that, secreted by nerve cells, binds to receptors in the worm’s gut cells. When the levels of the secreted molecule fall, this sets off a complicated chain reaction that activates the powerful immune defense against bacterial infection. Since bacteria are what C. elegans mainly eats, this is a handy defense to have.

The notion of crosstalk between our nervous and immune systems is hardly surprising, said Tan. “A person who is undergoing prolonged psychological stress—say, because they’re taking care of someone who is sick—is more likely to have reactivation of a latent infection or become more susceptible to new ones,” he said. “That stressful situation cannot be changed. But by identifying the pathways through which the nervous system alters immune function in this simple creature C. elegans, we can perhaps start to think about how we can intervene in humans.”

The very complexity of the nervous and immune systems would make any interactions between them exceedingly tough to tease out in humans. So Kawli and Tan used C. elegans, because both its nervous and immune systems have been entirely mapped out. This enabled the researchers to manipulate the former, then watch what happened to the latter.

C. elegans has nerve cells that ordinarily secrete bioactive molecules contained within tiny membrane-wrapped bundles, called dense-core vesicles. The rate at which these molecules are secreted is governed by the activity of the nervous system. One of those secreted bioactive molecules is called ins-7. The Stanford team obtained or generated various C. elegans mutants that lacked the ability either to produce or to secrete ins-7, or secreted it excessively.

By using these and other advanced laboratory tools to manipulate the worm’s ability to secrete ins-7, the researchers were able to correspondingly alter the readiness of the minuscule creature’s innate immune system: a primitive but potent piece of the immune system shared by C. elegans and higher organisms including humans.

People often associate “immune response” with antibodies and roving T-cells dispatched to combat a particular viral or bacterial infection—the so-called adaptive immune response. But that response takes a week or two to develop, said Tan. In contrast, all of our cells have receptors that can recognize molecular patterns common to whole classes of pathogens (for example, characteristic viral DNA snippets, or bacterial cell-wall constituents), immediately triggering cascades of intracellular reactions, such as the activation of batteries of genes that code for antimicrobial proteins.

Both the innate and adaptive branches of the immune system have to function optimally in order for us to leave a healthy life. “The innate immune system is our first line of defense,” said Tan. “If not for the innate immune system, we’d be dead by the time the adaptive immune system raises antibodies to a pathogenic invader we have not encountered before.”

It is still a matter of speculation as to how crosstalk between the nervous and immune systems of humans regulates innate immune responses. But now that a clear pathway has been identified in the worm, it will be easier to conduct focused research on higher organisms to see if the phenomenon is universal, Tan said.

Tan acknowledged that it has not yet been proven that the signaling of the nervous system to the immune system of C. elegans, as shown in this experiment, occurs in nature. But there’s very good reason to believe it does.

In a separate paper set to be published online on Oct. 17 by another journal, PLoS-Pathogens, Tan and other Stanford associates demonstrate that P. aeruginosa—which is often isolated from the same soil samples in which C. elegans is found and, presumably, co-evolved with C. elegans—has a way of subverting this defense against it. The pathogen induces excess production of ins-7 by the worm to dull its immune responsiveness. In contrast, other human bacterial pathogens such as Salmonella typhimurium and Enterococcus fecalis have no such capability. Nor do abiotic stresses, such as heat or heavy metals.

This suggests to Tan that the fine-tuning of the innate immune response by the nervous system is effective enough in the natural state that some pathogens with which C. elegans coexists have evolved strategies to subvert this system.

An inducible immune response makes more sense—in worms and people—than a state of constantly hyper-elevated immune vigilance. People with hyperactive immune systems suffer from autoimmune and inflammatory conditions. Although worms with downregulated secretion from dense-core vesicles are better at combating infection, they don’t move well, which would probably prove lethal in the wild. One of the ins-7-deficient C. elegans mutants used in the Nature Immunology study is called unc, said Kawli, the paper’s first author. “That stands for ‘uncoordinated,” she said.

More than half of Americans (51%) believe there are good things about the current health care system, but major changes are needed, according to the 2008 EBRI Health Confidence Survey. The survey was released today by the Employee Benefit Research Institute and Mathew Greenwald and Associates Inc., and was underwritten by the Principal Financial Group.

“The economic crisis is serving as ‘the tipping point’ in terms of how Americans are changing behavior concerning their health care,” said Jerry Ripperger, national practice leader of consumer health at the Principal Financial Group. “We’ve finally reached a place where more Americans are focusing on making smarter health care decisions, and taking more personal responsibility that will improve their health and ease the strain on their wallets.”

The survey indicates that Americans are showing some level of personal responsibility through heightened awareness and action. Two out of five Americans (39 percent) report they are often or always aware of the cost of their doctor’s visit. For example, those Americans who have experienced higher health care costs over the last year:

• Tried to take better care of themselves (76 percent)
• Chose generic drugs more often (74 percent)
• Talked to the doctor more carefully about treatment options and costs (63 percent)

Goals for reform: quality, affordable and accessible

The survey indicates that when it comes to reforming the nation’s health care system, Americans said it is “extremely” important to make health care coverage affordable (63 percent), provide quality health care (63 percent), and provide health insurance coverage to all Americans (55 percent).

In order to ensure that all Americans have access to health insurance, those surveyed “strongly supported”:

• Expanding government programs, such as Medicare or Medicaid (43 percent)
• Requiring all employers to pay toward subsidized health insurance for employees (41 percent)
• Requiring everyone to participate in some kind of health insurance plan (37 percent)
• Providing tax breaks to help people pay for coverage they purchase on their own (54 percent) and to help people pay for employer coverage (48 percent)
• Allowing those who are uninsured to buy into government programs, like Medicare and Medicaid (48 percent)
• Allowing those who are uninsured to buy the health insurance coverage offered to government employees (37 percent)

Migrating to new infrastructure

The survey also indicated that Americans are beginning to show support for health care infrastructure that provides more transparency:

• More than half of Americans (55 percent) say it’s important for providers to use electronic medical records, and four out of five say these records should be stored in a central location so that their health information could be shared by all health care providers they authorize to use it.
• More than half (56 percent) of Americans say the total cost of the doctor or hospital would be “extremely” or “very” important when choosing a provider through an objective rating system (if the quality ratings were about equal).

This week, StatCom announced the findings of the 2008 National Survey on Patient Flow Challenges and Technologies, an independent, nationwide survey of more than 200 healthcare executives. According to the findings, the overwhelming majority of U.S. healthcare executives (89%) reveal their facility has poor patient flow.

While healthcare executives agree there is poor patient flow in their facility, they also reveal the following issues at the root of this problem:

• Poor communication (67%)
• Ineffective scheduling of activities and resources (36%)
• Lack of beds (36%)
• Lack of staff to help facilitate patient flow (34%)
• Poor centralized knowledge about the location and status of each patient (32%)

StatCom’s 2008 National Survey on Patient Challenges and Technologies was designed to capture the thoughts and opinions held by U.S. healthcare executives on issues facing their facilities regarding patient flow and technology. Results of the study can be downloaded at http://www.statcom.com/survey/national-survey-2008.aspx.

“The majority of healthcare executives recognize the issues their facility faces when it comes to poor patient flow,” said Michael Holland, EVP of sales and marketing of StatCom. “Whether it is long wait times in the ER or overcrowding issues, patient flow includes more than just bed space. This study validates the challenges hospitals face when dealing with patient flow, along with technology uses, capacity issues and how healthcare facilities are taking on those challenges directly.”

Hands down, healthcare executives say a hospital-wide patient flow system has the best potential to improve patient throughput at their facility, followed by ED tracker (ranked second), bed tracker (ranked third), departmental solutions (ranked fourth). Expanding facilities (ranked fifth) and manual process ranked last.

Surprisingly, more healthcare executives reveal in 2008 that they have not implemented a patient flow system at their facility (56%) compared to 50% in 2007. Similarly, in 2007, 92% of healthcare leaders said their facilities have incorporated process improvements to improve patient flow, and in 2008, this figure was 94%.

Regarding the use of technology, it was nearly an even split with 52% of healthcare executives saying their facility utilizes bed management technology and 48% saying they rely on other methods. The current use of bed management technology shows a 12% increase from the previous year. In 2007, 60% of healthcare executive respondents said there was no bed management software or technology within their facilities.

The majority (70%) of respondents report patient tracking and bed management information is made available to nursing staff via computer terminals, another slight improvement from the previous year. In 2007, 63 percent said patient information was made available via computer terminals. Respondents in 2008 also say their facility has patient tracking and bed management information available via phone calls and voice messages (67%), grease boards (29%), digital displays (19%) and registered mobile devices (12%).

“When it comes to displaying care milestone progression or waiting times, one in 10 facilities currently display this information to patients and their families,” said Sheri Sorrell, research manager for Jackson Healthcare. “Patient tracking should be a main focus, so loved ones are constantly informed and hospitals are more accountable.”

The responsibility of optimizing patient flow resides largely on chief nursing officers according to 32% of respondents, followed by the chief operating officers (15%), vice president of nursing (13%), chief executive officers (11%) and vice president of operations (4%).

To help track patient status, U.S. healthcare executives say they are currently considering technologies such as bar-coding (62%), patient tracking software (38%), tablets or PDAs (33%), RFID (29%), inpatient scheduling modules (23%) and other technologies (12%).

In the future, the vast majority (88%) of healthcare executives say improved productivity and/or efficiency at their facility is essential to meet patient demand. Additionally, 67 percent say improving technology, 43% say expanding facilities, 35% say hiring more nursing staff and three percent say hiring more administrative staff is necessary to meet future patient demand.