An Emergency Medicine–Primary Care Partnership to Improve Rural Population Health: Expanding the Role of Emergency Medicine

From the Annals of Emergency Medicine:

The health of rural America is failing and our traditional approaches have proved ineffective at improving health in rural communities. Rural populations are now a health disparity population, facing higher mortality rates for the 5 leading causes of death compared with their urban counterparts. We must generate novel, rural-specific approaches to solve this challenge—and there is a clear role for the field of emergency medicine. Building on emergency departments’ (EDs’) expanding role in health care delivery and emergency medicine’s increasing involvement in population health, we propose a new health care delivery model for rural population health based on partnership between emergency medicine and primary care that embraces the important role that EDs play in rural areas.

From The ER To Inpatient Care — At Home

From Kaiser Health News:

Brigham Health in Boston is one of a slowly growing number of health systems that encourage selected acutely ill emergency department patients who are stable and don’t need intensive, round-the-clock care to opt for hospital-level care at home.

In the couple of years since Brigham and Women’s Hospital started testing this type of care, hospital staff who were initially skeptical have generally embraced it, said Levine.

“They very quickly realize that this is really what patients want, and it’s really good care,” he said.

This approach is quite common in Australia, England and Canada but it’s faced an uphill battle in the United States.

Opioid-related emergency room visits grew by 35 percent in a year

From The Verge:

Emergency room visits due to opioid overdose grew by 35 percent in 16 states over the past year, according to the emergency room data from the Centers for Disease Control and Prevention.

Today’s data covers July 2016 to September 2017 and comes from the CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) Program, which collects information on both fatal and non-fatal opioid overdoses. Though overdose-related ER visits varied by region, the number increased for every demographic group. And in metropolitan areas (meaning areas around a city with a population of over 1 million), the number of overdoses grew by 54 percent.

White House wants user-friendly electronic health records

From WRAL (AP Wire) – Hat Tip: Deb:

The Trump administration says it’s launching a new effort to make electronic medical records easier for patients to use. Medicare will play a key role.

The MyHealthEData initiative will be overseen by the White House Office of American Innovation, headed by presidential son-in-law Jared Kushner.

Electronic medical records were ushered in with great fanfare but it’s generally acknowledged they’ve fallen short. Different systems don’t communicate. Patient portals can be clunky to navigate. Some hospitals still provide records on compact discs that newer computers can’t read.

Proposed federal limits to opioid prescriptions draw opposition from physicians and patients

From STAT:

In the final hours of public input on a controversial new rule limiting opioid prescriptions, a last-minute coalition emerged on Monday to oppose it.

The Centers for Medicare and Medicaid Services rule would restrict opioid doses to Medicare patients to the equivalent of 90 milligrams of morphine per day.

But a vocal group of doctors, pain patients, and public health experts — including three who contributed to the Centers for Disease Control and Prevention’s own prescribing guidelines — emerged near the Monday deadline to voice their opposition via comment, letter, and social media.

Bag-Mask Ventilation Fails to Improve on Intubation for OHCA

From Medscape:

In a randomized trial of patients with out-of-hospital cardiac arrest (OHCA), bag-mask ventilation (BMV) was associated with the same rate of 28-day functional survival as  seen with endotracheal intubation (ETI) during cardiopulmonary resuscitation (CPR) but failed to meet the statistical criteria necessary to demonstrate noninferiority.

The findings of the prospective, multicenter CAAM trial were first presented last August at the European Society of Cardiology (ESC) 2017 meeting and were published February 27 in JAMA.

“Our trial was inconclusive regarding the demonstration of noninferiority of bag-mask ventilation compared with endotracheal intubation for airway management during CPR for out-of-hospital cardiac arrest patients,” concluded Frédéric Adnet, MD, PhD during an ESC hot line session in Barcelona.