Have Cancer, Must Travel: Patients Left In Lurch After Town’s Hospital Closes

From NPR:

Rural cancer patients typically spend 66% more timetraveling each way to treatment than those who live in more urban areas, according to a recent national survey by ASCO, the American Society of Clinical Oncology. Dr. Monica Bertagnolli, a cattle rancher’s daughter who is now chair of ASCO’s board, called this a “tremendous burden.” Cancer care, she explained, is “not just one visit and you’re done.”

Repeat emergency department users changed how they used EDs after gaining Medicaid coverage

From Healthcare Finance:

The Affordable Care Act expanded health insurance coverage, including eligibility for Medicaid, and states have the ability to decide whether to expand eligibility for Medicaid coverage. As of earlier this year, 36 states and the District of Columbia had adopted Medicaid expansion, and other states are still debating whether to do so.

Against this background, a new study seeks to determine how the nature of visits to emergency departments changed for previously uninsured patients who gained Medicaid insurance expansion under the ACA in 2014, and who went to the ED at least once before and once after expansion.

It found that compared with patients who remained uninsured in states where Medicaid was not expanded, these patients shifted their use of the ED toward conditions that required subsequent hospitalization, and predominantly for illnesses that were not easily avoided by robust outpatient care.

Transforming Care Delivery to Improve Rural Health

From HealthLeaders Media:

Resource-strapped rural hospitals contend with factors outside hospital walls, including outcomes associated with poverty, unemployment, poor nutrition, and lack of care access.

An innovative program at Atrium Health Anson has transitioned 2,700 of its 15,000 ED patients into the medical home for more comprehensive disease management.

Marshfield Medical Center—Ladysmith is shifting from inpatient care toward a population health model that proactively manages patients’ chronic health issues.

North Memorial helicopter crashes near Brainerd, 2 dead

From KARE11:

A pilot and two crew members are dead after a North Memorial Air Care helicopter crashed near the Brainerd Airport early Friday.

The chopper went down around 1 a.m. A North Memorial spokesperson confirms the two casualties, and says no patients were aboard at the time of the crash. The pilot and a nurse died at the scene, while a third crew member was rushed to St. Joseph’s Medical Center in Brainerd. The spokesperson says they are not releasing information on his condition at this time.

Sanford Health and UnityPoint Health sign letter of intent to merge

From Modern Healthcare (hat tip: Jared R):

Sanford Health and UnityPoint Health have signed a letter of intent to form an $11 billion integrated health system, the organizations announced Friday.

The combined entity would rank among the top 15 not-for-profit health systems by revenue. It would have 76 hospitals across 26 states and nine countries and employ more than 83,000 staff and 2,600 physicians.

Emergency department recommendations for suicide prevention in adults: The ICAR2E mnemonic and a systematic review of the literature

From the American Journal of Emergency Medicine:


Caring for suicidal patients can be challenging, especially in emergency departments without easy access to mental health specialists. The American College of Emergency Physicians and the American Foundation for Suicide Prevention appointed a working group to create an easy-to-use suicide prevention tool for ED providers.


The writing group created an easy-to-use mnemonic for the care of adult patients as a way of organizing sequential steps, accompanied by a systematic review of available ED-based suicide prevention literature. The systematic review was performed both to ensure that all relevant evidence was taken into account as well as to evaluate the strength of evidence for each recommendation. Levels of evidence were assigned utilizing the ACEP level of evidence classification.


The writing group created the mnemonic ICAR2E, which stands for Identify suicide risk; Communicate; Assess for life threats and ensure safety; Risk assessment (of suicide); Reduce the risk (of suicide); and Extend care beyond the ED. 31 articles were identified in the search, and were included in the systematic review.


The ICAR2E mnemonic may be a feasible way for practicing ED clinicians to provide evidence-based care to suicidal patients. However, further research is needed.

Elderly in U.S. emergency depts often can’t afford medicines

From Reuters:

As reported in the American Journal of Emergency Medicine, Ambrose and colleagues analyzed survey responses collected in 2017 and 2018 from 281 patients, age 65 and older, including 200 who visited an urban ED and 81 who went to a rural ED.

Although the vast majority, 99%, had some kind of health insurance, 14% of the urban patients and 26% of the rural patients said they didn’t always comply with doctors’ instructions for taking medicine because of the cost