In the medical desert of rural America, one doctor for 11,000 square miles

From the Longview News-Journal:

In the medical desert that has become rural America, nothing is more basic or more essential than access to doctors, but they are increasingly difficult to find. The federal government now designates nearly 80 percent of rural America as “medically underserved.” It is home to 20 percent of the U.S. population but fewer than 10 percent of its doctors, and that ratio is worsening each year because of what health experts refer to as “the gray wave.” Rural doctors are three years older than urban doctors on average, with half over 50 and more than a quarter beyond 60. Health officials predict the number of rural doctors will decline by 23 percent over the next decade as the number of urban doctors remains flat.

In Texas alone, 159 of the state’s 254 counties have no general surgeons, 121 counties have no medical specialists, and 35 counties have no doctors at all. Thirty more counties are each forced to rely on just a single doctor, like Garner, a family physician by training who by necessity has become so much else: medical director of Culberson County. Head physician for a nearby immigration detention center. Director of a rural health clinic. Chief of staff for Culberson Hospital. And medical director for the hospital’s emergency room, where the latest patient was being wheeled in as Garner introduced himself.

‘Sweet Spot’ of Optimal Compressions, Depth Identified in CPR

From Medscape (subscription required):

New research has identified the optimal combination of chest compression rate (CCR) and chest compression depth (CCD) when performing cardiopulmonary resuscitation (CPR) to improve survival rates.

A team of researchers analyzed data on more than 3600 patients who had experienced an out-of-hospital cardiac arrest and for whom CCR and CCD had been simultaneously recorded.

They found that the optimal CCR-CCD combination was 107 compressions per minute with a depth of 4.7 cm.

When CPR was performed within 20% of this value, survival probability was significantly higher. The findings remained unchanged regardless of age, sex, presenting cardiac rhythm, or CPR adjunct use.

Shift work tied to poor mental health

From Reuters:

People who work night shifts or varied schedules that disrupt their sleep may be more likely to develop depression than individuals with 9-to-5 jobs, a research review suggests.

Researchers examined data from seven previously published studies of work schedules and mental health involving a total of 28,438 participants. Overall, shift workers were 28% more likely to experience mental health problems than people with consistent weekday work schedules.

Sex disparities in the assessment and outcomes of chest pain presentations in emergency departments

From Heart:

Objective To determine whether sex differences exist in the triage, management and outcomes associated with non-traumatic chest pain presentations in the emergency department (ED).

Methods All adults (≥18 years) with non-traumatic chest pain presentations to three EDs in Melbourne, Australia between 2009 and 2013 were retrospectively analysed. Data sources included routinely collected hospital databases. Triage scoring of the urgency of presentation, time to medical examination, cardiac troponin testing, admission to specialised care units, and in-ED and in-hospital mortality were each modelled using the generalised estimating equations approach.

Results Overall 54 138 patients (48.7% women) presented with chest pain, contributing to 76 216 presentations, of which 26 282 (34.5%) were cardiac. In multivariable analyses, compared with men, women were 18% less likely to be allocated an urgency of ‘immediate review’ or ‘within 10 min review’ (OR=0.82, 95% CI 0.79 to 0.85), 16% less likely to be examined within the first hour of arrival to the ED by an emergency physician (0.84, 0.81 to 0.87), 20% less likely to have a troponin test performed (0.80, 0.77 to 0.83), 36% less likely to be admitted to a specialised care unit (0.64, 0.61 to 0.68), and 35% (p=0.039) and 36% (p=0.002) more likely to die in the ED and in the hospital, respectively.

Conclusions In the ED, systemic sex bias, to the detriment of women, exists in the early management and treatment of non-traumatic chest pain. Future studies that identify the drivers explaining why women presenting with chest pain are disadvantaged in terms of care, relative to men, are warranted.

CMS issues final rule on discharge planning

From Becker’s:

CMS finalized a rule Sept. 26 that revises discharge planning requirements for hospitals.

Three things to know:

1. Under the rule, hospitals must focus on patients’ care goals and treatment preferences during the discharge planning process.

2. Hospitals must assist patients in selecting a post-acute provider by sharing relevant quality performance data for post-acute facilities, including readmission and patient fall rates.

3. The rule also requires hospitals to ensure each patient has access to an electronic version of their medical records.

CMS finalizes hospital antibiotic stewardship requirements

From Modern Healthcare:

The CMS on Wednesday finalized a rule requiring all hospitals to have antibiotic stewardship programs, which experts say is a big step forward in the fight against superbugs.

The rule was first proposed in 2016 and requires all acute-care and critical access hospitals that participate in Medicare or Medicaid to develop and implement an antibiotic stewardship program as part of their infection control efforts.

Poor and minority patients are more likely to have cancer detected via emergency room visit

From Medical XPress:

Although cancer is typically diagnosed by an oncologist or a general practitioner, about 20 to 50 percent of global cancer diagnoses stem from an emergency room visit, explained the study’s lead author, Caroline A. Thompson, Ph.D., MPH, assistant professor of epidemiology at San Diego State University. Some of these visits are due to emergent clinical symptoms of a cancer that was not yet identified; some are “incidental” diagnoses in which a patient seeks help for one ailment and is also found to have cancer; and some are patients who visited the emergency room because they had no usual source of care.

Walmart offers near-free college tuition to employees seeking training in health specialties

From Modern Healthcare:

Walmart will offer nearly-free college training to its workers who want to become healthcare professionals as the giant retailer moves to expand its delivery of healthcare services.

Starting Monday, Walmart’s 1.5 million U.S. employees can apply for one of seven bachelor’s degrees and two career diplomas—as pharmacy technicians or opticians—for a total out-of-pocket cost of $1 per day. The company will cover the cost of tuition, books and fees and provide counseling support.

CBO Releases Score of No Surprises Act

Hat Tip: Dr. Menadue

The Congressional Budget Office (CBO) has released its cost estimate of legislation (H.R. 2328) advanced by the House Energy and Commerce Committee that includes provisions aimed at protecting patients from surprise insurance gaps. The agency estimates that the No Surprises Act would increase federal revenues by $20.9 billion and reduce direct spending by $1.0 billion for a total reduction in the deficit of approximately $21.9 billion over the next decade. CBO’s analysis estimates that premiums would be reduced by around one percent compared to current law. The cost estimate anticipates that providers currently earning in-network rates above the median would see reductions to more typical amounts and the decrease in premiums driven by lower payment rates would be somewhat offset by increases in payment rates for providers currently receiving below-median payments. CBO also assumes that the legislation would create new administrative costs stemming from the independent dispute resolution (IDR) process that would be used to settle out-of-network payment disputes between providers and health plans. The report finds that the inclusion of the IDR policy would offset expected premium reductions by almost 25 percent because of the likelihood that it would result in higher payments to physicians.

People don’t recognize heart attacks when symptoms come on slowly

From Reuters:

When heart attack symptoms start gradually and don’t follow exertion, patients are much slower to get to an emergency room and risk missing a critical window for preserving heart function, researchers say.

Among 474 U.S. patients who arrived in emergency departments with dangerous reductions in blood flow to the heart, those whose symptoms had come on gradually took up to six hours longer than recommended to call for medical help and get to the hospital, the researchers found.

Gradual symptoms were not recognized or taken seriously, despite reflecting a medical emergency, and patients took up to eight hours to get help compared with an average of 2.57 hours among those with abrupt or sudden symptoms, the research team reported in the European Journal of Cardiovascular Nursing.