6 ms·

Interesting you bring up heart failure readmissions. Not saying they aren't a problem, but here is a fascinating study in JAMA that argues that places with lowe

Interesting you bring up heart failure readmissions. Not saying they aren't a problem, but here is a fascinating study in JAMA that argues that places with lower readmissions have higher (worse) mortality. https://jamanetwork.com/journals/jamacardiology/article-abstract/2663213 https://jamanetwork.com/journals/jamacardiology/article-abst... Not sure we (I'm a physician) understand even what the problems we need technology to solve are. But yes, we need technology to help (find and) solve some major problems that will improve lives.

blhack 9y ago
Are there other examples of things you wish existed? Again, forget about if they could exist, just stuff you wish you had?
- joshgel 9y ago
  Loads. A functional EHR (UX). An easy way to keep track of what medications a patient is one and has been on (?blockchain). Better quality and cost measures (big data).
obastani 9y ago
Couldn't this finding be explained by the fact that the hospitals with lower readmissions tend to be poorer (since poorer patients are less likely to be able to afford care)? I only took a quick look, but I didn't see how the paper accounts for this and other possible causality issues. On the other hand, it's certainly plausible to me that lower readmissions can cause higher mortality.
- joshgel 9y ago
  Sure. Or those hospitals gamed the system and didn't admit patients who should have been admitted. Or plenty of other explanations... We call readmissions rate a Surrogate Marker. Something that isn't a hard outcome that we care about (that much), but rather an indicator of quality. We need surrogates to assess quality because hard outcomes are rarer. But this paper makes us think that maybe we need better markers.
  - slsii 9y ago
    Do you have recommendations for any books or other resources that cover topics on healthcare quality measures? This is the first time I’ve heard of surrogate markers. I’ve been searching around for more info on the concept you’ve described but didn’t have a term for it.
aviv 9y ago
Why do we need technology to help improve lives when so many diseases (type 2 diabetes, Crohn's, IBS, high blood pressure, arthritis, and dozens of others) can already be reversed and prevented by simply changing a person's diet and lifestyle habits? It's really quite insane that people would rather take pills for the rest of their lives to treat symptoms of a disease than actually getting rid of it altogether by giving up food habits. Part of it is also due to traditional physicians being so dismissive of the role nutrition plays in a person's well being.
- opportune 9y ago
  Well as a physician, you can't really force your patient to exercise and eat better. The best you can do is prescribe a medication to treat the symptoms, tell your patient to exercise and eat better, and send them off. Do you have an alternative to prescribing medication for type 2 diabetes and Crohn's? Do you think doctors should simply withhold care since it's their patients' faults that they have those conditions?
  - joshgel 9y ago
    Agree. My dad, also a physician, blames himself for being overweight. But if "everyone" is overweight, can it really be their fault? Surely "the system" has as much or more blame to share.
    - aviv 9y ago
      Your dad, Big Food, Big Pharma, MSM, his parents. The blame is in that order.
  - aviv 9y ago
    Sure, most physicians nowadays will mention to the patient that diet and exercise are beneficial, but at the same time will outright dismiss the critical role that diet specifically plays in curing the disease. Yes, the alternative is a 10 to 30 day water fast for both of those. I know several people that successfully cured both. Especially Crohn's, the amount of misinformation given by physicians is stunning and borderline criminal. $200K a year Remicade treatments GONE after 2 weeks of water fasting. Why would Big Pharma have any incentive to get this message out there? High blood pressure for example can be reversed entirely after 5 days of water fasting. Completely gone. I don't know how else to say it. I have first hand knowledge of many successful water fasts, but the medical world has brainwashed everyone to the point that I get shut down immediately in any social setting by even mentioning this. But that's okay. Not forcing anyone to do anything they don't believe in. All I can do is share my knowledge and point people in the right direction when they're ready.

blhack 9y ago

Are there other examples of things you wish existed? Again, forget about if they could exist, just stuff you wish you had?

joshgel 9y ago
Loads. A functional EHR (UX). An easy way to keep track of what medications a patient is one and has been on (?blockchain). Better quality and cost measures (big data).

obastani 9y ago

Couldn't this finding be explained by the fact that the hospitals with lower readmissions tend to be poorer (since poorer patients are less likely to be able to afford care)? I only took a quick look, but I didn't see how the paper accounts for this and other possible causality issues. On the other hand, it's certainly plausible to me that lower readmissions can cause higher mortality.

joshgel 9y ago
Sure. Or those hospitals gamed the system and didn't admit patients who should have been admitted. Or plenty of other explanations... We call readmissions rate a Surrogate Marker. Something that isn't a hard outcome that we care about (that much), but rather an indicator of quality. We need surrogates to assess quality because hard outcomes are rarer. But this paper makes us think that maybe we need better markers.
- slsii 9y ago
  Do you have recommendations for any books or other resources that cover topics on healthcare quality measures? This is the first time I’ve heard of surrogate markers. I’ve been searching around for more info on the concept you’ve described but didn’t have a term for it.

aviv 9y ago

Why do we need technology to help improve lives when so many diseases (type 2 diabetes, Crohn's, IBS, high blood pressure, arthritis, and dozens of others) can already be reversed and prevented by simply changing a person's diet and lifestyle habits? It's really quite insane that people would rather take pills for the rest of their lives to treat symptoms of a disease than actually getting rid of it altogether by giving up food habits. Part of it is also due to traditional physicians being so dismissive of the role nutrition plays in a person's well being.

opportune 9y ago
Well as a physician, you can't really force your patient to exercise and eat better. The best you can do is prescribe a medication to treat the symptoms, tell your patient to exercise and eat better, and send them off. Do you have an alternative to prescribing medication for type 2 diabetes and Crohn's? Do you think doctors should simply withhold care since it's their patients' faults that they have those conditions?
- joshgel 9y ago
  Agree. My dad, also a physician, blames himself for being overweight. But if "everyone" is overweight, can it really be their fault? Surely "the system" has as much or more blame to share.
  - aviv 9y ago
    Your dad, Big Food, Big Pharma, MSM, his parents. The blame is in that order.
- aviv 9y ago
  Sure, most physicians nowadays will mention to the patient that diet and exercise are beneficial, but at the same time will outright dismiss the critical role that diet specifically plays in curing the disease. Yes, the alternative is a 10 to 30 day water fast for both of those. I know several people that successfully cured both. Especially Crohn's, the amount of misinformation given by physicians is stunning and borderline criminal. $200K a year Remicade treatments GONE after 2 weeks of water fasting. Why would Big Pharma have any incentive to get this message out there? High blood pressure for example can be reversed entirely after 5 days of water fasting. Completely gone. I don't know how else to say it. I have first hand knowledge of many successful water fasts, but the medical world has brainwashed everyone to the point that I get shut down immediately in any social setting by even mentioning this. But that's okay. Not forcing anyone to do anything they don't believe in. All I can do is share my knowledge and point people in the right direction when they're ready.