If Health Care Is Going to Change, Dr.Brent Jamess Ideas Will Change ItThere are some real advantages to that, James says, and in some ways there are some real disadvantages too.The human mind can sometimes do a better job of piecing together amorphous bits of information diagnosing a disease, for example than even the most powerful computer.On the other hand, human beings can also be unduly influenced by just a few experiences, like the treatment of an especially memorable patient.As a result, different doctors frequently end up coming up with different answers to the same question.FAB-wastenot-090216-iStock.jpg' alt='Make Money With No Money Down New System Reveals All Executive Departments' title='Make Money With No Money Down New System Reveals All Executive Departments' />Cardiologists in Davenport, Iowa, are quick to insert stents cardiologists in Iowa City and Sioux City are not.They cant both be right.Some people with heart disease are getting the best treatment, and some are not.The same is true of debilitating back pain, various cancers and even pregnancy.Make Money With No Money Down New System Reveals All Executive Departments' title='Make Money With No Money Down New System Reveals All Executive Departments' />The health care debate of 2.Adobe Acrobat 9 Pro Keygen Macromedia .The crisis behind the debate, though, is about one thing above all the scattershot nature of American medicine.Mediagazer presents the days mustread media news on a single page.The media business is in tumult from the production side to the distribution side, new.The fee for service payment system combined with our own instincts as patients encourages ever more testing and treatments.Were not sure which ones make a difference, but we keep on getting them, and costs keep rising.Millions of people cannot afford insurance as a result.Millions more have had their incomes pinched by rising insurance premiums.Medicare is on a long term path to insolvency.Mindspark Interactive.Help Uninstall EULA Privacy.The American health care system is vastly more expensive than any other countrys, but our results are not vastly better.Any bill that Congress passes this year is unlikely to fix these problems.The lobbying groups for drug companies, device makers, insurers, doctors and hospitals have succeeded, so far, in keeping big, systemic changes out of the bills.And yet the modern history of medicine the story that James tells nonetheless offers reason for optimism.Medicine has changed before, after all.When it did, government policy played a role.But much of the impetus came from inside the profession.Doctors helped change other doctors.For the past decade or so, a loose group of reformers has been trying to do precisely this.They have been trying to figure out how to improve health care while also holding down the growth in costs.The group includes Dr.John Wennberg and his protgs at Dartmouth, whose research about geographic variation in care has received a lot of attention lately, as well as Dr.Mark Mc.Clellan, who ran Medicare in the Bush administration, and Dr.Donald Berwick, a Boston pediatrician who has become a leading advocate for patient safety.These reformers tend to be an optimistic bunch.Its probably a necessary trait for anyone trying to overturn an entrenched status quo.When I have asked them whether they have any hope that medicine will change, they have tended to say yes.When I have asked them whether anybody has already begun to succeed, they have tended to mention the same name Brent James.II.ON A RECENT Wednesday morning, about 2.Salt Lake City.The students were doctors and hospital executives who came to Utah to be taught by James.His four month course is called the Advanced Training Program, and it is a combination of statistical methods and management theory applied to the practice of medicine.Ive wanted to go for years, Janet Porter, the chief operating officer of the Dana Farber Cancer Institute in Boston, told me later.For anybody interested in improving the quality of health care, she said, the program is the equivalent of Harvard.At the front of the room stood James, a 5.Idaho native and likes to make his points by telling stories.On more than one occasion, including this one, I watched him pour himself a Diet Coke and then leave it untouched as he jumped from one illustrative tale to another.On this morning, he was telling the class the story of Intermountain Healthcare.In the late 1.Intermountain named Alan Morris received a research grant to study whether a new approach to ventilator care could help treat a condition called acute respiratory distress syndrome.The condition, which is known as ARDS, kills thousands of Americans each year, many of them young men.It can be a complication of swine flu.As Morris thought about the research, he became concerned that the trial might be undermined by the fact that doctors would set ventilators at different levels for similar patients.He knew that he himself sometimes did so.Given all the things that the pulmonologists were trying to manage, it seemed they just could not set the ventilator consistently.Working with James, Morris began to write a protocol for treating ARDS.Some of the recommendations were based on solid evidence.Many were educated guesses.The final document ran to 5.Morriss colleagues were naturally wary of it.I thought there wasnt anybody better in the world at twiddling the knobs than I was, Jim Orme, a critical care doctor, told me later, so I was skeptical that any protocol generated by a group of people could do better.Morris helped overcome this skepticism in part by inviting his colleagues to depart from the protocol whenever they wanted.He was merely giving them a set of defaults, which, he emphasized, were for the sake of a research trial.The crucial thing about the protocol was that it reduced the variation in what the doctors did.That, in turn, allowed Morris and James to isolate the aspects of treatment that made a difference.There was no way to do that when the doctors were treating patients in dozens of different ways.James has a provocative way of describing his method to doctors Guys, its more important that you do it the same way than what you think is the right way.While the pulmonologists were working off of the protocol, Intermountains computerized records system was tracking patient outcomes.A pulmonology team met each week to talk about the outcomes and to rewrite the protocol when it seemed to be wrong.In the first few months, the team made dozens of changes.Just as the pulmonologists predicted, the initial protocol was deeply flawed.But it seemed to be successful anyway.One widely circulated national study overseen by doctors at Massachusetts General Hospital had found an ARDS survival rate of about 1.For those in Intermountains study, the rate was 4.Photo.THE VANGUARD Intermountain Healthcares flagship hospital outside Salt Lake City.Credit. American Bevel Designer 2 Cracker . Dan Winters for The New York Times All along, Morris has been reluctant to give the protocol credit for the increase.As he explained to me, Intermountains trial differed from the earlier study in any number of ways.Still, his once skeptical colleagues were impressed.Orme said that the gap in survival was eye opening for him and others.James was thrilled not only by the results but also by the fact that the doctors managed to put together such a complex set of clinical guidelines.In the years since the ARDS study, one Intermountain department after another has embarked on a similar project.By now, the hospital has gone through the exercise for 5.Intermountains patients.For each, a committee made up of doctors, nurses and administrators has tried to identify variation and then figure out which treatments have not been working.The committee members are drawn from Intermountains network of 2.Utah and Idaho.
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