From the category archives:

Health legislation & reform

Dr. Claire McCarthy is a primary care physician and the Medical Communications Editor at Children’s Hospital Boston. Along with her blogs here on Thriving, you can find her at the Huffington Post and Boston.com. Follow her on Twitter @drClaire.

Those of us who do primary care often feel like Rodney Dangerfield: we get no respect. Compared to the specialists, our job is thought of as, well, lowly and ordinary.

But that’s changing—and Children’s Hospital Boston is leading the way. The primary care departments of Children’s, Children’s Hospital Primary Care Center (CHPCC) and Martha Eliot Health Center (MEHC), have been chosen by Harvard Medical School to take part in its Center for Primary Care’s Academic Innovation Collaborative. They have been awarded $900,000 over two years, to be matched by the hospital, to work with the Collaborative to transform primary care delivery and education. Full story »

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Sandra Fenwick, president and COO

I’ve worked at Children’s Hospital Boston for more than a decade, and I’m still inspired every day by the hope and strength I see on the faces of our patients and their families. As Children’s navigates a challenging and evolving health care landscape, I draw on that inspiration and determination, especially when many in our industry seem to imply that cost is the only measure of a hospital’s worth.

At Children’s, our worth—our value—is so much more than just dollars and cents. It means being treated by pediatric experts—doctors, nurses and support staff—who understand that children are not small adults and their care needs to reflect that fact. It’s a commitment to care and innovation that produces programs like our Community Asthma Initiative, which helps children with asthma have fewer attacks so they miss less school and their parents miss fewer days of work.

And it’s about a commitment to constantly improving the quality of the care we deliver. To that end, I am pleased to announce that we have signed an innovative new contract with the state’s largest health insurance provider, Blue Cross Blue Shield of Massachusetts (BCBSMA).

This agreement, known as an Alternative Quality Contract (AQC), calls for us to reach quality targets based on national pediatric quality benchmarks—the first such contract in the country—and keeps the contract value well below medical inflation

The AQC has specific quality measures in the areas of primary care (prevention and treatment), effectiveness of treatment for patients with certain conditions or needs (cystic fibrosis, dialysis or general surgery needs) and safety (central line infections). In addition, we have agreed to accept a 0 percent rate increase in the first year and an average 1.5 percent annual increase over the three years of the contract.

Since 2009, Children’s has taken more than $125 million out of the health care system to benefit insurers, employers and consumers

This contract is aligned with our efforts over the last three years to improve quality  while slowing the rising cost of care delivery. Since 2009, Children’s has taken more than $125 million out of the health care system to benefit insurers, employers and consumers. We have reduced insurers’ rates and prices, become more efficient and have innovated new ways to deliver care that improve quality while lowering costs. In addition, we have moved care to lower-cost settings within the hospital and to our less expensive suburban satellites and community hospital partners, and have improved care integration between primary care physicians and hospital subspecialists.

As far as I’m concerned, the greatest indication of Children’s value is the trust of the parents who place more than 170,000 children in our care each year. Whether they come to us from around the block, or the other side of the world, Children’s takes great pride in knowing that every patient who comes through our doors will receive the same level of world-class care that has made Children’s a leader in pediatrics for more than 140 years.

For more on the Blue Cross Blue Shield deal, read Sandra Fenwick’s interview with WBUR.

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Children’s legal eagles

by Steve Coldwell on January 12, 2012

As an attorney, Kristin Small, Esq., specializes in cases where the legal and health care needs of her clients cross paths. She recently worked with the parents of a 5-year-old child with autism.

The father had lost his job and the mother couldn’t work because of the time she needed to devote to her son’s care. Though the Social Security Administration (SSA) agreed that their son qualified for benefits medically, the family was deemed ineligible because they had “too many resources.” With both parents out of work and no means of income, legal counsel was the last option they thought was available to them.

Their pediatrician referred them to Small, a staff attorney for the Medical Legal Partnership | Boston (MLP) and liaison to Children’s for the newest MLP site in the Children’s Hospital Primary Care Center (CHPCC). Providing care for more than 13,000 children—65 percent of whom are covered by Medicaid—the CHPCC is well suited to host the MLP at CHB. “Our medical and social work staff already spend a lot of time advocating for our patients,” says Joanne Cox, MD, medical director for the CHPCC. “They’re writing letters to utility companies, helping families access food stamps and communicating with landlords about poor housing conditions.” Chronic illnesses such as asthma, cerebral palsy and diabetes are often exacerbated by environmental factors like lack of food, housing, education and employment. A child my be falling behind in school due to chronic illness, or a family may be forced to choose between medicine and food. By teaming with the MLP, the CHPCC can now offer their patients direct access to legal information and support to help them make sure their needs are being met. Full story »

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The medical home: what health care needs now

by Claire McCarthy on December 20, 2011

Dr. Claire McCarthy is a primary care physician and the Medical Communications Editor at Children’s Hospital Boston. Along with her blogs here on Thriving, you can find her at the Huffington Post and Boston.com. Follow her on Twitter @drClaire.

Claire McCarthy MD

You may have heard the term “medical home”—it’s been bandied about recently as something we all should have. No, it’s not a nursing home. Nor is it a house well-stocked with Band Aids and Tylenol, or one where doctors live.

The American Academy of Pediatrics defines medical home as “a model of care that is accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally effective.”

Well, that sounds exceedingly lovely. Of course we’d all want that. But still, what does it really mean? Full story »

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Education: My best weapon in injury prevention

by Childrens Hospital Boston staff on November 10, 2011

By Eric Fleegler, MD, MPH, attending in Pediatric Emergency Medicine; co-author, “Attempts to Silence Firearm Injury Prevention.”

I remember the first time I fired a shotgun: the noise was extreme, the kickback stronger than I anticipated. It was exhilarating. I was 17 years old.

At the time I was struck by the raw power of the gun, the enjoyment of the moment. Twenty-two years later I am struck by the potential on that day for a devastating accident. I was in the backwoods of a classmate’s house. We were by ourselves, shooting an old microwave in the middle of the day.

As a pediatric emergency medicine doctor I see the results of bad decisions every single shift: bike accidents that occur without helmets which lead to permanent brain injury. Intoxicated teenagers who aspirate their own vomit and end up in the intensive care unit. Sexually active adolescents who don’t use protection and get infections—or get pregnant. A 10-year-old child accidentally shot in the thigh by his friend while playing with his dad’s gun.

Discussions about risky behaviors are too late for these kids. They needed guidance, at regular intervals, prior to these incidents—the kind of guidance that is the mainstay of what we do as health care providers. Asking patients about tobacco, drug and alcohol use, sexual activity, and finding out if they are depressed, have suicidal thoughts and have access to weapons that can readily kill them is vital to my work as an emergency medicine physician.  Full story »

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The lessons health care can learn from Steve Jobs

by Childrens Hospital Boston staff on October 27, 2011

By Clement Bottino, MD, Fellow in General Pediatrics at Children’s Hospital Boston’s Primary Care Center

Steve Jobs Memorial outside an Apple store. Image flickr/Ron Cogswell

Like many people across the country, I was sad to hear about the passing of Steve Jobs.

I grew up with the technology Mr. Jobs created. My 5th grade final science project entitled “The Moray Eel” was typed on an Apple II computer. My college soundtrack was powered by a first generation iPod and nowadays I keep in touch with my sister who lives in Spain using face-time on my iPad.

The technology Steve Jobs created radically changed how we interact with computers, the way we listen to music, even the way we communicate with each other. Mr. Jobs was an innovator on a grand scale; some say a Thomas Edison or Henry Ford for our time.

Before Mr. Jobs, computers were big, clunky machines. There was no mouse, no desktop, just a solitary green cursor on the lower corner of an empty black screen. You needed to be an expert in the field to use one. Full story »

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Having a sick child is hard enough, but a current drug shortage is threatening to complicate matters even more for many families with chronically ill children.

“There is a supply problem with many drugs in this country right now, and it’s getting worse,” says Kathleen Gura, PharmD, BCNSP of Children’s Hospital Boston’s Department of Pharmacy. “Last year we had about 200 drugs in short supply, we’re already up to 211 this year, and that number may grow.”

Drug shortages are nothing new; in the past few decades several medications have dipped to very low supply levels, complicating care for many patients. But the problem with the current shortage is the fact that many different medications are becoming scarce at the same time, creating several shortages simultaneously. Full story »

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Doc talk: Reducing medical jargon to improve care

by Childrens Hospital Boston staff on August 19, 2011

by Sarah Teasdale, MD

“Don’t say febrile to me!”  My sister yelled from the other end of the phone.  “Don’t use doctor talk. I just want to know I need to take her to the emergency room.”

She was at home with her 4-year-old who had a sore throat and was throwing up.  I could hear my niece retching in the background, the dog was barking and her infant son crying.  My sister was worried and needed reassurance.  I was in medical mode, speaking in technical terms:  ‘Is she febrile?  Is the emesis bloody or bilious?  Any sick contacts?”  I was making her more nervous.  A dish fell to the floor on the other end of the phone and my sister sighed.  “I’m just going to call mom.”  She hung up.

My sister has plenty of education, and as a journalist she has a large vocabulary.  She knows what the word “febrile” means, but she wanted me to say “fever.” She wanted the clearest possible language because, in the middle of all the vomiting, crying and barking, she had no time to focus on translation. Full story »

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