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Wednesday, November 21, 2007 8:00 PM

Newscast: Lead Story - Choosing a Hospital

(opening music)

Rand: This is Healthcare 411 for the week of November 21, 2007

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. I’m Debra James.

Rand: And I’m Rand Gardner Coming up: Our News and Numbers tells you the cost of having a baby.

Debra: A cutting-edge project allows sick kids to get a long-distance diagnosis.

Rand: And tips on how to choose the right hospital, coming up in our segment on Navigating the Health Care System. More after this.


[Begin PSA: If You’re Pregnant and You Smoke]

(baby crying)

Narrator: If you’re pregnant and you smoke, you need to know that your risk of your baby being born too small is one and a half to three and a half times greater. By quitting now, your baby has a better chance to be born at a normal weight and to have healthy lungs. But it’s also important for you to stay smoke free after your baby’s born. For free materials on quitting or to speak to a quit coach, call the National Quitline at 1-800 QUIT NOW. A message from the U.S. Public Health Service.

[End PSA]



Debra: And now for numbers. From prenatal care to delivery day, the average cost of having a baby nowadays is about $7,600. In 2004 dollars, AHRQ’s latest analysis totaled up expectant mothers’ expenses for prenatal office visits, prescription medicines and hospital childbirths. Some soon-to-be mothers may pay more depending on their insurance. Women with Medicaid paid about $4,577 per inpatient delivery while privately insured women ended up spending about $6,520. Privately insured women also paid more out of pocket for their total pregnancy expenses. On average, women with private insurance paid about 8 percent out of pocket, while women on Medicaid only paid about 1 percent out of pocket. These data are from AHRQ’s Medical Expenditure Panel Survey.

Rand: For many busy adults, balancing busy careers and parenting is tough. When a child gets sick at day care or school, figuring out how to get them to the doctor’s office can be a challenge. But a project designed at the University of Rochester Medical Center used technology to bring the doctor’s office to child care centers and schools. The project is called Healthy Access and began in 2001 in five inner-city child care programs in Rochester, New York. Today the telemedicine network has grown to 22 sites, including suburban elementary schools and child care programs and 10 primary care practices. We’re joined now by Dr. Kenneth McConnonchie, the principal investigator for the project. Dr. McConnonchie welcome, would you please tell us how Healthy Access works?

Dr. McConnichie: Well, let’s say we have two-year old Sally, and she wakes from nap time with a fever or holding her ear. As with any child care program, the parent is contacted, but instead of the dreaded call to come pick up your child and don’t come back without a doctor’s note, child care staff, in this case, offers telemedicine as an option. Almost always, the parent chooses telemedicine. The trained child care staff person, known as the telehealth assistant, also uses this contact to obtain any history about the illness episode not already known. Then, at the child care site, the telehealth assistant collects additional information, including images, video clips and audio files, about the child’s condition and medical history. We use a digital camera with special attachments to take detailed, high resolution eye, ear drum, mouth, and skin images. We also capture lung sounds using an electronic stethoscope.

Rand: What does the telehealth assistant do with this information?

Dr. McConnichie: The information is then sent by the telehealth assistant to the child’s primary care practice, where a clinician can use the information to diagnose or treat the patient. If necessary, the clinician conducts a live video conference with the patient, staff, and sometimes parents, to help diagnose the child. If a prescription is appropriate, after diagnosis, the physician can instantly fax it to the pharmacy for delivery to the child care center or school. Once the visit is complete, parents get a personalized letter about the visit and any useful information that the doctor wants them to have, such as a standard handout on ear infections.

Rand: So, who determines which sick kids can stay in the classroom?

Dr. McConnichie: If the child care site if their guidelines say the child needs to go home, the child needs to go home. The American Academy of Pediatrics and their, sort of, school health handbook very much emphasizes the fact that most children with minor illnesses are safe for them to stay and that the decision to leave should be based, primarily, and in most instances, on the ability of the child to learn and participate.

Rand: It seems there are obvious advantages to parents and children in terms of this being less disruptive to both of their everyday routines. Have you noted any other benefits?

Dr. McConnichie: Our studies indicate that payers reimburse ED visits at least five- to seven-fold greater than for office visits or telemedicine visits for the same problems. So we anticipate substantial reduction in net health care costs for managing childhood illness, even after paying for telemedicine infrastructure, such as the telehealth assistants and the equipment. Considering the impact of telemedicine on absence from child care or school, and on parent absence from work, we expect that from a societal perspective in other words, going beyond just the health care perspective that cost effectiveness will be even greater.

Rand: That’s Dr. Kenneth McConnonchie, principal investigator of the Healthy Access telemedicine project at the University of Rochester Medical Center. To hear more of this interview with Dr. McConnochie, please go to this program’s Web page at healthcare411.ahrq.gov.

Debra: Coming up, Navigating the Health Care System with Dr. Carolyn Clancy.


Debra: Many people have a choice of where they get their hospital care. But how do you pick where to go? Our segment today on Navigating the Health Care System is about how to choose the right hospital. With us is AHRQ Director Dr. Carolyn Clancy. Dr. Clancy, do you think many people know that, when they don’t need emergency care, they may be able to choose their hospital?

Dr Clancy: I think it would be news to many people. They just assume that someone will tell them which hospital they’re going to. It turns out though that many doctors actually have admitting privileges at more than one hospital, and if that’s the case, then you have a right to be involved in that decision. You should check with your health insurance plan to make sure that you do have a range of choices. Some insurers will ask that you pay more out-of-pocket costs if you choose one hospital versus another and it’s important to know that ahead of time.

Debra: When you’re having a conversation with your physician regarding where to get a procedure done, should you be considering a general hospital or specialty hospital? Can you explain the difference?

Dr Clancy: A general hospital usually will care for people with a broad array of conditions. So they might treat common medical conditions like pneumonia, like acute infections, as well as perform surgery and so forth. In recent years we’ve seen more and more hospitals emerge that have a special focus, so there is one hospital in Toronto that does nothing but hernia surgery. There are a lot of cardiac hospitals that focus very explicitly on cardiac care. There are some that focus on hip and knee replacements, and so forth. Whether you want to be at a general hospital or a specialty hospital, I think, depends on how their ratings are for quality of care and as well as consultation with your own physician.

Debra: What if people are helping choose a hospital for their child or parent? What else should people consider?

Dr. Clancy: They’re going to want to know what are the visiting hours and so forth, and even, can their family members stay with them? Or, if you’re a parent, can you stay with your child in the hospital? It becomes very important if you have a relative who has special needs. It’s a good idea to ask the hospital where they’re going is there any place to stay? Is there something like a Ronald McDonald House where the family can stay, or some other facility that makes it easier for relatives or family members of a patient to be close to them?

Debra: So how can people investigate hospitals and their level of quality?

Dr Clancy: There are two sites where you can routinely find good information about quality at a national level. One is the Web site for the Joint Commission which is www.jcaho.org, and they have a section there called Quality Check. In addition, for the past two years, virtually all of the nation’s hospitals have been reporting on selected aspects of quality of care to a site called Hospital Compare. So if you Google Hospital Compare, you’ll get right to that site. Starting in the early part of 2008, there will be a survey published online that will be part of Hospital Compare that will describe in some detail patients’ experiences with care.

Debra: Is there anything else people can do to ensure they get high quality hospital care?

Dr Clancy: Wherever you end up being hospitalized, or your family member or friend, it’s very important to be as involved as possible in all aspects of your health care. Ask questions. Consult with your health care professional, and get as much information as you can because, in the end, you’re going to have better results if you do.

Debra: Dr. Clancy, thanks for being with us today.

Dr Clancy: Thank you for having me.


Rand: That’s it for the week. For more information on these and other health-related stories and topics go to www.ahrq.gov.

Debra: Healthcare 411 is produced by AHRQ, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services. For Rand Gardner, I’m Debra James. Please join us for the next edition of Healthcare 411.

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