sábado, 31 de enero de 2015

Expertos de la UB alertan sobre el uso y comercialización de datos personales - DiarioMedico.com

OBSERVATORIO DE BIOÉTICA Y DERECHO

Expertos de la UB alertan sobre el uso y comercialización de datos personales

Consideran real el peligro de vulneración de la intimidad y de la confidencialidad. La información puede servir para, por ejemplo, denegar servicios según el perfil individual.

Redacción. Barcelona | dmredaccion@diariomedico.com | 30/01/2015 00:00

El Grupo de Opinión del Observatorio de Bioética y Derecho (OBD) de la Universidad de Barcelona (UB), con la colaboración del Grupo de Investigación de Derecho Privado, Consumo y Nuevas Tecnologías, alertó ayer de los riesgos del uso y la comercialización de datos personales de salud en el contexto de las tecnologías de datos masivas en un informe titulado Bioética y Big Data en salud: la explotación y comercialización de los datos sanitarios de los usuarios de la sanidad pública.

El documento está coordinado por María Casado, directora del OBD; María Rosa Llácer, catedrática del Departamento de Derecho Civil de la UB, y Lidia Buisan, médica anestesista y miembro del OBD.

El VISC+ y otros
El estudio analiza diferentes modelos, como el proyecto catalán VISC +, y describe los peligros de la potencial y real vulneración de la intimidad y la confidencialidad de datos personales por los usos no deseados de información almacenada en bases de datos sanitarios. Atendiendo a que la comercialización se excusa o se justifica por el hecho de anonimizar los datos, el documento pone en evidencia que las tecnologías de datos masivas permiten acceder a un gran volumen de datos restringidos. El objetivo de los autores, según informaron en rueda de prensa, es crear una "cultura de la privacidad en un contexto en el que los datos personales se han convertido en un elemento estratégico de la sociedad de la información, y proponer medidas que permitan una garantía efectiva de los derechos de los afectados". Las recomendaciones del grupo se orientan "a promover, respetar y garantizar el derecho a la intimidad, en especial por parte de la Administración, e incluyen principios tales como la transparencia y la rendición de cuentas, necesarios para valorar los riesgos y beneficios en juego".

Según se expone en el documento, la información clínica puede convertirse en una herramienta que permita, por ejemplo, "denegar un servicio en función del perfil personal". Por tanto, "habría que abrir a la ciudadanía un debate en torno al uso y la comercialización de datos personales sanitarios".

Los autores también defienden que "la apuesta por la innovación no puede dejar de lado los aspectos éticos y los derechos fundamentales de las personas y habría que garantizar la protección de los ciudadanos en el contexto de los nuevos avances en tecnología". Por ello sugieren que se tomen medidas sobre la aplicación de las tecnologías de datos masivas en el ámbito de la salud a fin de asegurar "el ejercicio de los derechos y las decisiones libres e informadas de todas las personas implicadas".

Hay que recordar que la Autoridad Catalana de Protección de Datos estudió el proyecto de Big Data catalán y concluyó que requería más concreción, teniendo en cuenta "la casuística amplia y diversa que se puede dar en relación con los clientes potenciales, las finalidades previstas, los servicios ofrecidos y los archivos que serían fuente de información". Posteriormente el Departamento de Salud decidió tener en cuenta las observaciones de Protección de Datos.

El 'Big Data' catalán será de uso público

La Agencia de Calidad y Evaluación Sanitarias de Cataluña anunció ayer, tres horas antes de la presentación del informe de la UB, que su proyecto de Big Data, llamado VISC+, irá destinado únicamente a centros de investigación y a centros sanitarios públicos. "El Proyecto VISC + es un proyecto estratégico del Departamento de Salud y, dada su importancia y complejidad, se considera necesario contar con el máximo apoyo para su desarrollo. Es por este motivo que después de unos meses de trabajo la Agencia ha decidido llevar a cabo una reorientación estratégica del proyecto", reza su comunicado.

MÁS SOBRE NORMATIVA

SAS: el cupo acumulado por vacaciones se paga
por Diego Carrasco. Madrid | diego.carrasco@diariomedico.com
Juzgados contenciosos de Jaén reconocen al médico de AP el abono del complemento, recogido en un pacto entre los sindicatos y la Administración.
La mala derivación entre hospitales se indemniza
por Santiago Rego. Santander | dmredaccion@diariomedico.com

Los pagos del Obamacare a los médicos amplían el acceso para los pacientes de Medicaid, según un estudio: MedlinePlus

MedlinePlus Información de salud para usted

Un servicio de la Biblioteca Nacional de Medicina de EE.UU.
Desde los Institutos Nacionales de la Salud

Institutos Nacionales de la Salud

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Los pagos del Obamacare a los médicos amplían el acceso para los pacientes de Medicaid, según un estudio

Los investigadores encuentran una asociación entre unos reembolsos más altos y la disponibilidad para las citas

Traducido del inglés: viernes, 23 de enero, 2015

Tema relacionado en MedlinePlus

Medicaid

JUEVES, 22 de enero de 2015 (HealthDay News) -- Aumentar los pagos de Medicaid para los proveedores de atención primaria sí amplía la disponibilidad de primeras citas para pacientes nuevos, sugiere un estudio reciente.

El hallazgo ofrece lo que los investigadores afirman que es la primera evidencia de que uno de los objetivos del Obamacare funciona, que aumentar los reembolsos de Medicaid para la atención primaria a unos niveles más generosos de Medicare amplía el acceso de los pacientes a la atención de la salud. Medicaid es el programa gubernamental de seguro médico para los pobres.

Los resultados aparecen en la edición en línea del 21 de enero de la revista New England Journal of Medicine.

Medicaid es famoso por pagar a los proveedores menos que Medicare y que las aseguradores privadas por los mismos servicios. A los legisladores les preocupaba que la oferta de médicos de atención primaria dispuestos a atender a los inscritos en Medicaid no pudiera satisfacer la demanda de pacientes tras la ampliación de la cobertura de salud bajo la Ley del Cuidado de Salud a Bajo Precio.

Para abordar esa preocupación, la ley ordenó a los estados que aumentaran los pagos de Medicaid por los servicios de atención primaria en 2013 y 2014. Los aumentos variaron de un estado a otro, ya que algunos pagaban tarifas que se acercaban a las de Medicare, y otros pagaban tarifas que eran menos de la mitad respecto a las de Medicare, anotaron los autores del estudio.

Los estados recibieron un estimado de 12 mil millones de dólares en fondos federales adicionales en un periodo de dos años para aumentar los pagos de Medicaid para los proveedores de atención primaria elegibles, según la Academia Estadounidense de Médicos de Familia (American Academy of Family Physicians).

Pero los fondos federales adicionales expiraron a finales de 2014, y hasta ahora solo 15 estados planifican seguir con los aumentos en los reembolsos, anotó el estudio.

Para evaluar la efectividad de la cláusula sobre los pagos de Medicaid del Obamacare, los investigadores de la Universidad de Pensilvania en Filadelfia y del Instituto Urbano en Washington, D.C., recibieron financiación de la Robert Wood Johnson Foundation.

Unos telefonistas entrenados se pusieron en contacto con consultorios de atención primaria en diez estados, fingiendo ser pacientes, en dos periodos: antes y después de que se aumentaran los reembolsos. Los telefonistas indicaron que tenían cobertura a través de Medicaid o de un seguro privado, y solicitaron citas como pacientes nuevos.

Tras el aumento en los pagos, la disponibilidad de citas para Medicaid aumentó de forma significativa, encontró el estudio. En los estados con los aumentos más grandes en los reembolsos de Medicaid, el incremento en la disponibilidad para las citas fue particularmente alto, anotaron los investigadores.

En los 10 estados examinados en el estudio, el reembolso de Medicaid para la atención primaria aumentó en más de un 50 por ciento en promedio, lo que amplió la disponibilidad para las citas en casi 8 puntos de porcentaje.

"En los estados que denominaría como estados de aumento grande, las tasas subieron en promedio 13 puntos de porcentaje, y en los estados de aumento bajo, solo subió más o menos 4 [puntos de porcentaje]", señaló el autor del estudio, Daniel Polsky, director ejecutivo del Instituto Leonard Davis de Economía de la Salud de la Universidad de Pensilvania.

No hubo un aumento parecido en la disponibilidad de citas para el grupo de pacientes con seguro privado, lo que sugiere que el aumento en el reembolso fue responsable de incrementar la disponibilidad de citas, y no otros factores, explicó Polsky, que también es profesor de gestión médica y de la atención de la salud.

"Nos sentimos bastante confiados al atribuir lo que hallamos al aumento en el pago", añadió.

Pero los autores dijeron que se necesitarían más estudios para determinar si los costos y los beneficios de la política de pagos ameritan una continuación de la inversión estatal y federal.

Ahora que el aumento en los pagos ha expirado, los investigadores solo pueden especular sobre el impacto en el acceso de los pacientes.

"Creo que nuestra hipótesis para nuestro próximo estudio sería que quizá observemos un giro en algunos de los aumentos [en la disponibilidad de citas]", planteó Polsky.

Los investigadores pensaban que el aumento en los reembolsos tendría un impacto más leve sobre la disponibilidad de citas en los estados que ampliaron Medicaid, dado que habría una mayor demanda de pacientes, pero no fue así. Tanto Nueva Jersey, que amplió Medicaid, como Pensilvania, que no lo hizo, tuvieron aumentos similares en la atención de nuevos pacientes, según el estudio.

Families USA, un grupo de defensoría del paciente, publicó esta semana un documento que describe los próximos pasos propuestos para la reforma de la salud, que incluyen un ajuste permanente en las tarifas de Medicaid para crear una paridad con las tasas de Medicare.

Los grupos de médicos de atención primaria también están presionando para que se restaure la cláusula de paridad en el pago.

"De verdad es uno de nuestros temas prioritarios", dijo Shari Erickson, vicepresidenta de asuntos gubernamentales y práctica médica del Colegio Americano de Médicos (American College of Physicians) en Washington, D.C., que representa a los médicos de medicina interna.

"Creo que es lamentable, obviamente, permitir que un programa que muestra datos promisorios (tanto de forma anecdótica como en este estudio) decaiga antes de que podamos realmente evaluar su verdadera efectividad", añadió Erickson.

Artículo por HealthDay, traducido por Hispanicare

FUENTES: Daniel Polsky, Ph.D., executive director, Leonard Davis Institute of Health Economics, and professor, medicine and health care management, University of Pennsylvania, Philadelphia; Shari Erickson, vice president, governmental affairs and medical practice, American College of Physicians, Washington, D.C.; Jan. 21, 2015, New England Journal of Medicine

HealthDay

About the National Quality Strategy (NQS)

About the National Quality Strategy (NQS)

Working for Quality logo

National Quality Strategy: Better Care. Healthy People/Healthy Communities. Affordable Care.

Register Now: February 4 Webinar on Using Payment, One of 9 National Quality Strategy Aims, To Improve Health Care Quality

AHRQ will host a webinar from 3:30 to 4:30 p.m. ET on February 4 about how organizations are using payment, one of the nine National Quality Strategy (NQS) levers, to improve health care quality. In showing how payment can be used to achieve the NQS aim to provide better, more affordable health care, the webinar will highlight the work of Buying Value, an initiative of private health care purchasers, in refocusing payment on person-centered care and Blue Cross Blue Shield of Massachusetts’ Alternative Quality Contract, which uses an innovative way to pay for care that focuses on promoting quality and rewards positive health outcomes.

Speakers include:

Nancy J. Wilson, B.S.N., M.D., M.P.H., Executive Lead for the National Quality Strategy
Gerry Shea, Director, Buying Value
Dana Gelb Safran, Sc.D., Senior Vice President of Performance Measurement and Improvement at Blue Cross Blue Shield of Massachusetts

Registration is open.

About the National Quality Strategy (NQS)

The National Quality Strategy was first published in March 2011 as the National Strategy for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and Quality on behalf of the U.S. Department of Health and Human Services (HHS).

Mandated by the Patient Protection and Affordable Care Act, the National Quality Strategy was developed through a transparent and collaborative process with input from a range of stakeholders. More than 300 groups, organizations, and individuals, representing all sectors of the health care industry and the general public, provided comments. Based on this input, the National Quality Strategy established a set of three overarching aims that builds on the Institute for Healthcare Improvement's Triple Aim®, supported by six priorities that address the most common health concerns that Americans face. To align with National Quality Strategy, stakeholders can use nine levers to align their core business or organizational functions to drive improvement on the aims and priorities.

Working Together to Improve Quality

Improving health and health care quality can occur only if all sectors, individuals, family members, payers, providers, employers, and communities, make it their mission. Members of the health care community can align to the National Quality Strategy by doing the following:

Adopt the three aims to provide better, more affordable care for the individual and the community.

Focus on the six priorities to guide efforts to improve health and health care quality.

Use one or more of the nine levers to identify core business functions, resources, and/or actions that may serve as means for achieving improved health and health care quality.

To learn more about the National Quality Strategy's impact on the nation's health and health care, review the 2014 Annual Progress Report, visit the Priorities in Action section, or view a past webinar for examples of quality improvement efforts that align to the NQS.

Measure Alignment

The National Quality Strategy also provides a focus for addressing the abundance of clinical quality measures currently used in national programs. The goal is to get to measures that matter and minimize provider burden. The HHS Measurement Policy Council was convened in early 2012 to begin the work of aligning measures across HHS. Composed of senior-level representatives from Agencies and operating divisions across HHS, the group also addresses new measure development and implementation, and measurement policy. The Council has so far reviewed nine topics to date: hypertension control, hospital-acquired conditions/patient safety, HCAHPs, smoking cessation, depression screening and care coordination, HIV/AIDS, perinatal, and obesity/BMI. The core measure sets that the Measurement Policy Council developed for each topic can be viewed here: (PDF File, 257 KB; PDF Help).

While these measures are used for Federal programs, the Measurement Policy Council supports State and private-sector efforts to adopt core measure sets for further harmonization and alignment across the health and health care community.

Aims

The National Quality Strategy pursues three broad aims. These aims will be used to guide and assess local, State, and national efforts to improve health and the quality of health care.

Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

Setting Priorities

To advance these aims, the National Quality Strategy focuses on six priorities:

Making care safer by reducing harm caused in the delivery of care.
Ensuring that each person and family is engaged as partners in their care.
Promoting effective communication and coordination of care.
Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
Working with communities to promote wide use of best practices to enable healthy living.
Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

Using Levers

Each of the nine National Quality Strategy levers represents a core business function, resource, and/or action that stakeholders can use to align to the Strategy. In many cases, stakeholders may already be using these levers but haven't connected these activities to National Quality Strategy alignment.

Measurement and Feedback: Provide performance feedback to plans and providers to improve care
Public Reporting: Compare treatment results, costs and patient experience for consumers
Learning and Technical Assistance: Foster learning environments that offer training, resources, tools, and guidance to help organizations achieve quality improvement goals
Certification, Accreditation, and Regulation: Adopt or adhere to approaches to meet safety and quality standards
Consumer Incentives and Benefit Designs: Help consumers adopt healthy behaviors and make informed decisions
Payment: Reward and incentivize providers to deliver high-quality, patient-centered care
Health Information Technology: Improve communication, transparency, and efficiency for better coordinated health and health care
Innovation and Diffusion: Foster innovation in health care quality improvement, and facilitate rapid adoption within and across organizations and communities
Workforce Development: Investing in people to prepare the next generation of health care professionals and support lifelong learning for providers

Evidence-Based Resources from AHRQ

On-Demand Continuing Education Webinars Available for Nurses, Nurse Practitioners and Nurse Educators

AHRQ offers Web-based continuing education for nurses, nurse practitioners, case managers, staff educators and nurse practitioner faculty. Eligible professionals can view recorded webinars that highlight resources such as the National Guidelines Clearinghouse, the Electronic Preventive Services Selector and the Improving Patient Safety in Long-Term Care Facilities training modules. The webinars offer practical insights on how these resources can be integrated into education and practice. Registration is open.

AHRQ CE for Nurses

AHRQ developed the following CE activities for nurses to increase awareness and ongoing use of AHRQ patient safety and quality resources.

Using Evidence in Practice: CE for NPs, Nurse Faculty, and Other Advanced Practice Nurses

The following Webinar explains how advanced practice nurse educators can incorporate AHRQ’s Electronic Preventive Services Selector and resources from theEffective Health Care Program into the educational process:

Integrating AHRQ Evidence-Based Resources Into Course Curricula: Recording available now

Target Audience: Advanced Practice Nurse Educators

The following Webinar explains how advanced practice nurses can use AHRQ's Electronic Preventive Services Selector and resources from the Effective Health Care Program to inform clinical practice:

A Review on How to Access and Implement AHRQ's Evidence-Based Resources To Inform Your Clinical Practice

Target Audience: Advanced Practice Registered Nurses

Patient Safety in Long-Term Care: CE for RNs, Case Managers, and Staff Educators

This is a series of four Webinars that will provide information on how to implement the Improving Patient Safety in Long-Term Care Facilities Training Modules:

Target Audience: Nurse administrators and nurse educators who provide staff training to first-line care staff or who work closely with staff at long-term care facilities

Multimodal intervention to improve osteoporosis care in home health... - PubMed - NCBI

2013 Oct;24(10):2555-60. doi: 10.1007/s00198-013-2340-7. Epub 2013 Mar 28.

Multimodal intervention to improve osteoporosis care in home health settings: results from a cluster randomized trial.

Kilgore ML1, Outman R, Locher JL, Allison JJ, Mudano A, Kitchin B, Saag KG, Curtis JR.

Author information

Abstract

SUMMARY:

We conducted a cluster randomized trial testing the effectiveness of an intervention to increase the use of osteoporosis medications in high-risk patients receiving home health care. The trial did not find a significant difference in medication use in the intervention arm.

INTRODUCTION:

This study aims to test an evidence implementation intervention to improve the quality of care in the home health care setting for patients at high risk for fractures.

METHODS:

We conducted a cluster randomized trial of a multimodal intervention targeted at home care for high-risk patients (prior fracture or physician-diagnosed osteoporosis) receiving care in a statewide home health agency in Alabama. Offices throughout the state were randomized to receive the intervention or to usual care. The primary outcome was the proportion of high-risk home health patients treated with osteoporosis medications. A t test of difference in proportions was conducted between intervention and control arms and constituted the primary analysis. Secondary analyses included logistic regression estimating the effect of individual patients being treated in an intervention arm office on the likelihood of a patient receiving osteoporosis medications. A follow-on analysis examined the effect of an automated alert built into the electronic medical record that prompted the home health care nurses to deploy the intervention for high-risk patients using a pre-post design.

RESULTS:

There were 11 offices randomized to each of the treatment and control arms; these offices treated 337 and 330 eligible patients, respectively. Among the offices in the intervention arm, the average proportion of eligible patients receiving osteoporosis medications post-intervention was 19.1 %, compared with 15.7 % in the usual care arm (difference in proportions 3.4 %, 95 % CI, -2.6 to 9.5 %). The overall rates of osteoporosis medication use increased from 14.8 % prior to activation of the automated alert to 17.6 % afterward, a nonsignificant difference.

CONCLUSIONS:

The home health intervention did not result in a significant improvement in use of osteoporosis medications in high-risk patients.

PMID:: 23536256; [PubMed - indexed for MEDLINE]
PMCID:: PMC4089895

Free PMC Article

Unintended consequences of a Medicaid prescription copayment policy. - PubMed - NCBI

2014 May;52(5):422-7. doi: 10.1097/MLR.0000000000000119.

Unintended consequences of a Medicaid prescription copayment policy.

Lieberman DA1, Polinski JM, Choudhry NK, Avorn J, Fischer MA.

Author information

Abstract

BACKGROUND AND OBJECTIVES:

Medication copayments can influence patient choices. We evaluated 2 copayment policies implemented by Massachusetts Medicaid incentivizing the use of selected generic medications.

RESEARCH DESIGN AND MEASURES:

In 2009, Massachusetts Medicaid copayments were $1 for generics and $3 for brands. On February 1, 2009, copayments for generic antihypertensives, antihyperlipidemics, and hypoglycemics (target medications) remained at $1, whereas copayments for all nontarget generics increased to $2 (policy #1) and $3 on July 1, 2010 (policy #2). Using state-level, aggregate prescription data, we developed interrupted time-series models with controls to evaluate the impact of these policies on use of target generics, target brands, and nontarget essential medications (defined as medications required for ongoing treatment of serious medical conditions).

RESULTS:

After policy #1, target generic use increased by 0.93% (P<0.001) with a subsequent quarterly slope decrease of -0.16% (P<0.01); policy #2 led to a slope increase of 0.20% (P<0.01) for target generics; increase in target generics attributable to policy changes was 28,000 prescriptions per year. Neither policy affected target brand use. For nontarget essential generics, there was a -0.27% (P<0.001) quarterly slope decrease after policy #1 and a 0.32% (P<0.01) slope increase after policy #2 with total decrease attributable to policy changes of 127,300 prescriptions per year. For nontarget essential brands, there was a level increase of 0.91% (P<0.001) after policy #1 with increased use attributable to policy changes of 98,300 prescriptions per year.

CONCLUSIONS:

Two copayment policies designed to encourage use of selected generic medications modestly increased their use; however, there was a shift in other essential medications from generics to brands, which could increase Medicaid costs. When adjusting copayments, careful consideration must be given to unintended consequences of specific policy structures.

PMID:: 24686394; [PubMed - indexed for MEDLINE]

AHRQ Safety Program for End-Stage Renal Disease Facilities – Toolkit | Agency for Healthcare Research & Quality (AHRQ)

New AHRQ Toolkit Helps Keep Dialysis Patients Safer

To help prevent infection in people with end-stage renal disease, AHRQ has developed a new resource, the AHRQ Safety Program for End-Stage Renal Disease Facilities Toolkit. Dialysis clinics can use this toolkit to prevent healthcare-associated infections in their patients. The toolkit helps clinicians and other health care workers follow clinical best practices, create a culture of safety, use checklists and other audit tools and engage patients and their families in infection prevention practices. This new resource has science-based, practical information—including educational videos—that reflects the experiences of the frontline providers who helped develop the toolkit.

AHRQ Safety Program for End-Stage Renal Disease Facilities – Toolkit

The ESRD Toolkit was created to help end-stage renal disease clinics prevent healthcare-associated infections in dialysis patients. The toolkit helps dialysis center clinicians make care safer by following clinical best practices, creating a culture of safety, using checklists and other audit tools, and engaging with patients and their families. The toolkit has science-based, practical resources that reflect the real-world experiences of the frontline providers who participated in the toolkit’s development.

How To Use the ESRD Toolkit

The toolkit consists of four instructional modules that a facilitator can use to teach dialysis center team members specific ways to create a culture of safety. The modules are modifiable to meet individual dialysis center training needs.

ESRD Toolkit Modules

Modules contain PowerPoint slides, facilitator notes, video vignettes, and tools. Each module includes teaching tools and resources to support change at the unit level, presented through facilitator notes that take you step by step through the slides, tools, and videos.

About the Toolkit Development

The ESRD Toolkit was developed during a 2-year project called the National Opportunity To Improve Infection Control in End-Stage Renal Disease Facilities, conducted through a partnership that brought together subject matter experts and providers in the field.

Page last reviewed January 2015

Internet Citation: AHRQ Safety Program for End-Stage Renal Disease Facilities – Toolkit. January 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/esrd/index.html