TB Test Produces Better Results

 The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID, UNITAID, and the Bill & Melinda Gates Foundation are partnering to significantly reduce the cost of a new highly accurate rapid diagnostic test for TB in 145 high-burden and developing countries.

Funds provided by this partnership will reduce the cost of Xpert MTB/RIF cartridges from $16.86 to $9.98 a price which won’t increase until 2022. To date, the high unit cost of the cartridges produced by the medical device manufacturer Cepheid has proven to be a barrier for the widespread use of the diagnostic TB test in low and middle income countries.

Until Cepheid developed the cartridge, the only method used in most developing countries laboratories was smear microscopy which is particularly insensitive for diagnosing TB in patients who are co-infected with HIV and does not help clinicians detect drug-resistant strains of TB.

The capacity of the Xpert MTB/RIF assay to yield a rapid and accurate diagnosis has the potential to improve TB diagnosis and treatment in rural clinical settings. A large percentage of people with TB fail to start treatment promptly because of the long wait for results from older conventional tests and they also may need to return to the clinic that may be far from where they live.

Cepherd’s GeneXpert is a molecular diagnostic system that can detect TB in patients co-infected with HIV and resistant to the antibiotic rifampicin and produce the results in less than two hours. Patients are able to start immediately on an on appropriate treatment, including second-line drugs in cases of drug resistance.

Research suggests that the incremental scale up of GeneXpert in countries with high TB burdens could enable the rapid diagnosis of 700,000 cases of TB and save health systems in low and middle income countries more than $18 million in direct health costs.

Technology to Assess Fall Risks

One in three people over the age of 65 suffer from a fall every year in Ireland. Two-thirds of this group falls again within six months leading to risk of hospitalization and significant decline in health. In addition, a recent study by the Irish Centre for Social Gerontology showed that the cost to the economy from falls and fractures in older people is about five billion annually.

In Ireland, Sean Sherlock TD, Minister for Research and Innovation recently launched the novel falls risk assessment suite within the clinic at the Technology Research for Independent Living (TRIL) Center. TRIL was established to develop competitive state-of-the-art technologies for aging given increasing aging demographics. TRIL is funded by Intel, GE Healthcare, and IDA Ireland.

The TRIL Center along with the University College Dublin, Trinity College Dublin, St James’s Hospital, and industry partners are researching using mobile devices with novel sensor technology and algorithms to predict the risks for falling.

The TRIL Clinic in St. James’s Hospital involves:

·        Exploring the physical, social, and psychological dimensions of aging through comprehensive assessment of a large group of older Irish adults

·        Validating novel technologies for assessment

·        Having a well characterized group of older adults participate in various research projects within the center.

In total, the TRIL Center has undertaken a substantial aging research program resulting in 240 publications and the creation of 15 technologies and technology trials being conducted in the homes of over 500 older people. By the end of 2012, 1,335 comprehensive bio-psycho-social assessments will be carried out at the Clinic.

For more information, go to www.trilcentre.org.

HRSA Leader Speaks at IOM Workshop

The Institute of Medicine (IOM) HRSA sponsored workshop on the “Role of Telehealth in an Evolving Health Care Environment” was held August 8-9, 2012 at the National Academy of Sciences in Washington D.C.  Karen S. Rheuban, M.D. serving as Chair of the Workshop Planning Committee, a Professor of Pediatrics (cardiology), and the Director of the University of Virginia Center for Telehealth, introduced keynoter Mary Wakefield PhD, RN, Administrator for HRSA.

As a leading rural healthcare advocate and a native of North Dakota, Dr. Wakefield brings much expertise to the field of providing rural healthcare from her position as the Associate Dean for Rural Health at the University of North Dakota’s School of Medicine and Health Sciences before joining HRSA in 2009.

Dr. Wakefield wants to see new opportunities for telehealth technologies to be used effectively and become a key player in the medical and health fields. However, there are challenges that lie ahead especially in rural areas. For example:

• The rural population is spread across 80 percent of the country side which means that the technology has to be widely dispersed in order to connect rural residents to healthcare
• Rural communities tend to be older, residents have lower incomes, and higher rates of certain chronic diseases which can create additional barriers
• There are difficulties in attracting not only physicians but also pharmacists in rural communities
• Hospitals in rural areas are generally small and operating on a thin margin

As Dr Wakefield pointed out the Affordable Care Act is going to produce special tools and benefits to help expand insurance coverage in rural areas, develop team-based centered care utilizing telehealth, help address health disparities in rural and minority populations, and expand rural community health structures.

HHS is involved in several telehealth initiatives linked to all aspects of healthcare. For example, during the recent AIDS International Conference, Secretary Sebelius announced a series of innovative public-private partnerships in the fight against the HIV/AIDS epidemic where telehealth can play an important role.

Dr. Wakefield discussed the “UCARE4LIFE program where HHS will partner with the MAC AIDS Fund to launch a mobile texting pilot program to help patients get important reminders and tips for managing their HIV/AIDS health issues. The program will develop a message library to deliver timely phone text reminders in English and Spanish to remind HIV-positive individuals about their medical appointments and when to take their medications. This two-year project will focus on the southern states where the epidemic is rising fast among youth.   

Dr Wakefield pointed out that the White House Rural Council is working to help veterans in rural areas. The goal is to help create jobs, increase the flow of capital to rural areas, promote innovations, and expand digital and physical networks in rural communities.

Dr. Wakefield mentioned several other efforts to help the rural population. For example, HRSA’s Office of Rural Health Policy awards grants through the Flex Rural Veterans Health Access Program to provide mental health services and other services to veterans and other residents of rural areas.

The state of Montana with a very rural population received an award through the Flex program that now reaches out to more than 30,000 veterans in the most rural areas of the state to deliver high quality mental health services.

In addition, the Telehealth Network Grant Program funds projects that demonstrate the use of telehealth networks to improve healthcare services for underserved populations in urban, rural, and frontier populations.

High on the agenda are collaborative efforts to involve the federal agencies in a plan to move telehealth forward. To achieve this goal, the “FedTel: Cross-Federal Work Group on Telehealth” has been established to identify possible collaboration mechanisms and share lessons learned across multiple agencies. The agencies participating include NIH, HRSA, AHRQ, CDC, CMS, FDA, and IHS.

As Dr Wakefield noted, HRSA is proud of their Telehealth Resource Centers so that individuals are able to learn about new developments to help them achieve the most effective use of telehealth. This program is funded by HRSA’s Office for the Advancement of Telehealth and maintains eleven Regional TRCs and one Technology Assessment Center.

Other items on HRSA’s agenda include addressing the licensure portability issue. This year, HRSA posted an announcement soliciting applications for the Licensure Portability Grant Program (LPGP). The purpose of this grant program is to support State professional licensing boards to carry out programs so that licensing boards in various states can develop and implement state policies that will reduce statutory and regulatory barriers to telemedicine.

To sum up, Dr. Wakefield said, “To provide more effective and better quality healthcare, we have to go to a new place and to do this, we need to develop new technologies, new ways of thinking, and at the same time, maximize resources. Telehealth can lead the way by making the best and latest telehealth resources available to serve all Americans.”

Go to www.iom.edu/Activities/HumanServices?Telehealth/2012-AUG-08.aspx for more details on the meeting.

SAMHSA Awards $4 Million for HIT

 The Substance Abuse and Mental Health Services Administration (SAMHSA) administrator Pamela S. Hyde announced on August 6^th that more than $4 million was available in new grants for HIT services for communities across the nation.

The purpose of this program is to leverage technology to enhance and/or expand substance abuse treatment providers to serve people who traditionally have been underserved because of lack of access to treatment in their immediate community. This lack of access can be due to transportation concerns, an inadequate number of substance abuse treatment providers in communities, and/or because of financial constrains.

HIT to be used will include web-based services, smart phones, and behavioral health electronic applications (e-apps), will enable providers to communicate with patients in treatment and help physicians track and mange their patient’s health to ensure that treatment and services are available where and when needed.

The six awardees will receive up to $840,000 or the three year projects. Continuation of the awards is dependent on the availability of funds and progress achieved by the awardees. The following grants were awarded to Buffalo Valley, Inc—Hohenwald Tennessee ($840,000), Iowa Department of Public Health—Des Moines ($838,200), First Choice Services—Charleston West Virginia ($790,083), Forest County Potawatomi Community—Crandon Wisconsin ($840,000), Irene Stacy Community Mental Health Center—Butler Pennsylvania ($718,547), and Promesa Behavioral Health—Fresno California ($840,000).

$1 Billion Possible in Savings

A new study appearing in the August 2012 Health Affairs issue titled “Substantial Medicare Savings May Result if Insurers Cover Artificial Pancreas Sooner for Diabetes Patients” was co-authored by incoming Washington D.C. West Health Policy Center President Mike O’Grady former Assistant Secretary of HHS.

The article suggests that almost one billion dollars in cost savings would result after twenty five years from the use of the artificial pancreas which is a powerful new combination of an insulin pump and continuous glucose monitor developed to help patients more effectively control their diabetes.

Diabetes accounts for almost 42 percent of Medicare’s fee-for-service spending with kidney failure, heart attack, stroke, blindness, and amputation potential complications of the disease. Medicare expenses from diabetes are expected to almost quintuple to $171 billion by 2034 from 2009 annual expenditures of $45 billion.

A key to controlling diabetes is controlling glucose levels, which is very difficult, labor intensive, and costly. By combining an insulin pump and continuous glucose monitor with improved software controls working together as an artificial pancreas, diabetics can more effectively and continuously control their glucose levels.

The current study models the impact of the artificial pancreas on clinical results as costs over time, based on early results from clinical trials. Projected Medicare savings are $937 million in nominal dollars after twenty five years, the study notes.

The article co-authored by Priya John and Aaron Winn, was produced when O’Grady was Senior Fellow at NORC at the University of Chicago and Principal of O’Grady Health Policy. O’Grady joined the Washington D.C. based West Health Policy Center in August.

For more information, go to www.healthaffairs.org or www.westhealthpolicy.org.   

Grants to Improve Patient Care

Creating patient-centered models of primary care is a priority at UT Medicine San Antonio and the Health Science Center. Providing a medical home for patients is the recommended national model of care, as well as a major focus of healthcare reimbursement and policy reform.

Providing a medical home means that UT needs to improve access to care at the clinic. However, there can be many challenges and variables in scheduling residents and interns in the clinic. Some of the challenges revolve around how often residents and interns can be in the clinic since they must be scheduled for many different types of clinical experiences and responsibilities and then it may be difficult to determine how many patients they can see in a day.

Another concern is about the guidelines and expectations set for each type of residency program set nationally by the Accrediting Council for Graduate Medical Education. According to Luci Leykum M.D. of UTHSC San Antonio and lead researcher for several grants, “We have to adjust the schedule when residents have a scheduling conflict and we need to find someone else to work in their place. We also have to maintain a certain ratio of supervising faculty members to the residents.”

To work on challenges that are part of the complicated scheduling process in clinics and hospitals, UT Health Science Center in San Antonio awarded two grants for $560,000 to improve the quality of patient care. One grant for $280,000 will optimize the scheduling process for medical interns and resident in two primary care clinics where UT Medicine San Antonio provides care and clinical training.

The second grant also for $280,000 is designed to better organize and streamline hospital processes for patients who need surgery. Realizing that preparing a patient for surgery and post-operative care often involves coordination among several different kinds of physicians as well as nursing care and other services, a process needs to be developed to create individualized patient plans. This is important so that each patient will receive the right pre-operative imaging and tests, fill out the appropriate paperwork, see their specialists in the right order, and coordinate care and information among all providers.

The primary end goal is to build systems engineering tools to improve processes needed in specific areas, such as in two primary care clinics and the surgery department of the University Hospital. The tools will then be made available to other clinics within UT Medicine San Antonio and the Health Science Center community and to corresponding departments at other institutions within the UT System.

Grants to Fund ATAC

The Department of Labor’s Office of Disability Employment Policy (ODEP) on August 2, 2012 published a notice on www.grants.gov that makes $950,000 in grants available to fund a cooperative agreement to establish the Accessible Technology Action Center (ATAC). This new resource will promote the use of accessible information and communication technologies when employing individuals with disabilities.

One of the tasks to be carried by ATAC includes developing and maintaining a web portal with resources related to accessible technology in the workplace. The web portal needs to meet the needs of individuals with disabilities, private and public sector employers, IT professionals and developers. In addition, trainings and webinars on issues related to accessible technology in the workplace will need to be required.

Non-profits, public or private institutions of higher education, for-profit entities and small businesses or a consortium are eligible to apply. The closing date for applications is August 31, 2012.