Brooklyn Health Needs Assessment In:
Listen and Share Your POV

Kings County Hospital Center opens Cancer Center, 2010. Credit: NYC Health and Hospitals Corporation

Tomorrow and Thursday, you have your chance to hear about a Brooklyn Health Needs Assessment that analyzed opinions from more than 700 North and Central Brooklyn residents on their healthcare. Many people involved in this process are dedicated to getting the public’s point of view on what is needed in hospital and healthcare across Brooklyn and building a rational healthcare system. Is it possible? Let’s hope so.

Lately, enormous Brooklyn pride has not extended to healthcare. In fact, nearly a year ago, the New York Times reported that, according to a group appointed by Governor Cuomo, “the NYS Health Commissioner should be given sweeping new powers to replace the executives and board members of private hospitals. ” A lot has transpired since then, including the closure of Downstate’s Mental Health Hospital, departures of some executives, and tales of patients languishing in hospitals for extended periods. Hospital mergers are uncertain. Whether the scope of the city’s public hospital inpatient and outpatient programs will remain intact, become privatized, or what, worries public health advocates. How much does poverty in Brooklyn stress the system?

Judy Wessler, who is with the Commission for the Public’s Health System, which goes by the byline, “putting the public back into the public health system,” sent out news of the meeting, urging people to learn and suggest ways to reconfigure Brooklyn health care.

Brooklyn Health Needs Assessment Results

will be presented at two meetings:

In Downtown Brooklyn and Bed-Stuy.

Wednesday, October,24, 2012, at Brooklyn Borough Hall, 209 Joralemon Street, between 4 and 6 pm. That’s tomorrow, as I post now.

Thursday, Oct. 25, 2012 at the Bed-Stuy YMCA, 1121 Bedford Ave., between 5 and 7 pm.

If you use tumblr, I talk about it there  too.

Have thoughts about changes that you’d like to see in Brooklyn? Share them here. Be sure to go to one of these meetings too.





Six Outrageous Threats to Labor and The Public’s Health


Chicago Teachers Union Rally, Labor Day, Daley Plaza, Chicago, Sept. 3, 2012 Credit: Bob Simpson.

When public policy undermines the public’s health, patient empowerment is not really on the table. Patients may be well informed, doctors may share unbiased, good information, but if public policy does not support public health, patient empowerment is just not there. Today, I take up Labor Day and six threats to labor and the public’s health:

  1. Governor Scott Walker’s attacks on collective bargaining.
  2. Privatizing of public programs, for example, Paul Ryan’s push to privatize public services, including Social Security and Medicare, privatizing hospitals, healthcare services, and prisons.
  3. Employers have unfair advantages in union organizing campaigns, including delaying union representation elections, terminating union organizers with impunity, and more.
  4. There is a perceptual problem that people feel that unions are irrelevant. This is a huge problem. Nonunion workers have significantly lower wages, fewer benefits, and no job security, compared to union members.
  5. The rise of unpaid internships with no benefits.
  6. Attempts to rollback of child labor protections – which fortunately,  have been rebuffed.

Voting this November can shut some of this down.

Patient Centeredness: Definitions Fuzzy,
Testing, Lawsuits Ahead #ECRI_FDA

Panel #2 –

Lawyers are going to have a field day with what is patient centeredness.

Jane Hyatt Thorpe, JD, Assoc. Research Prof.

ACA – Medicare – care individual/population, average.

IOM – patient centeredness refers to care – needs, desires of patient

another notion: patient experience.

right care, right patient every time — is this something that we can really provide?

Informed consent – case law — what do providers need to give pts. TeachBack type concept. What we are seeing – risks/benefits procedure. Drug use, volume – part. if influence outcomes. Financial disclosures – increasing requirements.

Advanced Directives – convey what their wishes are.

Provider liability – joint role. translate. liability, according to

Rights and responsibilities.

New delivery models – teams of care, focusing on empowering patients. HC law – a lot of policy variation.

Many openings for better definitions.

Michael Park, JD, Counsel, Alston and Bird

“the average patient”

20 quality measures in ACA – overlap with shared savings programs.

evidence towards individual.

Can we define better?

“Consent the patient” — grammar is important, words are important.

too much focus on getting the consent —

FDA only agency in country, no requirement that minorities. Diversity in clinical trials.

Hornbaugh? – Disability – we can’t have patients who can’t travel. should be accommodated. clinical trials


averages used in payment systems reconciling with indvidual in patient centeredness


Patient Centeredness in Policy & Practice:
Live from ECRI_FDA Meeting

Numerous challenges various entities are facing and building patient-centeredness.

Panel #1: Susan Dentzer, Health Affairs, Margaret Hamburg, FDA Commissioner, MD, Carolyn Clancy, MD, Director, AHRQ, Joe V. Selby, MD, MPH, Executive Director, PCORI

Hamburg: onslaught of HIV/AIDS epidemic in NYC brought patients full square at table, extend that model in cancer, but needs to be more broadly disseminated to rest of medicine. those instances worked.

We are here today bec. not working res, policy, etc.

Increase pt. empowerment- have ability to bolster research environment.

Clancy: HIV Practice Network – how effective txs are and get to people who  need them. National Minority – NIH – health literacy tools, education.

Disparities worsening. How to change on the care side in heart failure.

Clancy: Disparities report very informative. Need to customize for different ethnic groups, SES.

Selby: If not careful, can have systemwide intervention that can widen disparities. Race/ethnicity crude.

Hamburg: behind in science and math education. makes it tough for patients to grasp risk.

New Zealand/Australian woman, Harkness Fellow for Commonwealth Fund: commends mtg. first time in US where patients in title of conference. how will you engage with patients?

Patient Advisory Councils/ patient safety –  in healthcare and research. Clancy: how do we find common ground. Pts. see evidence differently.

Hamburg: FDA: Engage pts. on advisory committees, product review. reaching out to critical. Pt. centered drug stuff likely to expand.

Belzer: elevating minority health issues to institute status at NIH. Stop excluding patients from team. still don’t sufficiently. Mission enlarged and deepened by ACA. Bring patients in, not just consumers.

HHS has strategic plan re disparities.

Flexible trial design, out of academic medical center into community.



What’s the Patient Got to Do with It?

Here we are discussing the prostate cancer screening guidelines, but what bothers me is that the patient is brought in as a footnote at the end of the analysis. I find it really dispiriting that there is so much lip service to “patient-centered” medical homes, outcomes research, and more, yet the patients are on the periphery of the discussion. Heck, we are an industry now, except it is all from the outside looking in!

Maybe, before academics, policy wonks, and patient engagement companies hole up and review the evidence on important issues affecting you and me, they ought to open the general topic for public commenting and questioning that is out there for everyone to see.

I know what you are thinking –and of course, it has occurred to me too: I am talking chaos. Well, perhaps…but…maybe we must do better. What if we had more feedback loops where patients and the public enter into real-time discussions at the front end, when priorities are being set, where care is being given?

In some parts of the world, medical technology assessment discussions bring patients in from the start before decisions are made on whether or not to cover specific items. What about webcasts available on demand where the logic of evidence reviews is easy to find? What about more Q&As bringing patients in? Maybe the questions asked would shift if patients participated as real partners. Maybe the answers would be more understandable.

We need more of this in the US. Without it, we perpetuate distrust, anger, and a mockery of the science.