Home Care Hospitalization: An Experiment with Promise

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November 11, 2016; Forbes

As the cost of healthcare, particularly in hospitals, continues to skyrocket, a few are exploring alternative methods of providing high quality care for lesser costs. One nonprofit in particular is reintroducing a method of care from decades ago: home visits from doctors.

When Dr. William Terry arrived at Boston’s Brigham and Women’s Hospital with violent chills and a high fever, emergency room staff determined he needed hospital care. Instead of being admitted, however, Dr. Terry became part of a study where he would receive the same care at home, including at least one home visit from his doctor plus two nurse visits every day.

The Brigham and Mass. General studies are limited to patients living within five miles from the hospital who present with heart failure, pneumonia, chronic obstructive pulmonary disease, or infections. (Terry’s chest x-ray showed a “suspicious spot.”) The study is focusing on these conditions because patients do not normally require intensive care or major procedures.

The preliminary results of the Brigham study were published in a recent issue of JAMA Internal Medicine. Patients were found to suffer from lower infection and readmission rates. The cost savings was an average of $2,000 per patient as compared to a hospital stay. More importantly, patients receiving care at home reported feeling happier. Perhaps that is not surprising, given hospitals’ reputations for awful food, harsh lighting, loss of privacy, snoring roommates disturbing sleep, and nurses on a schedule that works for the hospital system rather than the patient. The list goes on.

The study is part of a larger movement led by Hospital at Home, a program created by the Johns Hopkins School of Medicine and Public Health. Their research found the model lowered costs by almost a third and reduced complications of hospital stays. Surprisingly, the first study of these types of programs was conducted in 1997, leaving a supporter to describe the treatment plan as the “most studied innovation in health care.”

Although common in England, France, and Australia, in-home care is not widespread in the U.S., mainly because most insurance companies and Medicare do not cover it. Many of the treatment providers, such as Brigham and Women’s Hospital, are picking up program costs. New York City’s Mount Sinai Hospital is part of a $9.6 million, three-year similar study funded by the Centers for Medicare and Medicaid Services.

Overall, due to technology and revolutionary research, plus the emerging population health and wellness reimbursement structure of the Affordable Care Act, medical care is shifting. As research and technology has disrupted once-deadly diseases like HIV-AIDS and we continue to live longer and healthier, some are describing the hospital of the future as a “NASCAR pit-stop.”—Gayle Nelson

Original cite: https://nonprofitquarterly.org/2016/11/16/home-care-hospitalization-experiment-promise/

New England Sees 900% Increase in Organ Donations Tied to Opioid Epidemic

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October 14, 2016; NPR, “Shots”

This year, some hospitals in Massachusetts, like Lahey Hospital and Medical Center in Burlington, have dramatically increased the number of organ transplants they perform. The sources of these lifesaving gifts are the victims of the opioid epidemic. Although the increase in available organs represents hope for some and brings a small degree of comfort to the families of those lost to deaths from drug abuse, the wait continues for many more on the transplant list as well as families of addicts seeking services.

On June 30, 2015, Colin LePage found his thirty-year-old son, Chris, unresponsive after an apparent drug overdose. Over the next 24 hours, medical personnel from one of Boston’s largest medical centers revived Chris’s heart but struggled to stabilize his blood pressure and temperature. After two rounds of tests displayed no sign of brain activity, LePage listened to his son’s beating heart one last time before Chris was wheeled away. Although Chris died that day, his liver continues to function in a new body, that of a 62-year-old pastor.

The liver represents just part of the dramatic increase in New England organ donations since 2010, according to the New England Organ Bank, the organization responsible for gathering the organs in the six New England states. The expansion is due to the growing number of organ donors who fell victims to the growing epidemic of opioid abuse. Since the beginning of the year, more than one in four organ transplants in the New England area originated from people suffering a drug overdose. Nationwide, organs from deceased drug users accounted for 12 percent of all donations this year. Traffic accidents used to be the fourth-largest source of organ donation, behind deaths from strokes, blunt injuries, and cardiovascular disease, but drug overdoses, now the fastest growing category of organ donor, eclipsed them in 2014.

Before the epidemic took hold, organs from drug users were considered too risky for transplant. Drug users have long been associated with HIV, hepatitis C and other diseases. Although contraction from transplants is rare, tests have sometimes failed to detect infectious diseases, leading to donors contracting the diseases. (For example, in 2007, one donor transmitted both HIV and hepatitis C to four organ recipients.)

But as the shortage of organs continues to grow, the number of opioid overdose victims rises, and testing procedures improve, more people are receiving these donated organs. “We know now that the mortality rate of being on the waiting list for several years is higher than that of getting an organ with an infection that is treatable,” said Dr. Robert Veatch, a professor emeritus of medical ethics at Georgetown University, who has authored numerous articles on organ transplants. At the same time, recipients with HIV can receive organs from donors with HIV without additional risk. Earlier this year, surgeons from Johns Hopkins University Medical Center performed the first transplant of this kind.

“It’s an unexpected silver lining to what is otherwise a pretty horrendous situation,” said Alexandra K. Glazier, chief executive of the New England Organ Bank.—Gayle Nelson

Original cite: https://nonprofitquarterly.org/2016/10/26/new-englands-900-increase-organ-donation-tied-depth-opioid-epidemic/

When Public Parks Become a Civil Rights Issue

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September 29, 2016; The Atlantic

Public parks and recreational areas in urban regions often support activity and healthy living for low-income communities. In the past, these amenities were mostly suburban enhancements, but today’s city leaders realize their importance in encouraging more vital lifestyles for all residents. They can also lead to gentrification driving out the people they were designed to serve.

For three years in a row, Minneapolis has boasted the best parks system in the U.S. as judged by The Trust for Public Land, a forty-four-year-old nonprofit dedicated to protecting and creating public parks throughout the country. The city’s numerous parks are also the center of a bitter dispute with many residents of color, who allege the parks are primarily maintained and presented for the benefit of the metro area’s affluent white residents. As noted in The Atlantic article:

In America, bike trails and baseball fields are luxurious perks of many affluent neighborhoods, boosting property values and creating a sense of community. Meanwhile, in many inner cities, public parks are magnets for crime and casualties of disinvestment.

The battle is most evident at the Minneapolis Parks and Recreation Board’s regular meetings. The semi-autonomous agency, overseen by a nine-member elected commission and superintendent, is responsible for managing the City’s parks. Often, the meetings are disrupted by groups of young African American men carrying signs demanding the agency increase minority hiring and equalize park funding throughout the region. The protest is organized by Voices for Racial Justice and Community and other nonprofits. The park board is all white, while the city is only 66 percent white, compared to 87 percent in 1980. It has a history of funneling substantially more funding to parks in wealthier areas in southwest Minneapolis at the expense of northern areas where most of the city’s low-income minority residents live.

The protests led to Minneapolis being the first city-park system to prioritize capital spending to parks in low-income/large-minority communities and those in the worst condition. State leaders are also advocating for expanded funding to increase minority communities’ knowledge of regional parks. Millions of residents visit regional parks annually, but only three percent are minorities.

The disproportionate access of minority communities to parks and recreational areas is a national concern. Earlier this year, the U.S. Secretary of the Interior, Sally Jewell, recognized the country’s history of funding parks in areas where older, white Americans reside and the need to expand access to younger, more diverse residents.

In Chicago, city residents are celebrating the one-year anniversary of the 606 Trail. Eighty thousand residents live within ten minutes of the 2.7-mile trail, which was converted from an abandoned railroad track. Residents use it year-round for recreation as well as traveling to and from work. It has also sped up gentrification in surrounding communities. The real estate industry has marketed homes near the trail nationwide.

Compare the $95 million project to the Major Taylor, a similar project in Chicago’s low-income South Side communities. The Major Taylor trail is over twice as long, but without the lighting, snow removal, and other amenities of the 606 Trail, it has fewer users and property values surrounding the trail have not increased.—Gayle Nelson

Original cite: https://nonprofitquarterly.org/2016/10/11/public-parks-become-civil-rights-issue/

Is the Future of Higher Education a “Multi-Directional Swirl?”

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September 22, 2016; Inside Higher Ed

It’s no surprise that as the economy goes through a profound shift, driven partly by new uses of technology, higher education has come to an inflection point. But an article in Inside Higher Ed adds information that reemphasizes that the picture that’s emerging needs to be understood as a whole system and understood in a values framework. This, in other words, is a wicked problem.

The article points out that 35 percent of first-time college students were part of what a new report refers to as the “multidirectional transfer swirl,” transferring from one institution to another throughout their college careers. As the number of students who fail to graduate and become unable to pay back their college loans continues to grow, perhaps it is time to explore whether college is the best investment for all.

Last week, the Commission on the Future of Undergraduate Education, a program of the American Academy of Arts and Science, released a report titled, “A Primer on the College Student Journey.” The study, funded by the Carnegie Corporation of New York at a cost of $2.2 million, began with the author’s list of “Top Ten Takeaways” on the undergraduate experience. These included the continued troubling effect of a person’s race and class on their chances of graduating from college and the escalation in the number of students who enroll in remedial courses during their college experience.

In the report, the Commission explored the increased number of students attending college. Overall, 68 percent of millennial students enrolled in college months after graduation from high school and almost ninety percent began their college experience within eight years from graduation. While more are attending, a much smaller number are graduating. Only 40 percent of students entering a four-year institution actually graduated within four years. The figure only improved to 60 percent if the amount of time in school increased to six years. Of the students graduating, less than half (48 percent) attain their bachelor’s degree. Of the remaining graduating students, 26 percent earned their associates degree and 25 percent earned certificates.

The growth in both time attending and tuition has no doubt increased the amount of debt students carry upon graduation. While two-thirds of full-time students pay less than the full cost of tuition, the percentage of students with federal loans increased from around 50 percent to 60 percent between 2000 and 2012. The median loan balance of college graduates increased by almost 25 percent in that same period.

While students are graduating with higher amounts of debt, they are not the students with the greatest chance of defaulting on their loan obligations. Instead, students who fail to graduate and take on smaller amounts of debt are more likely to default. One-fifth of adults over 25 have attended college but did not attain a degree. Twenty-four percent of these students will eventually default on their loans.

Although 18- to 21-year-old dependent students working toward their bachelor’s degree are the stereotype, in 2013, almost a third of enrolled college students, or 5.5 million, were over the age of 25. (By 2014, according to the National Center for Educational Statistics, that number had risen to 41 percent, or 8.2 million.) Fifty-five percent of these students were enrolled part-time. Overall, 37 percent of all students study part-time.

As the amount of state funding of public colleges and universities continues to decrease, it is not surprising schools continue to look toward foreign students, who typically pay the full tuition price tag, to balance their budgets. The number of foreign students in U.S. colleges and universities has increased 67 percent since 2000. University of Michigan researchers found a ten percent decrease in state funding corresponded with a 12 percent increase in foreign student enrollment in public universities. China, Saudi Arabia, and South Korea sent the most foreign students to American universities.

The Commission expects the number of students graduating high school and attending college to remain flat at 3.3 million per year over the next decade to remain flat at 3.3 million over the next decade. Next summer, it plans on releasing a supplementary report exploring the future state of higher education.—Gayle Nelson