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Most Adverse Events at Hospitals Still Go Unreported
Nearly 13 years after the release of the Institute of Medicine’s landmark report To Err Is Human, which called national attention to the rate of preventable errors in U.S. hospitals and galvanized the patient-safety movement, 6 out of every 7 hospital-based errors, accidents, and other adverse events still go unreported.
That’s the troubling conclusion of a report released in January by the Department of Health and Human Services’ Office of the Inspector General (OIG). According to the OIG, the report the National Incident Study on Adverse Events in Hospitals Among Medicare Beneficiaries, is the first truly national adverse-event study in the nation documenting hospital-based adverse events among Medicare beneficiaries.1
Previous studies assessing errors and adverse events had tracked the number of events reported, but they had no denominator; in other words, one hospital might have 1,000 reports of adverse events and errors in a given month, while another might have 50, but there was no way to know how many adverse events had been missed and how much harm had actually occurred.
The OIG study dug deeper, conducting in-depth, yearlong reviews led by independent physicians to first identify the rates of harm, then returning to the hospitals in the study where they knew harm had occurred to find out if it had been reported or not.
Overall, the inspector general estimated that more than 130,000 Medicare beneficiaries experienced one or more adverse events in hospitals in a single month. Perhaps one of the most surprising findings was that even some of the most serious, egregious adverse events were not reported. Of the 12 deaths in the sample that were iatrogenic, only two were reported as errors. More serious errors were no more likely to be captured as errors than mild reactions, such as breaking out in hives as the result of a medication.
Why aren’t more hospital-based errors and adverse events being reported, and how can this situation be changed? The OIG’s report provides some insight into the underlying problem: The dominant reason that events weren’t reported was that they weren’t perceived as adverse events. (Not all adverse events are medical errors: A medical error is a preventable adverse event.) A urinary catheter infection, while not necessarily a medical error, is always an adverse event—and yet, only one of the 17 urinary catheter infections identified by doctors in medical review was reported.
Lack of recognition—seeing adverse events and errors as just part of routine care—is only one part of the problem, says Rosemary Gibson, MSc, a former senior program officer at the Robert Wood Johnson Foundation and author of “The Treatment Trap” and “Wall of Silence.” Other issues include:
- Fear of retribution. “You have to feel safe to report someone else’s error, or your own,” Gibson says. “Most hospitals have yet to create a safety culture.”
- A sense of disbelief. “I remember talking to a hospital CEO once right after the IOM report,” Gibson recalls. “He said that after a significant error, he would get up in the morning and look in the mirror and think, ‘Did this really happen here?’ There’s almost a sense that if you don’t see it, it didn’t exist.”
- Competing pressures. “The requirements of healthcare reform have taken up so much time and energy that I fear safety has moved to the back burner,” Gibson says. “Someone in a quality and safety leadership role at one hospital said to me, ‘Safety was just a fad. We’re not doing that anymore.’”
- Productivity demands. “Healthcare’s mantra today has become volume, volume, volume. If you already have an environment that’s not as safe as we would like, and you ramp up the volume so people have to do more in the name of productivity, what’s going to happen?” asks Gibson.
The Hospitalist Perspective
Greg Maynard, MD, SFHM, director of the University of California San Diego Center for Innovation and Improvement Science (CIIS) and senior vice president of SHM’s Center for Healthcare Improvement and Innovation, says hospitalists face multiple barriers to regular reporting. Some errors, he says, are so pervasive that they are “considered routine” and “happen all the time.”
“Hypoglycemic events, for example, don’t always get entered into adverse-event reporting systems because they’re so common,” he explains, “even though you should be entering and examining them all.”
—Dan Budnitz, MD, MPH, director, Medication Safety Program, Centers for Disease Control and Prevention
Improper coding is another hospitalist-centric issue. Since Oct. 1, 2008, the Centers for Medicare & Medicaid Services (CMS) has reduced payment for acute-care inpatient cases when designated hospital-acquired conditions are not present on admission and the condition would have increased the reimbursement.
“CMS went to a lot of trouble to implement codes that could help them identify, in the coding process, patients who had an iatrogenic event,” Dr. Maynard says. “But those codes simply aren’t being used properly, and administrative coding is always a problem with regard to accuracy.”
Hospitalists can be particularly vulnerable to errors due to the nature of their work—multiple tasks, multiple team members, multiple interruptions. “[Hospitalists] are prone to the type of errors that are related to the hectic nature of being a doctor and an air traffic controller at the same time,” Dr. Maynard says. “You’re in the middle of admitting someone and get two urgent calls on two other patients, so you have to switch out of what you’re doing on that patient, issue orders on the other two, and immediately switch back. It’s hard to keep your focus when dealing with many complex patients, many of whom you’re seeing for the first time, and try to remember all the things you should not omit.”
One area that has, in recent years, become more important to hospitalists in terms of error prevention—and reporting—is discharge planning.
“When you’re sending your patient out of the hospital, they may have started on new medications or changed medications while an inpatient,” says Dan Budnitz, MD, MPH, director of the Medication Safety Program at the Centers for Disease Control and Prevention. “A recent report in the New England Journal of Medicine looked at drug-only causes of emergency hospitalizations, and the most common drugs involved are blood thinners, insulin, and some diabetes pills. The implication for the hospitalist is clear: If you start a patient on these medications in the hospital, or change them, you need to pay particular attention, because they’re two of the top drugs that may put your patient back in the hospital.”
National Models
One institution that is far ahead of the curve in error reporting is the University of Michigan Health System. In 2001, just two years after To Err is Human was published, the health system adopted a process of full disclosure of medical errors. The process involves multiple components, including an online incident reporting system, a multidisciplinary claims review committee, open and honest communication with patients and families, and quality-improvement (QI) initiatives guided by reported errors.
“They’ll get 7,000 or 8,000 reports a year from staff,” Gibson says. “That’s what you want. Most of them are minor or near-misses, and you want to know about those so you can learn from them and prevent the larger errors. But you have to create a space where it’s safe for people to report.”
She says that hospitals must adhere to the principle of “just culture” in error reporting, a philosophy that recognizes that even competent professionals make mistakes. Quality-improvement leader and Harvard School of Public Health professor Lucian Leape, MD, has said that the biggest impediment to error reporting and prevention in medicine is “that we punish people for making mistakes.”2
“If I made a mistake and anybody else in my position could have made that same mistake, the chances are the system contributed to my making that mistake, and just culture would suggest I shouldn’t bear all the blame for it,” Gibson says. “That’s different from a case in which I did something that was truly negligent. Hospitals often do not make this distinction, and [they] lack a just culture.”
—Greg Maynard, MD, SFHM, director, University of California San Diego Center for Innovation and Improvement Science, senior vice president, SHM’s Center for Healthcare Improvement and Innovation
Traditional reporting systems in healthcare, however, often do not support a just-culture model or a true patient-safety-focused approach, says Brian Nussenbaum, MD, associate professor of otolaryngology and head and neck surgery at Washington University School of Medicine in Seattle. “Paper or online reports are sent to hospital risk management departments, whose concerns are primarily to limit the potential legal risk,” he says. “There is little emphasis on systems improvement or prevention. Dissemination of incidents to others in the organization is unusual, and the impact on clinical care is often not felt by providers.”
Who should be reporting errors? The responsibility ideally lies with everyone involved in patient care, Dr. Nussenbaum says. In practice, physicians are more likely to report events that caused permanent harm or the death or near-death of a patient, but overall, they report only 1% of adverse events.3 Nurses, on the other hand, are more likely to report events that cause no harm or harm that’s only temporary, and report about 45% of events. Residents, in the same study, reported only a little more than half of adverse events to attending physicians.
“Nurses and pharmacists have a lot more training in how to fill out the voluntary reporting,” Dr. Maynard says. “Nurses and pharmacists report the overwhelming majority of adverse events and errors. I think physicians need to take some responsibility for ensuring that errors are reported into the voluntary reporting system. When I get called about something that happens on one of my patients, or detect it, I don’t necessarily enter it myself, but I will specify with whoever is calling me that it should be reported.”
Society Initiatives
SHM has taken an aggressive stance that is more focused on improving quality and safety than that of most professional organizations, according to Dr. Maynard. “We feel that the best way to build hospitalists in their careers is to increase their value by helping them take care of patients and being part of the solution to these problems,” he says. “We have quality and safety modules for learning about error and medical harm and ways to prevent it.”
SHM’s website (www.hospitalmedicine.org)
features resources and tools for DVT prevention, glycemic control, and anticoagulation—all well-known areas for medical errors. “We’re about ready to embark on putting together an adverse-drug-events module, and Project BOOST [Better Outcomes for Older Adults through Safe Transitions] provides materials to help optimize transitions of care,” Dr. Maynard says. “We want to build this into the daily fabric of the hospitalist’s career.”
At the CDC’s medication safety program, Dr. Budnitz says, his focus is less on error reporting and more on tracking backward to see what could have been the cause of harm to a patient—error or not.
“Sometimes, medication-induced harms are caused by things that we classically think of as errors, and sometimes they are not,” he says. “Error reporting is important, but sometimes things don’t fit neatly into the ‘healthcare error’ box—like when a patient misses a follow-up appointment to get their blood thinner level checked, and [the] patient has an unintended bleeding event.”
—Rosemary Gibson, MSc, author, former senior program officer, Robert Wood Johnson Foundation
Gibson believes that what’s needed is a public system for the reporting of adverse events in hospitals—like a Consumer Product Safety Commission for healthcare.
“If your child gets injured by a defective crib, there’s a system for you to report that,” she says. “We need that for hospitals. There should be an open capability for reporting events online, in person, any way you want, whether you’re on the hospital staff, a patient, or a family member. Such a system should acknowledge the report, provide for an immediate action step in urgent situations, and offer assistance and support to the person doing the reporting.”
But overall, the response in the healthcare industry to the OIG’s report has been “we need to do more research,” Gibson notes. “We don’t need more research; we need to apply what is known. There are institutions that have made pockets of progress, and patients are alive today and home with their families because we’ve made care safer, but safety still hasn’t become a system property in healthcare.”
Gina Shaw is a freelance writer in New York City.
References
- Levinson DR. Adverse events in hospitals: national incidence among Medicare beneficiaries. U.S. Department of Health and Human Services’ Office of Inspector General website. Available at: http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf. Accessed May 31, 2012.
- Leape LL. Testimony, United States Congress, House Committee on Veterans’ Affairs; Oct. 12, 1997.
- Rowin EJ. Does error and adverse event reporting by physicians and nurses differ? Jt Comm J Qual Patient Saf. 2008;34(9):537-545.
Nearly 13 years after the release of the Institute of Medicine’s landmark report To Err Is Human, which called national attention to the rate of preventable errors in U.S. hospitals and galvanized the patient-safety movement, 6 out of every 7 hospital-based errors, accidents, and other adverse events still go unreported.
That’s the troubling conclusion of a report released in January by the Department of Health and Human Services’ Office of the Inspector General (OIG). According to the OIG, the report the National Incident Study on Adverse Events in Hospitals Among Medicare Beneficiaries, is the first truly national adverse-event study in the nation documenting hospital-based adverse events among Medicare beneficiaries.1
Previous studies assessing errors and adverse events had tracked the number of events reported, but they had no denominator; in other words, one hospital might have 1,000 reports of adverse events and errors in a given month, while another might have 50, but there was no way to know how many adverse events had been missed and how much harm had actually occurred.
The OIG study dug deeper, conducting in-depth, yearlong reviews led by independent physicians to first identify the rates of harm, then returning to the hospitals in the study where they knew harm had occurred to find out if it had been reported or not.
Overall, the inspector general estimated that more than 130,000 Medicare beneficiaries experienced one or more adverse events in hospitals in a single month. Perhaps one of the most surprising findings was that even some of the most serious, egregious adverse events were not reported. Of the 12 deaths in the sample that were iatrogenic, only two were reported as errors. More serious errors were no more likely to be captured as errors than mild reactions, such as breaking out in hives as the result of a medication.
Why aren’t more hospital-based errors and adverse events being reported, and how can this situation be changed? The OIG’s report provides some insight into the underlying problem: The dominant reason that events weren’t reported was that they weren’t perceived as adverse events. (Not all adverse events are medical errors: A medical error is a preventable adverse event.) A urinary catheter infection, while not necessarily a medical error, is always an adverse event—and yet, only one of the 17 urinary catheter infections identified by doctors in medical review was reported.
Lack of recognition—seeing adverse events and errors as just part of routine care—is only one part of the problem, says Rosemary Gibson, MSc, a former senior program officer at the Robert Wood Johnson Foundation and author of “The Treatment Trap” and “Wall of Silence.” Other issues include:
- Fear of retribution. “You have to feel safe to report someone else’s error, or your own,” Gibson says. “Most hospitals have yet to create a safety culture.”
- A sense of disbelief. “I remember talking to a hospital CEO once right after the IOM report,” Gibson recalls. “He said that after a significant error, he would get up in the morning and look in the mirror and think, ‘Did this really happen here?’ There’s almost a sense that if you don’t see it, it didn’t exist.”
- Competing pressures. “The requirements of healthcare reform have taken up so much time and energy that I fear safety has moved to the back burner,” Gibson says. “Someone in a quality and safety leadership role at one hospital said to me, ‘Safety was just a fad. We’re not doing that anymore.’”
- Productivity demands. “Healthcare’s mantra today has become volume, volume, volume. If you already have an environment that’s not as safe as we would like, and you ramp up the volume so people have to do more in the name of productivity, what’s going to happen?” asks Gibson.
The Hospitalist Perspective
Greg Maynard, MD, SFHM, director of the University of California San Diego Center for Innovation and Improvement Science (CIIS) and senior vice president of SHM’s Center for Healthcare Improvement and Innovation, says hospitalists face multiple barriers to regular reporting. Some errors, he says, are so pervasive that they are “considered routine” and “happen all the time.”
“Hypoglycemic events, for example, don’t always get entered into adverse-event reporting systems because they’re so common,” he explains, “even though you should be entering and examining them all.”
—Dan Budnitz, MD, MPH, director, Medication Safety Program, Centers for Disease Control and Prevention
Improper coding is another hospitalist-centric issue. Since Oct. 1, 2008, the Centers for Medicare & Medicaid Services (CMS) has reduced payment for acute-care inpatient cases when designated hospital-acquired conditions are not present on admission and the condition would have increased the reimbursement.
“CMS went to a lot of trouble to implement codes that could help them identify, in the coding process, patients who had an iatrogenic event,” Dr. Maynard says. “But those codes simply aren’t being used properly, and administrative coding is always a problem with regard to accuracy.”
Hospitalists can be particularly vulnerable to errors due to the nature of their work—multiple tasks, multiple team members, multiple interruptions. “[Hospitalists] are prone to the type of errors that are related to the hectic nature of being a doctor and an air traffic controller at the same time,” Dr. Maynard says. “You’re in the middle of admitting someone and get two urgent calls on two other patients, so you have to switch out of what you’re doing on that patient, issue orders on the other two, and immediately switch back. It’s hard to keep your focus when dealing with many complex patients, many of whom you’re seeing for the first time, and try to remember all the things you should not omit.”
One area that has, in recent years, become more important to hospitalists in terms of error prevention—and reporting—is discharge planning.
“When you’re sending your patient out of the hospital, they may have started on new medications or changed medications while an inpatient,” says Dan Budnitz, MD, MPH, director of the Medication Safety Program at the Centers for Disease Control and Prevention. “A recent report in the New England Journal of Medicine looked at drug-only causes of emergency hospitalizations, and the most common drugs involved are blood thinners, insulin, and some diabetes pills. The implication for the hospitalist is clear: If you start a patient on these medications in the hospital, or change them, you need to pay particular attention, because they’re two of the top drugs that may put your patient back in the hospital.”
National Models
One institution that is far ahead of the curve in error reporting is the University of Michigan Health System. In 2001, just two years after To Err is Human was published, the health system adopted a process of full disclosure of medical errors. The process involves multiple components, including an online incident reporting system, a multidisciplinary claims review committee, open and honest communication with patients and families, and quality-improvement (QI) initiatives guided by reported errors.
“They’ll get 7,000 or 8,000 reports a year from staff,” Gibson says. “That’s what you want. Most of them are minor or near-misses, and you want to know about those so you can learn from them and prevent the larger errors. But you have to create a space where it’s safe for people to report.”
She says that hospitals must adhere to the principle of “just culture” in error reporting, a philosophy that recognizes that even competent professionals make mistakes. Quality-improvement leader and Harvard School of Public Health professor Lucian Leape, MD, has said that the biggest impediment to error reporting and prevention in medicine is “that we punish people for making mistakes.”2
“If I made a mistake and anybody else in my position could have made that same mistake, the chances are the system contributed to my making that mistake, and just culture would suggest I shouldn’t bear all the blame for it,” Gibson says. “That’s different from a case in which I did something that was truly negligent. Hospitals often do not make this distinction, and [they] lack a just culture.”
—Greg Maynard, MD, SFHM, director, University of California San Diego Center for Innovation and Improvement Science, senior vice president, SHM’s Center for Healthcare Improvement and Innovation
Traditional reporting systems in healthcare, however, often do not support a just-culture model or a true patient-safety-focused approach, says Brian Nussenbaum, MD, associate professor of otolaryngology and head and neck surgery at Washington University School of Medicine in Seattle. “Paper or online reports are sent to hospital risk management departments, whose concerns are primarily to limit the potential legal risk,” he says. “There is little emphasis on systems improvement or prevention. Dissemination of incidents to others in the organization is unusual, and the impact on clinical care is often not felt by providers.”
Who should be reporting errors? The responsibility ideally lies with everyone involved in patient care, Dr. Nussenbaum says. In practice, physicians are more likely to report events that caused permanent harm or the death or near-death of a patient, but overall, they report only 1% of adverse events.3 Nurses, on the other hand, are more likely to report events that cause no harm or harm that’s only temporary, and report about 45% of events. Residents, in the same study, reported only a little more than half of adverse events to attending physicians.
“Nurses and pharmacists have a lot more training in how to fill out the voluntary reporting,” Dr. Maynard says. “Nurses and pharmacists report the overwhelming majority of adverse events and errors. I think physicians need to take some responsibility for ensuring that errors are reported into the voluntary reporting system. When I get called about something that happens on one of my patients, or detect it, I don’t necessarily enter it myself, but I will specify with whoever is calling me that it should be reported.”
Society Initiatives
SHM has taken an aggressive stance that is more focused on improving quality and safety than that of most professional organizations, according to Dr. Maynard. “We feel that the best way to build hospitalists in their careers is to increase their value by helping them take care of patients and being part of the solution to these problems,” he says. “We have quality and safety modules for learning about error and medical harm and ways to prevent it.”
SHM’s website (www.hospitalmedicine.org)
features resources and tools for DVT prevention, glycemic control, and anticoagulation—all well-known areas for medical errors. “We’re about ready to embark on putting together an adverse-drug-events module, and Project BOOST [Better Outcomes for Older Adults through Safe Transitions] provides materials to help optimize transitions of care,” Dr. Maynard says. “We want to build this into the daily fabric of the hospitalist’s career.”
At the CDC’s medication safety program, Dr. Budnitz says, his focus is less on error reporting and more on tracking backward to see what could have been the cause of harm to a patient—error or not.
“Sometimes, medication-induced harms are caused by things that we classically think of as errors, and sometimes they are not,” he says. “Error reporting is important, but sometimes things don’t fit neatly into the ‘healthcare error’ box—like when a patient misses a follow-up appointment to get their blood thinner level checked, and [the] patient has an unintended bleeding event.”
—Rosemary Gibson, MSc, author, former senior program officer, Robert Wood Johnson Foundation
Gibson believes that what’s needed is a public system for the reporting of adverse events in hospitals—like a Consumer Product Safety Commission for healthcare.
“If your child gets injured by a defective crib, there’s a system for you to report that,” she says. “We need that for hospitals. There should be an open capability for reporting events online, in person, any way you want, whether you’re on the hospital staff, a patient, or a family member. Such a system should acknowledge the report, provide for an immediate action step in urgent situations, and offer assistance and support to the person doing the reporting.”
But overall, the response in the healthcare industry to the OIG’s report has been “we need to do more research,” Gibson notes. “We don’t need more research; we need to apply what is known. There are institutions that have made pockets of progress, and patients are alive today and home with their families because we’ve made care safer, but safety still hasn’t become a system property in healthcare.”
Gina Shaw is a freelance writer in New York City.
References
- Levinson DR. Adverse events in hospitals: national incidence among Medicare beneficiaries. U.S. Department of Health and Human Services’ Office of Inspector General website. Available at: http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf. Accessed May 31, 2012.
- Leape LL. Testimony, United States Congress, House Committee on Veterans’ Affairs; Oct. 12, 1997.
- Rowin EJ. Does error and adverse event reporting by physicians and nurses differ? Jt Comm J Qual Patient Saf. 2008;34(9):537-545.
Nearly 13 years after the release of the Institute of Medicine’s landmark report To Err Is Human, which called national attention to the rate of preventable errors in U.S. hospitals and galvanized the patient-safety movement, 6 out of every 7 hospital-based errors, accidents, and other adverse events still go unreported.
That’s the troubling conclusion of a report released in January by the Department of Health and Human Services’ Office of the Inspector General (OIG). According to the OIG, the report the National Incident Study on Adverse Events in Hospitals Among Medicare Beneficiaries, is the first truly national adverse-event study in the nation documenting hospital-based adverse events among Medicare beneficiaries.1
Previous studies assessing errors and adverse events had tracked the number of events reported, but they had no denominator; in other words, one hospital might have 1,000 reports of adverse events and errors in a given month, while another might have 50, but there was no way to know how many adverse events had been missed and how much harm had actually occurred.
The OIG study dug deeper, conducting in-depth, yearlong reviews led by independent physicians to first identify the rates of harm, then returning to the hospitals in the study where they knew harm had occurred to find out if it had been reported or not.
Overall, the inspector general estimated that more than 130,000 Medicare beneficiaries experienced one or more adverse events in hospitals in a single month. Perhaps one of the most surprising findings was that even some of the most serious, egregious adverse events were not reported. Of the 12 deaths in the sample that were iatrogenic, only two were reported as errors. More serious errors were no more likely to be captured as errors than mild reactions, such as breaking out in hives as the result of a medication.
Why aren’t more hospital-based errors and adverse events being reported, and how can this situation be changed? The OIG’s report provides some insight into the underlying problem: The dominant reason that events weren’t reported was that they weren’t perceived as adverse events. (Not all adverse events are medical errors: A medical error is a preventable adverse event.) A urinary catheter infection, while not necessarily a medical error, is always an adverse event—and yet, only one of the 17 urinary catheter infections identified by doctors in medical review was reported.
Lack of recognition—seeing adverse events and errors as just part of routine care—is only one part of the problem, says Rosemary Gibson, MSc, a former senior program officer at the Robert Wood Johnson Foundation and author of “The Treatment Trap” and “Wall of Silence.” Other issues include:
- Fear of retribution. “You have to feel safe to report someone else’s error, or your own,” Gibson says. “Most hospitals have yet to create a safety culture.”
- A sense of disbelief. “I remember talking to a hospital CEO once right after the IOM report,” Gibson recalls. “He said that after a significant error, he would get up in the morning and look in the mirror and think, ‘Did this really happen here?’ There’s almost a sense that if you don’t see it, it didn’t exist.”
- Competing pressures. “The requirements of healthcare reform have taken up so much time and energy that I fear safety has moved to the back burner,” Gibson says. “Someone in a quality and safety leadership role at one hospital said to me, ‘Safety was just a fad. We’re not doing that anymore.’”
- Productivity demands. “Healthcare’s mantra today has become volume, volume, volume. If you already have an environment that’s not as safe as we would like, and you ramp up the volume so people have to do more in the name of productivity, what’s going to happen?” asks Gibson.
The Hospitalist Perspective
Greg Maynard, MD, SFHM, director of the University of California San Diego Center for Innovation and Improvement Science (CIIS) and senior vice president of SHM’s Center for Healthcare Improvement and Innovation, says hospitalists face multiple barriers to regular reporting. Some errors, he says, are so pervasive that they are “considered routine” and “happen all the time.”
“Hypoglycemic events, for example, don’t always get entered into adverse-event reporting systems because they’re so common,” he explains, “even though you should be entering and examining them all.”
—Dan Budnitz, MD, MPH, director, Medication Safety Program, Centers for Disease Control and Prevention
Improper coding is another hospitalist-centric issue. Since Oct. 1, 2008, the Centers for Medicare & Medicaid Services (CMS) has reduced payment for acute-care inpatient cases when designated hospital-acquired conditions are not present on admission and the condition would have increased the reimbursement.
“CMS went to a lot of trouble to implement codes that could help them identify, in the coding process, patients who had an iatrogenic event,” Dr. Maynard says. “But those codes simply aren’t being used properly, and administrative coding is always a problem with regard to accuracy.”
Hospitalists can be particularly vulnerable to errors due to the nature of their work—multiple tasks, multiple team members, multiple interruptions. “[Hospitalists] are prone to the type of errors that are related to the hectic nature of being a doctor and an air traffic controller at the same time,” Dr. Maynard says. “You’re in the middle of admitting someone and get two urgent calls on two other patients, so you have to switch out of what you’re doing on that patient, issue orders on the other two, and immediately switch back. It’s hard to keep your focus when dealing with many complex patients, many of whom you’re seeing for the first time, and try to remember all the things you should not omit.”
One area that has, in recent years, become more important to hospitalists in terms of error prevention—and reporting—is discharge planning.
“When you’re sending your patient out of the hospital, they may have started on new medications or changed medications while an inpatient,” says Dan Budnitz, MD, MPH, director of the Medication Safety Program at the Centers for Disease Control and Prevention. “A recent report in the New England Journal of Medicine looked at drug-only causes of emergency hospitalizations, and the most common drugs involved are blood thinners, insulin, and some diabetes pills. The implication for the hospitalist is clear: If you start a patient on these medications in the hospital, or change them, you need to pay particular attention, because they’re two of the top drugs that may put your patient back in the hospital.”
National Models
One institution that is far ahead of the curve in error reporting is the University of Michigan Health System. In 2001, just two years after To Err is Human was published, the health system adopted a process of full disclosure of medical errors. The process involves multiple components, including an online incident reporting system, a multidisciplinary claims review committee, open and honest communication with patients and families, and quality-improvement (QI) initiatives guided by reported errors.
“They’ll get 7,000 or 8,000 reports a year from staff,” Gibson says. “That’s what you want. Most of them are minor or near-misses, and you want to know about those so you can learn from them and prevent the larger errors. But you have to create a space where it’s safe for people to report.”
She says that hospitals must adhere to the principle of “just culture” in error reporting, a philosophy that recognizes that even competent professionals make mistakes. Quality-improvement leader and Harvard School of Public Health professor Lucian Leape, MD, has said that the biggest impediment to error reporting and prevention in medicine is “that we punish people for making mistakes.”2
“If I made a mistake and anybody else in my position could have made that same mistake, the chances are the system contributed to my making that mistake, and just culture would suggest I shouldn’t bear all the blame for it,” Gibson says. “That’s different from a case in which I did something that was truly negligent. Hospitals often do not make this distinction, and [they] lack a just culture.”
—Greg Maynard, MD, SFHM, director, University of California San Diego Center for Innovation and Improvement Science, senior vice president, SHM’s Center for Healthcare Improvement and Innovation
Traditional reporting systems in healthcare, however, often do not support a just-culture model or a true patient-safety-focused approach, says Brian Nussenbaum, MD, associate professor of otolaryngology and head and neck surgery at Washington University School of Medicine in Seattle. “Paper or online reports are sent to hospital risk management departments, whose concerns are primarily to limit the potential legal risk,” he says. “There is little emphasis on systems improvement or prevention. Dissemination of incidents to others in the organization is unusual, and the impact on clinical care is often not felt by providers.”
Who should be reporting errors? The responsibility ideally lies with everyone involved in patient care, Dr. Nussenbaum says. In practice, physicians are more likely to report events that caused permanent harm or the death or near-death of a patient, but overall, they report only 1% of adverse events.3 Nurses, on the other hand, are more likely to report events that cause no harm or harm that’s only temporary, and report about 45% of events. Residents, in the same study, reported only a little more than half of adverse events to attending physicians.
“Nurses and pharmacists have a lot more training in how to fill out the voluntary reporting,” Dr. Maynard says. “Nurses and pharmacists report the overwhelming majority of adverse events and errors. I think physicians need to take some responsibility for ensuring that errors are reported into the voluntary reporting system. When I get called about something that happens on one of my patients, or detect it, I don’t necessarily enter it myself, but I will specify with whoever is calling me that it should be reported.”
Society Initiatives
SHM has taken an aggressive stance that is more focused on improving quality and safety than that of most professional organizations, according to Dr. Maynard. “We feel that the best way to build hospitalists in their careers is to increase their value by helping them take care of patients and being part of the solution to these problems,” he says. “We have quality and safety modules for learning about error and medical harm and ways to prevent it.”
SHM’s website (www.hospitalmedicine.org)
features resources and tools for DVT prevention, glycemic control, and anticoagulation—all well-known areas for medical errors. “We’re about ready to embark on putting together an adverse-drug-events module, and Project BOOST [Better Outcomes for Older Adults through Safe Transitions] provides materials to help optimize transitions of care,” Dr. Maynard says. “We want to build this into the daily fabric of the hospitalist’s career.”
At the CDC’s medication safety program, Dr. Budnitz says, his focus is less on error reporting and more on tracking backward to see what could have been the cause of harm to a patient—error or not.
“Sometimes, medication-induced harms are caused by things that we classically think of as errors, and sometimes they are not,” he says. “Error reporting is important, but sometimes things don’t fit neatly into the ‘healthcare error’ box—like when a patient misses a follow-up appointment to get their blood thinner level checked, and [the] patient has an unintended bleeding event.”
—Rosemary Gibson, MSc, author, former senior program officer, Robert Wood Johnson Foundation
Gibson believes that what’s needed is a public system for the reporting of adverse events in hospitals—like a Consumer Product Safety Commission for healthcare.
“If your child gets injured by a defective crib, there’s a system for you to report that,” she says. “We need that for hospitals. There should be an open capability for reporting events online, in person, any way you want, whether you’re on the hospital staff, a patient, or a family member. Such a system should acknowledge the report, provide for an immediate action step in urgent situations, and offer assistance and support to the person doing the reporting.”
But overall, the response in the healthcare industry to the OIG’s report has been “we need to do more research,” Gibson notes. “We don’t need more research; we need to apply what is known. There are institutions that have made pockets of progress, and patients are alive today and home with their families because we’ve made care safer, but safety still hasn’t become a system property in healthcare.”
Gina Shaw is a freelance writer in New York City.
References
- Levinson DR. Adverse events in hospitals: national incidence among Medicare beneficiaries. U.S. Department of Health and Human Services’ Office of Inspector General website. Available at: http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf. Accessed May 31, 2012.
- Leape LL. Testimony, United States Congress, House Committee on Veterans’ Affairs; Oct. 12, 1997.
- Rowin EJ. Does error and adverse event reporting by physicians and nurses differ? Jt Comm J Qual Patient Saf. 2008;34(9):537-545.
Counseling Helps Women At Risk for Ovarian Cancer Take Action
NEW YORK — Enhanced counseling can help women at high risk of ovarian cancer make better use of the information they receive from genetic testing for BRCA1 and BRCA2 mutations, according to a study presented in poster form at a cancer symposium sponsored by New York University.
The few studies that have examined the effects of genetic testing on decision making have found that a significant proportion of eligible women don't take any action after learning their genetic status, according to Suzanne Miller, Ph.D., of Fox Chase Cancer Center in Philadelphia, and her associates.
The investigators randomized approximately half of the study's 80 women who were at high risk for ovarian cancer based on family history to receive “enhanced counseling” before genetic testing.
This process was aimed at helping the women “prelive” how they might respond to their test results.
“We wanted to help women anticipate how they would react, so they would be prepared for it,” Dr. Miller, the study's lead investigator, said in an interview.
Six months later, 68% of the women in the intervention group had sought prophylactic oophorectomy information, and 28% had undergone the surgery.
In the control group, which had received standard counseling along with information about improving their general health, 26% had sought information on oophorectomy and 6% had had the surgery.
“The women in the intervention arm were in a position to take action when they got their results,” Dr. Miller said.
“This indicates that enhanced counseling can play an important role in decision making after BRCA1 and 2 testing,” she added.
The symposium was also sponsored by the Lynne Cohen Foundation for Ovarian Cancer Research.
NEW YORK — Enhanced counseling can help women at high risk of ovarian cancer make better use of the information they receive from genetic testing for BRCA1 and BRCA2 mutations, according to a study presented in poster form at a cancer symposium sponsored by New York University.
The few studies that have examined the effects of genetic testing on decision making have found that a significant proportion of eligible women don't take any action after learning their genetic status, according to Suzanne Miller, Ph.D., of Fox Chase Cancer Center in Philadelphia, and her associates.
The investigators randomized approximately half of the study's 80 women who were at high risk for ovarian cancer based on family history to receive “enhanced counseling” before genetic testing.
This process was aimed at helping the women “prelive” how they might respond to their test results.
“We wanted to help women anticipate how they would react, so they would be prepared for it,” Dr. Miller, the study's lead investigator, said in an interview.
Six months later, 68% of the women in the intervention group had sought prophylactic oophorectomy information, and 28% had undergone the surgery.
In the control group, which had received standard counseling along with information about improving their general health, 26% had sought information on oophorectomy and 6% had had the surgery.
“The women in the intervention arm were in a position to take action when they got their results,” Dr. Miller said.
“This indicates that enhanced counseling can play an important role in decision making after BRCA1 and 2 testing,” she added.
The symposium was also sponsored by the Lynne Cohen Foundation for Ovarian Cancer Research.
NEW YORK — Enhanced counseling can help women at high risk of ovarian cancer make better use of the information they receive from genetic testing for BRCA1 and BRCA2 mutations, according to a study presented in poster form at a cancer symposium sponsored by New York University.
The few studies that have examined the effects of genetic testing on decision making have found that a significant proportion of eligible women don't take any action after learning their genetic status, according to Suzanne Miller, Ph.D., of Fox Chase Cancer Center in Philadelphia, and her associates.
The investigators randomized approximately half of the study's 80 women who were at high risk for ovarian cancer based on family history to receive “enhanced counseling” before genetic testing.
This process was aimed at helping the women “prelive” how they might respond to their test results.
“We wanted to help women anticipate how they would react, so they would be prepared for it,” Dr. Miller, the study's lead investigator, said in an interview.
Six months later, 68% of the women in the intervention group had sought prophylactic oophorectomy information, and 28% had undergone the surgery.
In the control group, which had received standard counseling along with information about improving their general health, 26% had sought information on oophorectomy and 6% had had the surgery.
“The women in the intervention arm were in a position to take action when they got their results,” Dr. Miller said.
“This indicates that enhanced counseling can play an important role in decision making after BRCA1 and 2 testing,” she added.
The symposium was also sponsored by the Lynne Cohen Foundation for Ovarian Cancer Research.
Breast MRI Shows Promise for High-Risk Women
NEW YORK — Breast MRI may have difficulty keeping up with the “potentially logarithmic demand” for its use as a cancer screening tool, experts said at a cancer symposium sponsored by New York University and by the Lynne Cohen Foundation for Ovarian Cancer Research.
The technique represents a vast improvement in sensitivity over traditional mammography and ultrasound, but it “may have been oversold” as a screening tool, said Linda Moy, M.D., of the university.
“MRI isn't suitable for use as an annual cancer screening tool for most women,” she said, noting that it is too expensive (at about 10 times the cost of a mammogram) and too time consuming (at about 45 minutes per exam) to replace the more than 30 million screening mammograms performed annually.
But MRI remains the most promising of all breast screening modalities for one group of patients: BRCA mutation carriers. “MRI is the clear winner in every screening study undertaken to date in high-risk women,” said Ellen Warner, M.D., of the University of Toronto.
In six large, prospective, nonrandomized studies that have compared screening tools for high-risk women, MRI's sensitivity was considerably higher than that of mammography, with ultrasound and clinical breast exam trailing far behind. Overall, Dr. Moy noted, most studies have found a sensitivity rate of 86%–100% for MRI in high-risk women, with reported sensitivities of only 33%–55% for mammography.
“This stands in sharp contrast to the excellent sensitivity of screening mammography for detecting [ductal carcinoma in situ] and early invasive breast cancers in the general population,” Dr. Warner said. The difference, in part, can be attributed to the younger age—and greater average breast density—at which mutation carriers present for screening; MRI is far less influenced by breast density than is mammography.
But while MRI is the undisputed sensitivity champion for screening high-risk women, it does have its drawbacks. First, it's not nearly as specific as it is sensitive. In the Dutch National Study, which followed 1,909 women, including 358 mutation carriers, MRI had a recall rate double that of mammography (10% vs. 5%), and triple the biopsy rate (5.8% vs 1.7%).
“The price of MRI's greater sensitivity is more false positives,” Dr. Warner said. “MRI researchers are now working on protocols that we hope will slash recall and biopsy rates.”
And no one yet knows whether MRI is actually saving women's lives. “To date, no study has proved that any screening regimen can actually increase survival rates,” she said.
“If MRI is picking up cancers prior to distant metastasis that would have gone undetected until after metastasis with other screening tools, then it will have a favorable impact on survival. But we don't know that yet,” Dr. Warner added.
At left, MRI without contrast hints at a mass near the nipple. At right, the mass that is seen on high-contrast MRI was found to be invasive ductal carcinoma.
The invasive ductal cancer present in the patient's right breast is not visible in a craniocaudal (CC) mammogram or a mediolateral oblique (MLO) mammogram. Photos courtesy Dr. Linda Moy
NEW YORK — Breast MRI may have difficulty keeping up with the “potentially logarithmic demand” for its use as a cancer screening tool, experts said at a cancer symposium sponsored by New York University and by the Lynne Cohen Foundation for Ovarian Cancer Research.
The technique represents a vast improvement in sensitivity over traditional mammography and ultrasound, but it “may have been oversold” as a screening tool, said Linda Moy, M.D., of the university.
“MRI isn't suitable for use as an annual cancer screening tool for most women,” she said, noting that it is too expensive (at about 10 times the cost of a mammogram) and too time consuming (at about 45 minutes per exam) to replace the more than 30 million screening mammograms performed annually.
But MRI remains the most promising of all breast screening modalities for one group of patients: BRCA mutation carriers. “MRI is the clear winner in every screening study undertaken to date in high-risk women,” said Ellen Warner, M.D., of the University of Toronto.
In six large, prospective, nonrandomized studies that have compared screening tools for high-risk women, MRI's sensitivity was considerably higher than that of mammography, with ultrasound and clinical breast exam trailing far behind. Overall, Dr. Moy noted, most studies have found a sensitivity rate of 86%–100% for MRI in high-risk women, with reported sensitivities of only 33%–55% for mammography.
“This stands in sharp contrast to the excellent sensitivity of screening mammography for detecting [ductal carcinoma in situ] and early invasive breast cancers in the general population,” Dr. Warner said. The difference, in part, can be attributed to the younger age—and greater average breast density—at which mutation carriers present for screening; MRI is far less influenced by breast density than is mammography.
But while MRI is the undisputed sensitivity champion for screening high-risk women, it does have its drawbacks. First, it's not nearly as specific as it is sensitive. In the Dutch National Study, which followed 1,909 women, including 358 mutation carriers, MRI had a recall rate double that of mammography (10% vs. 5%), and triple the biopsy rate (5.8% vs 1.7%).
“The price of MRI's greater sensitivity is more false positives,” Dr. Warner said. “MRI researchers are now working on protocols that we hope will slash recall and biopsy rates.”
And no one yet knows whether MRI is actually saving women's lives. “To date, no study has proved that any screening regimen can actually increase survival rates,” she said.
“If MRI is picking up cancers prior to distant metastasis that would have gone undetected until after metastasis with other screening tools, then it will have a favorable impact on survival. But we don't know that yet,” Dr. Warner added.
At left, MRI without contrast hints at a mass near the nipple. At right, the mass that is seen on high-contrast MRI was found to be invasive ductal carcinoma.
The invasive ductal cancer present in the patient's right breast is not visible in a craniocaudal (CC) mammogram or a mediolateral oblique (MLO) mammogram. Photos courtesy Dr. Linda Moy
NEW YORK — Breast MRI may have difficulty keeping up with the “potentially logarithmic demand” for its use as a cancer screening tool, experts said at a cancer symposium sponsored by New York University and by the Lynne Cohen Foundation for Ovarian Cancer Research.
The technique represents a vast improvement in sensitivity over traditional mammography and ultrasound, but it “may have been oversold” as a screening tool, said Linda Moy, M.D., of the university.
“MRI isn't suitable for use as an annual cancer screening tool for most women,” she said, noting that it is too expensive (at about 10 times the cost of a mammogram) and too time consuming (at about 45 minutes per exam) to replace the more than 30 million screening mammograms performed annually.
But MRI remains the most promising of all breast screening modalities for one group of patients: BRCA mutation carriers. “MRI is the clear winner in every screening study undertaken to date in high-risk women,” said Ellen Warner, M.D., of the University of Toronto.
In six large, prospective, nonrandomized studies that have compared screening tools for high-risk women, MRI's sensitivity was considerably higher than that of mammography, with ultrasound and clinical breast exam trailing far behind. Overall, Dr. Moy noted, most studies have found a sensitivity rate of 86%–100% for MRI in high-risk women, with reported sensitivities of only 33%–55% for mammography.
“This stands in sharp contrast to the excellent sensitivity of screening mammography for detecting [ductal carcinoma in situ] and early invasive breast cancers in the general population,” Dr. Warner said. The difference, in part, can be attributed to the younger age—and greater average breast density—at which mutation carriers present for screening; MRI is far less influenced by breast density than is mammography.
But while MRI is the undisputed sensitivity champion for screening high-risk women, it does have its drawbacks. First, it's not nearly as specific as it is sensitive. In the Dutch National Study, which followed 1,909 women, including 358 mutation carriers, MRI had a recall rate double that of mammography (10% vs. 5%), and triple the biopsy rate (5.8% vs 1.7%).
“The price of MRI's greater sensitivity is more false positives,” Dr. Warner said. “MRI researchers are now working on protocols that we hope will slash recall and biopsy rates.”
And no one yet knows whether MRI is actually saving women's lives. “To date, no study has proved that any screening regimen can actually increase survival rates,” she said.
“If MRI is picking up cancers prior to distant metastasis that would have gone undetected until after metastasis with other screening tools, then it will have a favorable impact on survival. But we don't know that yet,” Dr. Warner added.
At left, MRI without contrast hints at a mass near the nipple. At right, the mass that is seen on high-contrast MRI was found to be invasive ductal carcinoma.
The invasive ductal cancer present in the patient's right breast is not visible in a craniocaudal (CC) mammogram or a mediolateral oblique (MLO) mammogram. Photos courtesy Dr. Linda Moy
Innovative Use of Media Reaches Underserved
NEW YORK — When Elmer E. Huerta, M.D., left his oncology practice in Peru to come to the Washington, D.C., area in 1987, “I thought I was going to the heavens,” he recalls. In Peru, 85% of breast and cervical cancers are found at stage III or IV, he told physicians at a cancer symposium.
But when he arrived in the United States, Dr. Huerta found pockets of poverty and lack of access, where people were horribly underserved and where diagnosis of disease came much too late, just as it did in Peru. He treated women with breasts horribly swollen and disfigured by tumors, who hadn't sought care until their symptoms were overwhelming, and their cancers so far advanced that they were almost untreatable.
“I saw women who could not bring themselves to do breast self-exams, because their mothers and grandmothers told them never to touch their breasts,” Dr. Huerta said at the symposium, which was sponsored by New York University and the Lynne Cohen Foundation for Ovarian Cancer Research.
Dr. Huerta realized that cultural barriers—as well as unfamiliarity with the health care system, a lack of insurance coverage, and linguistic isolation—were keeping many Hispanic men and women in the United States from seeking preventive health care. Many would go to the doctor only when they were sick, which meant that diseases that could have been caught and treated early were being diagnosed in late, deadly stages. “The challenge I faced was how to convince people to seek care when they had no symptoms,” he said.
The answer came through television and radio. He asked a patient with an advanced case of cervical cancer why she had not had a Pap smear before, and she responded, “What's that?” Seeking to lighten the mood during the same visit, he asked her what she thought of the goings-on on a popular soap opera appearing on a Spanish-language television network. She was instantly engaged, telling him what she thought the characters would do next. So, “I thought, why can't we sell health like we sell shoes—through the media?”
In 1989, Dr. Huerta created his first radio program, “Cuidando Su Salud [Taking Care of Your Health],” selling not pills, potions, and products, but prevention. The show has run daily ever since, and now Dr. Huerta has added a weekly, nationally syndicated call-in talk show and a local live television program to his roster. Together, the programs are estimated to reach 90% of Hispanics in the United States.
In 1993, a Montgomery County, Md., health clinic learned about the power of Dr. Huerta's message. In an average quarter, the clinic saw perhaps 20 Hispanic women for mammograms and Pap smears. During the first quarter of 1993, for example, 23 Hispanic women came to the clinic.
But in the following 3 months, that number skyrocketed to 118—more than 5 times as many Hispanic patients as the clinic had seen in any quarter.
“How did you hear about us?” they asked this flood of new patients. “The doctor on the radio,” the women would reply, noting that he talks all the time about mammograms and Pap smears and refers them to the clinic.
Dr. Huerta also convinced his listeners to participate in clinical trials, which have struggled with low rates of accrual in the Spanish-speaking community. When he promoted one National Institutes of Health-sponsored trial on the radio, 325 of his listeners signed up, compared with no Hispanic participants in the previous month. Each day, he broadcasts clear, easy- to-understand information on topics ranging from how clinical trials work, to why men should examine their testicles regularly just as women should examine their breasts, to the importance of wearing seat belts.
Once people got the message about preventive care and screening, they were left to seek affordable care. This is one reason Dr. Huerta founded the Cancer Preventorium more than a decade ago at the Washington (D.C.) Hospital Center. The Preventorium is an affordable clinic where low-income people can go for screening tests and get referrals for treatment. It's the opposite of the sanatoriums that sprang up in the early part of the 20th century, which hosted people with long-term illnesses such as tuberculosis. You don't go to the Preventorium if you're sick, he tells his audience: You go there because you're well and want to stay that way.
Three weeks after its opening, the Preventorium had appointments booked through the end of the year. Patients pay $64 for a visit, and the collection rate is almost 100%. “Even poor people will pay if you give them something of value,” he said.
To date, the Preventorium has seen more than 15,000 patients. Most are recent immigrants who have been convinced by Dr. Huerta's broadcasts that prevention and early detection of illness are essential. Dr. Huerta said he believes that using the media to sell a disease prevention and health promotion message and providing preventive care and screening in an affordable, one-stop setting could work with almost any underserved group. This model could save thousands of lives and millions of dollars in health care costs by enabling physicians to treat patients at an earlier stage, he added.
NEW YORK — When Elmer E. Huerta, M.D., left his oncology practice in Peru to come to the Washington, D.C., area in 1987, “I thought I was going to the heavens,” he recalls. In Peru, 85% of breast and cervical cancers are found at stage III or IV, he told physicians at a cancer symposium.
But when he arrived in the United States, Dr. Huerta found pockets of poverty and lack of access, where people were horribly underserved and where diagnosis of disease came much too late, just as it did in Peru. He treated women with breasts horribly swollen and disfigured by tumors, who hadn't sought care until their symptoms were overwhelming, and their cancers so far advanced that they were almost untreatable.
“I saw women who could not bring themselves to do breast self-exams, because their mothers and grandmothers told them never to touch their breasts,” Dr. Huerta said at the symposium, which was sponsored by New York University and the Lynne Cohen Foundation for Ovarian Cancer Research.
Dr. Huerta realized that cultural barriers—as well as unfamiliarity with the health care system, a lack of insurance coverage, and linguistic isolation—were keeping many Hispanic men and women in the United States from seeking preventive health care. Many would go to the doctor only when they were sick, which meant that diseases that could have been caught and treated early were being diagnosed in late, deadly stages. “The challenge I faced was how to convince people to seek care when they had no symptoms,” he said.
The answer came through television and radio. He asked a patient with an advanced case of cervical cancer why she had not had a Pap smear before, and she responded, “What's that?” Seeking to lighten the mood during the same visit, he asked her what she thought of the goings-on on a popular soap opera appearing on a Spanish-language television network. She was instantly engaged, telling him what she thought the characters would do next. So, “I thought, why can't we sell health like we sell shoes—through the media?”
In 1989, Dr. Huerta created his first radio program, “Cuidando Su Salud [Taking Care of Your Health],” selling not pills, potions, and products, but prevention. The show has run daily ever since, and now Dr. Huerta has added a weekly, nationally syndicated call-in talk show and a local live television program to his roster. Together, the programs are estimated to reach 90% of Hispanics in the United States.
In 1993, a Montgomery County, Md., health clinic learned about the power of Dr. Huerta's message. In an average quarter, the clinic saw perhaps 20 Hispanic women for mammograms and Pap smears. During the first quarter of 1993, for example, 23 Hispanic women came to the clinic.
But in the following 3 months, that number skyrocketed to 118—more than 5 times as many Hispanic patients as the clinic had seen in any quarter.
“How did you hear about us?” they asked this flood of new patients. “The doctor on the radio,” the women would reply, noting that he talks all the time about mammograms and Pap smears and refers them to the clinic.
Dr. Huerta also convinced his listeners to participate in clinical trials, which have struggled with low rates of accrual in the Spanish-speaking community. When he promoted one National Institutes of Health-sponsored trial on the radio, 325 of his listeners signed up, compared with no Hispanic participants in the previous month. Each day, he broadcasts clear, easy- to-understand information on topics ranging from how clinical trials work, to why men should examine their testicles regularly just as women should examine their breasts, to the importance of wearing seat belts.
Once people got the message about preventive care and screening, they were left to seek affordable care. This is one reason Dr. Huerta founded the Cancer Preventorium more than a decade ago at the Washington (D.C.) Hospital Center. The Preventorium is an affordable clinic where low-income people can go for screening tests and get referrals for treatment. It's the opposite of the sanatoriums that sprang up in the early part of the 20th century, which hosted people with long-term illnesses such as tuberculosis. You don't go to the Preventorium if you're sick, he tells his audience: You go there because you're well and want to stay that way.
Three weeks after its opening, the Preventorium had appointments booked through the end of the year. Patients pay $64 for a visit, and the collection rate is almost 100%. “Even poor people will pay if you give them something of value,” he said.
To date, the Preventorium has seen more than 15,000 patients. Most are recent immigrants who have been convinced by Dr. Huerta's broadcasts that prevention and early detection of illness are essential. Dr. Huerta said he believes that using the media to sell a disease prevention and health promotion message and providing preventive care and screening in an affordable, one-stop setting could work with almost any underserved group. This model could save thousands of lives and millions of dollars in health care costs by enabling physicians to treat patients at an earlier stage, he added.
NEW YORK — When Elmer E. Huerta, M.D., left his oncology practice in Peru to come to the Washington, D.C., area in 1987, “I thought I was going to the heavens,” he recalls. In Peru, 85% of breast and cervical cancers are found at stage III or IV, he told physicians at a cancer symposium.
But when he arrived in the United States, Dr. Huerta found pockets of poverty and lack of access, where people were horribly underserved and where diagnosis of disease came much too late, just as it did in Peru. He treated women with breasts horribly swollen and disfigured by tumors, who hadn't sought care until their symptoms were overwhelming, and their cancers so far advanced that they were almost untreatable.
“I saw women who could not bring themselves to do breast self-exams, because their mothers and grandmothers told them never to touch their breasts,” Dr. Huerta said at the symposium, which was sponsored by New York University and the Lynne Cohen Foundation for Ovarian Cancer Research.
Dr. Huerta realized that cultural barriers—as well as unfamiliarity with the health care system, a lack of insurance coverage, and linguistic isolation—were keeping many Hispanic men and women in the United States from seeking preventive health care. Many would go to the doctor only when they were sick, which meant that diseases that could have been caught and treated early were being diagnosed in late, deadly stages. “The challenge I faced was how to convince people to seek care when they had no symptoms,” he said.
The answer came through television and radio. He asked a patient with an advanced case of cervical cancer why she had not had a Pap smear before, and she responded, “What's that?” Seeking to lighten the mood during the same visit, he asked her what she thought of the goings-on on a popular soap opera appearing on a Spanish-language television network. She was instantly engaged, telling him what she thought the characters would do next. So, “I thought, why can't we sell health like we sell shoes—through the media?”
In 1989, Dr. Huerta created his first radio program, “Cuidando Su Salud [Taking Care of Your Health],” selling not pills, potions, and products, but prevention. The show has run daily ever since, and now Dr. Huerta has added a weekly, nationally syndicated call-in talk show and a local live television program to his roster. Together, the programs are estimated to reach 90% of Hispanics in the United States.
In 1993, a Montgomery County, Md., health clinic learned about the power of Dr. Huerta's message. In an average quarter, the clinic saw perhaps 20 Hispanic women for mammograms and Pap smears. During the first quarter of 1993, for example, 23 Hispanic women came to the clinic.
But in the following 3 months, that number skyrocketed to 118—more than 5 times as many Hispanic patients as the clinic had seen in any quarter.
“How did you hear about us?” they asked this flood of new patients. “The doctor on the radio,” the women would reply, noting that he talks all the time about mammograms and Pap smears and refers them to the clinic.
Dr. Huerta also convinced his listeners to participate in clinical trials, which have struggled with low rates of accrual in the Spanish-speaking community. When he promoted one National Institutes of Health-sponsored trial on the radio, 325 of his listeners signed up, compared with no Hispanic participants in the previous month. Each day, he broadcasts clear, easy- to-understand information on topics ranging from how clinical trials work, to why men should examine their testicles regularly just as women should examine their breasts, to the importance of wearing seat belts.
Once people got the message about preventive care and screening, they were left to seek affordable care. This is one reason Dr. Huerta founded the Cancer Preventorium more than a decade ago at the Washington (D.C.) Hospital Center. The Preventorium is an affordable clinic where low-income people can go for screening tests and get referrals for treatment. It's the opposite of the sanatoriums that sprang up in the early part of the 20th century, which hosted people with long-term illnesses such as tuberculosis. You don't go to the Preventorium if you're sick, he tells his audience: You go there because you're well and want to stay that way.
Three weeks after its opening, the Preventorium had appointments booked through the end of the year. Patients pay $64 for a visit, and the collection rate is almost 100%. “Even poor people will pay if you give them something of value,” he said.
To date, the Preventorium has seen more than 15,000 patients. Most are recent immigrants who have been convinced by Dr. Huerta's broadcasts that prevention and early detection of illness are essential. Dr. Huerta said he believes that using the media to sell a disease prevention and health promotion message and providing preventive care and screening in an affordable, one-stop setting could work with almost any underserved group. This model could save thousands of lives and millions of dollars in health care costs by enabling physicians to treat patients at an earlier stage, he added.
Reaching the Underserved With a Preventorium : Health clinic effectively bridges cultures to offer at-risk group a proactive approach to health care.
NEW YORK When Elmer E. Huerta, M.D., left his oncology practice in Peru to come to the Washington, D.C., area in 1987, "I thought I was going to the heavens," he recalls. In Peru, 85% of breast and cervical cancers are found at stage III or IV, he told physicians at a cancer symposium.
But when he arrived in the United States, Dr. Huerta found pockets of poverty and lack of access, where people were horribly underserved and where diagnosis of disease came much too late, just as it did in Peru. He treated women with breasts horribly swollen and disfigured by tumors, who hadn't sought care until their symptoms were overwhelming, and their cancers so far advanced that they were almost untreatable.
"I saw women who could not bring themselves to do breast self-exams, because their mothers and grandmothers told them never to touch their breasts," Dr. Huerta said at the symposium, which was sponsored by New York University and the Lynne Cohen Foundation for Ovarian Cancer Research.
Dr. Huerta realized that cultural barriersas well as unfamiliarity with the health care system, a lack of insurance coverage, and linguistic isolationwere keeping many Hispanic men and women in the United States from seeking preventive health care. Many would go to the doctor only when they were sick, which meant that diseases that could have been caught and treated early were being diagnosed in late, deadly stages. "The challenge I faced was how to convince people to seek care when they had no symptoms," he said.
The answer came through television and radio. He asked a patient with an advanced case of cervical cancer why she had not had a Pap smear before, and she responded, "What's that?" Seeking to lighten the mood during the same visit, he asked her what she thought of the goings-on on a popular soap opera appearing on a Spanish-language television network. She was instantly engaged, telling him what she thought the characters would do next. So, "I thought, why can't we sell health like we sell shoesthrough the media?"
In 1989, Dr. Huerta created his first radio program, "Cuidando Su Salud [Taking Care of Your Health]," selling not pills, potions, and products, but prevention. The show has run daily ever since, and now Dr. Huerta has added a weekly, nationally syndicated call-in talk show and a local live television program to his roster. Together, the programs are estimated to reach 90% of Hispanics in the United States.
In 1993, a health clinic in Maryland's Montgomery County learned about the power of Dr. Huerta's message. In an average quarter, the clinic saw perhaps 20 Hispanic women for mammograms and Pap smears. During the first quarter of 1993, for example, 23 Hispanic women came to the clinic. But in the following 3 months, that number skyrocketed to 118more than 5 times as many Hispanic patients as the clinic had seen in any quarter.
Dr. Huerta also persuaded his listeners to participate in clinical trials, which have struggled with low rates of accrual in the Spanish-speaking community. When he promoted one National Institutes of Health-sponsored trial on the radio, 325 listeners signed up, compared with no Hispanic participants in the previous month. He broadcasts clear, easy to understand information on topics such as how clinical trials work, why men should examine their testicles regularly, and the importance of wearing seat belts.
Once people got the message about preventive care and screening, they were left to seek affordable care. This is one reason Dr. Huerta founded the Cancer Preventorium more than a decade ago at the Washington (D.C.) Hospital Center. The affordable clinic allows low-income people to go for screening tests and get referrals for treatment. It's the opposite of the sanatoriums that sprang up in the early part of the 20th century, which hosted people with long-term illnesses. You don't go to the Preventorium if you're sick, he says. You go because you're well and want to stay that way.
Three weeks after its opening, the Preventorium had appointments booked through the end of the year. Patients pay $64 a visit, and the collection rate is almost 100%. "Even poor people will pay if you give them something of value," he said.
NEW YORK When Elmer E. Huerta, M.D., left his oncology practice in Peru to come to the Washington, D.C., area in 1987, "I thought I was going to the heavens," he recalls. In Peru, 85% of breast and cervical cancers are found at stage III or IV, he told physicians at a cancer symposium.
But when he arrived in the United States, Dr. Huerta found pockets of poverty and lack of access, where people were horribly underserved and where diagnosis of disease came much too late, just as it did in Peru. He treated women with breasts horribly swollen and disfigured by tumors, who hadn't sought care until their symptoms were overwhelming, and their cancers so far advanced that they were almost untreatable.
"I saw women who could not bring themselves to do breast self-exams, because their mothers and grandmothers told them never to touch their breasts," Dr. Huerta said at the symposium, which was sponsored by New York University and the Lynne Cohen Foundation for Ovarian Cancer Research.
Dr. Huerta realized that cultural barriersas well as unfamiliarity with the health care system, a lack of insurance coverage, and linguistic isolationwere keeping many Hispanic men and women in the United States from seeking preventive health care. Many would go to the doctor only when they were sick, which meant that diseases that could have been caught and treated early were being diagnosed in late, deadly stages. "The challenge I faced was how to convince people to seek care when they had no symptoms," he said.
The answer came through television and radio. He asked a patient with an advanced case of cervical cancer why she had not had a Pap smear before, and she responded, "What's that?" Seeking to lighten the mood during the same visit, he asked her what she thought of the goings-on on a popular soap opera appearing on a Spanish-language television network. She was instantly engaged, telling him what she thought the characters would do next. So, "I thought, why can't we sell health like we sell shoesthrough the media?"
In 1989, Dr. Huerta created his first radio program, "Cuidando Su Salud [Taking Care of Your Health]," selling not pills, potions, and products, but prevention. The show has run daily ever since, and now Dr. Huerta has added a weekly, nationally syndicated call-in talk show and a local live television program to his roster. Together, the programs are estimated to reach 90% of Hispanics in the United States.
In 1993, a health clinic in Maryland's Montgomery County learned about the power of Dr. Huerta's message. In an average quarter, the clinic saw perhaps 20 Hispanic women for mammograms and Pap smears. During the first quarter of 1993, for example, 23 Hispanic women came to the clinic. But in the following 3 months, that number skyrocketed to 118more than 5 times as many Hispanic patients as the clinic had seen in any quarter.
Dr. Huerta also persuaded his listeners to participate in clinical trials, which have struggled with low rates of accrual in the Spanish-speaking community. When he promoted one National Institutes of Health-sponsored trial on the radio, 325 listeners signed up, compared with no Hispanic participants in the previous month. He broadcasts clear, easy to understand information on topics such as how clinical trials work, why men should examine their testicles regularly, and the importance of wearing seat belts.
Once people got the message about preventive care and screening, they were left to seek affordable care. This is one reason Dr. Huerta founded the Cancer Preventorium more than a decade ago at the Washington (D.C.) Hospital Center. The affordable clinic allows low-income people to go for screening tests and get referrals for treatment. It's the opposite of the sanatoriums that sprang up in the early part of the 20th century, which hosted people with long-term illnesses. You don't go to the Preventorium if you're sick, he says. You go because you're well and want to stay that way.
Three weeks after its opening, the Preventorium had appointments booked through the end of the year. Patients pay $64 a visit, and the collection rate is almost 100%. "Even poor people will pay if you give them something of value," he said.
NEW YORK When Elmer E. Huerta, M.D., left his oncology practice in Peru to come to the Washington, D.C., area in 1987, "I thought I was going to the heavens," he recalls. In Peru, 85% of breast and cervical cancers are found at stage III or IV, he told physicians at a cancer symposium.
But when he arrived in the United States, Dr. Huerta found pockets of poverty and lack of access, where people were horribly underserved and where diagnosis of disease came much too late, just as it did in Peru. He treated women with breasts horribly swollen and disfigured by tumors, who hadn't sought care until their symptoms were overwhelming, and their cancers so far advanced that they were almost untreatable.
"I saw women who could not bring themselves to do breast self-exams, because their mothers and grandmothers told them never to touch their breasts," Dr. Huerta said at the symposium, which was sponsored by New York University and the Lynne Cohen Foundation for Ovarian Cancer Research.
Dr. Huerta realized that cultural barriersas well as unfamiliarity with the health care system, a lack of insurance coverage, and linguistic isolationwere keeping many Hispanic men and women in the United States from seeking preventive health care. Many would go to the doctor only when they were sick, which meant that diseases that could have been caught and treated early were being diagnosed in late, deadly stages. "The challenge I faced was how to convince people to seek care when they had no symptoms," he said.
The answer came through television and radio. He asked a patient with an advanced case of cervical cancer why she had not had a Pap smear before, and she responded, "What's that?" Seeking to lighten the mood during the same visit, he asked her what she thought of the goings-on on a popular soap opera appearing on a Spanish-language television network. She was instantly engaged, telling him what she thought the characters would do next. So, "I thought, why can't we sell health like we sell shoesthrough the media?"
In 1989, Dr. Huerta created his first radio program, "Cuidando Su Salud [Taking Care of Your Health]," selling not pills, potions, and products, but prevention. The show has run daily ever since, and now Dr. Huerta has added a weekly, nationally syndicated call-in talk show and a local live television program to his roster. Together, the programs are estimated to reach 90% of Hispanics in the United States.
In 1993, a health clinic in Maryland's Montgomery County learned about the power of Dr. Huerta's message. In an average quarter, the clinic saw perhaps 20 Hispanic women for mammograms and Pap smears. During the first quarter of 1993, for example, 23 Hispanic women came to the clinic. But in the following 3 months, that number skyrocketed to 118more than 5 times as many Hispanic patients as the clinic had seen in any quarter.
Dr. Huerta also persuaded his listeners to participate in clinical trials, which have struggled with low rates of accrual in the Spanish-speaking community. When he promoted one National Institutes of Health-sponsored trial on the radio, 325 listeners signed up, compared with no Hispanic participants in the previous month. He broadcasts clear, easy to understand information on topics such as how clinical trials work, why men should examine their testicles regularly, and the importance of wearing seat belts.
Once people got the message about preventive care and screening, they were left to seek affordable care. This is one reason Dr. Huerta founded the Cancer Preventorium more than a decade ago at the Washington (D.C.) Hospital Center. The affordable clinic allows low-income people to go for screening tests and get referrals for treatment. It's the opposite of the sanatoriums that sprang up in the early part of the 20th century, which hosted people with long-term illnesses. You don't go to the Preventorium if you're sick, he says. You go because you're well and want to stay that way.
Three weeks after its opening, the Preventorium had appointments booked through the end of the year. Patients pay $64 a visit, and the collection rate is almost 100%. "Even poor people will pay if you give them something of value," he said.
Reaching the Underserved Through the Media
NEW YORK — When Elmer E. Huerta, M.D., left his oncology practice in Peru to come to the Washington, D.C., area in 1987, “I thought I was going to the heavens,” he recalls.
In Peru, 85% of breast and cervical cancers are found at stage III or IV, he told physicians at a cancer symposium.
But when he arrived in the United States, Dr. Huerta found pockets of poverty and lack of access, where people were horribly underserved and where diagnosis of disease came much too late, just as it did in Peru. He treated women with breasts horribly swollen and disfigured by tumors, who hadn't sought care until their symptoms were overwhelming, and their cancers so far advanced that they were almost untreatable.
“I saw women who could not bring themselves to do breast self-exams, because their mothers and grandmothers told them never to touch their breasts,” Dr. Huerta said at the symposium, which was sponsored by New York University and the Lynne Cohen Foundation for Ovarian Cancer Research.
Dr. Huerta realized that cultural barriers—as well as unfamiliarity with the health care system, a lack of insurance coverage, and linguistic isolation—were keeping many Hispanic men and women in the United States from seeking preventive health care.
Many would go to the doctor only when they were sick, which meant that diseases that could have been caught and treated early were being diagnosed in late, deadly stages.
“The challenge I faced was how to convince people to seek care when they had no symptoms,” he said.
The answer came through television and radio. He asked a patient with an advanced case of cervical cancer why she had not had a Pap smear before, and she responded, “What's that?” Seeking to lighten the mood during the same visit, he asked her what she thought of the goings-on on a popular soap opera appearing on a Spanish-language television network. She was instantly engaged, telling him what she thought the characters would do next.
So, “I thought, why can't we sell health like we sell shoes—through the media?”
In 1989, Dr. Huerta created his first radio program, “Cuidando Su Salud [Taking Care of Your Health],” selling not pills, potions, and products, but prevention.
The show has run daily ever since, and now Dr. Huerta has added a weekly, nationally syndicated call-in talk show and a local live television program to his roster. Together, the programs are estimated to reach 90% of Hispanics in the United States.
In 1993, a Montgomery County, Md., health clinic learned about the power of Dr. Huerta's message. In an average quarter, the clinic saw perhaps 20 Hispanic women for mammograms and Pap smears.
During the first quarter of 1993, for example, 23 Hispanic women came to the clinic. But in the following 3 months, that number skyrocketed to 118—more than 5 times as many Hispanic patients as the clinic had seen in any quarter. “How did you hear about us?” they asked this flood of new patients. “The doctor on the radio,” the women would reply, noting that he talks all the time about mammograms and Pap smears and refers them to the clinic.
Dr. Huerta also convinced his listeners to participate in clinical trials, which have struggled with low rates of accrual in the Spanish-speaking community. When he promoted one National Institutes of Health-sponsored trial on the radio, 325 of his listeners signed up, compared with no Hispanic participants in the previous month.
Each day, he broadcasts clear, easy to understand information on topics ranging from how clinical trials work, to why men should examine their testicles regularly just as women should examine their breasts, to the importance of wearing seat belts.
Once people got the message about preventive care and screening, they were left to seek affordable care. This is one reason Dr. Huerta founded the Cancer Preventorium more than a decade ago at the Washington (D.C.) Hospital Center.
The Preventorium is an affordable clinic where low-income people can go for screening tests and get referrals for treatment. It's the opposite of the sanatoriums that sprang up in the early part of the 20th century, which hosted people with long-term illnesses such as tuberculosis, he said.
You don't go to the Preventorium if you're sick, he tells his audience: You go there because you're well and want to stay that way.
Three weeks after its opening, the Preventorium had appointments booked through the end of the year. Patients pay $64 for a visit, and the collection rate is almost 100%. “Even poor people will pay if you give them something of value,” he said.
To date, the Preventorium has seen more than 15,000 patients. Most are recent immigrants who have been convinced by Dr. Huerta's broadcasts that prevention and early detection of illness are essential.
Dr. Huerta said he believes that using the media to sell a disease prevention and health promotion message and providing preventive care and screening in an affordable, one-stop setting could work with almost any underserved group.
This model could save thousands of lives and millions of dollars in health care costs by enabling physicians to treat patients at an earlier stage, he added.
NEW YORK — When Elmer E. Huerta, M.D., left his oncology practice in Peru to come to the Washington, D.C., area in 1987, “I thought I was going to the heavens,” he recalls.
In Peru, 85% of breast and cervical cancers are found at stage III or IV, he told physicians at a cancer symposium.
But when he arrived in the United States, Dr. Huerta found pockets of poverty and lack of access, where people were horribly underserved and where diagnosis of disease came much too late, just as it did in Peru. He treated women with breasts horribly swollen and disfigured by tumors, who hadn't sought care until their symptoms were overwhelming, and their cancers so far advanced that they were almost untreatable.
“I saw women who could not bring themselves to do breast self-exams, because their mothers and grandmothers told them never to touch their breasts,” Dr. Huerta said at the symposium, which was sponsored by New York University and the Lynne Cohen Foundation for Ovarian Cancer Research.
Dr. Huerta realized that cultural barriers—as well as unfamiliarity with the health care system, a lack of insurance coverage, and linguistic isolation—were keeping many Hispanic men and women in the United States from seeking preventive health care.
Many would go to the doctor only when they were sick, which meant that diseases that could have been caught and treated early were being diagnosed in late, deadly stages.
“The challenge I faced was how to convince people to seek care when they had no symptoms,” he said.
The answer came through television and radio. He asked a patient with an advanced case of cervical cancer why she had not had a Pap smear before, and she responded, “What's that?” Seeking to lighten the mood during the same visit, he asked her what she thought of the goings-on on a popular soap opera appearing on a Spanish-language television network. She was instantly engaged, telling him what she thought the characters would do next.
So, “I thought, why can't we sell health like we sell shoes—through the media?”
In 1989, Dr. Huerta created his first radio program, “Cuidando Su Salud [Taking Care of Your Health],” selling not pills, potions, and products, but prevention.
The show has run daily ever since, and now Dr. Huerta has added a weekly, nationally syndicated call-in talk show and a local live television program to his roster. Together, the programs are estimated to reach 90% of Hispanics in the United States.
In 1993, a Montgomery County, Md., health clinic learned about the power of Dr. Huerta's message. In an average quarter, the clinic saw perhaps 20 Hispanic women for mammograms and Pap smears.
During the first quarter of 1993, for example, 23 Hispanic women came to the clinic. But in the following 3 months, that number skyrocketed to 118—more than 5 times as many Hispanic patients as the clinic had seen in any quarter. “How did you hear about us?” they asked this flood of new patients. “The doctor on the radio,” the women would reply, noting that he talks all the time about mammograms and Pap smears and refers them to the clinic.
Dr. Huerta also convinced his listeners to participate in clinical trials, which have struggled with low rates of accrual in the Spanish-speaking community. When he promoted one National Institutes of Health-sponsored trial on the radio, 325 of his listeners signed up, compared with no Hispanic participants in the previous month.
Each day, he broadcasts clear, easy to understand information on topics ranging from how clinical trials work, to why men should examine their testicles regularly just as women should examine their breasts, to the importance of wearing seat belts.
Once people got the message about preventive care and screening, they were left to seek affordable care. This is one reason Dr. Huerta founded the Cancer Preventorium more than a decade ago at the Washington (D.C.) Hospital Center.
The Preventorium is an affordable clinic where low-income people can go for screening tests and get referrals for treatment. It's the opposite of the sanatoriums that sprang up in the early part of the 20th century, which hosted people with long-term illnesses such as tuberculosis, he said.
You don't go to the Preventorium if you're sick, he tells his audience: You go there because you're well and want to stay that way.
Three weeks after its opening, the Preventorium had appointments booked through the end of the year. Patients pay $64 for a visit, and the collection rate is almost 100%. “Even poor people will pay if you give them something of value,” he said.
To date, the Preventorium has seen more than 15,000 patients. Most are recent immigrants who have been convinced by Dr. Huerta's broadcasts that prevention and early detection of illness are essential.
Dr. Huerta said he believes that using the media to sell a disease prevention and health promotion message and providing preventive care and screening in an affordable, one-stop setting could work with almost any underserved group.
This model could save thousands of lives and millions of dollars in health care costs by enabling physicians to treat patients at an earlier stage, he added.
NEW YORK — When Elmer E. Huerta, M.D., left his oncology practice in Peru to come to the Washington, D.C., area in 1987, “I thought I was going to the heavens,” he recalls.
In Peru, 85% of breast and cervical cancers are found at stage III or IV, he told physicians at a cancer symposium.
But when he arrived in the United States, Dr. Huerta found pockets of poverty and lack of access, where people were horribly underserved and where diagnosis of disease came much too late, just as it did in Peru. He treated women with breasts horribly swollen and disfigured by tumors, who hadn't sought care until their symptoms were overwhelming, and their cancers so far advanced that they were almost untreatable.
“I saw women who could not bring themselves to do breast self-exams, because their mothers and grandmothers told them never to touch their breasts,” Dr. Huerta said at the symposium, which was sponsored by New York University and the Lynne Cohen Foundation for Ovarian Cancer Research.
Dr. Huerta realized that cultural barriers—as well as unfamiliarity with the health care system, a lack of insurance coverage, and linguistic isolation—were keeping many Hispanic men and women in the United States from seeking preventive health care.
Many would go to the doctor only when they were sick, which meant that diseases that could have been caught and treated early were being diagnosed in late, deadly stages.
“The challenge I faced was how to convince people to seek care when they had no symptoms,” he said.
The answer came through television and radio. He asked a patient with an advanced case of cervical cancer why she had not had a Pap smear before, and she responded, “What's that?” Seeking to lighten the mood during the same visit, he asked her what she thought of the goings-on on a popular soap opera appearing on a Spanish-language television network. She was instantly engaged, telling him what she thought the characters would do next.
So, “I thought, why can't we sell health like we sell shoes—through the media?”
In 1989, Dr. Huerta created his first radio program, “Cuidando Su Salud [Taking Care of Your Health],” selling not pills, potions, and products, but prevention.
The show has run daily ever since, and now Dr. Huerta has added a weekly, nationally syndicated call-in talk show and a local live television program to his roster. Together, the programs are estimated to reach 90% of Hispanics in the United States.
In 1993, a Montgomery County, Md., health clinic learned about the power of Dr. Huerta's message. In an average quarter, the clinic saw perhaps 20 Hispanic women for mammograms and Pap smears.
During the first quarter of 1993, for example, 23 Hispanic women came to the clinic. But in the following 3 months, that number skyrocketed to 118—more than 5 times as many Hispanic patients as the clinic had seen in any quarter. “How did you hear about us?” they asked this flood of new patients. “The doctor on the radio,” the women would reply, noting that he talks all the time about mammograms and Pap smears and refers them to the clinic.
Dr. Huerta also convinced his listeners to participate in clinical trials, which have struggled with low rates of accrual in the Spanish-speaking community. When he promoted one National Institutes of Health-sponsored trial on the radio, 325 of his listeners signed up, compared with no Hispanic participants in the previous month.
Each day, he broadcasts clear, easy to understand information on topics ranging from how clinical trials work, to why men should examine their testicles regularly just as women should examine their breasts, to the importance of wearing seat belts.
Once people got the message about preventive care and screening, they were left to seek affordable care. This is one reason Dr. Huerta founded the Cancer Preventorium more than a decade ago at the Washington (D.C.) Hospital Center.
The Preventorium is an affordable clinic where low-income people can go for screening tests and get referrals for treatment. It's the opposite of the sanatoriums that sprang up in the early part of the 20th century, which hosted people with long-term illnesses such as tuberculosis, he said.
You don't go to the Preventorium if you're sick, he tells his audience: You go there because you're well and want to stay that way.
Three weeks after its opening, the Preventorium had appointments booked through the end of the year. Patients pay $64 for a visit, and the collection rate is almost 100%. “Even poor people will pay if you give them something of value,” he said.
To date, the Preventorium has seen more than 15,000 patients. Most are recent immigrants who have been convinced by Dr. Huerta's broadcasts that prevention and early detection of illness are essential.
Dr. Huerta said he believes that using the media to sell a disease prevention and health promotion message and providing preventive care and screening in an affordable, one-stop setting could work with almost any underserved group.
This model could save thousands of lives and millions of dollars in health care costs by enabling physicians to treat patients at an earlier stage, he added.
Pregnancy-Associated Breast Cancers Are On Rise as More Women Delay Childbirth
NEW YORK — As more women delay pregnancy into their 30s and 40s, physicians are seeing more pregnancy-associated breast cancers, experts noted at a New York University cancer symposium.
This trend may particularly impact women who carry BRCA1 and BRCA2 genetic mutations, since cancers develop in these women at significantly younger ages than in noncarriers, and some studies have indicated that mutation carriers are more likely to develop cancer during pregnancy.
“This underscores the importance of obstetricians' taking a good family history in their patients who are pregnant or planning to become pregnant,” said Ellen Warner, M.D., of the University of Toronto, who participated in a panel discussion.
“Women who carry a genetic mutation may need a baseline MRI to screen them for occult or early cancer prior to becoming pregnant, along with very close follow-up,” Dr. Warner said during the meeting, which was also sponsored by the Lynne Cohen Foundation for Ovarian Cancer Research.
“We can't say that we're going to save lives with certainty. Just as with other types of surveillance, this is based mostly on expert opinion,” said Elsa Reich, a genetic counselor at the university. “But I feel really strongly that obstetricians should be vigilant about evaluating family history. If a young woman has a mother who died of breast cancer at age 40, she should at least be advised of her increased risk and given the option of consulting a genetic counselor prior to pregnancy.”
Breast cancer is the most common cancer in pregnant and postpartum women, occurring in 1 in 3,000 women. The American College of Obstetricians and Gynecologists hasn't issued recommendations about screening in women with BRCA1 and BRCA2 mutations who plan to become pregnant, although it has noted that women whose first pregnancies occur after age 30 are at some degree of increased risk.
NEW YORK — As more women delay pregnancy into their 30s and 40s, physicians are seeing more pregnancy-associated breast cancers, experts noted at a New York University cancer symposium.
This trend may particularly impact women who carry BRCA1 and BRCA2 genetic mutations, since cancers develop in these women at significantly younger ages than in noncarriers, and some studies have indicated that mutation carriers are more likely to develop cancer during pregnancy.
“This underscores the importance of obstetricians' taking a good family history in their patients who are pregnant or planning to become pregnant,” said Ellen Warner, M.D., of the University of Toronto, who participated in a panel discussion.
“Women who carry a genetic mutation may need a baseline MRI to screen them for occult or early cancer prior to becoming pregnant, along with very close follow-up,” Dr. Warner said during the meeting, which was also sponsored by the Lynne Cohen Foundation for Ovarian Cancer Research.
“We can't say that we're going to save lives with certainty. Just as with other types of surveillance, this is based mostly on expert opinion,” said Elsa Reich, a genetic counselor at the university. “But I feel really strongly that obstetricians should be vigilant about evaluating family history. If a young woman has a mother who died of breast cancer at age 40, she should at least be advised of her increased risk and given the option of consulting a genetic counselor prior to pregnancy.”
Breast cancer is the most common cancer in pregnant and postpartum women, occurring in 1 in 3,000 women. The American College of Obstetricians and Gynecologists hasn't issued recommendations about screening in women with BRCA1 and BRCA2 mutations who plan to become pregnant, although it has noted that women whose first pregnancies occur after age 30 are at some degree of increased risk.
NEW YORK — As more women delay pregnancy into their 30s and 40s, physicians are seeing more pregnancy-associated breast cancers, experts noted at a New York University cancer symposium.
This trend may particularly impact women who carry BRCA1 and BRCA2 genetic mutations, since cancers develop in these women at significantly younger ages than in noncarriers, and some studies have indicated that mutation carriers are more likely to develop cancer during pregnancy.
“This underscores the importance of obstetricians' taking a good family history in their patients who are pregnant or planning to become pregnant,” said Ellen Warner, M.D., of the University of Toronto, who participated in a panel discussion.
“Women who carry a genetic mutation may need a baseline MRI to screen them for occult or early cancer prior to becoming pregnant, along with very close follow-up,” Dr. Warner said during the meeting, which was also sponsored by the Lynne Cohen Foundation for Ovarian Cancer Research.
“We can't say that we're going to save lives with certainty. Just as with other types of surveillance, this is based mostly on expert opinion,” said Elsa Reich, a genetic counselor at the university. “But I feel really strongly that obstetricians should be vigilant about evaluating family history. If a young woman has a mother who died of breast cancer at age 40, she should at least be advised of her increased risk and given the option of consulting a genetic counselor prior to pregnancy.”
Breast cancer is the most common cancer in pregnant and postpartum women, occurring in 1 in 3,000 women. The American College of Obstetricians and Gynecologists hasn't issued recommendations about screening in women with BRCA1 and BRCA2 mutations who plan to become pregnant, although it has noted that women whose first pregnancies occur after age 30 are at some degree of increased risk.
Better Counseling Facilitates Decision Making After Testing
NEW YORK — Enhanced counseling can help women at high risk of breast or ovarian cancer make better use of the information they receive from genetic testing for BRCA1 and BRCA2 mutations, according to a study presented in poster form at a cancer symposium sponsored by New York University.
The few studies that have examined the effects of genetic testing on decision making have found that a significant proportion of eligible women don't take any action after learning their genetic status, according to Suzanne Miller, Ph.D., of Fox Chase Cancer Center in Philadelphia, and her associates.
The investigators randomized approximately half of the study's 80 women who were at high risk for ovarian cancer based on family history to receive “enhanced counseling” before genetic testing.
This process was aimed at helping the women “prelive” how they might respond to their test results.
“We wanted to help women anticipate how they would react, so they would be prepared for it,” Dr. Miller, the study's lead investigator, said during an interview.
Six months later, 68% of the women in the intervention group had sought prophylactic oophorectomy information, and 28% had undergone the surgery. In the control group, which had received standard counseling along with information about improving their general health, 26% had sought information on oophorectomy and 6% had had the surgery.
“The women in the intervention arm were in a position to take action when they got their results,” Dr. Miller said. “This indicates that enhanced counseling can play an important role in decision-making after BRCA1 and2 testing.”
The symposium was also sponsored by the Lynne Cohen Foundation for Ovarian Cancer Research.
NEW YORK — Enhanced counseling can help women at high risk of breast or ovarian cancer make better use of the information they receive from genetic testing for BRCA1 and BRCA2 mutations, according to a study presented in poster form at a cancer symposium sponsored by New York University.
The few studies that have examined the effects of genetic testing on decision making have found that a significant proportion of eligible women don't take any action after learning their genetic status, according to Suzanne Miller, Ph.D., of Fox Chase Cancer Center in Philadelphia, and her associates.
The investigators randomized approximately half of the study's 80 women who were at high risk for ovarian cancer based on family history to receive “enhanced counseling” before genetic testing.
This process was aimed at helping the women “prelive” how they might respond to their test results.
“We wanted to help women anticipate how they would react, so they would be prepared for it,” Dr. Miller, the study's lead investigator, said during an interview.
Six months later, 68% of the women in the intervention group had sought prophylactic oophorectomy information, and 28% had undergone the surgery. In the control group, which had received standard counseling along with information about improving their general health, 26% had sought information on oophorectomy and 6% had had the surgery.
“The women in the intervention arm were in a position to take action when they got their results,” Dr. Miller said. “This indicates that enhanced counseling can play an important role in decision-making after BRCA1 and2 testing.”
The symposium was also sponsored by the Lynne Cohen Foundation for Ovarian Cancer Research.
NEW YORK — Enhanced counseling can help women at high risk of breast or ovarian cancer make better use of the information they receive from genetic testing for BRCA1 and BRCA2 mutations, according to a study presented in poster form at a cancer symposium sponsored by New York University.
The few studies that have examined the effects of genetic testing on decision making have found that a significant proportion of eligible women don't take any action after learning their genetic status, according to Suzanne Miller, Ph.D., of Fox Chase Cancer Center in Philadelphia, and her associates.
The investigators randomized approximately half of the study's 80 women who were at high risk for ovarian cancer based on family history to receive “enhanced counseling” before genetic testing.
This process was aimed at helping the women “prelive” how they might respond to their test results.
“We wanted to help women anticipate how they would react, so they would be prepared for it,” Dr. Miller, the study's lead investigator, said during an interview.
Six months later, 68% of the women in the intervention group had sought prophylactic oophorectomy information, and 28% had undergone the surgery. In the control group, which had received standard counseling along with information about improving their general health, 26% had sought information on oophorectomy and 6% had had the surgery.
“The women in the intervention arm were in a position to take action when they got their results,” Dr. Miller said. “This indicates that enhanced counseling can play an important role in decision-making after BRCA1 and2 testing.”
The symposium was also sponsored by the Lynne Cohen Foundation for Ovarian Cancer Research.