It may be a new trend in hospital marketing (or maybe not): A hospital system in Ohio has begun advertising emergency room “door-to-doc” wait times on billboards around town and on the Internet, according to the The Akron Beacon Journal.

Wait-times for six local ERs, operated by the Akron General Health System, are updated on digital roadside billboards every 20 minutes, the paper reports, based on current patient information from electronic medical records. The article states:

The campaign is geared toward patients ”who don’t have to call 911 to come in,” said Dr. Nick Jouriles, interim chairman of Akron General’s Department of Emergency Medicine. Patients with chest pain, for example, should call for help, not shop for the shortest wait time.

”We value our patients, and we value our patients’ time,” Jouriles said. ”This is our way of saying, ‘We’re working hard to make our experience better and the time that they have to spend shorter for the same quality care.’ ”

Evan Lyon, MD, an associate physician at the Division of Global Health Equity at Brigham and Women’s Hospital and an instructor in medicine at Harvard Medical School, focuses on community-based approaches to HIV and TB treatment. Dr. Lyon, a longtime affiliate of Boston-based Partners in Health, has worked in Haiti since 1996, and recently spent several weeks there just after the earthquake hit. He argues that community health workers, or “accompagnateurs,” should play a key role in rebuilding the country:

Partners In Health (PIH) is not a disaster relief organization. But PIH’s deep roots in Haiti allowed PIH to respond more quickly to provide emergency medical care following the earthquake on January 12 than most disaster-relief organizations. Over the past twenty years, PIH has hired a Haitian staff of more than 4,000, built 12 hospitals and health centers in the Central Plateau and Lower Artibonite Valley, and cultivated a strong working relationship with the Haitian Ministry of Health (MOH).

When the earthquake struck most of our staff was at home, in Haiti. There was no delay or bottleneck getting doctors and nurses to where they were needed most – PIH staff poured into Port-au-Prince to get to work. In the days immediately following the quake, PIH was designated by the World Health Organization (WHO) to “accompany” the recovery of Hôpital Université de l’Etat Haiti (HUEH), the University General Hospital in Port-au-Prince. Standing shoulder to shoulder with our Haitian colleagues, we helped them coordinate the outpouring of international assistance to support their devastated hospital.

PIH dispelled rumors of “insecurity” allowing aid to flow more quickly from the U.N., U.S. military, and other international aid agencies. Also because our 12 facilities (all outside the capital) were largely undamaged by the earthquake, we had the capacity to quickly receive and care for the injured who managed to leave Port-au-Prince. Our facilities in Cange, Hinche, St. Marc, and elsewhere are still overflowing with earthquake related patients.

PIH’s work in Haiti is built around community health workers (CHW), a job in Haitian Creole known as an “accompagnateur.” Accompagnateurs have a deep understanding of the needs and challenges of their own communities and care for patients as if they were their own family members. The CHW model not only helps PIH quickly identify where the needs are and provide proper care, but it also gives community members a means to provide for their families, at a time when jobs and food and water are scarce.

Half of PIH’s employees are already CHWs, and in the wake of the earthquake, PIH has hired dozens more to work on mobile teams that are providing medical care and essential supplies in the tent cities across Port-au-Prince. By injecting resources directly into communities, PIH is helping boost local communities and reaching thousands of people in need. Read more…

Maureen Corry, executive director of the non-profit research and advocacy organization, Childbirth Connection, offers recommendations for a revamped system of excellent care for new mothers and babies, at an appropriate cost:

With the seemingly endless furor over health care reform, you wouldn’t think a well-planned roadmap toward health care nirvana already existed. At least it does when it comes to maternity care – the number one reason for hospitalization.

Last week, Childbirth Connection released two reports that are the fruit of over two years’ labor by more than 100 maternity care leaders representing every industry stakeholder – from hospitals and health plans to consumers, quality experts and providers. The “2020 Vision for a High-Quality, High-Value Maternity Care System” and “Blueprint for Action” lay out the values of and recommendations for a maternity care system in which women receive high quality evidence-based care at an appropriate cost.

Maternity care is the sweet spot for what we all want: high quality, high value care. It’s one of the only sectors of the health care industry where less care often means better care. Most mothers experience interventions that are inappropriate to use routinely among the population of primarily young and healthy women who give birth to 4.3 million babies each year. And while we spend so much more on health care, our performance lags distantly behind other developed nations on quality indicators including low birthweight, prematurity and maternal death. (See the USA Today stories “High-tech interventions deliver huge childbirth bill” and “Maternity-care failings can be remedied with cost-saving fixes.”)

Similar to what the Institute of Medicine’s Crossing the Quality Chasm did to define high quality health care, the 2020 Vision presents a shared view of fundamental values, principles and attributes that constitute a high quality maternity care system. The Blueprint provides detailed recommendations and action steps developed by five stakeholder workgroups to achieve the Vision. Specific strategies in 11 critical areas are outlined and answer the question: “Who needs to do what, to, with, and for whom to improve the quality of maternity care over the next five years?”

The reports are only the first step in a concerted effort to transform maternity care. We’ve established a public-private multi-stakeholder partnership to carry out the next phase of our initiative and implement Blueprint steps to accelerate health system change. The potential to improve maternity care is within our reach, but we can’t do it alone. There’s much to learn from those who have successfully implemented maternity care QI programs. We call upon them to share their knowledge and experiences and invite others that want to make change to get in touch with us.

Health care reform offers many opportunities, but with or without it, there’s work to be done to ensure optimal care for women and newborns. The Vision and Blueprint are tools we can use now to build a maternity care system that works.

A Few Highlights of Blueprint Recommendations:

Performance Measurement
Fill in gaps to attain a complete set of nationally endorsed consensus measures to assess maternity care performance across the full episode of maternity care, including outcomes and value of care, and experiences of women and families. Read more…

Barbara Hagan, a former state representative from Manchester, NH and self-described “right to life activist,” awaits Wednesday’s vote on a controversial hospital acquisition:

The clock is ticking in New Hampshire over the secular Dartmouth Hitchcock Health’s controversial takeover of Catholic Medical Center in Manchester. Although the New Hampshire attorney general has 120 days to review the merger proposal, filed on January 21st, that review may be coming to an abrupt end. A resolution approved by the Legislature’s Commerce Committee to refer the matter to Probate Court goes before the full New Hampshire House of Representatives for a vote on Wednesday, February 3.

If the House votes in favor, Catholic Medical Center’s CEO Allison Pitman will no longer be able to hide behind semantics, empty promises and blanket denials. CMC will be confronted by a reality it has yet to face: a thorough legal review. CMC and DHH will be forced to answer questions candidly under oath. Calling an acquisition an “affiliation” as they have done for six months, will not play as well in the court room as it does on talk radio. The Probate Court can review CMC and Dartmouth’s plans to create a statewide healthcare giant that dominates healthcare consumers from Boston to the Canadian border, forces increased costs on New Hampshire residents and businesses and limits choices for patients.

Meanwhile, a group of concerned Catholics have appealed to Vatican offices to stop the takeover and preserve a Catholic healthcare option in new Hampshire. The state’s Catholic community continues to be ill-served by a bishop whose punishment for making a mess of things in Boston was to be sent to New Hampshire to create new controversies. Bishop John McCormack’s tacit approval of this merger from the start has been about as genuine as Pontius Pilate’s hand-washing.

Soon enough, the clock will stop ticking, and the bell will toll. The only question left is when, since we Catholics know better than to ask for whom.

The Boston Globe reports that the British medical journal, The Lancet, retracted a flawed study that linked autism and other problems to childhood vaccines for measles, mumps and rubella.

The study, by the controversial (and now officially discredited) doctor Andrew Wakefield, was one of the key documents to launch the anti-vaccine movement among parents in the U.K and the U.S. The Globe states:

Last week, Britain’s General Medical Council ruled that Wakefield had shown a “callous disregard” for the children used in his study and acted unethically. Wakefield and the two colleagues who have not renounced the study face being stripped of their right to practice medicine in Britain.

For the study, Wakefield took blood samples from children at his son’s birthday party, paying them 5 pounds each ($8) for their contributions and later joking about the incident.

And in her Motherlode blog in the New York Times, Lisa Belkin offers a post by a mom frustrated by false promises that children with autism can be “cured” (see also, actrees turned autism-cure crusader, Jenny McCarthy).

A number of health care experts assess the chances of President Obama and Congress enacting a revamped health industry overhaul. These analyses, pulled together by Kaiser Health News, include an historical look at reform attempts in the mid-1990s under President Clinton, as well as Obama’s direct plea to Republicans on a YouTube-sponsored Q&A to keep negotiations moving forward. The Wall Street Journal quotes Obama saying:

“We had this enormous opportunity, but the way the rules work in the United States Senate, you’ve got to have 60 votes for everything. After the special election in Massachusetts, we now only have 59. We are calling on our Republican colleagues to get behind a serious health reform bill, one that actually provides not only the insurance reforms for people who do have health insurance but also the coverage for folks who don’t. My hope is, is that they accept that invitation and that they work with us together over the next several weeks to get it done.”

Here’s the story of a 53-year-old woman with breast cancer who decided to move to England to gain access to affordable treatment. Erika Rex, writing for Kaiser Health News, says after dating a British man for less than a year, she left New York for the U.K, and into the open arms of the National Health Service, where she encountered poetry in the doctor’s waiting room, free prescription drugs and a truly compassionate physician. Rex writes:

I had some wonderful doctors in New York, caring and helpful. But I also had to fight with my hospital there to get the tests I needed, and several of the specialists were so difficult to deal with I chose medical protocols to avoid them—no matter what the best option for treatment was. What I really notice about the health care providers in England is that they seem to have more than half a second for me – and they actually listen.

Feel like venting? A new website, My American Health Care Story, is collecting just that — video clips of regular folks telling their stories of life in the health care system (or of opting out). It may not do much, at this point, given the national impasse on health reform, but at least you can get it off your chest.

Dr. Gene Lindsey, president and CEO of Atrius Health, an alliance of medical groups, describes the potential of a new partnership aimed at lowering health care costs while improving quality:

We are at a “tipping point” in health care. As Don Berwick, MD, MPP, president and CEO of the Institute for Healthcare Improvement put it: “Almost for certain, the American health care system is on the threshold of a leap into a new era of integrated, coordinated care. Patients as individuals and society as a whole badly needs that leap to achieve better quality and lower total cost…that will require new, highly cooperative relationships between foresighted hospitals and progressive medical groups.”

Atrius Health and Beth Israel Deaconess Medical Center have made the decision to move forward together to create this new type of organization based on a network of providers who share the responsibility for the cost and quality of patient care.

(See also, Sacha Pfeiffer’s story today on “medical homes,” on WBUR.)

Our goal is to demonstrate that by working together, the two organizations can fulfill Berwick’s vision to provide the highest quality, best service and the lowest cost health care in the Commonwealth.

Here’s how—and many of these principles have been outlined by the Massachusetts Health Care Quality and Cost Council and the Payment Reform Commission:

Give primary care physicians responsibility for coordinating patient care from the doctor’s office to the hospital and everywhere in between; make sure physicians work as a team with nurses, technicians, and other allied health professionals; further enhance and integrate electronic medical records so a physician in his office can see the hospital records and vice versa; be transparent to reduce and prevent medical errors; improve efficiency by continuous process improvement as exemplified by the Lean methodology; empower patient involvement through advisory councils, secret shoppers, patient satisfaction surveys and other mechanisms; and reduce health disparities and ensure a diverse workforce. Read more…

For anyone who missed Frank Rich in the New York Times yesterday, here’s his take on “The Massachusetts Massacre,” of Jan. 19th and what it means for the Obama administration. Rich writes:

It was not a referendum on Barack Obama, who in every poll remains one of the most popular politicians in America. It was not a rejection of universal health care, which Massachusetts mandated (with Scott Brown’s State Senate vote) in 2006. It was not a harbinger of a resurgent G.O.P., whose numbers remain in the toilet. Brown had the good sense not to identify himself as a Republican in either his campaign advertising or his victory speech.

But it does underscore Obama’s missteps, Rich says, on health care and the economy:

Worse, the master communicator in the White House has still not delivered a coherent message on his signature policy. He not only refused to signal his health care imperatives early on but even now he, like Congressional Democrats, has failed to explain clearly why and how reform relates to economic recovery — or, for that matter, what he wants the final bill to contain. Sure, a president needs political wiggle room as legislative sausage is made, but Scott Brown could and did drive his truck through the wide, wobbly parameters set by Obama.

Ask yourself this: All these months later, do you yet know what the health care plan means for your family’s bottom line, your taxes, your insurance? It’s this nebulousness, magnified by endless Senate versus House squabbling, that has allowed reform to be caricatured by its foes as an impenetrable Rube Goldberg monstrosity, a parody of deficit-ridden big government. Since most voters are understandably confused about what the bills contain, the opponents have been able to attribute any evil they want to Obamacare, from death panels to the death of Medicare, without fear of contradiction.

It’s too late to rewrite that history, but it may not be too late for White House decisiveness. Whatever happens now — good, bad or ugly — must happen fast. Each day Washington spends dickering over health care is another day lost while the election-year economy, stupid, remains intractable for Americans who are suffering.