Sound health care planning, or not, in the District of Columbia

Over the past couple months there has been discussion about plans the District government has introduced to build a new hospital in the area of the old DC General Hospital, which closed in the face of a great deal of controversy. There was a great thread of messages about this in themail@dcwatch.com. Today, some of this discussion is recapped in two pieces on the "Close to Home" page of extended letters to the editor that runs on Sundays in the Washington Post--D.C. Won't Be Any Healthier by the pediatrician Eric Rosenthal, who wrote many great pieces in themail and Other Hospitals Have a Stake In the Outcome, authored by a representative of the DC hospital association.

The fact that the DC Government wants to bull this project forward without the normal "certificate of need" review process doesn't bode well. It's a strategy choice that usually means that such a project can't hold up to scrutiny.

Rosenthal makes a distinction between health improvements by proximity--that you'll be healthier somehow because you live closer to a hospital versus a "planning process that takes a hard look at why D.C. residents become sick and addresses those causes."

How is more of the same helping? There are many hospitals in the city, and many terrible health outcomes. Maybe hospital services aren't the best way to address chronic health problems.

I find this interesting for a number of reasons, but I'll just mention a couple things that I've run across in the past couple days that are relevant to this discussion.

First, earlier in the week the Wall Street Journal ran this article (which fortunately is available online through the Pittsburgh Post-Gazette) Getting your health care at Wal-Mart about how pharmacies and large retail stores are starting to offer health care services on premises.

From the article:

In a development that has broad implications for the nation's primary-care system, a rising number of major pharmacy and retail chains -- including CVS Corp., Wal-Mart Stores Inc. and Target Corp. -- are opening in-store health clinics. They offer patients fast access to routine medical services such as strep-throat tests, sports physicals and flu shots. The clinics, which typically charge between $25 and $60 per visit, don't require an appointment and are open during pharmacy hours including evenings and weekends. To keep costs down, they are staffed by nurse practitioners, who can legally treat patients and write prescriptions in most states.

The trend is rapidly spreading in pharmacy chains as they look for ways to stem losses to mail-order pharmacies and big-box stores. Three of the nation's largest drugstore chains -- Rite Aid Corp., Brooks Eckerd Pharmacy and Osco Drug -- have announced plans to open health clinics in the coming months.

I think this is particularly interesting, not because this proposed health care center faces additional competition from CVS and the like, but because of what it says about the importance of making health care access more widely available and at times outside of normal 9-5 business hours.

This is another reiteration of Rosenthal's point that the biggest question that isn't being asked is something like this (my words, not his) "is our current system of delivering health care services in the District of Columbia contributing to improved health outcomes. If not why not? And how can we better deliver health care services to achieve higher outcomes."

The other thing is another email from the comm-org list, about community-based asthma services. Asthma is a big problem in DC neighborhoods, particularly among African-Americans. Will building another hospital reduce death and catastrophic asthma attacks (this is but one of many issues and questions) or are there better ways to direct resources and provide services to generate positive health outcomes?

Here was the original comm-org email--

My name is Holly and I am a graduate student in the University of New England's Social Work program. I am collecting information on community based asthma control. I would be interested to hear if any early intervention programs or in home programs are working with the head starts or other programs in your communities to educate parents and held identify asthma triggers within homes. Your input would be appreciated!

and one response--

You may want to consider getting in touch with Family Services, Inc. in Lawrence. They do quite a bit of community and in-home education relating to asthma. Also, the Latino Health Institute (which I think is also based in Lawrence) may have some leads for you. Another thing you might consider is contacting community health centers in areas that have high asthma rates. I would recommend East Boston Neighborhood Health Center, Dimock Community Health Center, and Fenway Community Health Center (although there are undoubtedly mor ehealth centers that you could contact). Also, the Center for Community Health Education, Research and Service here at Northeastern University may also be able to point you to some sources.

What about the community health responses to chronic DC health care problems? Does another hospital change the fundamental process issues at all?

Maybe DC is on the cutting edge with regard to community-based asthma control initiatives, but I seem to recall reading plenty of articles in the Washington Post about asthma attacks, inadequate emergency response, and deaths (e.g., the death of the son of a close friend of Sharon Pratt Kelly, etc.).