elated, enamoured, educated, exhausted.

We had a wonderful time. And did lots. And saw friends (and Grandpa).

And I have never been prouder of my beautiful, smart, adventurous, loving son.

I'll write more when I am more coherent (I am still recovering from jet-lag).

This photo was taken at the Tower of London. More are up Flickr (taken from Monday, April 14 to Wednesday, April 16) with others to follow when I am back to life.

I am so very glad we took this trip. It was made possible by people who love us and as a conscious decision to make some very good memories.

I was a bit anxious about going but the trip, my son, my friends and family and the people of London, all exceeded my expectations.

Did I mention that we had a wonderful time?

There's Matria the Company and then there is Matria the Brand

While the Disease Management Care Blog gets settled in at the World Health Care Congress, it’s been updating itself about Matria. Mixed in among the stock price news and other corporate happenings are interesting alerts from mom-blogs and pregnancy bulletin boards that mention the company by name. Amidst all the references to cerclage, hyperemesis and terbutaline, they tell a compelling and under-recognized story about the role of disease management in supporting pregnant women at home. They also suggest Matria's brand in this corner of population-based care may be significant.

Top line revenue from a payor for pregnancy home support: good
Meaningful clinical & financial outcomes: important
Anecdotes from moms to be: priceless.

'I still felt crappy, but at that point, I wasn't feeling any worse than I'd felt all night, so I decided to wait to call Matria until it turned over from After-hours to the local center, so that I had a higher likelihood of talking with a nurse who knew me. At 8:30 I called over there and spoke with a nurse who, as it happened, I'd never spoken with before. She suggested giving myself an extra bolus, but also said that she'd recommend contacting the doctor, since this was a change from the norm for me. So she paged the doctor for me. '

'At this point they suggested something called a Zofran pump. I was totally freaked out to get this and dreaded having something attached to me at all times. A company called Matria sends a nurse to your home and hooks you up. I had to put a needle in my thigh and hook up a syringe - the syringe went in a tiny contraption (the size of a remote) that slowly administers the medicine throughout the day. '

'I was on Matria's service and I credit it and their amazing staff with helping me get to 31 weeks of my pregnancy and giving my daughters a fighting chance. I was regularly impressed with this service and its staff and at times, felt they were more dependable than my own OB. I feel so strongly about Matria that I booked a FL Matria rep on a South FL news program (I'm a publicist) for free just to help promote this wonderful company.'

'It takes a while for your body to absorb so you have to massage the area a bit. Ask your doctor if he works with MATRIA, that's who managed my home monitoring for contractions and they would send out a nurse to come out weekly to monitor the baby and give me the shots at home.'

The Disease Management Blog will be the 5th Annual World Health Care Congress

... and it's looking forward to it. Check out the web site and you'll see that there will be an impressive array of health care rock stars. While it'll be a learning experience, this will also be a chance for the DMCB to play cub reporter, ask the tough questions no else has thought of and post the answers here. Hopefully there will be sufficient caffeine and internet access.

Pennsylvania Leads in Health Care Reform

The Disease Management Care Blog attended a meeting of the Pennsylvania Diabetes Action Partnership on April 17. It was notable because it was attended by the ‘important’ health care leaders from across Pennsylvania. By ‘important,’ the DMCB means those nurses, physicians, nurses, administrators, nurses, others and, yes, nurses who occupy the lower strata in myriad health care organizations and make things actually happen. The energy and enthusiasm in the room was remarkable.

PDAP is sponsored by the Pennsylvania Department of Health and has its eyes on making the recommendations of Pennsylvania’s Chronic Care Commission a reality. Attendees at the meeting learned about the coming roll-out of 'learning cooperatives' designed to promote the Chronic Care Model for the care of persons with diabetes. A 1st phase cooperative has already started in Southeastern part of the State. The DMCB heard that participation by primary care practices has been impressive: they are turning doctors away.

Why is this important?

To the knowledge of the DMCB, this is the first attempt anywhere to implement the Chronic Care Model on a large and sustainable (emphasis on the word sustainable) scale outside of research settings, publicly funded clinics, and integrated delivery systems.

There seems to be considerable mainstream primary care physician support.

This is one of the cornerstones to extend health insurance coverage to all Pennsylvanians. In contrast to the Massachusetts experience, coverage is being paired with a credible attempt to provide better access.

If successful, the DMCB thinks this could a model for national health care reform.

The absence of the disease management community was conspicuous.

Provider Payment "Food Fight"

For some time I have been saying that we are about to have a "food fight" between health care providers over who will sustain Medicare payment cuts--HMOs, docs, hospitals, nursing homes, durable medical equipment, and others.But even I was surprised by a recent email from the AMA that included this connection between provider payments and food:“While it’s unusual to think of farmers and hospitals

The Latest Edition of Health Wonk Review is Up!

An assemblage of insights, opinions and commentary awaits you at the latest Health Wonk Review, hosted by the mostests Maggie Mahar and Niko Karvounis at HealthBeat. Check it out.

The New England Journal, Electronic Medical Records and Personal Health Records - Now For Something Completely Different

The April 17 New England Journal of Medicine has a pair of Perspective pieces (subscriptions required) on personal electronic health medical records or whatever they are called.

The 1^st is an eminently concise and readable review of ‘personally controlled online health data’ by Robert Steinbrook. Have you been as confounded as me about Dossia, Google and Health Vault? Look no further, because this summary describes the reality and theory behind the notion that consumers are going to take control of their medical history, drug lists, allergies, immunizations, insurance information and doctor visit records. According to Dr. Steinbrook, the major players are Dossia (founded by some large companies including AT&T and Intel), Microsoft’s Health Vault (already working with New York Presbyterian Hospital) and the not-yet-available Good Health (being test-driven at the Cleveland Clinic). Their business model is based on three sources of income: 1) revenue from ‘hospitals and health plans from the recruitment and retention of patients who want such [electronic] records’ and 2) advertising directed at patients while they perform on-line health information searches and 3) savings from coordinated care, disease management, worker productivity and wellness. Will consumers really manage this? Will proprietary systems owned by doctors and hospitals be allowed to format and ‘upload’ their data? Will doctors themselves get a grip on what is coming? Did anyone anticipate the explicit link to ‘disease management?’ Take a look at the article and decide for yourself.

The 2^nd is an even more readable and extremely contrarian view on the ugly downside of electronic records. How about physicians’ repeated use of cutting and pasting text, leading not only to plagiarism but the risk that wrong information is repeatedly and perpetually documented? Lab tests being dropped into physicians’ notes without any monitoring? Repetitive text being so voluminous in the name of documentation, it hobbles the physicians’ ability to discern what is really important? Imagine all these doctors staring at monitors, filling in templates and ignoring their patients. Drs. Hartzband and Groopman point out they are not Luddites, but ask us to pause and think about the difference between data and information, automaticity and efficiency, technology and thinking. Well worth the read.

In the meantime, the Disease Management Care Blog plans to sit back and wait for the medical IT bloggers to light up, especially those who hold fast to the notion that our brave new medical-digital world means higher quality, lower costs, better medical practice, saved babies, reversal of aging, a ban on whale hunting and a stop to Kristi Yamaguchi’s certain victory.