About

 Globe1234 is aimed at diligent patients looking for doctors, and trying to understand incentives in the healthcare system. 

It's also aimed at primary care physicians looking to find details about specialists' practice, when deciding where to refer patients having various conditions.

The site covers specialist doctors, generalist doctors, privacy, end-of-life planning, salt as a nutritional and practical issue, hospitals' financial position, government penalties and incentives. It has a large amount of information on Medicare, because of Medicare's pervasive influence on care.

The site editor is Paul Burke, an independent researcher who has managed and analyzed data for HUD, Congress' Office of Technology Assessment and the UN Development Program.

He is not financed by Medicare or the healthcare industry. There are links to some books with helpful information, but they do not generate fees for the site.

His career has focused on analysis of data.

• He has consulted for the UN Development Program on issues in education, development, the environment, economics, poverty, gender, and government spending.
• He chaired the committee on member surveys of a health care cooperative with 100,000 members.
• He has led seminars on data analysis at the University of California-Berkeley, Columbia University, Fordham University, Venezuela's National Council on Human Resources, and the International Labor Statistics Center of the US Department of Labor. He taught mathematics, physics and French in Ghana.
• He was President of the Jefferson County (WV) Planning Commission.
• For HUD he designed and analyzed national surveys. He did research on planning, counseling, subsidized and free-market housing.
• As a sworn Census agent, he analyzed data about individuals on the Census Bureau's central computers.
• He has an undergraduate degree in Mathematics, and a Master's degree in Interdisciplinary Urban Studies, both from Brown University.
• He also has a website on election security, VoteWell.net.

Paul Burke
9169 W State Street, #1881
Boise, ID 83714
Burke@Globe1234.com
The designated agent for any notice under 17USC512(c)(3)(A), claiming copyright infringement, is the same person and address, also at CopyrightNotice@Lang1234.com, 304-876-2227
​
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Globe1234 by Globe1234.com is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

PRESS ANNOUNCEMENTS

Readmission Penalties:
2015 August 10 - Hospitals Treat Fewer Seniors when Medicare Charges Penalties
2014 August 6 - Hospitals Fined $529 Million, or here
2014 May 30 - Readmission Penalties Put Burdens on Hospitals, or here
          Coverage by Bloomberg BNA
2013 August 14 - Size of Readmission Penalties, or here
          Coverage by EHRIntelligence, Orthopedics This Week

Accountable Care Organizations:
2014 July 15 - Medicare Plans to Penalize Hospital Use, or here
2014 February 12 - Medicare Pays Doctors To Cut Treatment

Comments on 2015 Diet Guidelines

 Writing for Older Adults

I try to make this site clear for young and old. I realize there is a long way to go.

For readers who need to analyze the statistics here, there are suggestions in the page on Excel, including links for statistics at the bottom of that page.

Online Reading
Older adults online are engaged. "People 55 years and older have a three times higher propensity to click on a digital ad than the younger generation."

Here are some suggestions on presenting information, remembering that many people are distracted, stressed and hurried when reading health information:

• CDC Simply put
• CDC  Everyday words for public health communication
• NIH Formatting and Visual Clarity  
• NIH Clear & Simple
• HHS Health Promotion tips for websites
• NIH MedlinePlus Health Literacy links to specialized research
• CMS Toolkit Part 9 "if your written material is for older adults" (pdf, 18 pages, 2010)
• National Cancer Institute Pink Book. Making Health Communication Programs Work (pdf, 262 pages, 2014)
• Institute of Medicine, "A Prescription to End Confusion" (pdf, 350 pages, 2004)

• HHS Health Promotion, tips for websites
• JAMA Cardiology 2018 Navar et al. say a bar graph is more motivating to patients than a pictograph: "Using a pictogram led to lower risk perception and therapy willingness than a bar graph or no graphic."
• JAMA Guide to Statistics and Methods, 2019 Saver et al. justify showing survival as percents, not number needed to treat, since percents are easier to compare among groups. "benefit per hundred... more readily facilitates comparisons because it expresses the treatment effect magnitude using a uniform (100) and familiar (from percentages) denominator"
  
• ResolvePhilly on describing groups, places, people
  

Here are some articles on widespread badly written information for patients:

• Breast exams
• COVID-19
• Bone+muscle doctors

Health Literacy

The articles above have good suggestions, but their figures on adults' health literacy are too low. Adults are probably more literate than they say. Their estimate of 90 million people with low general literacy comes from a 1993 study (Kirsch et al pdf 171 pages) with flawed measurements. The health literacy numbers come from an unreliable 2003 voluntary study of people 16 and older, with only 60% response in households, and no nursing homes. They did not pay or reward participants, so there was no incentive to complete the long survey or try hard on long reading assignments. They started with 35 pages of sensitive questions on language, health, income, welfare, work, voting, parenting, etc. Then they tested people's reading ability for 45 more minutes.

They published only 4 of the ability questions. The 4 questions have big flaws, as is  typical  in Education Department surveys. Health issues are indeed hard, but this survey did not measure well. They said:

1. 74% answered correctly question N110101 on why finding one's blood pressure is hard*
2. 64% answered correctly question C080201 by finding a small warning in a medicine label. However the real-world problem isn't finding this warning when you're told to look, the problem is taking time to look, and then remembering all the warnings.
3. 60% answered "correctly" question C080101 aboutwhat time to take a medicine which must be 2 hours after lunch. The question said when lunch started, not when it ended, so the right answer depends on how long you think lunch takes.
4. 40% answered correctly question N110201 by calculating the Black death rate from the White rate and the ratio of the rates*

* The 74% and 40% questions required reading a brochure on Blacks dying from high blood pressure, with data from the 1960s. No surprise that 26% of adults didn't have time or interest to pore over a brochure about death so long ago, and 60% didn't calculate a Black death rate. The second column of the brochure says "The only way you can be sure is to have the doctor check your blood pressure." Why do they think home machines, or nurses, who usually take it, are not good enough? Why would people keep reading a brochure with such suspect advice?