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Study Ranks Oregon Last For Mental Health Care

A study looking at mental health care among states has ranked Oregon dead last.

The president of Mental Health America, Paul Gionfriddo, said researchers considered 13 elements for the ranking: from the number of residents with mental illness to access to care.

Study Ranks Oregon Last For Mental Health Care

Michael Clapp/OPB

A study looking at mental health care among states has ranked Oregon dead last.

The president of Mental Health America, Paul Gionfriddo, said researchers considered 13 elements for the ranking: from the number of residents with mental illness to access to care.

“Oregon does generally poorly on the prevalence of mental illness ranking," he said. "In other words, there are more children and adults with mental illnesses; with dependence on alcohol or drugs; with serious thoughts of suicide.”

The study also looked at factors like how many people have access to insurance, whether that insurance is adequate, and how high are the barriers to accessing mental health care. 

Minnesota was ranked at the top of the list for its mental health care, while Idaho and Washington also ranked near the bottom — coming in at 45th and 47th, respectively. 

When looking only at access to care, Oregon did better in the study, ranking 21st. 

Despite the low ranking, Chis Bouneff with the Oregon chapter of the National Alliance on Mental Illness defended mental health care in the state, saying the data used were from 2013.

“It's very old data," he said.

"Oftentimes the difference between 2015 and 2013, those two years, may not be a big deal. But because you had a seminal event under the Affordable Care Act, in that we expanded Medicaid, it’s hard to look at this data right now and use it to really inform future policies,” Bouneff said.

Both Bouneff and Gionfriddo say they expect Oregon to do better when new data are included next year.

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Portland Has Lowest Preterm Birth Rate In Nation

Portland has the lowest rate of preterm births of any city in the nation — according to a new study by The March of Dimes.

After decades of increases, the rate of premature birth in the U.S. is now declining. But not fast enough, according to the charity March of Dimes.  So it graded 100 cities on their rates.

At 7.2 percent, Portland's rate was much lower than anywhere else. Nationally, about 9.6 percent of births are preterm.

Aaron Caughey, the chair of the department of obstetrics at OHSU, said: "One of the reasons why we can do things here in Oregon that might be harder in other states, is there’s a willingness to work together with disregard of our own personal agenda, our own personal egos, to the best outcomes for the women that we care for.”

Babies born before 37 weeks can suffer from short-term breathing and heart problems, as well as long-term complications like cerebral palsy and poor vision.

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Providence And PeaceHealth Announce Joint Wellness Center In Vancouver

A couple of days after two of Oregon’s largest health care organizations announced a merger, two competitors say they’re also going to collaborate.

PeaceHealth and Providence have signed a letter of intent to develop a new health and wellness center in Vancouver, Washington.

They companies said it’s the first of multiple initiatives.

Dave Underriner, CEO of Providence in Oregon, said his organization and health care services around the nation are reacting to the Affordable Care Act.

“I think you’re going to see all sorts of partnerships and affiliations and collaborations, different ways for organizations to come together to work in concern, in terms of serving communities,” he said.Underriner said the PeaceHealth Providence collaborative will likely result in more jobs — both from building the new center and staffing it.

The recently announced merger between Legacy and PacificSource is also expected to create jobs.

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Oregon To Restructure Health Insurance For State Employees

The state has voted to restructure health care premiums for its employees, to avoid paying the federal government’s new "Cadillac Tax."

The Cadillac Tax goes into effect in a few years. It will take money from people who have high-end health insurance plans to help pay for all the additional people who now have insurance under the Affordable Care Act.

The state’s existing individual employees plans would trigger the tax, costing the state more than $300 million.

Kathy Loretz of Oregon’s Public Employee Benefit Board, or PEBB, says the state is re-balancing premiums so they won’t trigger the tax.

“What is going to happen is that employee premiums are going to go down a little bit, and the employee and family group will go up," she said.

"So total premiums will end up being the same from PEBB's point of view. However, how it is distributed is different.”

Union members on the PEBB board voted for the change, meaning there shouldn't be much opposition to the change.

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As In Vitro Fertilization Methods Improve, Abortion Rates Drop

Mardi Palan is a 30-year-old hair dresser from Portland. She has a partner and a one-year-old son. She hopes to carry twins for a gay couple from Israel.

If successful, she’ll get about $30,000 — money she hopes to use to buy a home.

In August, she had two embryos transferred and just found out via a blood test, that she’s pregnant. Does she feel different?

“Not really. I mean, like there were a couple of songs on the radio that I started crying to and that’s like how I knew," said Palan. "I was like, 'Oh yeah. Something's up.'"

As part of her contract with the intended parents, Palan has agreed to what people in the industry call "selective reduction" — that is, if an embryo develops a serious medical problem, or if it divides and she ends up carrying triplets.

"They have the right to abort the child if they don't want to go with it," she said. "They do a lot of testing when I'm carrying the baby to see if it has Down syndrome or things like that ... but I talked to them and they said if it was disabled they'd still have it."

In some countries like India or Nepal, it’s not unusual for three, four or more embryos to be transferred at a time — and to improve the odds, some companies will transfer that many eggs into multiple surrogates.

That can lead to a lot of "selective reduction" terminations.

But Palan is working with Oregon Reproductive Medicine in Portland.

Dr. Brandon Bankowski, who’s a partner at ORM, said the company focuses on reducing its rate of "selective reduction" by improving the science.

"Our goal is to get to the point where we transfer one embryo and we have one baby," said Bankowski. "The only options that we offer to our patients now are transferring one or two embryos. We would never transfer more than that."

On average, ORM transfers 1.7 embryos. Ten years ago, that average stood at about three embryos.  Still, said Bankowski, they do perform "selective reductions."

"This used to be something that we would talk about much more commonly," he said. "But because we only transfer one or two, it’s an incredibly rare thing for us to have to talk about. It’s essentially a needle procedure where you terminate one of the pregnancies. You can lose the entire pregnancy by doing that.”

Terminations are carried out well within legal time limits for abortion.

So, what is ORM’s success rate?

For women who use donated eggs, about 70 percent of transfers result in live births  — that’s according to the Society for Assisted Reproductive Technology (SART).

The national success rate is 56 percent.

SART is the in vitro fertilization industry's trade group and governing body. It audits success rates and makes them publicly available.

Bankowski said ORM has a high success rate for several reasons. It does an extensive medical check of egg donors, turning away 93 percent of applicants.

It also freezes and thaws eggs in a very specific way.

“That is sort of the secret sauce of the embryologist," he said. "Sometimes they’re keeping an embryo in a bath for five seconds longer.”

And the lab where eggs are collected? It’s essentially a clean room.

“It’s not just, 'Oh, well. Here’s a room and we’ll put in a little filter and here’s some incubators.' It was designed as this special box within a box after we consulted with the clean-room engineers at Intel,” said Bankowski.

People who go into the lab are asked not to wear perfume, because the volatile organic compounds they contain may harm developing eggs. Even new machines are left to air-out before being installed.

But Bankowski said their latest scientific improvement involves taking a tiny slice off the outside of a developing embryo and putting it on a microchip.

That chip contains a series of sensors that can tell whether or not a certain gene is corrupted.

“Four or five years ago, if we were to test an embryo, we would attach about 10 genetic probes to it," he said. "Now we attach about 500,000.”

Craig Reisser, a former banker who lives in London, chose to use Oregon Reproductive Medicine after putting together a spreadsheet comparing clinics across the world on their success rates and costs.

“We felt that where we had the best chance of success the first time round, was also the most financially cost effective place to go,” Reisser said.

Meanwhile, Palan is enthusiastic about the next nine months.  She’ll find out in about six weeks — via ultrasound — whether she’s carrying twins.

She gets an extra $5,000 for twins.

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Study: Working On Children Rattles EMS Staff

Emergency medical staff sometimes get rattled and make mistakes when dealing with children, according to a new study out of Oregon Health & Science University.

OHSU Dr. Jeanne-Marie Guise interviewed more than 750 emergency workers across the nation. Those are the workers who help out after a car accident or similar emergency.

She asked them when were they most likely to make mistakes.

“The EMS workers identified that airway management, their own personal heightened anxiety when caring for children, interference with the family members. That those are the factors that they were listing as commonly contributing to patient safety events,” she said.A ‘patient safety event’ is essentially a mistake that may cause a patient harm.

Guise said medical equipment that isn’t properly sized for children can also be a problem.

She said more training that simulates pediatric emergencies could help improve care.

Her report is published in the latest issue of The Journal of Pediatrics.

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Feds Propose Paying Doctors To Have End-Of-Life Conversations

After years of debate about whether the government should encourage end-of-life plans, the feds have proposed reimbursing doctors to have those conversations.

Medicare, which insures 55 million older and disabled people, is taking another look at paying doctors to talk to patients about how they’d like to be kept alive if they become too sick to speak.

The idea was lambasted by former Alaska Gov. Sarah Palin, as a "death panel."

But Oregon doctors have been squeezing in such conversations during scheduled appointments for years. They just haven’t been able to bill for them.

Dr. Susan Tolle with the Center for Ethics in Health Care at Oregon Health & Science University welcomes the idea.

"What it does is it gives this really important conversation dignity and standing," she said.

Patients in Oregon make their end-of-life directions clear on what’s known as a POLST form. Over the last five years, a quarter of a million forms have been submitted to the state POLST registry.

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