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House calls push health reform forward

By Robert Bazell, NBC News Chief science correspondent

We received several thoughtful responses to last night's report on Duke University's experiments to enhance their health care system. (You can find them below my blog post from yesterday.)

The Duke researchers began their experiments by talking to people who were using the emergency room for non-emergency purposes. They then used their stories about the medical system in general for ideas on how to improve Duke's--and some of North Carolina's--health care delivery system, including Duke's family practice

offices.
 
In tonight's report, we describe how the Duke team makes house calls to people who have difficulty making it to the doctor, and how the team has set
up satellite clinics in neighborhoods as well, including inside some high schools where they provide care for adolescents.
 
One complaint about last night's report came in an e-mail to me from a spokeswoman for the American College of Emergency Physicians. It questioned 

the assumption that care in the ER (or ED, for emergency department) of a hospital is more expensive or inefficient than care in a doctor's office. Instead of getting into that argument, which is multi-layered, I offered to do more future reports about the current state of emergency medicine in the country.
 
But one statistic from that email exchange stands out to me: Out of America's annual expenditure of $2.1 trillion for health care, $37.5 billion–-or
1.8 percent--goes toward emergency medicine. The ER is truly our health care lifeline, the backup if all else fails.  The medical staff who work in those facilities often put in long hours for far less pay than those in other specialties.
 
Just because the Duke researchers began their research in the ER does not imply an opinion on their part--or mine--that the staff in the ER is doing
anything wrong.
 
I hope you find the second part of this two-part report enlightening. And again, I repeat, no one knows what health care reform will look like in the
U.S., but it is useful to see the experiments already underway to try and improve health care delivery.