TASK DEFINITION: Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.
PROBLEM: The question of cost is cited in the final line of the story, which suggests that the scoring system can “address escalating health care cost issues.” But we didn’t think that was specific enough to warrant a Satisfactory score. The story doesn’t clue readers in to the fact that the financial burden can be measured in billions of dollars — a single screening test recommended for millions of Americans can cost thousands of dollars apiece. The other cost issue specific to this test is that it takes valuable time for providers to retrieve a reputable risk calculator when sitting with a patient and enter in the specific data points, including in this case waist circumference, which clinicians often do not measure as a ‘vital sign’ per se. The story cites a study that credits colonoscopy with reducing the risk of death from colon cancer by about 50 percent, by removing polyps. It would have been helpful for the story to explain what that relative reduction in risk means in absolute terms (e.g. did the rate of cancer death go from 50% to 25% or from 2% to around 1%?) The story also notes that the study found that patients with a low to intermediate risk score “still have a risk between of between 1.9 percent to 9.9 percent of harboring a polyp that can develop into cancer.” We’ll give credit here for the story’s provision of these key statistics, which do give a sense as how well the test accurately identifies truly low-risk individuals. However, we’d note that the benefit here should ideally refer to the ability of the algorithm to classify people at all risk levels (including high-risk), and therefore target the highest-risk patients for colonoscopy. The story doesn’t really get into discussion of the predictive power of the test, referred to as a likelihood ratio, which is in the study manuscript. However, this is a difficult concept for most health care providers and patients, and we think it’s understandable that the story did not include a full discussion of this topic. The harm of a screening test such as this really is “getting it wrong” in terms of predicting someone to be at low risk and finding them to have a higher risk polyp or malignancy. As noted above, the story cautions that “low- to intermediate-risk patients still have a risk between of between 1.9 percent to 9.9 percent of harboring a polyp that can develop into cancer.” This story accurately explains that the research was about predictive modeling, and explains the components of the risk score as well as the study design. There are some cautionary notes in the text, including a statement from outside expert that “the data from this study is not strong enough to spur any changes in current screening recommendations,” an opinion shared by an editorialist on the study. We think this is sufficient for a Satisfactory rating. The story does not hype the incidence or seriousness of the disease. The prevalence statistics cited are consistent with these National Cancer Institute figures. The story contains two independent voices. The perspective they provide is a particular strength of the article. We wish that more stories would reach out to experts not affiliated with the studies being reported on for context. The story notes that a variety of screening tests exist, but the relevant alternative here is actually other risk calculators, which the authors of the study describe and cite but are not routinely used. The story doesn’t mention these other calculators and why they are seldom used — context that would have deepened reader understanding of the issue. Although availability isn’t explicitly addressed, this risk calculator is now available (implicitly) by virtue of publication of the paper. It is a simple scoring system that can be implemented based on the information in the paper, and the story makes this clear. We’ll rate this Satisfactory. The story makes it sound as if this is a first-of-its-kind tool. However, risk calculation tools for colon cancer have been in circulation for many years. We could not find a news release related to this study. But in any case, the comments from two independent experts assure us that the story wasn’t based on a news release.

SOLUTION: 'Scoring System' May Spot Those in Greatest Need of Colonoscopy; But one expert cautions that even 'low risk' patients can still develop suspicious polyps

PROBLEM: Since 2000, 34 of Iowa’s 118 community hospitals have closed their birthing units, according to the Iowa Department of Public Health. There have been two so far this year, down from eight closures last year — the most in a single year. Most of those closures have happened at smaller facilities than the 49-bed Marshalltown hospital. Iowa’s aging population is a key reason for these closures, Dr. Stephen Hunter, vice chairman of obstetrics at the University of Iowa Hospital & Clinics in Iowa City, told Iowa Public Radio . “Some rural counties have lost as many as 40 percent of their population in the last three decades,” Hunter said. “That’s a lot of people gone, unfortunately. That leaves a system that’s not adequate for those that remain in those counties.” Hunter said the state is also facing a severe shortage of OB/GYNs and family practice doctors who practice obstetrics. And, he said, Medicaid reimbursements are so low for obstetrics that hospitals can’t support the service. According to figures from the University of Iowa Hospitals & Clinics, Medicaid reimbursed it about one-third of what commercial insurance plans did for services such as ultrasounds and deliveries last year. Competition from bigger hospitals in bigger cities presents a business challenge, too. “There simply aren’t enough women choosing to deliver locally,” UnityPoint Health President Jenni Friedly said. “This is a problem that has been going on for a long time. . There are enough women becoming pregnant, but they are going elsewhere to deliver. It’s clear OB/GYN patients are already selecting Ames and Des Moines for their care.” Stephanie Trusty, a nurse who tracks birthing trends for the state, told the Marshalltown Times-Republican that “some of these birthing units are beautiful. They’re like a four-star hotel.” But does the loss of birthing units at the smaller hospitals and consolidation of birthing services affect health outcomes? A 2017 University of Minnesota study said the loss of labor and delivery units in smaller, more remote counties is linked with a decrease in prenatal care and increase in out-of-hospital and preterm births. The Iowa Public Health Department and the University of Iowa are keeping watch for any such problems, but so far have not seen any sizable incidence, Trusty said. Hansen Family Hospital CEO Doug Morse in Iowa Falls told Iowa Public Radio that hospital officials decided labor and delivery care were too expensive to continue in the aging, rural community with a declining birth rate. After three months of public meetings, Morse said, hospital officials opted to use half the money they would save to turn the unit into a mental health program for seniors. “It really did become fairly clear that people recognize that this wasn’t necessarily ... delivering babies isn’t necessarily a service that matches an elderly population,” he said. The closing of the birth unit at the Iowa Falls hospital forced Jessica Sheridan to change her plans to have her baby born there, just five minutes from her home. She established relationships with doctors in Ames, an hour away, where her daughter was delivered in mid-December. “We were lucky. It was nice weather,” Sheridan said.

SOLUTION: Costs forcing some hospitals to stop delivering babies.

PROBLEM: Most lawmakers will spend the week in their home districts but a select few will gather in New York City for a hearing on what experts say is a looming crisis in home health care services. When the full Legislature returns Feb. 28, lawmakers can look forward to a month of backroom negotiations over the state budget. Democratic Gov. Andrew Cuomo has proposed a $152 billion spending plan. Lawmakers hope to agree on a final budget before April 1, the start of a new fiscal year. Another unresolved issue is Uber’s request to expand upstate. Ride-hailing services Uber and Lyft are both prohibited from operating outside of New York City. ___ This story has been corrected to show the home health care services hearing in in New York City, not Albany.

SOLUTION:
This Week from Albany: Break before budget work.