Archive for August, 2007

Incorporating Cultural Diversity into Your Healthcare System

August 17th, 2007 by Melanie Matthews

This week’s Disease Management Update features two recent studies published in the American Cancer Society’s journal CANCER that illustrate that race can and does play a part in disease management. For example, Asian men are have better prostate cancer survival rate, while African American women are worse off when it comes to breast cancer.

These studies highlight the fact that hospitals, physicians and the likes are incorporating diversity into their practices and treating the patient and not just the disease, recognizing that diagnoses and outcomes differ from patient to patient and from race to race.

How can hospitals and primary care providers take steps to incorporate diversity into their practices and accommodate the diverse nature of their patients?

SAMHSA toolkit

  • The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a free resource kit for American Indian, Alaska Native and Native Hawaiian populations that addresses fetal alcohol spectrum disorders (FASD). Native cultures are known for their understanding of healing, wellness, and the cycles of nature. The Native Initiative works with these strengths and the strengths of community elders to bring Native people messages about FASD that are culturally respectful and meaningful.

  • Patti Ludwig-Beymer, administrative director of education and research at Edward Hospital in Naperville, Illinois says just knowing a few key words of a foreign language helps healthcare providers develop a trusting relationship with their patients.

  • Barnes-Jewish Hospital created a Center for Diversity and Cultural Competence in May 2006 to promote diversity and cultural competence initiatives and programs throughout the hospital, reduce health disparities, promote dialogue for issues of diversity, recruit diverse staff and create an environment where all patients and staff are respected and included. The hospital believes it must face the racial, class and economic inequities in healthcare. The region is home to 52 percent of St. Louis’s African American population, and 17 percent of the population use a primary language other than English. In addition, 24 percent of the population in the region is diverse.

What initiatives are YOUR organization taking to address the issues of diversity and disparities within the healthcare industry? Leave a comment and let us know!

Evaluating Quality of Care Between Admittance and Discharge

August 16th, 2007 by Melanie Matthews

Current quality measures focus on quality of care upon admittance and end of stay but tend to ignore all aspects of care during the patient’s stay, says Dr. Dale Bratzler, medical director of the Hospital Interventions Quality Improvement Organization Support Center. In an audio interview on some of the unintended consequences of pay for performance in healthcare, Dr. Bratzler identifies several areas in healthcare management where improvement may result in better transitions of care, including the patient’s discharge from the hospital. He is observing a cultural shift toward the acceptance of quality ratings at healthcare organizations from the top down, and believes that team-based training — both for medical students and full-fledged doctors and nurses — will help improve the quality of healthcare for patients. Listen to Dr. Bratzler’s comments.

Perception of Health Coaches

August 13th, 2007 by Melanie Matthews

A recent news story on MSNBC news profiles the use of health coaching – in particular about the health coaching
services offered through UPS.

The article emphasizes the postive effect of coaching, but the headline of the article “Health coaches nag employees
to better care” illustrates that the health coaching field needsto educate consumers on what is and is not coaching.

The full article is online at:
http://www.msnbc.msn.com/id/19918648/

Out-of-the-Box Thinking That’s Working

August 13th, 2007 by Melanie Matthews

This week’s HIN Weekly Business Update offers some out-of-the-box thinking that’s getting results: health coaching for seniors that reduces Medicare claims (Danielle Butin of SecureHorizons says you can teach an old dog new tricks), creative connections with hard-to-reach Medicaid members, and re-thinking patients who don’t fit neatly into prescribed clinical measures when launching pay-for-performance programs.

For some examples of how “practices succeed by innovating rather than strictly through blocking and tackling and paying attention to management details,” visit medinnovationblog by Richard L. Reece, MD, is pathologist, editor, author, speaker, innovator, and believer in abilities of practicing doctors and their patients to control and improve their health destinies through innovation. You’ll see where some current practices got their start.

We hope these ideas inspire innovation. If an unconventional approach is working for your organization, there’s a good chance it can succeed elsewhere. Share your innovations by emailing editor@hin.com, or post a comment here.

Transforming Patient Care Processes With the Help of Senior-Level Support

August 10th, 2007 by Melanie Matthews

“If you think there is somebody more important than the patient, then think again.” This is the view passed down from Hackensack University Medical Center (HUMC)’s CEO, according to Lenore Blank, a nurse practitioner and administrative manager of HUMC’s heart failure and pulmonary hypertension team.

With senior-level support like that, it’s no surprise that HUMC has been successful in transforming its patient care processes. The model that HUMC is implementing is a collaborative patient care model that empowers the primary care nurse to communicate patient needs to physicians, which has improved patient care and outcomes and reduced hospital re-admissions.

Blank’s team is part of Pursuing Perfection, a healthcare quality initiative from the Institute of Healthcare Improvement. During a recent interview, Blank described this cultural view at HUMC and how it has enabled her organization to create perfect care processes. Listen to Blank’s comments online in this podcast.

Blank, along Michelle Gilbert, education coordinator for the heart failure team and pulmonary hypertension program at HUMC will be sharing their identification and stratification strategies, how they mentor and educate nurses serving these patients, the indicators and tools they use and how they’ve streamlined the discharge process and improved medication reconciliation during the August 22nd audio conference, Pursuing Perfect Care: Improving Chronic Care Outcomes by Treating the Whole Patient.

They will be joined by Donna Isgett, vice president for clinical effectiveness at McLeod Health, who will describe the perfect care processes at McLeod while Leanne Huminski, chief nursing officer, McLeod Regional Medical Center, who will provide the inside details on the medication management program, which has a goal of eliminating adverse drug events.

Easing Parents’ Fears about the HPV Vaccine

August 9th, 2007 by Melanie Matthews

When the Food and Drug Administration approved Merck & Co.’s human papillomavirus (HPV) vaccination, Gardasil, to prevent cervical cancer in females as young as 9 years old, many parents viewed it as an opportunity to reduce their child’s risk for this disease. However, with everything controversial, there are two sides, and for some parents, Gardasil was cause for concern. Many are still not sure what exactly the vaccine or the disease itself is all about.

So what can doctors do to calm these fears? HIN tackles the most common fears parents have about Gardasil and helps physicians who are trying to do the same in their own practices.

FEAR: The HPV vaccine will encourage young girls to engage in sexual activity since it would make them immune to certain sexually transmitted diseases (STDs) that are caused by HPV.

FACT: According to Amanda F. Dempsey, M.D., Ph.D., MPH, a pediatrician at the University of Michigan, the vaccine will not encourage sexual activity. Scientific evidence does not support the idea that a vaccine for an STD can influence a person’s behavior. Dempsey likens it to seatbelts — are you more apt to drive recklessly now that you are securely fastened to your vehicle?

FEAR: The vaccine may not be effective against all types of HPV.

FACT: The vaccine is nearly 100 percent effective in protecting against four strands of HPV. While there are currently more than 100 strands of HPV, the vaccine protects against types 6 and 11, which are responsible for more than 95 percent of genital warts cases, and types 16 and 18, which are responsible for more than 70 percent of cervical cancer cases. In addition, over the next few decades, the occurrence of HPV could be reduced by more than 70 percent due to this vaccine.

FEAR: The vaccine is unnecessary because condoms are meant to protect against STDs.

FACT: The vaccine can prevent a very common infection that is not completely controlled by condoms. HPV is mainly contracted from skin to skin contact, unlike most other STDs, making condoms not 100 percent effective prevention methods.

Demsey says that parents’ opposition to the vaccine could become a major barrier to the use of this preventive treatment, if their concerns and questions about the HPV vaccines are not adequately addressed. Currently, only 44 percent of U.S. parents polled by the C.S. Mott Children’s Hospital National Poll on Children’s Health support a school HPV mandate.

Study Shows Disconnect Between Medical Home Beliefs and Practices

August 7th, 2007 by Melanie Matthews

An observational study by the Rhode Island Department of Health of pediatricians caring for children with permanent hearing loss found that while the pediatricians believed they should be the medical home for these patients, there were gaps in the doctors’ care-coordination practices for these patients. More information about the study appears in the August issue of Pediatrics.

Caring for Caregivers

August 6th, 2007 by Melanie Matthews

At the risk of stating the obvious, caregivers need care, too. Healthcare organizations that address caregiver needs and involve them in care planning see payoffs in improved outcomes and reduced hospitalizations among the cared-for. This week’s Healthcare Business Weekly Update features a blog post about an online caregiver resource, news on proposed clarifications to the Family Medical Leave Act that could impact those caring for a seriously ill family member, and a link to the August HIN e-survey on caregiver support and education programs. If you’d like to find out what your peers are doing in this area, take the survey and receive a free e-summary of the results this fall.

Thoughts on Breastfeeding Week

August 3rd, 2007 by Melanie Matthews

A colleague mentioned the other day that we’re in the middle of National Breastfeeding Week — August 1 through 7, 2007, according to the International Lactation Consultant Association. The next day’s New York Times reported that New York City’s 11 public hospitals will no longer offer free samples of baby formula in gift bags to new mothers. The city’s Health and Hospitals Corporation said the decision was meant to promote breast-feeding as part of the city’s campaign to improve infant health. The agency estimated that 24 percent of women who deliver at public hospitals breast-feed exclusively after they are discharged, up from fewer than 15 percent of such women a year ago.

Instead, new gift bags for moms will include a breast milk bottle cooler, disposable nursing pads, breastfeeding tips and an “I eat at mom’s” baby t-shirt. Distribution begins during National Breastfeeding Week. Formula will still be available, but the new moms have to ask for it.

My “new mom” days are far behind me, but I say “bravo.” I remember how much I counted on the hospital staff for guidance in that area. The new gift bags send a subtle message that breastfeeding is an “opt-out” rather than “opt-in ” choice.

The next challenge will be to convince moms to breastfeed longer. A government survey this week found that only about 30 percent of new moms are feeding their babies breast milk alone three months after birth. At six months, only 11 percent are breast-feeding exclusively.

Strategies for Getting Current Medicaid Enrollee Contact Information

August 3rd, 2007 by Melanie Matthews

Using the Internet as a search tool has proved a fruitful way for McKesson Health Solutions to locate contact information for Medicaid patients for inclusion in disease management programs, Caryn Jacobi, associate vice president of operations for Illinois for McKesson Health Solutions told participants in last week’s audio conference, “The Medicaid Population: Identifying, Locating and Engaging a Hard-to-Reach Population for Disease Management Success.”

Jacobi described the types of Internet searches her organization conducts, such as reverse directory lookups and web matches and the yield this strategy brings in. This was just one of the innovative strategies that McKesson uses in its Medicaid patient contact and engagement strategy.

Dr. Philip Bonaparte, chief medical officer with Horizon NJ Health, who also presented during the conference described how his organization has created unique and beneficial relationships with the various state agencies in New Jersey to get current contact information for Medicaid enrollees.

These were just some of the “out-of-the-box” identification strategies used by these organizations. What strategies have you found to be successful in locating Medicaid patients?