This week's DM Update is a "best of" issue, looking back on the most read stories in 2009. Interestingly enough, two of the top stories are prevention stories one on breast cancer and the other on worksite wellness indicating the growing emphasis on prevention in disease management. Diabetes care costs was another top story a big topic of discussion throughout 2009 as data on rising costs of care and diagnostic trends emerged.
Archive for December, 2009
Of all the reasons for heart failure hospital readmissions, which account for the lion's share of Medicare readmissions, half are related to diet non-adherence and drug non-adherence, says the education coordinator for Hackensack University Medical Center's heart failure team in a featured story in this week's Healthcare Business Weekly Update. Even more sobering: a new University of Colorado finding that 96 percent of discharged patients were unable to recall the name of at least one medication that they had been prescribed while in the hospital. Also, almost half of study participants believed they were taking a medication when they were not.
With $27 million in Recovery Act funds just allocated to help older individuals with chronic conditions manage and improve their health, communities should dedicate a portion of these funds to programs that raise patients' medication awareness levels. Confirming that a patient clearly understands the purpose for taking each medication is part of Dr. Eric Coleman's three-question Care Transitions Measure, a patient survey endorsed by the National Quality Forum that reflects how well a hospital has prepared a patient for discharge.
A recent HIN blog post suggests a strategy for improving patient motivation for medication adherence.
With much of science focused on reducing childhood obesity, there is still scientific hope for reducing adult obesity. In this week's issue of the DM Update, discover how obese adolescents experience sleep apnea more than younger children and how watching less television affects calorie counts in obese adults. Also, tune in to a new NIH program to help reduce obesity rates among different populations.
Liz Reardon, a healthcare consultant, president of Reardon Consulting and a member of the National Council for Community Behavioral Healthcare’s Integration Consulting Team, discusses the reasons why connecting with the community would be essential in establishing a medical home.
If asked to give a single piece of advice to organizations contemplating establishing a medical home for their members, Liz Reardon advises that they “connect with community resources rather than trying to duplicate them in the practice.”
“A hospital system I worked with has a number of hospitals and practices and is initiating a major medical home initiative. We were talking about some of their challenges [regarding the medical home]. We were talking about this community piece and trying to figure out how much responsibility they had for making connections around dietary counseling or exercise programs or not just for a Medicaid population but certainly the social services that people might need. They were spending a lot of time trying to maintain lists of who was doing what where. They were finding it incredibly frustrating, because the minute you develop a community resource guide, immediately something changes.
“Because things change so rapidly, it’s difficult for a practice to do all the care coordination and connect people with all kinds of resources. What was important for them was to develop relationships with key social service agencies. In this instance, their local health department was really helpful because they also have the connection to some of the fuel assistance, nutrition assistance and other assistance programs that low-income people needed.
“Practices can run themselves ragged sometimes trying to be everything for everybody. Spend some time and find out who the key people or key organizations are in your community, develop that relationship with them and then you’re not necessarily taking over everything.”
According to the American Stroke Association, stroke is the number three cause of death in the United States, behind heart disease and cancer. In this week's issue of the DM Update, you will discover which U.S. residents may have a higher risk of dying from a stroke, how salt intake is linked to stroke risk and the medication patients are consuming to prevent repeat strokes.
Gregg O. Lehman, Ph.D., president and chief executive officer of Health Fitness Corporation and former president and CEO of INSPIRIS, Inc., maps out when and how care transition breakdowns can occur for the Medicare population.
When do breakdowns in care transitions occur? First, breakdowns when moving from a primary care physician (PCP) to a specialty physician are common often, information is not well documented. And because it’s common for the Medicare population to be cognitively impaired, it can be difficult for them to effectively communicate their symptoms to the physician. Therefore, physicians need to try to gather information such as changes in eating habits or low-grade fever through a brief physical check.
Second, breakdowns can also occur when moving patients within the hospital. For example, when moving a patient from the ER to another department such as surgical or the ICU, things can fall between the cracks. Treatment for one condition may exacerbate another, causing a more serious problem. Recidivism is also common, and patients usually end up back in an acute care setting.
Thirdly, discharges from the hospital to a home setting or an assisted- or skilled-living facility are often a huge challenge. Typically, these patients cannot take on a self-management role and ask the right questions, or they get confused and cannot remember what their PCP told them. It’s a challenge to maintain a consistent database. Many companies have implemented electronic medical records (EMRs) for this population. The database can be maintained on a virtual or real-time basis for the primary caregivers. Our company uses a registered nurse practitioner (RNP) as the lead person triaging care. The EMR helps to effectively disseminate appropriate information on a timely basis during the care transition process.
Fourth, ineffective communications are a huge problem when dealing with the Medicare population. Communication problems can lead to medication errors and delayed treatment. It can also lead to duplicate test results because records were not transferred in real time. In addition, there’s often a misunderstanding of the rules. For example, HIPAA is designated to protect patient information. However, it can work against patients in transition. Despite the fact that HIPAA permits provider-to-provider disclosure without patient authorization, some providers will not do this without prior patient authorization, and sometimes not without actual patient signatures. In many cases, the power of attorney or signature authorization belongs to a family member not even residing in the same state. That compounds the problems you’re already dealing with. A lack of common platforms for sharing data is also a big problem. Using real-time information that is accessible to the caregiver is critical in minimizing the breakdowns that occur.
Finally, for this population, there are problems inherent in the transition itself. If we move a patient out of a familiar setting &$151; where they’re comfortable with the staff and into an acute-care setting, often they become disoriented. This commonly results in a downward spiral of the individual’s overall health status. The frail elderly are frequently at various stages of cognitive impairment or the early stages of dementia or Alzheimer’s. A low-grade fever can cause a spike in the patient’s confusion. However, it may not get noticed since the caregiver may attribute it to their other cognitive impairments. This lack of treatment can be the beginning of a decline in the patient’s health.