This week's issue of the DM Update is all about the heart and keeping it healthy. Discover the link between COPD and heart function, as well as the risk of heart disease among America's youth. And our prevention story for this week answers the following question about reducing heart attack risk: should treatment be tailored toward an individual's heart attack risk or cholesterol levels?
Archive for January, 2010
This week we're talking about trends that could transform healthcare. In separate stories, learn why the doctor will see you now (at least in California) and maybe even in your car. Besides these consumer-centric concepts, this issue of the Healthcare Business Weekly Update also offers a blueprint for a successful accountable care organization (ACO). Loosely defined, ACOs are a set of providers associated with a defined population of patients that is accountable for the quality and cost of care delivered to that population.
According to healthcare consultant William DeMarco, "through technology, these small groups can link together and act, think and leverage themselves as a larger group, giving them a reward and also an asset value they didn't have before. This also allows them to coordinate services virtually between the medical group and the hospital."
Still haven't taken our medication adherence survey? You'll miss out on strategies from the 100 healthcare organizations that already have. There's still one week left to take the survey and receive an e-summary of compiled results.
Mary Cooley, manager of case and disease management at Priority Health, describes a discharge protocol that is preventing hospital readmissions among patients with cardio vascular conditions.
Our heart failure initiative sprang from our work in 2008 with cardiovascular conditions. Heart failure is one of those top readmission diagnoses for Medicare. We are following the Institute for Healthcare Improvement (IHI) Getting Started for Heart Failure Guide, which says that, “patients must be seen within five days of discharge.” We’re promoting that across our network of providers; the patient is seen in the office to review medications, any early symptoms, the patient’s progress since hospitalization and any questions they might have. We feel that that’s been a key ingredient to our success.
We want to be sure that we empower the patient to be an active participant or an active consumer in their healthcare. We want them to communicate their healthcare concerns and not wait until things get out of hand and an ER visit or an inpatient hospitalization is warranted.
One important concept is to not only discuss the red flags of management and document them in the personal health record (PHR), but to employ “teachback” strategies so that we’re sure that this is all in concert with our health literacy efforts. We want to be comfortable that the patient has heard what we have said, has been able to process that information and has been able to teach that back to us in a way that’s meaningful for them. That will serve them well in managing their condition moving forward.
We also want to not only address current concerns but also anticipate any needs and concerns, and to be proactive. Discuss with the patient that they should talk about their symptoms and any side effects of medication when they see their physician. Not necessarily to stop that medication, but to call the physician first and discuss what’s going on and maybe how that treatment plan can be remedied based on their current effects of the treatment protocols. And also, not only when to call the physician, but who to call. These patients have multiple comorbidities and when they are coming out of the hospital with many different symptoms, they don’t always know who to contact. It’s very important to say who is on first base and who to call when and if you’re having difficulty.
Marijuana is in the air. Last week, the Garden State became the fourteenth in the union to approve the use of medical marijuana, while the Golden State took the first steps toward legalizing the drug for everyone. While it's unlikely that the California bill will come to fruition, the public safety committee of the state assembly voted 4-3 on a measure that would tax and regulate marijuana in the same way alcohol is controlled.
And in a first-run movie I saw last week, a pair of 50-somethings smoke a joint before attending a party at the home of one of their children. Hilarity ensues and their children are rightly mortified. Hollywood may not be so far off the mark. In a featured story in this week's Healthcare Business Weekly Update, SAMHSA reports on a dramatic increase in levels of illicit drug use among aging baby boomers that is likely to strain existing substance abuse treatment services in the years to come.
On the flip side, healthcare companies recognize the value of proper adherence to a medication regime. In the first week of our survey on medication adherence, more than 60 companies have already told us about the individuals and conditions targeted by their medication adherence programs as well as the strategies, technologies and tools that are producing results in this area. It's not complicated — take the survey by January 31 and get a free e-summary of these results.
With the recent news that people with severe depression receive more of a benefit from antidepressant medication than people with mild or moderate depression, this week's issue examines other aspects of this particular mental illness. Discover the link between sleep and depression, the risks of depression during pregnancy and some surprising disparities in depression care.
The consequences of untreated or inadequately treated depression are significant; therefore, adherence to antidepressant medication is very important. Be sure to take this month's e-survey on medication adherence by January 31 you'll receive a summary of compiled results and learn how your peers are improving medication adherence.
Dr. Judith Hibbard, professor of health policy at the University of Oregon and developer of the Patient Activation Measure™ (PAM), answers the question of whether or not patient activation can be measured.
We started out the process of defining activation by first asking whether it is something that we can measure. The first step was to get some clarity on the definition of activation because people use the term loosely. We went through a rigorous process that included reading the literature, holding patient focus groups and having expert consensus panels. For all of those groups we asked the question, what does it take to manage successfully when you have a chronic illness? We did have some consensus in answering that question; however, the definition that emerged was that people need to believe that they have a role to play in self-management, in collaborating with their provider and in taking preventive action. They also need to have some skill and confidence.
We used a process called Rasch analysis for our measurement, which is used when more precise and consistent measurement is important. This process yields a measurement that is stronger, more precise and consistent than most social science-based measures. The analysis consists of short and tall bars that represent the difficulty structure of the measure. There are 13 questions, with each question having a calibration how hard it is for most people to admit if something is true about them or not. The short bars represent those people who can say that something is true about them and the tall bars represent those people who can’t. This difficulty structure is quite robust. We have had the measures translated into 15 languages. We have evaluated the results of about six of those translations. This difficulty structure is maintained across language and culture.
The other characteristic of the measurement that is important and different is that we seem to be tapping into one underlying idea, even though there are 13 different questions. We think the underlying idea is, “I understand what my job is and I feel able to do it.” That is important because it can allow us to predict how people will behave in different situations. If you can imagine having measurement on someone’s self-esteem, and if you knew their level of self-esteem, you could predict how they might behave in different situations. That is the same with the PAM. It is tapping into an underlying idea that tells us about people’s behaviors.
After looking at the measurement, we were able to see that it looks like people go through different phases or levels on their way to becoming effective self-managers. We have conducted in-depth interviews with people at these different levels and what we see is that people at the low end are discouraged. They have had many experiences with failure. They feel overwhelmed with the job of managing their health. They have low confidence in themselves and they become passive. Some of them may not recognize that their job is to manage their health. At the high end of activation, we have the opposite. People are very proactive and goal-oriented. They also have good problem-solving skills, which is something that the individuals at the low-end do not have.
Imagine someone at the low end of activation, who has a chronic illness, going in to see their clinician. They are told that they have to change many different things about their lifestyle. What happens? They feel overwhelmed. They might try to do it, but they can’t. By not understanding what is going on with that person, the clinician may be helping to keep that person in a low activation state.