Archive for the ‘Cardiac Care’ Category

3 Nurse Navigator Tools to Enhance Care Management

January 29th, 2014 by Jessica Fornarotto

Where does the nurse navigator spend their day? Certainly on transitions of care. Bon Secours Health System nurse navigators use a trio of tools to identify patients’ obstacles to care and connect them to needed resources, explains Robert Fortini, vice president and chief clinical officer of Bon Secours Health System.

One tool that our nurse navigators use that’s built into our EMR is the hospital discharge registry from Laburnum Medical Center, one of our largest family practice sites with about nine physicians. This tool is used to identify which patients the navigators need to work with, and it’s where the navigators begin and end their day. This registry provides a list of all the patients who have been discharged from one of our hospitals in the last 24 hours, and each patient is listed by the physician. The navigators have to reach out to each of these patients and make telephonic touch within 24 to 48 hours of discharge. Medication reconciliation is extremely important at this time and can be very challenging. When a patient goes into a hospital, often their medications get scrambled, and they come out confused and taking the wrong prescriptions. Nurse navigators spend a lot of time on medication reconciliation at this point.

The Navigators also conduct ‘red flag’ rehearsals with this tool, so that the patient knows the signs and symptoms of a worsening condition and what to do for it. We also schedule the patient with a follow-up appointment, either with a specialist who managed the individual in the hospital or with their primary care physician. We try to do it as close to the time of discharge as possible, within five to seven days, or more frequently if the risk of readmission is higher.

Second, nurse navigators also use a documentation tool to help manage the care of heart failure patients. This tool allows the navigator to stage the degree of heart failure using a hyperlink called the ‘Yale tool.’ The Yale tool allows us to establish what stage of heart failure the patient is in: class one, two, three, or four. Then, a set of algorithms is launched based on these stages’ failure; we manage the patient according to those algorithms. For example, if a patient falls into a class four category, we might bring them in that same day, or the next day, for an appointment rather than wait five or seven days because they’re at more risk. We might also make daily phone calls or network in-home health, as well as make sure that the patient has scales for weight management and an assessment of heart failure status. All of those interventions will be driven by the patient’s class of heart failure.

The last tool we use is a workflow for ejection fractions. The patient’s ejection fraction will define specific interventions that the navigator will follow.

Excerpted from: Profiting from Population Health Management: Applying Analytics in Accountable Care.

Healthcare Business Week in Review: Oncology PCMH; Medication Management; Seniors on FB

November 29th, 2013 by Cheryl Miller

As families gathered this week to celebrate Thanksgivikkuh, (which won’t happen again for 77,000 years!) we offered several stories that demonstrate the strength of partnerships.

To begin, a first-of-its-kind patient-centered medical home (PCMH) model for oncology from Aetna and Consultants in Medical Oncology and Hematology, PC (CMOH).

The collaboration combines evidence-based decision support in cancer care with enhanced personalized services and realigned payment structure and is designed to increase treatment coordination and improve quality outcomes and costs for cancer patients. Researchers found that more than half of all new cancer patients are 65 or older, and most have one or more health conditions in addition to cancer. Given their frequency of contact with patients, oncologists are well positioned to help their patients coordinate care for multiple conditions.

Physician-led, team-based models of care are the future of healthcare, according to the AMA, which has issued a set of recommendations for implementing these models, including a report for the development of payment mechanisms that promote satisfaction and sustainability of team-based models in various practice settings. Among the recommendations: establishing payment distribution models that foster physician-led team based care, and reimbursing those physicians who lead these teams accordingly.

High-risk heart failure patients receiving nursing interventions were four times as likely to take their medication, but their hospital readmission rates were not impacted, according to a new study at Duke Medicine.

Patients who were tutored about managing their symptoms, taking their pills on schedule, and developing an action plan for addressing their symptoms were more likely to take their prescribed medications. They were encouraged to use doctors’ offices and clinics rather than the emergency department.

But when the researchers looked at the hospital readmission rate, they found that readmissions were not significantly different between the two groups. Medication management is just one of many issues facing patients most at risk for their conditions to worsen, researchers found, and redesigning care to confront the issues that are keeping the vulnerable from regaining their health has to be addressed.

Developing a communication hub, virtually and in person, is critical to a successful care coordination plan for dual eligibles, says Timothy C. Schwab, MD, FACP, former chief medical officer of SCAN Health Plan. It ensures that all members of the immediate and long-term support team are in sync with each other.

Seniors want to stay connected. According to a new Accenture survey, more than half of seniors 65 years and older are seeking digital options for managing their health services remotely. In fact, researchers found that at least three-fourths of Medicare recipients access the Internet at least once a day for e-mail (91 percent) or to conduct online searches (73 percent) and a third access social media sites, such as Facebook, at least once a week.

And lastly, a way for you to communicate with us: participate in our fourth comprehensive online survey, Reducing Hospital Readmissions Benchmark Survey, and we will send you a free e-summary of the results once they are compiled.

Healthcare Business Week in Review: Affordable Care Act, Medical Apps, Cardiac Care Costs

October 4th, 2013 by Cheryl Miller

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Technological problems hindered aspects of the October 1st rollout of the new health insurance exchanges — both at the state and federal level. According to New York Times reports, some aspects of the eagerly awaited exchanges in several states, including Oregon, Colorado, District of Columbia and Nevada, may not be fully operational for weeks and even months, with some officials referring to October as a “soft launch” period.

Last week, the Obama administration acknowledged it will not be ready to accept online applications from small businesses when the program officially launches October 1st.

Once fully operable, the exchanges, one-stop online shopping sites for consumers’ health insurance needs, will enable consumers to comparison shop for health benefits much like they do now for airline tickets or hotel rooms, and see if they qualify for tax credits. Plans are categorized according to levels of coverage and co-pays, and no one can be denied coverage because of preexisting conditions. There will be a six-month open enrollment period that runs through March 2014, and coverage should begin as early as January 1st.

Smart phones can now diagnose abnormal heart rhythms, act as ultrasound devices, or function as the “central command” for a glucose meter used by a person with insulin-dependent diabetes. To ensure that patients’ safety isn’t compromised for the sake of technological innovation, the FDA is clamping down on those apps considered dangerous. The agency has cleared about 100 mobile medical applications over the past decade; about 40 of those were cleared in the past two years.

The costs of patient care after heart attacks, continues to climb, according to a new study from the University of Michigan (U-M) Frankel Cardiovascular Center. Despite advancements in cardiac care and increases in less invasive procedures to treat symptoms, including more angioplasty instead of open heart surgery, hospital stays have decreased by just one day. Medicare spending to treat heart attack patients rose by 16.5 percent between 1998 and 2008, with the majority of costs incurred weeks after patients left the hospital.

According to researchers from the NYU School of Medicine, elderly nursing home residents with advanced dementia who were enrolled in a Medicare managed care insurance plan were more likely to have do-not-hospitalize orders and less likely to be hospitalized for acute illness than those residents enrolled in traditional Medicare. The frail elderly received more nursing home-based primary care visits every 90 days, and more nursing home-based nurse practitioner visits in general. The extra individual attention precluded the need for more acute treatment, and resulted in less aggressive, more humane end-of-life care.

And lastly, sophisticated analytics behind today’s health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw material for the development of prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health on our Health Risks Assessments online survey by October 15, 2013 and get a FREE executive summary of the compiled results

Infographic: Preventable Deaths from Heart Disease and Stroke

September 19th, 2013 by Jackie Lyons

Approximately 800,000 Americans die from heart disease and stroke each year. Although some populations are more susceptible, there are steps to take to lower risk these risks.

Black men and counties in southern states are at greatest risk for preventable deaths related to heart disease and stroke, according to a new infographic from the Centers for Disease Control and Prevention. This infographic shows the progress made in preventing these deaths, an in-depth look at risk per race, gender and location, and solutions for managing certain risk factors.

Preventable Deaths from Heart Disease and Stroke

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: Chronic Care Professional Manual 5.0.

Healthcare Business Week in Review: Managing Heart Disease; Insurance Reform; Hospital Charge Disparities

September 13th, 2013 by Cheryl Miller


Nearly one in three Americans die of cardiovascular disease (CVD), including heart disease and stroke, each year, according to the latest Vital Signs report from the CDC. In 2010 alone, more than 200,000 deaths from CVD occurred, with more than half happening to people younger than 65 years of age.

Most CVD can be managed or prevented in the first place by addressing risk factors, such as reducing blood pressure and cholesterol and quitting smoking, CDC officials say, and they offer a list of recommendations for providers, communities and health departments for reducing the death rates.

Contrary to reports that individual health insurance policy costs will jump steeply under the ACA, there will be no widespread premium increase, according to a RAND analysis of 10 states and the United States.

There will be widespread differences in individual policy costs from state to state, however, as well as an increase in health insurance coverage and higher enrollment among people who purchase individual policies.

RAND researchers predicted how the ACA will likely change cost and coverage patterns in both the individual market and small group market in 10 states, including Florida, Kansas, Louisiana, Minnesota and New Mexico. Costs will be influenced by a specific range of individual factors, including age, tobacco use, geographic location, family size and amount of coverage purchases.

Geographic diversity is at the root of another study from the Center for Studying Health System Change (HSC). According to the report, hospital prices for privately insured patients — especially for outpatient care — are much higher than Medicare and vary widely within and across communities.

Within individual communities prices vary widely, even after accounting for differences in the complexity of services provided. The highest-priced hospital typically is paid 60 percent more for the same inpatient services than the lowest-priced hospital. The price gap within markets is even greater for hospital outpatient services, with the highest-priced hospital typically paid nearly double the lowest-priced hospital, according to the study.

In contrast to hospital prices, prices for PCP services generally are close to Medicare rates and vary little within markets, the study found. Prices for specialist physician services, however, are higher relative to Medicare and vary more within and across markets.

And lastly, sophisticated analytics behind today’s health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw material to develop prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health in our Health Risk Assessments e-survey by October 15, 2013 and get a FREE executive summary of the compiled results.

Healthcare Business Week in Review: Health Insurance Exchanges, Navigators, Medication Adherence

August 30th, 2013 by Cheryl Miller

Contrary to popular opinion, young adults between the ages of 19 and 26 do not think they’re immortal and do think they need health insurance. In fact, according to a study from The Commonwealth Fund, if members of this population don’t have health insurance, it’s because they can’t afford it.

Nearly half of the 15 million young adults enrolled in a parent’s health plan last year most likely would not have been eligible for coverage without the health reform law’s dependent coverage provision.

The survey also found that only 27 percent of young adults were aware of the state health insurance marketplaces launching October 1. The demographic that would benefit most from these marketplaces are those without coverage and those from low- or middle-income households, or, those least likely to be aware of them.

But these young adults, and all other adults, can seek out help through a coterie of navigators funded by the HHS. The agency has granted $67 million to 105 applicants in federally run and state partnership marketplaces, for navigators trained to help Americans who need assistance in shopping for and enrolling in plans in the health insurance marketplaces beginning this fall.

Health information navigators are trained to provide unbiased information in a culturally competent manner to consumers about health insurance, the new HIEs, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program (CHIP). Funding was available to eligible private and public groups and the self-employed who met certain standards to promote effectiveness, diversity, and program integrity, HHS officials say.

If all the health reform changes have made Americans’ blood pressure soar, there is help: a large scale study from Kaiser Permanente found that single pill combinations and consistent follow-ups with hypertension patients helped improve the rate of blood pressure control by nearly twice as much. Through one of the largest community-based hypertension programs in the nation, Kaiser Permanente Northern California nearly doubled the rate of blood pressure control among adult members with diagnosed hypertension between 2001 and 2009, helping to reduce the risk of stroke and heart attack for patients.

And speaking of soaring, accountable care organizations are flooding the healthcare landscape; with the number of public and private ACOs nearing 500, participants and pundits alike are looking more closely at the model’s structure, challenges and benefits.

How is your organization participating in ACOs? Take HIN’s third annual survey on ACOs by September 6, 2013 and receive a FREE executive summary of the compiled results.

Healthcare Business Week in Review: Stroke Costs Up, MRSA Prevention Tactics, Employee Wellness

June 4th, 2013 by Cheryl Miller

Stroke costs are predicted to more than double by 2030, and the number of people having strokes by then may increase by 20 percent, according to the American Heart Association/American Stroke Association. The aging U.S. population is the main reason for the increases, with almost four percent, or one in 25 American adults, predicted to have stroke in 2030, or an additional 3.4 million people. Annual costs due to lost productivity could rise from $33.65 billion to $56.54 billion, and costs to treat stroke may increase from $71.55 billion in 2010 to $183.13 billion. What steps need to be taken? See our story for details.

Using germ-killing soap and ointment on all intensive-care unit (ICU) patients can reduce bloodstream infections by nearly half and significantly reduce the presence of methicillin-resistant Staphylococcus aureus (MRSA) in ICUs, according to a multi-disciplinary team study published in the New England Journal of Medicine.

The study, REDUCE MRSA trial evaluated the effectiveness of three MRSA prevention practices: routine care, providing germ-killing soap and ointment only to patients with MRSA, and providing germ-killing soap and ointment to all ICU patients.

In addition to being effective at stopping the spread of MRSA in ICUs, the study found the use of germ-killing soap and ointment on all ICU patients was also effective for preventing infections caused by germs other than MRSA.

Young children who missed more than half of recommended well-child visits had up to twice the risk of hospitalization compared to children who attended most of their visits according to a study published in the American Journal of Managed Care.

Children with chronic conditions like asthma and heart disease were even more likely to be hospitalized when they missed visits, according to the study, which included more than 20,000 children enrolled at Group Health Cooperative. And children with chronic conditions who missed more than half of the recommended well-child visits had more than three times the risk of being hospitalized compared to children with chronic conditions who attended most of their visits.

In other prevention-related news, HHS issued final rules on employment-based wellness programs, supporting workplace health promotion and prevention as a means to reduce the burden of chronic illness, improve health, and limit growth of healthcare costs, according to the HHS.

And lastly, more than 10 million Americans directly benefited from a telemedicine service during the past year, likely double the number from just three years ago, according to American Telemedicine Association estimates. Telehealth’s broad reach encompasses telemedicine — the use of telecommunications technology to deliver clinical diagnosis, services and patient consultations — as well as the exploding field of mobile health. Tell us how you’re utilizing telehealth in HIN’s third comprehensive e-survey on Telehealth. Respond by June 30, 2013 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.