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Inspiring Older Patients to Seek Online Communities: How the National Osteoporosis Foundation Engages Over 19,000 Middle-Aged and Senior Women and Men

David Sheon

David Sheon

By David Sheon

 

When it comes to talking about health, online communities are turning shades of gray.

Websites hosting online patient communities, such as Inspire.com, are bringing seniors together on a common platform where they can learn about their condition from other patients in similar situations.  Inspire offers discussion forums where patients can communicate to fulfill scientific, emotional, and practical needs regarding their medical conditions.

What sets Inspire apart from other online disease communities is the partnerships that it creates with condition-specific patient advocacy groups, including the National Osteoporosis Foundation (NOF), which works with Inspire to offer credible information and to deliver timely research and news of interest to the community of osteoporosis patients.

NOF is the nation’s only health organization dedicated specifically to promoting bone health.  NOF takes a strong stance on bringing awareness to the fact that one in two women, and one in four men over the age of 50 will have an osteoporotic fracture.  NOF informs the patient community and key opinion leaders that fractures caused without blunt force, such as the result of a car accident, typically are the result of low bone density.  NOF hopes to turn the tide of bone fractures from osteoporosis by raising awareness of prevention and treatment options.

Brian Loew and Claire Gill at the 2014 Patient Centricity and Advocacy Summit

Brian Loew and Claire Gill at the 2014 Patient Centricity and Advocacy Summit 

In their September 29th presentation at the World Congress Summit on Patient Centricity and Advocacy, Alexandria, Virginia, Brian Loew, CEO of Inspire, and Claire Gill, Senior Director of Marketing and Consumer and Corporate Outreach of NOF spoke of the successes that have come from their partnership, noting the dynamic growth of the osteoporosis community on Inspire.com.  The community has over 19,000 members, with about 500 new users every month.  Posted surveys and hot topics drive engagement.

“We check everyday online, answer questions, [and] send information,” said Ms. Gill. “We’ve never had a need to stimulate conversations.  There’s a robust dialogue on every imaginable topic.”

Osteoporosis patients are holding the majority of these conversations, with some contribution coming from family members and caregivers.  Because of the age of appearance of most bone-related diseases, these patients are usually over the age of 55.

According to Loew, “the online tax of usability for elderly people is either gone or dramatically diminished.”

“We know the age of new users on Facebook is older, and the growth of the online community is further proof that older users are here to stay,” said Gill.

Gill related her experience with this community’s adaptability to the Internet when NOF eliminated the option to immediately speak to an operator by telephone. Now, upon calling NOF, patients are directed to the website.  After the change was implemented, the site’s page views jumped from 60,000 to 100,000 per month, according to Gill. Callers could leave a message if they prefer, and would later be contacted.  Instead, many chose to go online.

The partnership between Inspire and NOF shows that middle-aged and senior patients are turning in record numbers to online communities to manage their health.  Does this surprise you? Would you recommend Inspire to a patient with osteoporosis that you know?

Artist Turned Health Advocate: An Interview with Regina Holliday

David Sheon

David Sheon

By David Sheon

Artist Regina Holliday uses her talent to change the way health care professionals see and experience their patients.  Her innovative approach to draw attention to the needs of patients to be treated as individuals has already impressed thousands of health care practitioners.

 

When her husband suddenly became sick in early 2009, she saw the flaws in the health care system first-hand.  Now, she uses unique art to advocate for patients and push for changes in health care.  Holliday, joined now with other artists she’s inspired, paints patient stories on the backs of blazers and lab coats, so that they can be worn to medical summits and conferences. When doctors, policy makers, and hospital administrators see these jackets, they are reminded to put patients first and view each for their own unique health history.

 

Through her ambitious initiative, “The Walking Gallery,” Holliday and other artists have painted over 300 jackets, each worn by a proud patient, family member, or friend.

 

Patient advocacy needs fresh ideas, and we admire what Holliday is trying to do, so we interviewed her recently.

 

The Walking Gallery at the 2011 Health Innovation Summit at The Kaiser Permanente Center for Total Health
(Source: https://www.flickr.com/photos/taedc/5824507774/in/photostream/)

 

 “Don’t tell me to zip it”- By Regina Holliday (Source: http://reginaholliday.blogspot.com/2012/06/walking-gallery-walks-on-year-two.html)

“Don’t tell me to zip it”- By Regina Holliday
(Source: http://reginaholliday.blogspot.com/2012/06/walking-gallery-walks-on-year-two.html)

RWHC: How did you become interested in health care issues?

Holliday: I became involved in health care after my husband, Fred Holliday, was hospitalized in 2009 and we saw how dysfunctional things could be.  He was admitted to five facilities in 11 weeks. He died in home hospice during the 12th week.  We had trouble accessing his medical record and I became an advocate for patient data access.

 

What issues particularly interest you right now?

I study patient data access, the intersection of art and health, hospital hygiene and national autopsy rates to name a few areas of interest.

 

If you weren’t a patient advocate, what would you be doing?

I would probably still be selling toys at my old toy store and teaching pre-k art.

 

What are you most proud of achieving throughout your time as a patient advocate?

I testified in 2010 to make sure that patient data access was included in Meaningful Use as a core measure. It was.

 

[Meaningful Use is a government regulation that provides incentives to providers to show that electronic health records are being used in meaningful ways by reaching certain thresholds.  The first threshold includes capturing all patient’s electronic health records in a standard format.  The second threshold focuses on increasing the access of medical records to other health professionals, including hospitals, pharmacies, and labs. The final threshold focuses on improving overall public health with better quality assurance, safety, and efficiency of health care by using these health record databases.]

 

What is the greatest lesson that you have learned along the way?

Never give up. Perseverance wins in the end.

 

What is the most important thing that you want our readers to take away from this?

You can do great things even if you are one person.

 

How can our readers get involved?

I highly recommend using Twitter if you are focused on a cause in health care.  Tweets can help you crowd source and crowd fund.  You will make many friends while helping patients.

 

How did the idea for The Walking Gallery come about?

The Walking Gallery exists because Jen McCabe followed me on Twitter on May 30th 2009.  That was the day before I placed the Medical Facts Mural in Pumpernickels Deli on Connecticut Ave.  That was a day when my Fred was still alive and could speak and eat again because of the wonderful care he was receiving in Washington Home Hospice.  On August 20th, she emailed me after I had posted a comment on her blog and asked me if I would paint a series of paintings on the back of her blazers to wear to upcoming health meetings.  I told her I would be honored to paint jackets for her. The art jacket were the first part of the origin of The Walking Gallery.

 

In April of 2011, I went to an event with Ted Eytan, MD at the new Kaiser Permanente Center for Total Health.  I told him the space was so beautiful that we should do a gallery show there.  He said that they would never let us nail into the smart walls to place canvas work.

 

I told him the art would not be on the walls.  We would wear the art and each be a docent of our own lives.

 

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Looking for a great charity to help patients across America to donate to this Fall? Consider The HealthWell Foundation, a safety net for underinsured patients that provides access to life-changing medical treatments they otherwise would not be able to afford. To learn more and donate to patients in need, click here!
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What is your favorite thing about The Walking Gallery?

Every one has a patient story and all are welcome.

 

Do you have a favorite jacket?

No. I love each for its unique story.

 

We noticed in your video that other artists are encouraged to paint these medical stories for The Walking Gallery, what can we do to help to inform other artists to join in this effort?

It is my hope that people will watch [this video] and paint the stories of patients far and wide.

 

What are you hoping The Walking Gallery will change?

I hope that when members of The Walking Gallery meet people they talk [about] the most important moment in their life and then that reframes their entire conversation on health care.

 

How can our readers have their health story painted on a Walking Gallery jacket?

Reach out to me. I get them done eventually. Otherwise, if you know an artist explain the concept and you can join together.

 

What’s next? Where do you see this going?

Next summer, I am planning a conference that will be a kind of Burning Man meets health care. That will be June 4-6, 2015 [in] Grantsville, MD #Cinderblocks is our hashtag.

Categories: General

Five Ways to Manage the Costs of Your Medicine

While a main precept of the Affordable Care Act is to expand access to health care, in some cases that improved access means more patients are being treated with medications that come with a cost. As a pharmacist, I have to be an insurance sleuth, use common sense, and teach my patients the old-fashioned methods of negotiation.

Joel Zive

Joel Zive

I work in solid organ transplant, HIV, and Hepatitis C medicine. I have patients on regimes ranging from 4 to over 20 medications. For my patients, obtaining consistent, reasonably-priced medications – both over-the-counter and prescription – is vital.

1. Make sure all the medications are at one pharmacy.  It’s important to keep a clinical eye on things for drug interactions. As a bonus, the pharmacist and the patient know what costs need to be examined.

2. Seek out insurance prior authorization.  Some insurance companies require prior authorization to cover certain drugs. Your pharmacist can help you seek prior authorization for medications that require it using software that creates forms specific to each insurance company. Ask if your pharmacist can fill out the form as much as possible before sending it to your doctor.

3. Contact the drug company.  Many pharmaceutical companies offer patient assistance programs or co-pay assistance cards to help eligible patients obtain free medicines, particularly for biologics and expensive drugs. These programs are especially helpful for patients who have insurance gaps and need the medications quickly. Depending on the assistance from a case manager or care coordinator, I have received authorization for medications right away or within 72 hours.

4. Search for a co-pay assistance program that covers your condition.  If your drug company does not offer a patient assistance program or you are not eligible based on your income and insurance coverage, it is possible that a charitable patient assistance program through a non-profit organization such as the HealthWell Foundation may be able to help you.

5. Seek discounts for over-the-counter medications.  Over-the-counter medications can put a strain on the wallet. In many cases, purchasing over-the-counter medications is more expensive than prescription medications covered by insurance. Other items like vitamins, natural supplements, and enteral formulas (also known as ‘milks’) require the patient to do a little negotiating. If you tell the pharmacy or vitamin store you will be taking these items indefinitely, they may be inclined to discount. Also, be on the lookout for buy one get one deals (BOGOs). Finally, enteral formulas can be quite expensive, so if you get prescribed a specially formulated one, ask if you can take a more basic formulation instead. Remember to let your prescriber and pharmacist know which over-the-counter medications and supplements you are using.

In conclusion, while the path to affordable medications is not always easy, there are individuals, programs, and strategies that can help you meet your health care goals.

How do you manage your medications? Share your tips in the comments section.

Categories: General

A Shot of Courage for Those Who Fear Needles

This is the first of a two-part series on what’s working to prevent and address needle fear.

Most people don’t enjoy shots.

But for those with needle phobia, the fear of shots can be so severe that they actively avoid medical procedures involving injections, and in extreme cases avoid medical care more generally.

Jamie Elizabeth Rosen

Jamie Elizabeth Rosen

Needle phobia can arise from genetic and environmental factors, including experiencing pain during encounters with needles or seeing others uncomfortable or distressed by needles. Studies show that approximately two out of three children and one in four adults are afraid of needles, and 10 percent of adults have an outright needle phobia, characterized by avoidance behavior and physiological responses, such as increased heart rate or fainting.

The miracle of modern medicine has enabled us to protect ourselves from a range of dangerous or life-threatening diseases. In one recent study, seven to eight percent of adults and children reported avoiding potentially life-saving immunizations as a result of needle fear. Given the growth of vaccine-preventable outbreaks throughout the world (check out this interactive map), this is not only a concern for individual health but also for public health.

Preventing and Addressing Needle Fear

Fortunately, a growing cadre of empathetic health professionals is taking the prevention of needle pain, which can trigger needle fear, to the next level.

“In order to combat pain, vascular access professionals across the country are looking at creative ways to address patient pain and patients’ perception of pain,” said nursing leader and vascular access expert Lorelle Wuerz, MSN, BS, BA, RN, VA-BC. “Offering the patient options before you do any procedure is important.”

Wuerz said that she uses a variety of interventions to combat needle fear and pain in patients, including:

  • Ensuring patients know what to expect;
  • Deep breathing;
  • Guided imagery;
  • Distraction techniques;
  • Topical agents;
  • Warm compresses;
  • Involvement of child life professionals;
  • Pain control devices, such as Buzzy®;
  • Aromatherapy (“Anecdotally, this is something patients find soothing and calming during an uneasy time,” Wuerz said.).

Needle pain prevention extends beyond traditional health care settings. For instance, after discovering that 23 percent of Americans who skipped flu vaccination did so to avoid needles, Target Pharmacy began offering micro-needle flu vaccines. The needles are 90% smaller than those that have traditionally been used and reportedly result in less muscle ache and pain immediately following injection.

“Treating needle pain reduces pain and distress and improves satisfaction with medical care,” wrote pain researcher Anna Taddio in a chapter on needle procedures in the Oxford Textbook of Paediatric Pain. “Other potential benefits include a reduction in the development of needle fear and subsequent health care avoidance behaviour.” 

The 4 Ps of Needle Pain Management

In the Oxford Textbook chapter, Taddio outlined the four domains of interventions that can reduce needle pain for patients, known as the 4 Ps: procedural, pharmacological, psychological, and physical.

Procedural interventions involve bypassing needles altogether through the use of needle-free immunization or non-invasive sampling devices. Pharmacological interventions include local anesthetics, which have been shown to be effective and safe for reducing pain from common needle procedures, and sweet solutions for infants up to 12 months, which have been shown to reduce needle pain behaviors. Psychological interventions include coaching people to cope and providing distractions. Physical interventions – such as upright body positioning, tactile stimulation, and use of cooling agents or ice – can also reduce the perception of needle pain.

Empowering Ourselves

Many people will celebrate the day when shots are replaced with futuristic technology, such as a robotic pill or one of many other innovations currently in development.

In the meantime, what can patients do to help themselves? “A patient should never not speak up,” Wuerz said. “It’s okay to have all of the information before you make a choice.”

Stay tuned for Part II of the series, in which Dr. Amy Baxter, MD – pain researcher, CEO of MMJ Labs, and inventor of Buzzy® Drug Free Pain Relief – will outline how you can protect yourself and your family from needle pain. Dr. Baxter will appear on ABC’s Shark Tank Friday, February 28 at 9:00 pm EST.

How do you respond to needles? What works for you? Have you had a good experience with a health care professional? Post your experiences to the comments section.

Should clinicians replace medication with an ancient spiritual practice?

Researchers from Johns Hopkins University sifted through over 18,000 studies on a potential treatment for pain, anxiety and depression, narrowing their meta-analysis to 47 scientifically rigorous clinical trials. The results, published in the journal JAMA Internal Medicine, revealed what many have experienced over thousands of years: while it’s not a cure-all, this treatment can help alleviate pain, anxiety and depression. The treatment? Meditation.

David Sheon

David Sheon

Meditation began as an ancient spiritual practice but is now also utilized outside of traditional settings to promote health and well-being. The study findings incorporate the effects of mindfulness meditation on over 3,500 participants who were selected to take part in either a meditation regimen or a different therapy, such as exercise. Overall, researchers found that the effect of meditation on participants was moderate and on par with that of prescription medications.

While this is a promising result on the benefits of meditation, the researchers identified a number of limitations. The study did not find any evidence of meditation affecting other health concerns such as positive mood, attention, substance use, eating habits, sleep and weight. Also, meditation did not provide any long-term therapy as compared to medication. “The benefits did attenuate over time — with the effectiveness of meditation decreasing by half, three to six months after the training classes ended,” said study leader Dr. Madhav Goyal, an assistant professor of medicine at Hopkins. “We don’t know why this occurred, but it could have been that they were practicing meditation less often.”

Still, Dr. Goyal said he is encouraged by the study’s results, specifically because of the short training periods for the participants. There may be greater potential for individuals with more instruction or experience in meditation. “Compared to other skills that we train in, the amount of training received by the participants in the trials was relatively brief,” he said. “Yet, we are seeing a small but consistent benefit for symptoms of anxiety, depression and pain. So you wonder whether we might see larger effects with more training, practice and skill.”

While the new study suggests that in some cases, meditation may be used in addition to or in lieu of prescription drugs to treat pain, anxiety and depression, it is important for patients to consult their doctors before altering any course of treatment.

At RealWorldHealthCare.org, we have been interested in meditation’s potentially positive impact on health. Last April, we posted about a recent study in which meditation halved the risk of death, heart attack and stroke in African American men.

Meditation may have economic benefits as well. According to a July 2013 Huffington Post blog, Aetna’s employee health care costs went down by 7 percent in 2012 after the company implemented a wellness program, which CEO Mark Bertolini attributes to reducing stress through meditation and yoga. In recognition of its positive health impact, some insurance companies provide benefits for meditation instruction. For example, CareFirst’s Options Discount Program offers up to 30% off fees for participating meditation instructors. In 2010, Americans spent more than $11 billion on antidepressants, according to the American Psychological Association.

The National Center for Complementary and Alternative Medicine of the NIH offers an introduction to meditation, its uses and guidance for those who wish to practice meditating. The National Meditation Specialist Certification Board, an organization that seeks to promote meditation as a specialized field in health care, keeps a directory of meditation specialists, and there are many other such directories available online or through participating insurance providers.

In a Psychology Today article guiding those interested in mindfulness meditation, Dr. Karen Kissel Wegela emphasizes that sick or healthy, meditation can help people cope. “The sitting practice of mindfulness meditation gives us exactly this opportunity to become more present with ourselves just as we are,” she says. “This, in turn, shows us glimpses of our inherent wisdom and teaches us how to stop perpetuating the unnecessary suffering that results from trying to escape the discomfort, and even pain, we inevitably experience as a consequence of simply being alive.”

Have you ever meditated? Have you or someone you know ever meditated to treat depression, pain or anxiety? Did you find it effective?

Categories: General

Does More Data = More Accurate Results?

Every year U.S. News & World Report comes out with its “Best Hospitals” rankings, and providers wear them like a badge of honor. No doubt the recognition is prestigious. But how many people know why hospitals are ranked as they are? We decided to dig a little deeper and break down the methodology behind the rankings. What we found might surprise you.

Paul DeMiglio

Paul DeMiglio

“Best Hospitals” scores top hospitals across 16 specialties, from Cancer to Urology. For 12 of the 16 specialties, the rankings are based on performance measurements in structure, process and outcomes. Rankings in the remaining four specialties are based on hospital reputation as determined by a physician survey.

The methodology has evolved since the list was first published in 1990, transitioning from a heavy reliance on the reputation of hospitals (based on surveys of medical specialists) to incorporating more hard data to determine which providers make the cut. In an effort to increase accuracy and develop more objective, higher scoring methods, U.S. News & World Report moved away from expert opinion as a major factor of its criteria. Reputation now comprises only 32.5% of the overall score, except for hospitals in the areas of ophthalmology, psychiatry, rehabilitation and rheumatology.

The clinical data now used as the primary basis to rank hospitals measure patient outcomes and processes of care, based on factors including mortality, nurse staffing and advanced technologies. Hospitals also have to meet specific minimums for patient volume and are immediately considered high performing if they have a specialty like cancer or cardiology, among many others.

The power in this report lies in the objectivity as well as the information sharing from multiple, well-respected health care organizations and databases that exist as treasure troves for comprehensive patient information. The continuum of survey strategy — structure, process and outcome — defines essentially every step of the patient experience, from diagnosis to treatment to outcome.

For decades, much of patient care revolved around anecdotal teachings and recommendations. Hospital choices for individuals with complicated conditions often occurred subjectively and by word-of-mouth from both patients as well as caregivers. The strength in the “Best Hospitals” study design lies in the breadth of specialties, objectivity, number of hospitals, as well as the reachability and understandability of the results to the general public.  As the number of survey variables continues to increase by virtue of an aging population and the emergence of newer diseases and a greater number of treatment options, survey criteria will evolve and may correlate patient cost to outcome.  In other words, how much health care bang does one get for the buck?

For a detailed overview of the methodology behind “U.S. News & World Report’s Best Hospitals,” click here.

Is this system for ranking hospitals as objective as it could be? Does making the qualification guidelines more data-driven increase the reliability of the outcomes?

Keeping Boston Strong: How Disaster Training at Osteopathic Medical School Helped Save Lives

VCOM Image 2

The Bioterrorism and Disaster Response Program equips students at VCOM with critical skills through field exercises and more (photo courtesy of VCOM).

When Danielle Deines crossed the finish line of the Boston Marathon on April 15, she had no idea her unique medical training as Doctor of Osteopathic Medicine would make a real difference in the life-and-death events that would soon unfold.

A 2012 graduate of the Edward Via College of Osteopathic Medicine – Virginia Campus (VCOM), Dr. Deines immediately sprang into action after the explosions violently rocked the most prestigious race in the country. Triaging people in the medical tent to ensure they received the care they needed, she helped make room for victims on a moment’s notice:

“They asked all of the runners to move to the back of the tent,” Dr. Deines said. “Once there as the volunteer physicians headed to the explosion sites, I made an effort to get to my feet and informed the nurse near me that I wanted to help. I was asked to discharge runners who were able and interested in leaving to help make room for the victims who were starting to be brought in from the street. I cleared those wishing to leave and signed off on their discharge paperwork, then helped to get them out of an entrance that had been made in the side of the tent.  We then moved the freed up cots to form triage areas. The back corner became the most severe triage area, nearest the entrance where the ambulances were arriving. I saw victims with traumatic amputations of the lower extremities, legs that had partially severed or had shrapnel embedded, and clothing and shoes literally blown off of victims’ bodies.”

Dr. Deines’ ability to help at the time of urgent need did not come coincidentally. Her education at VCOM equipped her — and all other graduates of the Blacksburg, Virginia school — with the critical life-saving skills that are needed when attacks or other emergencies strike.

The Bioterrorism and Disaster Response Program, a two-day, mandatory training curriculum for all second-year osteopathic students at VCOM, has immersed students in real-life disaster training, field exercises and specialized courses since its inception in 2003. This comprehensive approach gives participants expertise in areas including terrorist and major disaster response, hospital planning, behavioral risk factors, psychological response to trauma, and media relations.

Students who have completed the program now serve as lifelines, having the ability to respond to catastrophes locally, nationally and internationally – from Hurricane Katrina to the Virginia Tech shootings, tsunamis and tornado damage in Virginia.

Now more than ever, a working knowledge of disaster response issues is central to providing quality patient care.

“All medical students and practicing physicians need to be able to respond to natural and manmade disasters.  With changing global weather patterns such as global warming and changing political climates, disasters are now a part of the framework,” said Dr. James Palmieri, Associate Professor and Dept. Chair at VCOM. “I always teach the students that no matter what kind of disaster takes place, both natural and manmade, it will always begin in someone’s neighborhood and the local medical community will be part of the initial response.  In light of today’s instant communication, if and when you respond, the world will see you as the local expert.  You had better know how to respond properly for both your benefit and that of your patients.”

How can VCOM’s leadership role in disaster response training be replicated by other medical training programs?  In what ways can more medical schools develop and leverage their curricula to prepare students for disaster response?

Today, more than one in five medical students in the United States are training to be osteopathic physicians, who can pursue any specialty, prescribe drugs, perform surgeries and practice medicine anywhere in the U.S. Osteopathic physicians bring the additional benefits of osteopathic manipulative techniques to diagnose and treat patients, helping patients achieve a high level of wellness by focusing on health education, injury prevention, and disease prevention.

For students who are interested in going into osteopathic medicine, visit the American Association of Colleges of Osteopathic Medicine, www.AACOM.org; and VCOM at http://www.vcom.vt.edu/.

It Takes a Community for Effective Disease Prevention and Management

To help stem the tide and high cost of persisting disparities in U.S. health care, providers are leveraging Community Health Workers (CHWs) as critical players in improving health outcomes by successfully linking “vulnerable” patient populations to better care. Living in the communities where they work, CHWs understand what is meaningful to those communities, communicate in the language of those they serve, and incorporate cultural buffers to help patients cope with stress and promote health outcomes.

As the CDC reports, growing evidence supports the involvement of CHWs as a critical link between providers and patients in the prevention and control of chronic disease:

  • They help high-risk populations, especially African-American men in urban areas, to control their hypertension.
  • They enable diabetic patients to reduce their A1C values, cholesterol triglycerides and diastolic blood pressure.
  • Their interventions improve knowledge about cancer screenings as well as screening outcomes.
  • Their interventions help patients reduce the severity of asthma.

Many Americans – especially those with low incomes, have no insurance or face other socio-economic barriers to primary care – often distrust the health care system, or lack the resources and awareness needed to take charge of their health. As a result, they wait until health issues and chronic disease escalate enough to drive them into the emergency department, where they receive short-term solutions that drive up the total cost of health care.

CHWs are changing that, community by community. Examples of CHW programs – both at home and abroad – abound. One is Penn Medicine’s IMPaCT Program.

IMPaCT (Individualized Management for Patient-Centered Targets) pairs patients in need of extra support with relatable neighbors and peers (people who have shared language, ethnic and geographic backgrounds) to assist them in navigating the medical system and identify the underlying causes of illness.

“Lower income patients tend to poorly manage chronic disease and have worse health outcomes than other patient populations,” explains Dr. Shreya Kangovi, Director of the Penn Center for Community Health Workers, which houses the IMPaCT program. “They are less likely to get preventive care and more likely to end up in the hospital. This scenario leaves health care practitioners frustrated, because they can’t move the needle on health outcomes. And it makes it difficult for the health system to meet its quality targets.”

Dr. Kangovi notes that many patients served by IMPaCT didn’t have a relationship with a primary care physician prior to joining the program.

“There is a lot of focus today on reducing hospital re-admissions,” she says. “But before we can reduce re-admissions, we need to make sure patients have a substitute for the emergency department.”

She shared the story of “Ben,” a young man with a bad case of lupus and no insurance. Ben had been visiting Penn’s Emergency Department regularly for lupus flare-ups. There, he received steroids and pain medications before being sent along his way. Thanks to IMPaCT, Ben was set up with a primary care doctor who understands his health problems, and placed Ben on a better medication regimen. Not only does Ben now feel better, he has more trust in the health care system that he sees as an ally, she says.

IMPaCT currently serves about 500 patients via two programs – one for hospitalized inpatients and one for primary care outpatients. The program’s CHWs meet with patients upon admission to the hospital to set short-term goals and identify pathways to solving their clinical and socioeconomic hurdles. They advocate for patients during their hospitalization, then work with them during discharge and beyond to get them connected to resources in their community. On the primary care side, patients work with their IMPaCT partner over six months to break long-term health goals down into smaller, achievable steps.

“Once patients leave the hospital, real-life issues intervene,” Dr. Kangovi says. “IMPaCT’s community health workers address these health and life issues on the ground, and do so much better and at a much lower cost than clinically trained personnel.”

Are CHWs making a difference where you live? How are they helping to reduce costs and improve access to health care?

Categories: Access to Care

National Patient Safety Program Cuts Bloodstream Infections to Save Lives and Money

Central-line catheters are lifesavers. They’re used in hospitals to deliver therapy where needed and when needed for patients with a wide range of conditions.  Unfortunately, central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and billions of dollars in added costs to the U.S. health care system, according to the CDC.

But there’s one collaborative program that has cut CLABSIs in intensive care units by 40 percent, preventing more than 2,000 infections, saving more than 500 lives and avoiding more than $34 million in health care costs. The program, funded by the Agency for Healthcare Research and Quality (AHRQ), used the Comprehensive Unit-based Safety Program (CUSP) to achieve these landmark results.

CLABSIs occur when germs enter the bloodstream through the central line (also known as a central venous catheter), which is placed in a large vein in a patient’s neck, chest or groin to give medication or fluids or to collect blood for medical tests. Such lines are commonly used in intensive care units and can remain in place for weeks or months.

Thanks in part to CUSP, progress is being made to protect people from these infections. In fact, nearly 60 percent fewer bloodstream infections occurred in hospital ICU patients with central lines in 2009 than in 2001. This decrease in infections saved up to 27,000 lives and $1.1 billion in excess medical costs. More recently, CLABSIs dropped 41 percent from 2008 to 2011, up from a 32 percent reduction in 2010.

CUSP Programs, like the one used in the AHRQ project, are being used by a number of state health departments to help prevent CLABSIs. CUSP combines clinical best practices with an understanding of the science of safety, improved safety culture and an increased focus on teamwork. It helps clinicians understand how to identify safety problems and gives them the tools to tackle those problems.

“In the CLABSI project, we learned that the principles of CUSP worked to make care safer, and that clinical teams could sustain those improvements over time,” said Jeff Brady, MD, MPH, Associate Director, Center for Quality Improvement and Patient Safety. “The CUSP toolkit, which is a free resource on AHRQ’s web site, is designed to help clinical teams improve any safety problem, not just CLABSIs or infections.”

Indeed, Dr. Brady notes that new projects are already underway to apply CUSP principles to other safety problems like perinatal care and other settings of care, like ambulatory surgery. In addition, AHRQ is developing a CUSP toolkit module to address patient and family engagement – a resource slated for introduction in the late spring.

The bottom line: CLABSIs are preventable and we have the replicable tools we need to protect more patients.

How are health care providers in your area preventing CLABSIs? Are there steps patients can take? If so, what are they?

Hospitals, Physicians Embrace Strategies To Reduce Cost of “Frequent Flyer” ER Visits

Pardee Memorial Hospital in Hendersonville, N.C., shaved nearly $405,000 from its Emergency Room (ER) expenses over a one-year period thanks to an integrated program that its founder calls a “patient-centered medical home on steroids.”

The program, Bridges to Health, helped its uninsured participants reduce their ER visits from an average of seven per year (at a typical cost of $14,004 per person) to three per year (at an average cost of $2,760 per person). Another indicator of success: 10 participants secured employment and six previously homeless members found places to live by the end of the first year.

It’s estimated that non-urgent Emergency Department (ED) visits cost the U.S. about $4.4 billion annually. At Pardee Memorial Hospital alone, 255 frequent users (“frequent flyers”) of the ED racked up more than $3 million in unpaid medical bills. Frequent flyers account for up to 40 percent of total ER visits nationwide.

Bridges to Health decreases ER expenses by providing this patient population with primary care, behavioral health services and a nurse case manager through bi-weekly health clinic visits.

“Many of these people just went to the ER because they were in pain or scared,” said Dr. Steve Crane, a family physician who started the program. “You see them going back so many times because their real issues are not supposed to be treated in the ER and are not taken care of.”

The Pardee Bridges to Health free clinic integrates medical checkups and group therapy, with doctors providing treatment and patients offering one another tips ranging from how to obtain legal assistance to saving money on food and shelter. In this way the program addresses the two main problems seen in these patients: lack of social support and access to regular primary care.

Although the results of the program are promising, Dr. Crane cautions that the patient group is small and that it only works for participants who attend the clinic meetings.

Another example of how hospitals can lower frequent flyer ER visits is in the story of Providence St. Peter Hospital (Olympia, Washington). The first step was to join a special community program called the Emergency Department Consistent Care Program and CHOICE, a unified program involving five area hospitals and a non-profit regional coalition of health care providers.

This collaborative effort resulted in ER visits among frequent flyers shrinking by about 50 percent, for a cost savings of nearly $10,000 per patient. That translated to a $2.2 million reduction in ED and inpatient expenses over two years at Providence St. Peter’s alone.

This program flags patients who visit the ED at least twice in one month or four times in six months then examines their cases for narcotic dependency, mental health issues and other factors. The program team uses that data to identify patients, then develops individual care plans and offers the assistance of primary care physicians, clinicians and specialists skilled in the patients’ particular needs.

What’s key to the success of the program? It effectively coordinates efforts with other hospitals in the area, according to its administrative coordinator, ensuring that frequent flyers get a consistent message wherever they go.

What approaches should be pursued to provide more efficient care systems while decreasing readmissions for frequent flyers? Encourage more doctors to keep their offices open longer? Leverage mental health coalitions that focus on continuity of care instead of short-term fixes?

Tell us what you think.

Categories: Cost-Savings