Real World Health Care Blog

Tag Archives: disease

Profiles in Courage: Beating Breast Cancer One Story at a Time

As we recognize Breast Cancer Awareness Month, heroes, organizations and allies nationwide are leveraging creative strategies to empower patients and families, educate communities and mobilize supporters to overcome the disease and live healthier.

Paul DeMiglio

Paul DeMiglio

Are You Dense?

Dedicated to “informing the public about dense breast tissue and its significance for the early detection of breast cancer” Are You Dense? seeks to educate the public and raise awareness around dense breast tissue and the need for early detection through online tools and resources in addition to speaking engagements. This organization helps women diagnosed with breast cancer by highlighting what it’s like to live with the disease, advocating changes to public policy around detection and supporting new and existing research.

Athena® Warriors

From the time she was a little girl, six-time Grammy winner singer/songwriter Amy Grant knew that cancer “was a force to be reckoned with.” Amy was inspired at a young age by the work of her father – an oncologist who spent his entire medical career treating cancer – to join the band of warriors. A tireless advocate, she draws courage from the countless women she helps empower every day to fight breast cancer, along with her fellow warriors: Amanda Beard, Angela Stanford and Karen Gooding.

“I am inspired by every Athena Warrior. If my music can bring women together and make a connection, then I have contributed something. Athena water takes a terrible situation and does something good for many; that’s why I love being an Athena Warrior,” Grant said.

Terror for Ta-Tas

Woods of Terror — a haunted theme park in Greensboro, North Carolina — hosts the annual “Terror for Ta-Tas Night” to benefit breast cancer survivors. A percentage of the proceeds from this year’s event will be donated to Cone Health Cancer Center’s “Finding your New Normal” program for breast cancer survivors.

Tami Knutson, Breast Cancer Center Manager for Cone Health, is passionate about helping Terror for Ta-Tas because she believes it will empower more Americans to live healthier and bring us closer to ending breast cancer.

“I teach young women about self-breast awareness,” Knutson said. “There is not another venue that I have access to young people.  Most health fairs attract people in the middle years and older. I find teaching  in such a crazy, unexpected location very rewarding. It catches people off guard and I think my message is really heard.”

The Terror for Ta-Tas event runs from 7:30–11 p.m. Friday, October 11. For event information visit terrorfortatas.com, and to learn more about the “Finding Your New Normal” program e-mail Tami Knutson at Tami.Knutson@conehealth.com.

Tough Enough to Wear Pink

A non-profit marketing campaign sponsored by Wrangler, Tough Enough to Wear Pink (TETWP) began with breast cancer survivor Terry Wheatley who, with Wrangler, challenged cowboys and cowgirls to wear pink at the Wrangler National Finals Rodeo to raise awareness and to honor the women in their lives that had been affected by the disease.  TETWP serves as a springboard for communities to create rodeos and other western events that raise awareness around breast cancer.  By focusing attention on women’s health, this initiative raises money for women’s health education, supports women’s treatment centers and much more.

“The success of the Tough Enough to Wear Pink campaign – which has raised over $14.5 million dollars since its inception in 2004 – is that every community that participates through their rodeo or their western event is encouraged to keep their money locally to do good in their own back yards through contributions to their women’s breast cancer center, the women’s breast cancer wing of the local hospital or whatever breast cancer support group is in need in their community,” Wheatley said. “It is the decision of the local rodeo committee or event on who receives their donation.  The success of the campaign is that it is truly grass-roots, with people raising $5 at a time to support someone in their community.”

For example, Red Bluff Round-Up raises money for breast cancer treatment at the St. Elizabeth Imaging Center in their community of Red Bluff, California, to provide mammograms and other women’s health services directly from the funds generated through their TETWP rodeo event. This is just one of the many examples of how individual rodeos and western events use their funds to help women live healthier lives.

Now tell us how you are touching the lives of women living with breast cancer. What are you doing in your local community, place of worship, school or workplace to spread the word about how we can stop this disease together?

Are You Ready to Show Your Purple to Stop Alzheimer’s?

Advocates nationwide are gearing up to participate in activities around Alzheimer’s Action Day on September 21, a pre-event to World Alzheimer’s Awareness Month in November. As the facts demonstrate, the need for education and action around this disease is great. A form of progressive dementia that adversely impacts memory, thinking and behavior, Alzheimer’s is the sixth leading cause of death in the United States and there is no cure.

Paul DeMiglio

Paul DeMiglio

To build support and increase visibility, the Alzheimer’s Association leverages Alzheimer’s Action Day to educate the public and fund research for Alzheimer’s, urging individuals to “Go Purple to End Alzheimer’s.” The association empowers supporters to raise money for Alzheimer’s research with the following creative ideas that can be used in the workplace, at school or at home:

  • Go purple at your office or campus by encouraging your co-workers or your peers to wear purple.
  • Decorate common areas at your workplace or school with purple. Share the latest stats and trends about the disease, like the 10 warning signs of Alzheimer’s. Call (800) 272-3900 to request fact sheets.
  • Go “Casual for the Cause” at work. Order $5 stickers from the association that you can then sell in your office to raise funds. Download a flier here and e-mail Kaarmin Ford at kaarmin.ford@alz.org for stickers.
  • Host a dinner party at your home and ask each attendee to donate what they would have spent going out. Click here to download meal ideas that can be used at home or in the cafeteria.
  • Invite your friends to Tailgate to Tackle Alzheimer’s starting this month. Supporters who host these purple-themed tailgates can ask participants to donate $5 to help the 5 million Americans living with Alzheimer’s.

Over the past decade, Alzheimer’s has become an even more urgent public health crisis, demanding greater attention from both a patient care and cost-savings standpoint:

  • Five million Americans and one in three seniors live with Alzheimer’s.
  • Since 2000, the number of deaths attributed to Alzheimer’s has increased by 68 percent.
  • The disease accounts for 50-80 percent of all dementia cases.
  • Alzheimer’s will cost the nation an estimated $203 billion this year.
  • Costs are expected to increase by 500 percent by the year 2050, meaning that the annual cost will swell to $1.2 trillion.

The Alzheimer’s Association is collaborating with partners from around the country to help communities “Go Purple.” These include the Las Vegas CME – Medical and Health Education for All, the California Association of School Health Educators (CASHE) and Cox 11, a community station in Hampton Roads, VA, which are all spreading the word about ways to get involved at the local level. Ruby Tuesday will also raise awareness for Alzheimer’s Action Day at select locations, giving 20 percent of purchases to the Walk to End Alzheimer’s when customers present a flyer to their server on September 21.

“Supporting Alzheimer’s Association specifically on Alzheimer’s Action Day will help generate much needed awareness about this disease and what we can do as a community to support families with this disease on a daily basis,” a Ruby Tuesday spokeswoman said. “With the GiveBack Program specifically, we hope to raise funds within the communities of our restaurant that will directly contribute to research and ultimately find a cure for Alzheimer’s.”

What are you doing in your community to educate colleagues, peers, family and others about this disease? How can other stakeholders – including health systems and government – get more involved and join in efforts to raise awareness around the impact of Alzheimer’s year-round?

Categories: Access to Care

Targeted Therapies Open Door to Improved Outcomes and Lower Costs to Treat HCV

As we were reminded on World Hepatitis Day, early detection is critical to turning the tide of this “silent epidemic” that impacts millions. However, strategies to end the deadly effects of viral hepatitis don’t stop there. Personalized treatment is another essential tool that fuels better outcomes for patients with hepatitis C (HCV) while saving money in the long term for the health care system too. 

Paul DeMiglio

Paul DeMiglio

The importance of finding effective therapies for HCV is underscored by the reality that the disease often goes undetected, with an estimated 80 percent of Americans with HCV unaware of their status. Many HCV-positive people show mild to no symptoms, making it more likely for the illness to progress and become more expensive to treat as a result. 

Although safe and effective vaccines are available for hepatitis A and B, none exist for HCV. To help answer this need, Abbott created the fully automated RealTime HCV Genotype II Test – the first FDA-approved genotyping test in the United States for HCV patients – to facilitate targeted diagnosis and treatment that boosts desired outcomes.

This treatment-defining genotyping test empowers physicians to better pinpoint specific strains of HCV, determine which treatment option is best for the patient, and make more informed recommendations about when it should be administered. Available to individuals with chronic HCV, the test is not meant to act as a means to screen the blood prior to diagnosis.

So how does finding the right HCV treatment save money?

Targeted therapies like these are important for diseases like HCV because they reduce the “trial and error” of having to use additional treatments when the initial ones don’t work, saving money and time for patients and providers. Early detection, combined with follow-up care, can prevent patients from developing later stages of hepatitis that can mean more serious long-term conditions that are harder and more expensive to treat.

Treating HCV patients with end-stage liver disease, for example, is 2.5 times higher than treating those with early stage liver disease. Advanced HCV can also escalate to chronic hepatitis infection, a side effect of this being cirrhosis (scarring of the liver and poor liver function) and liver cancer. Treatment for these two conditions (which can include a liver transplant) can cost more than $30,000. Liver cancer treatment can be more than $62,000 for the first year, while the first-year cost of a liver transplant can be more than $267,000.

As more and more patients find themselves unable to afford treatments, HCV is becoming an increasingly larger financial burden on the health care system.

The annual costs of treating HCV in the United States could be up to $9 billion, and over the course of a lifetime the collective cost associated with treatments for chronic HCV is estimated to total $360 billion.

“As we see patients with more advanced liver disease, we see significantly more costs to the system,” says Dr. Stuart Gordon, author of the Henry Ford Study. “The key, therefore, is to treat and cure the infection early to prevent the consequences of more advanced disease and the associated economic burden.”  

Targeted therapies show great promise to improve outcomes while saving time and money by linking patients to the specific treatments they need at earlier points of diagnosis. But what can health systems do to make innovations like the HCV Genotype II Test accessible to more patients and increase the cost-savings benefit on a larger scale?

World Hepatitis Day Spotlights Importance of Early Detection to Improve Prevention and Treatment Strategies

This Sunday, July 28, is World Hepatitis Day, an observance that reminds us that hepatitis (inflammation of the liver) remains largely unknown as a major health threat. Approximately half a billion people worldwide and 4.4 million people in the U.S. live with chronic viral hepatitis, with one million deaths resulting from the disease each year.

Linda Barlow

Linda Barlow

The goal of World Hepatitis Day is to move from awareness to action to address the “silent epidemic” of viral hepatitis – so named because most people don’t experience symptoms when they first become infected, often not until they develop chronic liver disease many years later.

Stakeholders in government and private industry are stepping up to answer the call, supporting early detection and medical intervention as key starting points to effectively address the epidemic.

Earlier this month, Quest Diagnostics announced a partnership with the CDC to improve public health analysis of hepatitis C screening, diagnosis and treatment for the 3.2 million Americans living with it. Under the collaboration, anonymous patient data will be evaluated to identify and track epidemiological trends in hepatitis C virus infection, testing and treatment and determine how those trends differ based on gender, age, geography and clinical management.

“Our collaboration with the CDC underscores the importance of using diagnostic information to derive useful insights enabling effective prevention, detection and management programs for diseases with significant impact on public health,” Jay Wohlgemuth, M.D., senior vice president, science and innovation, Quest Diagnostics, said in a statement.

Early detection was also the focus of a 2012 National Institutes of Health (NIH) study published in Proceedings of the National Academy of Sciences. In the study, researchers concluded that elevated blood levels of a specific enzyme and a specific protein early on in the course of hepatitis C infection were much more likely to develop into advanced fibrosis or cirrhosis. The study found:

  • The long-term course of chronic hepatitis C is determined early in infection.
  • Rapidly progressive disease correlated with persistent and significant elevations of alanine aminotransferase (ALT), an enzyme released when the liver is damaged or diseased.
  • Rapidly progressive disease correlated with persistent and significant elevations of the protein MCP-1 (CCL-2), a chemokine that is critical to the induction of progressive fibrogenesis and ultimately cirrhosis.

Armed with this information, clinicians are expected to make a fairly accurate assessment of which patients are likely to develop advanced disease rapidly. Instead of waiting for a new class of drugs to be approved, these patients are likely to be pressed to start treatment right away – with the goal of treating the virus before it causes cirrhosis of the liver.

Because hepatitis does not result in symptoms until serious liver damage occurs, getting tested is also crucial. In fact, the CDC recommends that everyone born from 1945-65 get a one-time test for hepatitis C because they are five times more likely than American adults in other age categories to be infected and face an increased risk of dying from hepatitis C-related illnesses.

The first FDA-approved hepatitis C genotype test is now available in the U.S. From Abbott, the fully automated Realtime HCV Genotype II test determines the specific type or strain of the HVC virus present in the blood of an HCV-infected individual.

To locate organizations where you can access services including Hepatitis testing, vaccines and treatment, click here. You can also take this 5-minute Hepatitis Risk Assessment to obtain a personalized report from the CDC.

Early awareness and prevention-based practices are crucial to avoiding hepatitis. But what else can be done to ensure access to and availability of reliable and cost-effective screening and diagnostics, in addition to safe and simple treatment regimens for people with the disease?

We hope this post serves as a resource for journalists covering or interested in writing stories about World Hepatitis Day and related issues. Also stay tuned for our follow-up post next week that will address the cost-savings implications of vaccination and early treatment of hepatitis.

Juvenile Arthritis Awareness Month Underscores Efforts to Identify Causes and Develop Treatments

That’s right. Children get arthritis too. In fact, according to the Arthritis National Research Foundation (ANRF), nearly 300,000 children in the U.S. have been diagnosed with juvenile arthritis (JA) – one of the most common childhood diseases in the country.

Linda Barlow

Linda Barlow 

When Juvenile Rheumatoid Arthritis (JRA) first shows its symptoms in a child’s body, many parents write off swollen joints and fever as the flu, or think a sudden rash might have occurred from an allergic reaction. The symptoms might even recede slightly before showing up again, sometimes delaying diagnosis. 

Because a child’s immune system is not fully formed until about age 18, JRA can be especially virulent, compromising the body’s ability to fight normal diseases and leaving children open to complications that can adversely affect their eyes, bone growth and more.

Both the Arthritis Foundation and the ANRF are on the forefront of combatting this disease by supporting research into causes and treatments.

The ANRF’s Kelly Award is one example of how the organization dedicates part of its research effort toward treatment of JRA. The $75,000 grant is given annually to a researcher focused solely on JRA treatment and cures. For the past two years, the award went to Dr. Altan Ercan at Brigham & Women’s Hospital in Boston, whose work has the potential to provide novel targets for new therapies.

Another example is the Arthritis Foundation’s partnership with the Childhood Arthritis and Rheumatology Research Alliance (CARRA). Through the partnership, the Foundation is working to create a network of pediatric rheumatologists and a registry of children with the disease, allowing researchers to identify and analyze differences and similarities between patients and their responses to treatment. Ultimately, the registry will help researchers cultivate personalized medicine, the ultimate weapon in battling the disease. The CARRA Registry has been launched at 60 clinical research sites and has enrolled 8,000 patients.

The Arthritis Foundation has also committed to providing more than $1.1 million in funding this year to researchers investigating a wide range of topics, including: 

  • Exploring how environmental and genomic factors might play a role in triggering juvenile arthritis; 
  • Collecting data and evaluating the efficacy of standardized treatment plans; and 
  • Developing and testing a smart phone app to help children cope with pain.

According to the Arthritis Foundation, there is no single test to diagnose JA. A diagnosis is based on a complete medical history and careful medical examination. Evaluation by a specialist and laboratory studies, including blood and urine tests, are often required. Imaging studies including X-rays or MRIs may also be needed to check for signs of joint or organ involvement.

“When joint pain, swelling or stiffness occurs in one or more of your child’s joints for at least six weeks, it’s important not to assume these symptoms are temporary, and to get a proper diagnosis from a pediatric arthritis specialist,” says Arthritis Foundation Vice President of Public Health Policy and Advocacy, Dr. Patience White. “Early medical treatment of juvenile arthritis can prevent serious, permanent damage to your child’s joints and enable her to live an active, full childhood.”  

Management of JA depends on the specific form of the disease but can include:

  • Care by a pediatric rheumatologist.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to control pain and swelling.
  • Corticosteroids such as prednisone to relieve inflammation, taken either orally or injected into inflamed joints.
  • Biologic Response Modifiers (BRMs), such as anti-TNF drugs to inhibit proteins called cytokines, which promote an inflammatory response. These are injected under the skin or given as an infusion into the vein.
  • Disease-modifying anti-rheumatic drugs such as methotrexate, often used in conjunction with NSAIDs to treat joint inflammation and reduce the risk of bone and cartilage damage.

One promising therapy in the fight against juvenile arthritis has been recently approved by the Food and Drug Administration – Actemra (tocilizumab) – from Roche. Used to treat polyarticular juvenile idiopathic arthritis (PJIA), the medicine can be used in children ages 2 and older. It is also approved for the treatment of active systemic juvenile idiopathic arthritis (SJIA).

How can organizations like the Arthritis Foundation and the ANRF increase awareness that arthritis happens to children, and build support to advance development of research and therapies?

HPV Vaccine Reduces Infection Rates in Teen Girls

Since the human papillomavirus (HPV) vaccine was introduced in 2006, vaccine-type HPV prevalence has decreased by 56 percent among females 14-19 years old, according to a new study published in The Journal of Infectious Diseases.

Linda Barlow

Linda Barlow

HPV is the most common sexually transmitted virus in the United States. Although the vast majority of HPV infections do not cause serious harm, some will persist and can lead to cervical cancer. Each year in the U.S., about 19,000 cancers caused by HPV occur in women.

“Unfortunately, only one-third of girls aged 13-17 have been fully vaccinated with HPV vaccine,” says CDC Director Tom Frieden, M.D., M.P.H. “Our low vaccination rates represent 50,000 preventable tragedies, which means 50,000 girls alive today will develop cervical cancer over their lifetime. This would be prevented if we reach 80 percent vaccination rates. For every year we delay in doing so, another 4,400 girls will develop cervical cancer in their lifetimes.”

Study author Markowitz notes that the decline in vaccine type prevalence could be due to factors such as “Herd” Immunity (also called “community immunity”), which occurs when most members of a community are protected against a contagious disease because a critical portion of the population has been immunized and the opportunities for an outbreak are reduced. “Herd” Immunity has been shown to control a variety of contagious diseases, including measles, mumps, rotavirus (MMR), influenza and pneumococcal disease.

Public health experts recommend routine HPV vaccination at ages 11-12 for both boys and girls. A series of three shots is recommended over six months. HPV vaccination is also recommended for older teens and young adults who were not vaccinated when younger.

The HPV vaccine is not without its critics, and health care providers are not consistently giving strong recommendations for the vaccine, particularly for younger teens, according to the CDC.

“One of the most common criticisms from parents – that their teen is not sexually active yet – misses the point,” suggests Frieden, who says that vaccines should be administered well before people are exposed to an infection.

Frieden also points out that, with the Vaccines for Children Program and the Affordable Care Act, vaccination is easy and cost should not be a barrier because many insurers are required to cover the vaccine at no cost to either female or male patients.

The power of an effective and widespread vaccination program should not be ignored. Smallpox, for example – a serious and sometimes fatal infectious disease – has no specific treatment and is only prevented by a vaccine. Although outbreaks of the disease have occurred from time to time over thousands of years, it is now eradicated worldwide because of a successful and comprehensive vaccination campaign.

A similar initiative is underway to eradicate polio worldwide. The development of effective vaccines to prevent paralytic polio was one of the major medical breakthroughs of the 20th century. Supported by the Bill & Melinda Gates Foundation, the Global Polio Eradication Initiative (GPEI) has helped to reduce the incidence of polio by more than 99 percent.

As with smallpox, if enough people in a community are immunized, the virus will be deprived of susceptible hosts and will die out. But high levels of vaccination coverage must be maintained to stop transmission and prevent outbreaks.

Will HPV go the way of smallpox and polio thanks to “Herd” Immunity? Do you agree with the CDC that it’s time to ramp up efforts to protect the next generation with the HPV vaccine? Or do you share the critics’ concerns?

Real-Time Health Alerts Join Twitter to Expand Access to Public Health Information

Is Twitter now monitoring your allergies or sleeping patterns?

Linda Barlow

Linda Barlow

In today’s era of real-time information, Twitter has emerged as a leading go-to source for the latest in news, entertainment and more. Now, Twitter is joining Everyday Health, Inc. to create HealthBeat, the first global real-time health alert and news offering. The partnership seeks to provide relevant health information and breaking news to the Twitter community in real time, offering promoted Tweets linking to Everyday Health’s news, expert advice, videos and tools that users can put into action.

HealthBeat will scour the 2 million daily health-related tweets in the U.S. to identify impending outbreaks and other health crises.

“We’ll be looking at the key health terms flaring up every day, and when something is indexing in an abnormal way, we’ll let Twitter know and we’ll supply content about what to do,” said Everyday Health President Michael Keriakos, in an interview published in Ad Age.

For example, Keriakos noted that HealthBeat could have been used to provide vaccination information to residents affected by a whooping cough outbreak in South Central Los Angeles two years ago.

Not only will the partnership provide important information relating to public health, it will also serve as a targeting mechanism for advertisers who are being sought by HealthBeat to promote content around broad health topics like allergies, flu season and insomnia.

While HealthBeat touts itself as the “first global real-time health alert” service, there are other online services – like Google’s flu tracker — that provide similar information on a regional or national level:

  • Launched in 2010, Health & Safety Watch is a Canadian-based web portal and iPhone app that lets users customize the type of alerts they want to see. It also indicates when an advisory or warning is over, for example, when a local water quality issue has been resolved.
  • In the U.S., the Centers for Disease Control and Prevention (CDC) provides alerts about health issues travelers may face when going abroad as well as alerts about disease outbreaks at home.
  • Also in the U.S., a service called HealthMap, developed out of Boston Children’s Hospital, offers an online portal called The Disease Daily, and a mobile app called Outbreaks Near Me.

“The sooner we get a signal of an infectious disease outbreak, the sooner we can devise an appropriate response, and hopefully, the negative impacts can be mitigated,” explained Anna Tomasulo, MA, MPH, HealthMap Program Coordinator, Boston Children’s Hospital.

According to Tomasulo, HealthMap has other tools that help prevent health problems.

“Our Vaccine Finder takes a person’s zip code and provides information on where they can access vaccines nearby,” she says, noting that the project started with flu vaccines but has since been expanded to other vaccines including human papillomavirus (HPV), measles, mumps and rubella (MMR), Varicella and more. “A questionnaire helps users determine what vaccine is most appropriate and provides a list of participating pharmacies within a given radius that provides the vaccine the user needs. Such vaccines help prevent costs associated with illness and potential hospital stays.”

So are HealthBeat, HealthMap and other real-time alert programs providing an important public health service? Are these alerts helpful or will they cause undue concern?

Categories: Access to Care

More Patients Choosing Hospice “Comfort Care” Option

In today’s health care environment, so much attention is paid to preventing and eradicating disease to improve health outcomes. But for patients facing terminal illness or life-limiting conditions, accessing quality care can be a frightening and lonely challenge.

Linda Barlow

Linda Barlow

That’s where hospice comes in as an option for more and more people. A unique philosophy of care, hospice enhances quality of life for many patients and strengthens the health system’s quality of care by saving critical resources.

Supporting those who choose comfort care with pain and symptom management rather than curative care, it is designed to neither hasten nor postpone death. Hospice is provided in the patient’s home, hospital, extended care facility or residential care homes. Individual insurance plans vary in terms of coverage guidelines.

According to the National Hospice and Palliative Care Organization (NHPCO), an estimated 1.65 million patients received services from hospice in 2011.

“It is important for patients to understand that hospice is as much a part of the health care system as the birthing process,” says Barbara J. Westland, RN, BSN, Director/Administrator, BJC Hospice. “We are there to bring you into the world and we will be there to support you in your journey through hospice until the end.”

Because hospice focuses on care rather than cure, patient outcomes are measured in more qualitative ways, focusing on issues like pain relief within 48 hours of admission, avoiding unwanted hospitalizations and avoiding unwanted cardiopulmonary resuscitation (CPR). And according to NHPCO, family caregivers who had the support of hospice report less instances of serious depression in the six months following the death of their loved one.

In addition to serving the physical, emotional, spiritual and practical needs of patients and their families, hospice also saves money. In fact, research published in the March issue of Health Affairs found that hospice enrollment saves money for Medicare – from $2,561 to $6,430 per patient, depending on the length of care – and improves the quality of care across a number of different lengths-of-stay.

“If 1,000 additional beneficiaries enrolled in hospice 15 to 30 days prior to death, Medicare could save more than $6.4 million,” notes the study’s authors. “In addition, reductions in the use of hospital services at the end of life contribute to these savings and potentially improve quality of care and patients’ quality of life.”

J. Donald Schumacher, NHPCO president and CEO, points to a study on the benefits of hospice from a cost and quality of care perspective:

“Hospice can reduce the number of intensive care visits, hospital readmissions and other services, which not only saves health care system dollars, but also contributes to a higher quality of life,” he says.

“With the aging population, we expect to see the hospice population growing,” Westland says, noting that between 2000-2007, the number ofhospice patients nearly doubled and the number of providers grew by 45 percent. “Hospice offers a choice for the final journey that is selected by some, but not right for everyone.”

Despite evidence that hospice provides many benefits some critics question whether the implications of market competition and commercialization driving this form of care are ethically consistent with the delivery of health services. In an article that appeared in the Journal of Law, Medicine and Ethics during the summer of 2011, the authors argue that hospice care should be considered with great caution:

“The conflicting interests inherent in the incentive structures of for-profit health care endeavors demand careful scrutiny,” they say. “This is particularly important in the end-of-life hospice context.”

What do you think? Share your experiences and thoughts with us.

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

Telehealth Opens Doors to Enhance Health Outcomes and Reduce Costs

Telehealth solutions are making significant inroads to reverse high health care expenditures and reduce noncompliance with prescription therapies – issues that especially impact those living with chronic disease.

By engaging patients in health education through classes, patient portals, real-time patient-provider consultations, online discussion forums and more, telehealth strategies empower providers to monitor disease progression and intervene with patients at an earlier stage, when conditions may be more easily treated.

A digital conduit that delivers medical care, health education, and public health services, telehealth connects multiple users in separate locations. Telehealth services consist of diagnosis, treatment, assessment, monitoring, communications and education. It includes a broad range of telecommunications, health information, videoconferencing, and digital image technologies.

And what’s best of all? Telehealth is working in many situations. Here are a few examples:

Case Study #1: Telehealth plays an instrumental role in supporting the care of veteran patients with chronic conditions. They are part of a national program from the US Veterans Health Administration to coordinate the care of veterans with chronic conditions at home and avoid unnecessary admission to long-term institutional care. The program included the systematic implementation of health informatics, home telehealth, and disease management technologies for six conditions including diabetes mellitus, congestive heart failure, hypertension, posttraumatic stress disorder, chronic obstructive pulmonary disease, and depression.

Patients involved in the program benefitted from a 25 percent reduction in the number of bed days of care and a 20 percent reduction in hospital readmissions. According to a study of the program, the basis for reduced utilization of health care resources for the patients involved was due to the program’s foundation in patient self-management, disease management and the use of virtual visits.

Case Study #2: At Partners HealthCare in Boston, a home telehealth program focusing on cardiac care resulted in a 50 percent reduction in heart failure hospital readmissions, for a total cost savings of more than $10 million since 2006. The Connected Cardiac Care Program is a centralized telemonitoring and self-management and preventive care program for heart failure patients that combines telemonitoring with nurse intervention and care coordination, coaching and education. The daily transmission of weight, heart rate, pulse and blood pressure data by patients enables providers to more effectively assess patient status and provide just-in-time care and patient education.

Patients in the program use equipment – a home monitoring device with peripherals to collect weight, blood pressure, and heat rate measurements, and a touch-screen computer to answer questions about symptoms – on a daily basis for four months. Telemonitoring nurses monitor these vitals, respond to out-of-parameter alerts, and guide patients through structured biweekly heart failure education.

Cost to the patients? Zero.

Case Study #3: A telehealth strategy using webinars had a small but “positive impact on hypertensive patients” in Brazil, in terms of their adherence to antihypertensive drugs, low salt diet and physical activity. The program was managed by Family Health Teams (FHTs) consisting of doctors, nurses, nurse technicians and community health agents. According to researchers studying the program, the vast majority of practitioners do not specialize in primary care, and only recently have specialized courses emerged to provide that training.

“Given the country’s continental dimensions, high demand, and inadequate amount of training and continuing education centers for primary care professionals, telehealth presents itself as a promising strategy to improve access to training, leading to the improvement of hypertension,” they noted.

Despite growing evidence that telehealth is working for more and more patients, concerns remain about security, privacy and medical liability, with critics also arguing that telehealth lacks common standards. Government agencies, they say, have often been slow to reimburse patients for many telehealth services. Further, some health professionals argue that telehealth threatens to compromise the doctor-patient relationship.

Tell us what you think. Do the advantages of telehealth outweigh possible drawbacks? Have you leveraged telehealth services, either as a patient or provider?

For more information on how telehealth is changing the concept of health care delivery, dowload the White Paper from Tunstall Americas: “Telehealth Solutions Enhance Health Outcomes and Reduce Healthcare Costs.”

Categories: Cost-Savings