Real World Health Care Blog

Tag Archives: U.S.

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?