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Sepsis: A Quiet Killer

patient in hospital bed

Several months ago, I attended a conference where a mother and father spoke about their son's tragic battle with sepsis. Their experience left an impression with me that I will never forget. In 2012, their 12-year-old son, Rory Staunton, received a scrape on his arm during a basketball game. The scrape became infected and Rory received a slow diagnosis of sepsis, which eventually led to his death. The Rory Staunton Foundation was created in his honor as a way to help the fight against sepsis.

In addition to hearing about Staunton's experience, I also have two close friends who have battled sepsis. I visited both in the intensive care unit during their battle with this devastating infection. At one point, they were hardly recognizable because of inflammation.

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Trading Places: Lessons Learned by a Caregiver Who Became a Patient

Doctor with Patient and Family

Recently, I was admitted to a hospital for the first time in my adult life. While I'd experienced hospitalization (and subsequent follow-up visits with specialists) from the caregiver/advocate point of view, I had not actually been a patient before. This gave me a new perspective on both roles.

I learned that I'm much more anxious as a caregiver than as a patient. Surprisingly, as a patient, I found that I was able to wait and see what the tests revealed without focusing on "what if" scenarios. As a caregiver, I am much more nervous and always thinking about how to prepare for the various possibilities.

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The Perfect Patient

Doctor with patients

A recent article in JAMA told the story of an Ivy League educated woman in her early 30s, well insured, a native English speaker, health savvy, with no medical history -- for all intents and purposes the "perfect" patient -- who went to a hospital emergency department for lower abdominal pain. A questionable mass in her colon was discovered on a CT scan. After three days in the hospital she didn't know whether the mass was cancerous or not, and she had not received information about the next steps for diagnosis and treatment at the time of discharge. She spoke up when the nurse handed her the discharge instructions and asked to speak to her physician again. No clear answers were provided. She left the hospital confused with no obvious follow-up plan. Her abdominal pain didn't get better, but it also didn't get worse. So she did what was easiest: nothing at all. Her negative experience discouraged her from further interaction with the health care system. Three months later, she still had not sought follow-up medical care.

What makes a seemingly ideal patient so disillusioned that she neglects her own care?

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New Mexicans Step Up for Health Care Value

New Mexico Coalition for Healthcare Value Logo

HealthInsight New Mexico joined nine other stakeholders in New Mexico as founding members of the New Mexico Coalition for Healthcare Value, a new not-for-profit organization that includes private and public employers, health care providers, insurers, and one of the state's largest retiree health care organizations. The focus of this organization is to provide a neutral forum to discuss ways to improve value and transparency in health care in the state.

The coalition was formed as a result of the momentum generated by the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) grant that had been operating in New Mexico over the past six years. Employers in New Mexico were interested in sustaining the efforts of the AF4Q initiative and were a driving force behind forming the new organization.

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Delivering Widespread Improvement in Health Care through Learning and Action Networks

Participants taking notes

There are many ideas, interventions and literature on evidence-based practices that have been effective in delivering quality care. However, the challenge is sharing these practices among health care providers to make the care experience better for every patient. How can providers share their experiences and learn from others' experiences to improve care instead of reinventing the wheel or continuing ineffective practices?

HealthInsight is convening Learning and Action Networks (LANs) as a forum that brings together stakeholders, providers and improvement experts in an "all-teach, all-learn" model that encourages peer sharing, rapid testing of change ideas, and support for adaptation and spread of successful improvements. The goal of a LAN is to bring providers and community partners together to:

  • Create a forum for sharing of best practices
  • Develop an action plan to overcoming barriers and problems for improving quality processes and outcomes, demonstrated through quality measures
  • Offer resources to providers to assist in improvement efforts (such as webinars, clinician tool kits, meetings and best practice advice from successful clinicians and facilities, along with subject matter experts)
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Patients are People Too

Gardener with plants

In the emerging field of patient engagement there is considerable debate about what exactly to call it: patient engagement, consumer engagement, person-centered care, the list goes on. Regardless of the name, the key is to first and foremost recognize that a patient's health care isn't at the center of their universe. And if it is, then we have failed; we have taken the care out of health care.

When I was in college, I worked as a nursing assistant at the nursing home close to campus. During my training I was told to think of the residents as though they were family members. How would I want my grandmother or mother to be treated? I was assigned to work in the Special Care Unit, which is where the residents with dementia or Alzheimer's disease lived. I was nervous at first but quickly fell in love with all of them. I learned that in order to provide the best care possible I had to meet them where they were. For one lady, that meant waiting at the bus stop (a chair just outside the nurse's station) for Alice so they could go to the movie. For another, it was asking him where he put the library book that he was so desperate to return. Reorienting them to person, place and time was not helpful—it only caused more distress. In many cases, I became a long-lost daughter or childhood friend and that was OK. It was more than OK; it made them calmer, more relaxed. Outside of each room was a memory box filled with mementos and photographs from their past. The purpose was to help the residents find their rooms, but they served another purpose for me. Every time I entered the room I would pause, just for a few seconds, to look at their pictures. The pictures told so many stories of families, of professions, of sacrifices, of love. I could recall similar pictures of my grandparents and parents. The task of treating them like family was easy; in a short time, they were my family.

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Caregivers: Not Just Nurses and Mothers Any More

Three gnerations of family in the park

I found myself thinking about what to write for this blog post on Mother's Day, which fell in the middle of Nurses' Week this year. Both moms and nurses have a long and intertwined history of caregiving. Most nurses are women, and if asked what nurses do, it would not be surprising if the answer was, "they take care of us." We would say the same about our mothers.

For about a decade before my father died, my mother and I were his at-home caregivers. It was a labor of love. However, it wasn't until after he was gone that I truly realized how much labor it had actually been. I was exhausted and had been for years without realizing it. I jumped every time the phone rang because I was afraid something had happened to my father that might involve calling 911 or rushing to his side. Over the years, I prepared a file of all the phone numbers and information I thought I might need "when the time came." I also tried to support my mother so she still had a quality life outside of caring for dad. Did I mention I was exhausted? Even as a registered nurse for many years, I was ill-prepared for this role.

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The Value of Diabetic Self-Management

Blood sample using finger

Diabetes continues to be one of those "sticky" problems -- one that is not easily solved by simple strategies. Typically, "sticky" problems take a variety of coordinated approaches to solve.

Diabetes is one of the leading causes of death in the United States. In 2012, the cost of diabetes in the U.S. was $176 billion for direct medical costs, and $69 billion in reduced productivity. A snapshot view of those who have diabetes demonstrates the criticality of the problem. According to the American Diabetes Association, 29.1 million people have this disease, which means 1 out of 11 people has been diagnosed with diabetes; 1 in 3 adults has pre-diabetes; 1 in 4 adults over the age of 60 has diabetes; and 1 out of 4 adults is living with undiagnosed Type II diabetes.

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Wearable Tech: Keeping Your Data Close to You

Smart watch

I'm sitting in a quiet room working on my computer when suddenly my watch alarm goes off. This isn't an alarm to tell me to get ready for my next meeting; it's a notification from a news aggregator letting me know about a trending article. I quickly tap my smartwatch, which loads the article on the watch face and allows me to read it. Afterward, I check my watch's pedometer to see if I should take the stairs instead of the elevator today to reach my daily step goal. At the end of my day, I can review my sleeping patterns to see if I'm sleeping soundly or not -- a good night's sleep, for me, is an indicator of my stress level. My smartwatch has become a tool that provides information that directly influences my health.

Wearable tech is a quickly evolving field and its impact on health care is becoming more and more significant. Wearable technology can be loosely defined as technology that is embedded into or used to accentuate devices such as wristwatches, glasses, shirts, dresses, necklaces or even shoes. Some wearable technology can even be embedded in contact lenses. My smartwatch provides a convenient approach to tracking my own health statistics such as heart rate, sleeping patterns, calories burned and glucose levels. No longer do I need to write down stats on a notepad -- I can simply use some mobile applications paired to my wearable tech to record, collect and oftentimes perform low-level analyses for me. There are other wearable devices that patients can use to store and update their medical history to have it available at a moment's notice or to share with their physicians. An infographic on Orange Healthcare's website shows how wearable tech can expand to fit a large number of potential needs for both patients and physicians.

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What Does HealthInsight Do, Anyway?

Peopl at a meeting

From time to time at HealthInsight, we engage in a little exercise to develop and define what we refer to as our "elevator speech." We try to think about how we could, in the 30-second time span of an elevator ride, best and most succinctly answer the question, "What does HealthInsight do?"

As you might imagine, HealthInsight does a whole lot of things in the field of health and health care improvement, and distilling a description of our work down to a clear, concise response to this question is neither obvious nor easy to summarize in a sentence or two -- the way it might be if we were, say, a law firm or a hospital. While we may continue to struggle to craft the perfect elevator speech response, we can point the reader to some recently published information that helpfully describes important work that we perform as the federally designated Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Medicare in the states of Nevada, New Mexico, Oregon and Utah. This report illustrates the kinds of things we do to improve health and health care.

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