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New ATOP Director Talks Project Progress and Perspective

Nurses

I fully embraced the opportunity to join HealthInsight Nevada as the director of the Admissions and Transitions Optimization Program (ATOP) in October 2016 and take the reins of the Phase 2 project. It has been an extraordinary six months of learning and leading for me with invaluable professional and personal growth. ATOP began in 2012 with Phase 1 targeting 24 nursing facilities in Nevada to receive supplemental clinical resources by making RNs and APRNs available to improve the health care outcomes of long-term residents and reduce health care costs without restricting access to care or choice of provider. ATOP nurses focused on the training and education of facility staff (CNAs, LPNs, RNs) as well as providing direct care (in a teaching manner) to facility residents. This project was driven by a Centers for Medicare & Medicaid Services (CMS) measurement showing that a staggering 45 percent of hospital transfers for this population are deemed potentially avoidable.

Phase 1 concluded in September 2016 with impressive results. The ATOP project in Nevada reported that total spending dropped 21.7 percent per resident on average and potentially avoidable hospitalization occurrences declined by 25.5 percent.

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Medication Management: No Simple Task

Closeup pills

$320 billion – this is how much money was spent in 2015 on prescription medications, according to the Centers for Medicare & Medicaid Services' Office of the Actuary National Health Statistics.

10 percent – this is the percentage of people who are taking at least five medications a month, according to the Centers for Disease Control and Prevention's National Center for Health Statistics.

We know that older adults are likely to be on more medications to manage their chronic conditions, and we also know that four out of every 1,000 patients visit the emergency room for adverse events related to their medications. Patients see many different providers. New drugs are coming into the market that may interact with others. Transport to the pharmacy may be an issue. Older patients may not be able to hear the prompts to refill a prescription. And, of course, costs continue to rise. How do patients and their care givers keep on top of all of this?

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The Connected Patient

Runner lacing shoes

Wearable technology and the resultant increase in the potential data they can provide continues to spread and evolve. During the holiday season I saw a large increase in the advertising of virtual reality headsets, especially during the Super Bowl. Several commercials during the big game showed grandparents engaging with a virtual reality headset – some with their family around them watching. They were all having very unique and powerful experiences. It was a poignant reminder to me about the far reaching potential of new technology – not only for entertainment, as the commercials were claiming, but for how we could use this type of technology with health care in the future.

An August 2016 article on CNET by Sarah Tew talked about that very thing. She talked about a pair of wireless earbuds, created by Jabra an intelligent sound solution manufacturer. The earbuds can interface with a HIPAA compliant software and provide health data about a patient's fitness level. The earbuds were provided to certain patients (along with a fitness plan) with a primary focus to use the information to treat obesity, cancer and diabetes. The data provided was shared with the physician and the patient at the same time – everyone had the same data at the same time to help make informed decisions going forward! Wearable devices continue to provide an increasingly strong potential for data collection and are evolving from simple watches to ear buds, and in some rarer instances, some devices that are implanted beneath the skin. The potential uses for wearables seems to only be limited by our imagination.

Physicians will need to continue to explore ways to engage patients and help them become an integral part of their own health. As patients feel more engaged and responsible for themselves, in tandem with an ability to actively view and manage "real time" data, they could become more motivated to keep performing activities that move them toward or continue to support a healthy lifestyle.

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More staff please. California staffing ratio bill heats up dialysis industry.

Doctors and Nurses

There is a lot of debate happening these days in California around a proposed staffing ratio bill that has been introduced. It has led to considering the impact this would have on the quality of care for the dialysis patient in California. The Conditions for Coverage that govern dialysis providers nationally give this guidance: "Adequate number of qualified personnel are present whenever patients are undergoing dialysis so that the patient/staff ratio is appropriate to the level of dialysis care given and meets the needs of the patients." Now that is adequately vague.

SB 349, the Dialysis Patient Safety Act, introduced by state senator Ricardo Lara, D-Bell Gardens, proposes a 1:8 nurse to patient ratio, a 1:3 patient care technician to patient ratio, and a 1:75 social worker to patient ratio. When compared to the nine other states that have already passed laws with some kind of staffing ratio language included, California would hold the most stringent ratios.

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Keeping You Updated: Working Toward a Transparent Health Care System

Provider taking blood pressure

Encouraging, creating and improving transparency in health care is a priority for us here at HealthInsight. So much so that transparency is a major part of our Ends policies that guide and direct the work we do here. Transparency in health care means having the right information available to the right people when they need it.

As part of the work to create a transparent health care system, we have created and worked to continually improve our UtahHealthScape website. Late last year, the website underwent a major renovation, which included reworking the look and feel of the site, improving mobile optimization and adding new data to better serve patients, providers, health care facilities and the community in general.

UtahHealthScape is continually being updated to better serve our community. Data from the Centers for Medicare & Medicaid Services Nursing Home Compare, Home Health Compare and Hospital Compare has been updated and added to UtahHealthScape. We have also added locally sourced information about HealthInsight Quality Awards, Community Health Information Exchange (cHIE) participation and nursing home participation in a community coalition to reduce potential adverse drug events for new patients.

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Saving for your Retirement – and your Health

Piggy bank with money

When it comes to satisfying our immediate needs and desires versus focusing on important future needs, the here and now usually wins out. And whether it's saving for our future retirement security or taking important, incremental actions now to achieve better, future health security, our innate, psychological tendency is to prioritize the present over the seemingly far-away future. People tend to allocate their limited time, resources and attention to immediate, pressing events, rather than focusing on important things that will happen at some much later point.

What can make wise behavioral health actions even more challenging than saving money is that the hoped-for improvement in our future health outcomes is much less tangible and predictable than, say, the size to which one's retirement fund balance will grow over time.

Here are a few ways that you can motivate yourself to act sooner in your own, long-term interest - whether your goal is a healthier retirement nest egg or achieving better health throughout your retirement years.

Envision the Future

Academics and behavioral psychologists are discovering ways that you can change your point of view and thereby create essential tension you will need to change your behaviors.

In one study, researchers at Stanford University were able to make the future feel more vivid, real and immediate by "age-morphing" photos of study participants into avatars of their older selves. (Just what we all want to view, right?) When those participants stared their future, aging selves in the face, their short-term perspective shifted. They became much more motivated to save for the future.

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Focus on the fundamentals

Kids playing basketball

Round the back, under the legs, and...It's a miss!

Don't you love March Madness? Go Cougars, Ducks, Beavers, Lobos, Bruins, Trojans, Rebels and Utes (if your team is missing, please add them somewhere in between the Cougars and the Utes).

I love to play and watch basketball. From ages 13-15, I would get up at 6 a.m. nearly every day to practice the fundamentals of shooting foul shots and layups at the hoop outside my home. With the ultimate goals of scoring and winning the game, the fundamentals are the best way to ensure that the ball will go in the hoop.

I love quality improvement too. You set your aim and goal; create your plan; use outcome, process and balance measures to guide the effort; put it in practice; and study the outcomes. When it works, you save people from mistakes, help them realize how to manage their care better and catch people before they fall through the cracks.

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Who knows us best?

Providers and Patients

Why concerned family members matter.

We talk a lot about patient and family engagement at HealthInsight. I'm sure it is on the mind of most health care professionals at some level. But building this into our day-to-day muscle memory of how we respond in situations is still pretty rare. I would like to tell a story of a dear friend of mine who recently dealt with the lack of patient and family engagement and all it is intended to prevent.

This is a 75-year-old man, overweight, not in horrible shape but who has long suffered from breathing problems (frequent bronchitis, sleep apnea, etc.). He has desperately needed a knee replacement for as long as I've known him but was very reluctant to take such a drastic step. Finally, he knew he didn't have any choice and made the decision to proceed. He researched local surgeons and settled on one with full confidence that he had picked the best in the area.

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Are We Providing Patient-Centered Care?

Providers and Patients

There are many definitions of "patient-centered care" or "shared decision making" floating around. But most agree that it ideally includes certain aspects such as:

  • Consideration of the patient's preferences and needs
  • Integration of care through the teamwork of all providers involved
  • Respect for the non-medical needs of the patient and family
  • The patient's physical comfort
  • Free flow of communication among the patient, family members and medical team members

When I first heard of patient-centered care, I was somewhat perplexed. It reminded me of my own situation when I was 12 years old and had just been found to have a chronic medical condition. Our family internist sat down with me and my parents and explained that this was a problem that I would have for the rest of my life. He told us that there would be ups and downs, but that it was manageable. He went over the treatment options and asked what we thought would work for us. I have always considered that situation to be an example of patient-centered care.

Since then, there have been two big changes. The first change is the formation of care teams working together for the benefit of the patient and family. This has been a great help, but at times someone tries to force members of the care team on the patient. When that happens, we start to negate the positive effect of the team. The patient's perspective always needs to be considered. The second change is the free flow of information found online. Half of patients, both old and young, have already looked up their provider's credentials on the Internet before their first visit. Sometimes the patient will get false or dangerous information about either their provider or their ailment. This information must not be brushed aside, rather explained why it is not correct or appropriate for their condition. Then the patient should be directed to good, evidence-based care websites for more information. The Internet can be an ally in the patient care, almost like a team member when used correctly.

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Patient Engagement: A Passing Fad or Revolution?

Family

At the end of February, I had the privilege of attending the 2017 Patient & Family Centered Care Conference, presented by PFCCpartners. Immediately, I was struck by the growth in attendance and the depth of the presentations highlighting best practices and innovations in patient engagement. I first attended this conference as the sole representative from HealthInsight in 2012, wanting to start the journey of Patient and Family Advisory Councils for HealthInsight Utah. This year, HealthInsight was represented by eight staff and six patient and family advisors from Nevada, Oregon and Utah-it is safe to say that patient engagement is here to stay.

Wendy Nickel, MPH, from the American College of Physician's Center for Quality and Patient Partnership in Healthcare, kicked off the conference by providing an overview of four key principles of patient engagement:

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