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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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A Rallying Call for Value-Based Health Care

stethoscope with money

As a part of my professional development, I was certified by the National Committee for Quality Assurance (NCQA) as a Healthcare Effectiveness Data and Information Set (HEDIS) auditor in 2001. I have kept this certification while expanding my skills to include data validation and Pay for Performance Value-Based Program (P4PVBP) certification as I began to recognize the changing environment and the potential shift to VBP.

With today's uncertainties in health care, the NCQA has joined several health care organizations in a call for a new model of care. In a letter to Congress and the administration, these groups have endorsed a shift from the fee-for-service health care system to value-based care. NCQA and its allies (doctors and specialty societies that represent physicians, health plans and payers) have developed a set of recommendations on how to move our health care system toward innovative, patient-centered care. These recommendations include:

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Patient Portals Wish List

Senior Couple Using Computer

Recently, when I arrived at my new dermatologist's office, I noticed an iPad was sitting on the counter instead of a clipboard, and a patient was working his way through the sign-in process. The receptionist handed me a clipboard with several sheets of paper, instructing me to fill them out. She explained that, by later that afternoon, all of my information would be in a patient portal, a secure website that gives patients 24-hour access to personal health information, and I would be able to update it, if needed.

As promised that afternoon, I received an email with a note telling me how to log in. After clicking the link and following some simple instructions, I arrived at a dashboard that prominently showed my next appointment and links to other areas of my record. The information from the forms I had filled out was there along with the notes from the visit. Two weeks later, I wanted to access the portal to see if my lab results were in. I couldn't remember the link to the site or locate the email, so I went to the clinic's website and found a link to the patient portal. The portal was easy to use, and I had all of my information right at my fingertips.

I am somewhat familiar with patient portals because I have used them before. Another portal I occasionally access, while offering secure emailing, summaries of visits, prescriptions and labs, is a bit "clunky" to use. It provides the basics; it's just not as easy to use.

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Changing the Conversation from Health Care to Health

Senior man sitting with his daughter and grandson

I was excited to hear Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC), speak at this year's Centers for Medicare & Medicaid Services (CMS) Quality Conference about the importance of moving "upstream" and strengthening the relationship between community-based prevention services and health care. This is a topic near and dear to my heart, as I started my career working in public health to help communities improve the systems that support community health and prevention. Now that I work in health care quality improvement, I see daily the health care community's challenges and opportunities in not only providing good health care, but helping people achieve health.

Most of us who work in health have learned that there are significant limitations to what the health care system can achieve alone. Our systems of care must change to meet the growing burden of chronic disease.

Cardiovascular diseases, pre-diabetes and diabetes are at a record high. According to the CDC, cardiovascular diseases are the leading cause of death in the United States. Nearly one in 10 Americans has diabetes, and without intervention, this number will likely continue to grow. More than one-third of American adults have pre-diabetes, an estimated nine out of 10 of don't know they have it. The good news is many risk factors for these conditions can be prevented or managed with lifestyle changes between visits to the doctor. Success, in many cases, depends as much on lifestyle as it does on quality care.

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