Improving Patient Outcomes Through Education

If a tree falls in the woods and no one heard it, did it make a sound? Technology is affecting the world. The future of healthcare is looking brighter thanks to technological advancements. And yet, so many advances fall silent, and patients do not reap the benefits. Sound is a human experience. Advances in healthcare should be a human experience. However, if advances are not made known by the community, how can they be utilized?

MyHealthE.net wants you to know and utilize the health information that is available in your community, and online.

At MyHealthE.net we compile health education and health resources making it easier for patients and caregivers to find the health information they need–when they need it. We believe an informed patient will make better decisions about their health. This belief is the foundation of our mission, which is to remove barriers to patient education and help patients increase their health literacy. We are working in Kentucky with the Age-Friendly cities and partnering with health organizations that believe in the power of educating their patients and increasing health literacy.

Low health literacy is a major factor in limiting access to quality care. The National Assessment of Adult Literacy defines health literacy as, “the use of a wide range of skills that improve the ability of people to act on information in order to live healthier lives. These skills include reading, writing, listening, speaking, numeracy, and critical analysis, as well as communication and interaction skills.” Further, their research showed that only 12% of our US population have proficient health literacy skills.

Low health literacy results in poorer health outcomes; higher out-of-pocket patient costs and places additional strain on the patient and their family. Low health literacy is a major source of economic inefficiency in the U.S. health care system.” The estimated cost of low health literacy to the U.S. economy is between $106 billion to $238 billion annually. 

Inadequate communication is a barrier to effective care. Patients or caregivers sometimes receive conflicting recommendations, confusing medication regimens, and unclear instructions about follow-up care. They may lack a sufficient understanding of the medical condition or the care plan. As a result, they do not buy into the importance of following the care plan or lack the knowledge or skills to do so. People who reported that they were not involved in their care during the original encounter were 34% more likely to experience hospital readmission.

Health literacy is complex and encompasses a number of skills and abilities for patients to be successful. Healthcare interaction success is reduced because a patient’s anxieties have many sources: low health literacy, the fear of a painful procedure, embarrassment about being naked or being touched, fear of being criticized for unhealthy behavior or fear of a bad diagnosis. These anxieties can be combatted through education.

Increasing health literacy is a great way to empower patients, reduce anxiety and help them navigate the complex healthcare system. Precisely what can be done to help empower patients and help reduce some of the anxieties?

Patients: 

  • Find health classes provided by hospitals, advocacy groups, government and community outreach centers. Educate yourself, empower yourself and engage with your healthcare providers.
  • Use MyHealthE.net to find local onsite and online health and wellness education classes in Louisville, Lexington, Bowling Green and soon Berea and Cincinnati.

Providers: 

  • Implement social determinants of health (SDH) screening protocols to help patients at high risk for complications. SDH factors that contribute to a patient’s state of health may be biological, socioeconomic, psychosocial, behavioral, or social in nature. Implement a patient health education department in your organization and integrate education as a standard of care policy.
  • Make time for patient questions and employ methods such as “information teach-back” a strategy in which patients repeat the information back to providers. Remind patients of follow-up care appointments and discuss what follow-up care entails and why it is important.
  • Improve patient engagement by educating patients about follow-up care. Connect patients to in-house, community-based support organizations or MyHealthE.net where they can learn more about their health.

Let the trees fall, as they will. Trees fall and will make a vibration, which can only be turned into sound if we hear it. Make your sound next time you visit your healthcare professional; you need to be heard.  Ask questions, get answers, get engaged and stay healthy.

My Health E is a patient health literacy advocacy company using data technology to bring healthcare organizations together to share patient health education resources on one platform. This collaboration aids patients in finding the resources they need, when they need it and allows them to make better decisions about their health. Our mission is to help educate, empower and engage patients by providing easier access to health education and through those means support healthier and happier patients. 

Free Joint Pain Seminar

Tuesday, July 30, 2019 at 5:30 PM

Where

The Medical Center – WKU Health Sciences Complex

Register

The registration period has not yet opened for this event. Registration starts 5/30/2019.

Registration open through 7/30/2019 at 5:30 PM (EST).

Details

There’s a way beyond the pain. Get the facts at our free seminar.

Come to our free Joint Pain Seminar to learn about ways to relieve your pain. Our UK HealthCare Orthopaedic Surgeon will discuss non-surgical and surgical treatment options.

As Southcentral Kentucky’s leader in orthopedic surgery, Med Center Health is proud to offer advanced technologies such as Mako Robotic-Arm Assisted Surgery, helping surgeons plan and perform each hip and knee replacement with advanced precision.

Presented by Rasesh Desai, MD.

The Blockbuster Drug of the Century: An Engaged Patient

So why, oh why, is patient engagement such a big part of MU and the Medicare shared-savings program for ACOs?

All this is so different for healthcare providers. It’s like a great restaurant learning that their new business is going to be – in addition to continuing to provide a great in-restaurant experience – teaching people how to cook at home. What? This isn’t what we do!  It’s impossible!

Actually, it’s surprising that it has taken us this long to focus on patient engagement because the results we have thus far are nothing short of astounding. If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it.

Let’s first take a look at the evidence, and then see where we can go from here.

First, the evidence for blockbuster drugs. In Dr. Eric Topol’s book “The Creative Destruction of Medicine,” he takes a deep look at the evidence for statins, possibly the biggest group of blockbuster drugs the last 20 years. Statins are a requirement of Meaningful Use Stage 1 clinical quality measures, as well as key measures for the CMS hospital quality measures used by many organizations, internal and external to the hospital, to grade the quality of care at a hospital. Prescribing statins, in many instances, is no longer optional. Topol states that “of every 100 patients taking Lipitor to prevent a heart attack one patient was helped, 99 were not.”  These drugs cost $4 per day per patient and $1500 per year. While they are great at lowering cholesterol, it remains unclear that they do much to prevent heart attacks.

Now let’s take a look at a 2009 Kaiser study of coordinated cardiac care. Compared to those not enrolled in the study, coordinated care “patients have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program.” And, “clinical care teams reduced overall mortality by 76 percent and cardiac mortality by 73 percent.”

“Recognizing the importance of early treatment and intervention, every patient who presented with CAD was enrolled in the program for both short- and long-term care.

“Physicians, nurses, and pharmacists, using proven CAD risk-reduction strategies, work collaboratively with CAD patients to coordinate care. Activities such as lifestyle modification, medication management, patient education, laboratory results monitoring, and management of adverse events are all coordinated across a multifunctional team.”

Can you imagine what the headlines would be if a new cardiac drug showed this kind of effectiveness?

Patients were actively engaged, physicians were coordinated, and ongoing monitoring was taking place.

Certainly, statin use was part of the monitoring they described, which leads me to believe that the strange discrepancy we see between lowering cholesterol and fewer heart attacks may lie somewhere in patient engagement and behavior change. When we have more data through Meaningful Use and accountable care, I suspect we’ll be able to see this answer and what the relationship might be.

A similar example at the VA’s Coordinated Care and HomeTelehealth (TELEMEDICINE and e-HEALTH.  DEC 2008; VOL.14 (10): 1118-1126) program (h/t to Mark Blatt, MD, Global Medical Director at Intel) showed similarly stunning results about coordinated care for chronic disease management, including:

  • 19.74% reduction in hospital admissions
  • 25.31% reduction in bed days of care
  • 86% patient satisfaction
  • $1,600 average cost per patient per year, compared to $13,121 for primary care and $77,745 for nursing home care
  • 20% to 57% reduction in the need to be treated for the chronic diseases studied, including diabetes, COPD, heart failure, PTSD, and depression

Can you imagine if a drug reduced the need to go to the hospital by this amount? Again, it would be malpractice not to use it.

Healthcare must be built on a foundation of Health IT-supported care coordination and patient engagement, there is no other way to consistently and quickly scale improvements and care, and to accelerate the overall learning of the health care system.

As Topol points out, this is the path to real, personalized medicine, and away from the population-based studies and results that we’ve seen with statins. Medicine and the people it treats are complex adaptive systems; we need a complex adaptive systems approach to medicine because each person reacts differently. We can only treat the population for so long and get great results; we need to use data and engagement to continuously learn how to improve care for each individual.

So how do we get there? Engagement is just the very first step of what I think will become a new science of behavioral economics and behavior change in healthcare. It’s no accident that in both the examples here, the providers and the payers were tightly aligned, because the economics have to be aligned before any of this will work. ACOs are a positive step. Based on the results above, there’s plenty of potential for shared settings, if it’s done right. To do it right, we’ll need experts from other domains who have been honing their skills and engaging people for years.

Ultimately, we’re talking about cultural and behavior change. There are many resources available from other disciplines to help healthcare move to where it needs to be in terms of patient engagement and understanding consumer behavior and medicine as a complex, adaptive system. There are some great minds working in this space, including behavioral economists, user experience designers, community leaders, interaction designers, software developers and game designers, risk managers, data scientists, and actuaries.

In my next article, I’ll review where we can find them and how we can put them to work with caregivers and patients on stuff that matters. We can’t afford not to.

Opioid Beneficiary Fact Sheet

Below is a beneficiary fact sheet, CMS publication No12033 titled, “Safer Use of Opioid Pain Medication.” Please review and share this information with your counselors, partners, and beneficiaries with whom you interact, including through your social media channels.

Opioid Resources

Weblinks

Fact Sheets posted in various spots:

Social Media

Medicare Facebook:

Medicare is dedicated to helping you use prescription opioid pain medications safely, and is introducing new opioid policies in the Medicare Part D prescription drug program. Check out this fact sheet for more information: URL. #OpioidEpidemic

@MedicareGov Twitter:

#Medicare is dedicated to helping you use prescription opioid pain medications safely and is introducing new opioid policies in the Part D prescription drug program. Check out this fact sheet for more info.: URL #OpioidEpidemic

Prescription opioid pain medications can help treat pain after surgery or an injury, but they carry serious risks. To help you use your prescription opioid pain medications safely, we are implementing pharmacy safety reviews & drug management programs. URL

Talk w/ your dr about your pain treatment options, including whether taking an opioid medication is right for you. You might be able to take other medications or do other things to help manage pain with less risk. Get more info. here à URL. #OpioidEpidemic

Safer Use of Opioid Pain Medication CMS 

Prescription opioid pain medications—like oxycodone (OxyContin®), hydrocodone (Vicodin®), morphine, and codeine—can help treat pain after surgery or after an injury, but they carry serious risks, like addiction, overdose, and death. These risks increase the higher the dose you take, or the longer you use these pain medications, even if you take them as prescribed. Your risks also increase if you take certain other medications, like benzodiazepines (commonly used for anxiety and sleep), or get opioids from multiple doctors and pharmacies. Medicare is dedicated to helping you use prescription opioid pain medications more safely.

Safety Reviews at the Pharmacy

When you fill a prescription at the pharmacy, Medicare drug plans and pharmacists routinely check to make sure the prescription is correct, that there are no interactions, and that the medication is appropriate for you. They also conduct safety reviews to monitor the safe use of opioids and other frequently abused medications. These reviews are especially important if you have more than one doctor who prescribes these drugs. In some cases, the Medicare drug plan or pharmacist may need to first talk to your doctor before the prescription can be filled.

Your drug plan or pharmacist may do a safety review when you fill a prescription if you:

  • Take potentially unsafe opioid amounts as determined by the drug plan or pharmacist.
  • Take opioids with benzodiazepines like Xanax®, Valium®, and Klonopin®.
  • Are newly using opioids—you may be limited to an initial 7-day supply or less, to decrease the likelihood of addiction or long-term use.

If your pharmacy can’t fill your prescription as written, the pharmacist will give you a notice explaining how you or your doctor can call or write to your plan to ask for a coverage decision. If your health requires it, you can ask the plan for a fast coverage decision. You may also ask your plan for an exception to its rules before you go to the pharmacy, so you’ll know if your plan will cover the medication. Visit Medicare.gov/ claims-appeals/file-an-appeal/medicare-prescription-drug-coverage-appeals to learn how to ask for an exception. February 2019 2

Drug Management Programs

Some Medicare drug plans (Part D) will have a Drug Management Program to help patients who are at risk for prescription drug abuse. If you get opioids from multiple doctors or pharmacies, your plan may talk with your doctors to make sure you need these medications and that you’re using them safely.

If your Medicare drug plan decides your use of prescription opioids and benzodiazepines may not be safe, the plan may limit your coverage of these drugs. For example, you may be required to get these medications only from certain doctors or pharmacies to better coordinate your health care.

Before your Medicare drug plan places you in its drug management program, it will notify you by letter, and you’ll be able to tell the plan which doctors or pharmacies you prefer to use. You and your doctor can appeal if you disagree with your plan’s decision or think the plan made a mistake.

Note: The safety reviews and Drug Management Programs generally won’t apply to you if you have cancer, get hospice, palliative, or end-of-life care, or if you live in a long-term care facility.

Talk with Your Doctor

Talk with your doctor about all your pain treatment options, including whether taking an opioid medication is right for you. You might be able to take other medications or do other things to help manage your pain with less risk. What works best is different for each patient. Treatment decisions to start, stop or reduce prescription opioids are individualized and should be made by you and your doctor. For more information on safe and effective pain management, visit CDC.gov/drugoverdose/patients/index.html.

For more information on what Medicare covers and drug coverage rules, visit Medicare.gov. You can also call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

You have the right to get Medicare information in an accessible format, like large print, Braille, or audio. You also have the right to file a complaint if you feel you’ve been discriminated against. Visit Medicare.gov/about-us/accessibility-nondiscrimination-notice, or call 1-800-MEDICARE (1-800-633-4227) for more information. TTY users can call 1-877-486-2048.

Paid for by the Department of Health & Human Services.

Age Friendly Louisville — March 5, 2019 Meeting

My Health E is working with the University of Louisville Center for Optimal Aging who received a grant from the World Health Organization to spearhead The Age-Friendly Louisville program.

More info here: https://www.agefriendlylou.com/strategic-plan.

My Health E is working with the Age-Friendly Louisville program in the Community Support and Health Services (CSHS) domain of this initiative. The Community Support & Health Services workgroup is guided by the mission of ensuring that residents of Louisville:

  1. Will know how to access health resource clearinghouse networks.
  2. Will have access to health resources in their local community.
  3. Will be supported in their interest to “age in place” due the compassionate care of well-trained public service employees, caregivers, and family members.
This group works to promote health resource awareness, increase partnerships for aging-in-place training, and provide education for healthcare providers and community members on the risk of opioid medications. The group is looking for other healthcare stakeholders who are interested in being part of this initiative.
Learn more about the CSHS domain here. https://www.agefriendlylou.com/community-support 
This group meets on the 1st Tuesday of every month, so pencil us in or make a reoccurring appointment on your calendar.
To learn more please consider attending our next meeting on Tuesday, March 5, 2019 from 2:00 – 4:00 PM at Jewish Family & Career Services, 2821 Klempner Way, Louisville, KY 40205. 
Objectives of March’s meeting, which will include:
  1. A review of the Focus Groups (see attached) for the first hour.
  2. Then we will have brief presentations from several guest speakers from 211 Metro United Way, KIPDA, Sara Teeters from Metro Louisville, MyHealthE.net (to be scheduled).
Please direct any questions you are not able to answer to me.

Hospitals are Scary for Patients

Patricia Cantley: We must remember how scary hospitals can be for our patients!

We need to do everything we can to redress the imbalance between patients in hospital and healthcare professionals

My Mum always told me to be wary of doctors, a statement she had good cause to make in light of some of the care my disabled brother received. Recently, I’ve found myself thinking back to a specific time my brother was admitted to the hospital as a teenager. That experience shaped how I viewed hospitals and continues to influence me as a doctor today. I think it’s worth us all remember how strange and scary hospitals are for those who have a disabled child.

My brother Iain had Duchenne muscular dystrophy. In the genetic lottery, it’s a pretty ghastly set of cards to draw. From a normal start in childhood, most affected boys never get beyond a limited ability to walk, followed by slow wasting over several years until they cannot manage even the simplest of daily tasks.

Around the time in question, when he was in his mid-teens and I was a medical student, Iain ended up in the hospital. I don’t recall how long he was there, though it seemed like several days. What I do remember is that there could not have been a more unsuitable environment for a disabled teenage boy.

When you are living with a disability, one of the coping strategies is to develop your own routine. The problem with hospitals is that they too work to a routine. And it’s unlikely that the pattern of yours and theirs is going to match. I remember clearly that Iain needed help to be turned approximately every hour overnight. At home he would call out, one or other of my parents would shuffle through, adjust his position, and then return to bed before being called again around an hour later.

In a hospital, however, patients were turned according to when the charts said they should be. We were distressed to think of Iain being turned according to a timetable rather than “as required.” Each time he dropped off to sleep he was woken for a routine “turn,” then lay awake at other times begging for a shift in position only to be told it wasn’t the time yet. He hated every minute of it.

The power imbalance between patients, their families, and the staff in hospitals can be very scary. It can be hard to question what is happening or to ask for more information. As a family, we were concerned to find the ward house officer returning repeatedly for more blood samples, without any explanation. This was a traumatic experience, with all four of Iain’s limbs being contracted and misshapen. Venepuncture was challenging for both doctor and patient, and on the last occasion was undertaken by the appropriately named “femoral stab.”

Finally, my mother plucked up the courage to ask what was so wrong that he needed so many samples. It was hard to know how to react when we were informed that the problem in fact lay with a faulty laboratory analyzer.

We knew he wasn’t thriving in hospital and within a short time, my parents made the decision to request that he be discharged home. They were terrified that this would tarnish my future prospects as a medical student but felt they had to act.

The story has a happy ending, in the sense that Iain did get home.  My parents simply scooped him up into his wheelchair and brought him back to the house. It took him a while to recover but he did over time.

Iain later died in his sleep at the age of 21, partway through an Open University science degree. He had several more fulfilling years and he certainly got something out of seeing me through to qualification as a doctor. He had a clear view that he would never be admitted to the hospital again.

I sometimes wonder whether the story would play out the same way today—there is much talk of being “patient-centered” and holistic, so perhaps the difficulties we experienced back in the 1980s would not be a problem now. Although when I’ve spoken with friends who are disabled, it seems that the mismatch between patients’ and healthcare professionals’ routines in the hospital can still be a problem, even in 2018.

Perhaps bizarrely, my experience as Iain’s sister made me more determined than ever to work as a hospital doctor. With the optimism of youth, I had a sense that I could change the world. I couldn’t help feeling that there had to be a better way to do this—that we might work in partnership with patients and their relatives. Over 30 years on, I think we still have work to do.

Since the outset of my medical career, I have seen myself as a translator. Whether it’s for patients or their families, I have tried to interpret for them the mysteries of their illnesses and the treatments we offer. I feel passionately that we need to provide written information for people—it’s hard to take in new information when you are scared and vulnerable. So ever since I was a house officer, I’ve been scribbling notes for people and drawing them pictures.

We need to do everything we can to redress the imbalance, not only in power and knowledge but also in our respective states of mind. Many of our patients may be feeling scared or even frightened witless when, for us, it’s just another day at work.

And, remembering those multiple blood samples, I’ve never forgotten the importance of a good apology. Even if it isn’t your fault, saying sorry is important to break down the barriers of lost faith in the system. We all want a good outcome.

I’ve always disliked the phrase “discharged against medical advice.” If someone wants to leave the hospital, they will have their reasons for doing so. And rather than judging people, I believe we should support them.

My Mum is less wary of doctors than she used to be. But I carry her words with me to this day.

Reports of the Surgeon General, U.S. Public Health Service

The Surgeon General of the Public Health Service has focused the Nation’s attention on important public health issues. Reports of the Surgeon General on the adverse health consequences of smoking triggered nationwide efforts to prevent tobacco use. Reports on nutrition, violence, and HIV/AIDS—to name but a few—have heightened America’s awareness of important public health issues and generated major public health initiatives.

My Health E Lovingly Welcomes Dr. Patch Adams

We are a patient advocacy company with a web-based platform designed to help patients have easier access to health education events. We collaborate with accredited health education providers to make accessing patient educations events easier. We believe in increasing health literacy, and that empowering patients with health education allow them to make informed decisions. We believe that informed decisions create better health outcomes and happier patients.

Internationally known Dr. Patch Adams has practiced medicine at the Gesundheit Institute in West Virginia for over 30 years. TIME Magazine says, “Patch approaches the issue of personal, community & global health with zestful exuberance.” His presentation centers on compassion, wellness, humor, and joy when providing patient care.

Friday, June 15, 2018 Agenda

9:3– 10:30 AM GET MOVING KENTUCKIANA! FREE EVENT. Join Patch Adams as he leads walkers across the bridge to raise health literacy awareness and increase compassion in healthcare. Our walk begins on the Indiana side of the Big Four Walking Bridge. FREE T-SHIRT FOR FIRST 100 WALKERS.

12:30-2: 30 PM THE JOY OF CARING A 1.5-hour lunch presentation on the thrill of helping others is an essential investment in self-development. The inspirational talk includes dialogue to explore burnout prevention for healthcare staff and at-home caregivers. The focus of this presentation is on the magic and power of care, not only in the patient’s life but also in the caregiver’s life. Q & A and plated lunch. $200 per person or table for 10 $1900. Attire: Business casual. Red is recommended.

6:30-10: 30 PM HUMOR AND HEALTH A 1.5-hour presentation looking at the relationship between humor and the health of the individual, community, and society. In this funny and inspirational lecture Patch discusses his 30+ years of healthcare and clowning experience. Q & A, a plated dinner, and dancing.

$300 per person or table for 10/$2850.

Attire: Formal. Red is recommended.