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. 

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.

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.