University of Central Florida assistant professor Latarsha Chisholm and colleagues conducted a study, which found that nursing homes that serve predominantly black residents tend to struggle financially and provide lower quality care than nursing homes with no black residents. Results were recently published in the Health Services Research journal.
Now a major research project will bring handymen, occupational therapists and nurses into the homes of 800 low-income seniors in Baltimore to test whether some inexpensive fix-ups and strategies for daily living can keep them independent longer and save millions in taxpayer dollars spent on nursing home care.
“Very small changes can make a big difference,” said Sarah Szanton, a Johns Hopkins University associate nursing professor who leads the project. “We’re not saying, ‘What’s your blood pressure?’ We’re focusing on function: What do they want to do?”
The four-month intervention costs about $4,000 per participant, including the home modifications and specialists’ salaries. The average cost for nursing home care in the U.S. is $6,700 a month, so even a modest delay could save thousands of dollars. Szanton will track participants long term and, based on results from an earlier pilot test of 40 high-risk seniors, hopes to delay nursing home entry by up to a year in this frail population.
But a rather stunning study in the Journal of the American Geriatrics Society suggests the quality of communication between the hospital and the nursing home is horrendous. The study was led by researchers from the University of Wisconsin, including nurse researcher, Dr. Barbara King and Geriatrician Dr. Amy Kind.
Most of the nurses felt that they were left clueless about what happened to the their patient in the hospital. They lacked essential details about their patient's clinical status. The problem was not the lack of paper work that accompanied the patient. In fact, nurses often received reams of paper work, often over 80 pages. The problem is that the paper work was generally full of meaningless gibberish such as surgical flow sheets that told little about what was actually going on. Often the transfer information had errors, conflicted with what the facility was told before the transfer, and lacked accurate information about medications.
Essentially, SNF nurses found themselves asked to care for patients with little sense of what actually happened in the hospital, and little insight into the functional and cognitive status of their patients. These episodes of poor communication led to a number of adverse consequences:MDRC is part of one of these projects
“Navigators will be among the many resources available to help consumers understand their coverage options in the marketplace,” HHS Secretary Kathleen Sebelius said in an Aug. 15 statement. “A network of volunteers on the ground in every state — health care providers, business leaders, faith leaders, community groups, advocates and local elected officials — can help spread the word and encourage their neighbors to get enrolled.”
Thanks and a hat tip to Marty R.
Supplementation with cinnamon has been found to lower blood pressure in pre-diabetic and diabetic people. Cinnamon combined with magnesium, diet and lifestyle changes may lead to overall reductions in blood pressure up to 25mm Hg, a reduction lower than any hypertension medication can achieve without side effects.
Data from 22 trials with magnesium supplements revealed that the mineral may reduce systolic and diastolic blood pressure, researchers from the University of Hertfordshire report in the European Journal of Clinical Nutrition.
Combined with diet and lifestyle changes, magnesium and cinnamon supplementation may lead to an overall reduction of up to 25mm Hg more than any hypertension medication in the world with the advantage of no adverse effects.
Not so much in Michigan
First, 488 ACOs are now in existence, “more than double the number from June 2012,” the authors write. A look at a map of regions covered by ACOs shows that patients in all 50 states, the District of Columbia, and Puerto Rico has some form accountable care available to their residents.
United States specialty societies representing more than 500,000 physicians developed lists of Five Things Physicians and Patients Should Question in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.
These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.
The Kaiser program relied on close monitoring by a team of health care workers and the use of cheaper, more efficient drugs to treat high blood pressure. Over the course of an eight-year study, the percentage of patients with high blood pressure who had it under control increased from 44 percent in 2001 to 80 percent in 2009.
The rate continued to climb after the study ended, and as of 2011, 87 percent of patients had lowered their high blood pressure to a healthy level. Results of the study were published Tuesday in the Journal of the American Medical Association.
Four accountable care organizations that are meeting their goals in increasing quality of care while controlling costs say not everything is working out to their satisfaction — particularly, transitioning from fee-for-service to value-based payment models.
These health systems showed promising results. AtlantiCare reported a 40% drop in hospital admissions. Fairview said colon cancer screenings were up from about 62% to nearly 70%, and patient utilization was down by about 13% in one year. Memorial saved the state health department $20 million, and Presbyterian improved care management and reduced costs through oversight of entire care episodes.
But the report said pacing of the shift to new payment models for physicians was a stumbling block.
The pacing problem is because of the challenges of setting up fully integrated coordinated care systems while trying to simultaneously change the payment models to reward physicians based on value, efficiency and outcomes, rather than merely on a fee-for-service basis, said Steve Blumberg, senior vice president and executive director at AtlantiCare Health Solutions.
This study says that it is unrealistic to expect your family to honor your wishes without regard to their own interests if you have a cognitive disability.
The researchers found that family decision-makers considered the cognitively impaired patient's wishes and interests. But they also took into account their own needs and preferences.
Factors influencing surrogate decision-makers included:
- Respect for the patient's input.
- The patient's prior wishes.
- Consideration of the patient's best interests.
- The surrogate's own wishes as a guide.
- The surrogate's religious and spiritual beliefs.
- The surrogate's own interests.
- Family consensus.