Showing posts with label not. Show all posts
Showing posts with label not. Show all posts
Disease and Population Health Management Programs Do NOT Exclude Other Conditions
Tuesday, May 13, 2014
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| Playing whacamole |
"Health care blogging will never lead any serious beer money."
"Disease management coaching focuses exclusively on just one disease."
These are three falsehoods that bubble up in the unlikeliest of places, including cable news outlets, replying to the DMCB spouses asking "and what did you do today?" and webinars, webcasts and other educational meetings about population health and disease management.
While the Disease Management Care Blog finds all three vexing, the most irksome is the canard that the commercial health coaching service providers purposely limit their programs to just one chronic condition, like diabetes, weight loss or readmission prevention.
While that may have been the case in the earliest versions of disease management, that narrow approach was dropped years ago. Thats because patients typically seek advice for a wide range of overlapping concerns and the good nurses hired by the vendors will respond to them. The vendors also understand that their shared risk and performance guarantees depend on claims expense that is driven by the synergies of multiple co-morbidities.
While a purchaser, insurer or accountable provider organization may start out with a focus on a population defined by a single condition - such as diabetes mellitus - that doesnt mean their protocols and care plans wont span the continuum of care and include hypertension, tobacco abuse, depression, housing, chatting about the grandkid and responding to concerns whether this will be finally be NBA superstar LeBron James year.
And the published literature supports the DMCBs contention that modern population health management is multifaceted. Examples include this seven-condition program for dually eligible Medicaid beneficiaries in Georgia, this Midwest employer-sponsored program that enrolled persons with multiple care needs and this physician-focused program that used pay-for-performance to improve measures across multiple conditions. Check out some vendor web sites and youll see erences to "whole person health," the "interrelated aspects of social, emotional, and physical health" and "a holistic view of member health across internal and external care management initiatives."
That being said, the DMCB knows that perception and reality can be two different things. Given the whac-a-mole persistence of the "single disease" myth, the DMCB says the population health management community may benefit clarifying the broadness as well as the depth of their offerings as they continue to build their brand.
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6 Ways to Wreck Your Blood Sugar Level What not to do if you have type 2 diabetes
Friday, April 25, 2014
Type 2 diabetes is a tough disease. It requires constant vigilance to keep your blood sugar level under control.
It also requires avoiding some common mistakes, many of which are the product of long-held bad habits.
Here are six mistakes that you can learn to avoid.
1. Not Knowing Your Disease
By that he means that you are the one watching your diet, making sure you exercise, and taking your medication on schedule. Understanding how diabetes works will help you make better decisions about how to monitor and manage it. Classes on coping with diabetes are an excellent but underused resource.
“Not enough patients seek them out, and not enough doctors send their patients to them,” Ahmann says.
That’s unfortunate, because not only do they offer essential information; they are often de facto support groups as well, bringing together people who are experiencing the same issues and difficulties and giving them a forum in which to meet and talk with each other.
2. Expecting Too Much Too Soon
One of the biggest hurdles in controlling your blood sugar is sticking to the necessary adjustments you must make to your eating and exercise habits. Many patients become frustrated and give up because they don’t see results right away, says endocrinologist Preethi Srikanthan, MD, assistant clinical professor of medicine at UCLA’s David Geffen School of Medicine.
“Most people expect something dramatic is going to happen right away,” she says. “But it has taken them a decade or two to get to this point, and it will take a while for them to even to get to that initial 5%-10% reduction in weight…These are challenges that must be taken in small steps.”
Expecting too much change right away is a mistake. So is doing too much before you are ready, especially when it comes to exercise, Ahmann says. He advises starting off slowly and easing into the habit.
“If they do more than they can tolerate, they will often quit,” he says. “Or they will do too much and hurt themselves.”
Be sure to talk with your health-care provider before starting a new exercise program, especially if you aren’t already active. He or she can help plan a routine that’s safe and effective, as well as set realistic goals.
3. Going it Alone
There are a lot of resources out there to help you manage your disease. Don’t ignore the fact that one of the most helpful might be right there at home. Spouses, partners, friends, and family members can all make excellent exercise buddies.
“One error that people make when it comes to exercise is that they try to do it on their own without help from other people,” Ahmann says.
There are other advantages to the buddy system. Enlist your spouse or significant other in your efforts to stick your medication schedule and to maintain a healthy diet.
“Eating alone can be a problem,” Ahmann says.
4. Neglecting Other Problems
In her practice, Srikanthan sees a lot of patients who are dealing with more than just their diabetes. Depression and stress are common among people with the disease, and both can have a negative impact on blood sugar levels.
Constant stress, for example, may produce hormones that hamper the ability of insulin to do its job. “Stress should be considered as a significant contributor to glycemic variation by both patients and physicians,” Srikanthan says.
Ahmann agrees.
“Anything to reduce stress will improve your blood sugar,” he says.
Exercise helps relieve stress and there’s evidence that meditation and massage will have benefits on blood sugar levels, says Ahmann.
People with diabetes are twice as likely to be depressed, and an estimated one of every three people with diabetes have symptoms of depression. The lethargy common to depression can be so discouraging that you might give up your efforts to take care of your diabetes. Not only will that make your diabetes worse, it may also intensify your depression, creating a vicious cycle.
There’s good news, though. According to a new study, treating depression in patients with type 2 diabetes improved their mental and physical health.
“You need to recognize depression and work with it,” Srikanthan says.
5. Misunderstanding and Misusing Medications
Ahmann says that many of his patients share a common misconception when it comes to the drugs used to control their disease.
“They think that medications are more powerful than diet and exercise,” he says.
That’s not necessarily true. In many cases, type 2 diabetes can be controlled by a combination of a healthy diet and regular exercise without the need for medication.
Among patients who do require medications, Ahmann says, one mistake stands out.
“It’s surprising how many people miss doses,” he says.
That’s a quick way to wreck your blood sugar level, so it’s a problem that needs to be recognized and addressed.
“You need to be honest with your [health care] provider that this is an issue,” says Ahmann, who points out that often the solution is for your doctor to change your dosing schedule to one that better suits you. “There are options.”
6. Making Poor Food Choices
When it comes to food and blood sugar, the big mistake is not the single candy bar that you couldn’t resist, Srikanthan says. The bigger picture matters more; unhealthy eating habits, in the long term, will have a worse effect on your blood sugar.
“People think it’s a one-time diversion, but no, it’s a consistent problem that affects your test results,” she says.
The two biggest hurdles, Srikanthan says, are calories and carbohydrates. You have to control both in order to keep your blood sugar level steady.
“Try to be aware of what’s going into your mouth,” she says.
That means keeping a diet diary to keep track of what you are eating and reading nutrition labels so that you can calculate the proper amounts of the foods you choose to eat.
Patient Centered Medical Home PCMH Attributes and Correlation With Staff Morale Satisfaction and Burn Out From Bad to Not So Bad to So What
Sunday, March 23, 2014
| Nice medical home laptop, but how do I feel about it? |
a) asking other spouses in similar relationships if they feel as fortunate and, if so,
b) collecting data about the DMCB-like personality traits in their husbands.
Bonhomie? Check.
Willingness to share the TV remote? Check.
Cooking the occasional meal at great personal sacrifice? Check.
Announcing how good that meal is? Check.
Yet, when confronted with the indisputable statistical associations that correlate nuptial happiness and DMCB"ness," the spouse has remained stubbornly unmoved. At the spouses pointed request, the DMCB is rechecking the math.
Readers will probably also remain unmoved about this publication that uses a similar approach to examining the impact of the Patient Centered Medical Home (PCMH) on clinic staff morale, satisfaction and burnout. Sara Lewis and colleagues surveyed the staff of 65 "safety net" clinics participating in a "5 Year Safety Net Medical Home Initiative" that had been co-funded by the Commonwealth Fund.
At the time of the survey, the 65 clinics were in the process of implementing becoming PCMHs but had not yet attained that status. The authors used a Likert-style survey to assess PCMH-"like" attributes among these non-PCMH clinics, such as patient access, data tracking, care management and quality improvement. The survey also asked about staff morale, satisfaction and burnout. The authors then correlated whether individual scores or a total roll-up score of all the PCMH-like attributes correlated with better clinic morale, higher satisfaction and less burn out.
There were 773 providers and staff members and 603 (78%) responded. 33% rated morale as good, 54% rated job satisfaction as very good and 40% had some burnout. Based on an analysis of odds ratios, some features of a PCMH - particularly quality improvement - resulted in up to a three fold improvement in the three measures. However, while the total PCMH score was associated with better morale, it looked like there was also a greater association with worse burn-out, which had a statistically significant lower odds ratio of .48.
The DMCB finds these up and down results about the PCMH in nonPCMH clinics unconvincing. It believes the attributes of a PCMH, if carried out as envisioned, should add up to more than the sum of its parts. While some of the parts that are outside of a medical home seem, according to this paper, to correlate with morale, satisfaction and burnout, this gives little insight on how medical staff would really react to the transformation of a primary care clinic. By the way, this is not the first time a PCMH-"like: methodology has been used, which makes the DMCB wonder if fully functioning PCMHs are less common than we think.
What is striking, however, are the basic measures of morale, stress and burnout. Based on these data, it would appear that these safety net clinics have some serious staff issues with 67% not having good morale, 46% not having good job satisfaction and just under half having burn out.
More evidence of primary cares travails says the DMCB.
The good news is that the DMCB remains optimistic that the math will eventually bring the DMCB spouse around. Maybe the enthusiasm - and the math - about the PCMH will similarly prevail someday. Until then, this papers approach doesnt lend much insight about the real potential of the PCMH. Last but not least, if these 65 clinics are representative of primary care morale, satisfaction and burnout in general, the DMCB far less optimistic about their future with or without the PCMH.
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