Hospital Readmission Epidemic

Hospital Readmission Epidemic

The last thing anyone wants after spending time in the hospital is a return trip... yet almost one in five Medicare patients who are discharged from a hospital will be back within the month, according to a recent New England Journal of Medicine (NEJM) study. For patients with heart failure, it's even higher -- the readmission rate is about one in four.

Why are these numbers so high, and is there anything patients and family members can do to prevent this from happening? I called Eric Howell, MD, associate professor of medicine at Johns Hopkins University School of Medicine and chief, division of hospital medicine at Johns Hopkins Bayview Medical Center, to ask for advice. Dr. Howell is himself a hospitalist (a physician who specializes in the care of hospital patients), so he has much to say about this problem and how to prevent it from happening.

First of all, he pointed out that some repeat visits are inevitable simply because some patients are quite sick. "Patients with chronic diseases, such as heart failure, diabetes, renal failure or chronic obstructive pulmonary disease (COPD), are vulnerable to emergency situations which, in turn, can lead to readmission even with the best care," he noted.
Preventable Causes of ReAdmission

Dr. Howell identified several reasons why readmissions often happen and shared advice on what patients (and their loved ones) can do to reduce the likelihood of landing back in the hospital...

Transition plan. A key contributor to the problem of frequent readmissions, in Dr. Howell's opinion, is inadequate preparation for the patient's transition from hospital to home. "Patients typically spend about a half-hour with a doctor on the day of discharge," says Dr. Howell. "But it takes much longer than that for patients to learn how to take care of themselves after a complicated hospital stay, particularly one that is shorter than it used to be, as is the case with many hospitalizations."

What to do: Patients being discharged should understand their medical condition, the related test results, and what they need to do to manage their illness or recovery. Make sure you clearly understand how to take a new prescription, including how to adjust dosages if necessary. Get detailed written instructions on how to carefully monitor aspects of your condition -- for instance, heart failure patients are told to weigh themselves daily and to call the doctor if there is a significant change, because this is a sign of trouble.
Confusion at home. With limited guidance before leaving the hospital, it's common for patients to feel overwhelmed once they get home, most especially those who live independently without others around to remind them what to do. This can lead to mixing up or missing doses of medicines... forgetting specific instructions... problems caring for surgical wounds... and difficulty in performing the prescribed exercises to prevent pneumonia or to speed healing. Also, patients may not recognize early symptoms that should trigger a call to the doctor, so that minor problems don't become major ones.

What to do: If possible, someone else (a friend or family member) should be with you during the discharge discussion to take notes and help you remember the instructions.
Who's in charge? Another issue is that patients don't always know which doctor should be called if a problem arises when they are at home. Since many hospital patients are admitted through the emergency room, it's not unusual that your primary-care physician (and not everyone even has one) wouldn't know you were in the hospital at all. Then, given the increasing reliance upon hospitalists to oversee in-patient care, your personal doctor may or may not have been involved during your hospital stay. So, Dr. Howell says, you can't just assume that your doctor has been updated with your latest information or discharge instructions.

What to do: When you return home, call your doctor, at minimum. Better yet, schedule a visit so he/she can take over your care. Dr. Howell strongly suggests asking your hospitalist to contact your doctor when you are discharged to open up communication and share information about your condition and treatment. "When doctors communicate, there are fewer errors and less likelihood the patient will need to be readmitted to the hospital," notes Dr. Howell.

The Empowered Patient: Take Responsibility
It is less likely that you will have to head back to the hospital if you take steps at the time of discharge to learn how to manage your own care. Dr. Howell provided this checklist of proactive patient steps to facilitate a safe and healthy transition from hospital to home...
From your discharging doctor (or nurse)...

Get a clear and complete explanation of what is wrong... a list of medications you need to take and their dosage instructions, along with information on why each one is important... and details of all other aspects of your care at home, including what you should eat, how wounds should be dressed and so on.
Ask the hospitalist whether he/she has spoken to your primary-care physician -- if not, request that this be done.

Ask about signs and symptoms you should be on the lookout for... learn which ones require a call to the doctor... and find out which doctor you should call (the hospitalist or your personal physician) if a problem does arise.

Make sure you get copies of your discharge summary and your medical records, both of which you then can take to your own doctor at your next visit. (While the hospital will send the discharge summary to your doctor, this can take 30 days -- which can be too long.)
Once home, make an appointment with your own doctor to follow up. Bring all related paperwork, along with the name of the hospitalist who discharged you who can provide more information on your condition and treatment, if that turns out to be necessary. The more information everyone (including you) on your health-care team has, the better off you will be.
Source(s):

Eric Howell, MD, associate professor of medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, chief, division of hospital medicine at Johns Hopkins Bayview Medical Center.

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Hollecrest & Associates Inc   -"Turnaround Consultants" http://www.ic.gc.ca/ccc/search/cp?l=eng&e=123456239975 .


Back to Eden communities
Sunridge -261 Oakhill Drive, Brantford
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New Technology to Monitor Health and Safety

New Technology to Monitor Health and Safety
I'm impressed by some new technologies I am seeing and reading about that have the potential to improve the quality of life for people with chronic health problems -- and most particularly for elderly men and women who want to continue to live independently. I'm talking about devices that measure and track data, such as weight and blood pressure, over time, others that nudge people to take medications or perform physical therapy exercises, and yet others that send an alert to a designated recipient if something seems amiss -- for instance, on a morning when the monitored person doesn't get out of bed or there is a precipitous rise or drop in his/her blood pressure. In worst-case scenarios, a call is placed to 911 so that life-saving help comes quickly.
"Chronic health issues are driving this market and the development of these devices," says Susan Ayers Walker, managing director of the SmartSilvers Alliance and the Digital Health Summit at the annual Consumer Electronics Show, the world's largest annual consumer-technology trade show, where such products are typically introduced.
The field itself is new, but the technology isn't, I was told by Jeffrey Kaye, MD, director of the Layton Aging & Alzheimer's Disease Center at Oregon Health & Science University. He said the real breakthroughs are in the adaptations. For example, products like Life Alert -- worn as a pendant or wristwatch -- already enable seniors to call for help if they fall and can't get up or if another emergency occurs. Now a new product from Grandcare uses motion sensors to get the same result without the need to push a button or wear a device. Another product monitors heart failure patients to measure water retention through weight gain. "Now you can instrument a standard bathroom scale to send a signal to a health professional with simple software that charts a patient's weight within certain parameters," he explains.

Here are some of the technologies currently in use or being developed...
Home monitoring:
Grandcare systems (www.grandcare.com) offers a customizable combination of motion sensors, weight monitoring, prescription reminders, general messages from family and more. The system also gives seniors other reasons to want to interact with it... a TV interface can provide users with updates of photos, local weather, news and more.
Prescription monitoring:
For patients taking several medications but who are not sick enough to require full-time care, MedSignals (www.medsignals.com) monitors up to four prescriptions at a time, records when the pills are taken, and sends information to a designated party (a family member, doctor or other caregiver) to monitor use.
GlowCaps (www.rxvitality.com) are special prescription bottle tops that flash and play music when it's time to take a pill... order refills for you... and send a weekly report on use (caps can monitor when and how often they are opened) to physicians and family members.
Assisted living:
Elite Care (www.elitecare.com), an assisted-living facility in Oregon, uses monitoring technology to help care for its residents, assuming that the patient has granted permission to be monitored. Behavior and cognitive function are monitored unobtrusively to track changes that can signal decline or the onset of disease.
We're Not There Yet...
These products are available but expensive, and at present, few are covered by insurance. Also, standards for devices still are being developed. Add in concerns about privacy (who gets to see this electronic medical information and what can be done with it)... liability (if the system makes a mistake, who is to blame?)... and physician participation (do doctors have the capability to handle all this data?), and it becomes clear that there are still some kinks to be worked out with these systems.
Even so, their time is surely coming. Major companies, such as Microsoft (www.healthvault.com), Google (www.google.com/health), GE, Philips and Intel, are already hard at work on their own plans and products. Industry standards and design guidelines are being developed (www.continuaalliance.org).
Source(s):

Jeffrey Kaye, professor of neurology and biomedical engineering, director, NIA - Layton Aging & Alzheimer's Disease Center and NIA-ORCATECH -Oregon Center for Aging & Technology, Oregon Health & Science University and Portland Veterans Affairs Medical Center, Portland.
Susan Ayers Walker, managing director, SmartSilvers, www.smartsilvers.com/.

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Back to Eden communities
Sunridge -261 Oakhill Drive, Brantford
backtoeden.ontario@gmail.com
www.backtoeden.bravehost.com
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Merry CHRISTmas

Have a great holiday by giving of yourself in the spirit of Christ. Help others in need and you will gain true and needed satisfaction.

The rank commercialism -where 40% of total sales are made in one month -loses the original meaning of Christmas . Give of yourself not things please and get back to the original family tradition of good charity and cheer.

in reference to: Blogger: Blogs I'm following (view on Google Sidewiki)

Money is no problem if you are connected

The Highly Profitable Business of Vaccines

Exactly how the swine flu story will play out remains to be seen, but there is one business sector that may secretly be hoping for the worst -- vaccine manufacturers, that are more than $1 billion richer, a number that will soar far higher if, in fact, the winter outbreak is as bad as many fear.

Halo-worthy as vaccine makers may seem, the truth is that Big Pharma is motivated by more than a desire to save humankind, given the enormous profit potential from a successful vaccine. New blockbuster products and manufacturer-friendly legislation have combined to make the global vaccine market even larger and more lucrative than ever. In fact, the vaccine market is growing even faster than the market for regular pharmaceutical drugs, bringing in as much as $20 billion or more, by some estimates. That's because the markup on vaccines is larger than on pharmaceutical drugs, making them especially profitable. However, as the use of vaccines has expanded exponentially in recent years, so have concerns regarding their safety and efficacy.

Vaccine Risks
Vaccines have enabled us to take major steps forward in public health, virtually eradicating devastating diseases, such as polio and smallpox, says Larry Sasich, PharmD, MPH, an assistant professor of pharmacy practice at the Lake Erie College of Osteopathic Medicine (LECOM) School of Pharmacy in Erie, Pennsylvania. But vaccines are drugs, he points out, and all drugs carry some risks. Though rare, vaccines have been known to cause seizures, brain damage and even death.
In the early 1980s, consumers deluged manufacturers with lawsuits, most especially parents whose children had suffered complications after inoculation with the problematic DTP vaccine (immunization against diphtheria, tetanus and pertussis, or whooping cough). Fearing the public health consequences if vaccine makers responded by reducing production or pulling out of the market altogether, the federal government passed the National Childhood Vaccine Injury Act of 1986 to shield manufacturers from liability.

 
Legislated Protection from Liability
The 1986 act created the National Vaccine Injury Compensation Program (VICP), which protected vaccine manufacturers from lawsuits and set compensation standards for people injured by their products. For example, compensation for vaccine-related deaths is limited to $250,000 -- a fraction of what might be awarded by a jury in a civil trial if, say, a child had a fatal vaccine reaction. In truth, this amount of money is like pocket change to drug companies, and they aren't even the ones who must pay up -- the federal government writes the check. This protection may help get important vaccines to market faster, but it doesn't do much to ensure safety, because vaccine manufacturers are shielded from consequences for products that turn out to be problematic or even dangerous.
Also, vaccines are genetically engineered and competitors are forbidden by law from duplicating them. This gives manufacturers a virtual monopoly on their products. Since they never have to face competition, biologic-based vaccines continue to generate big profits for years and years and years.

Gardasil: A Cautionary Tale
Protecting manufacturers this way puts consumers at risk. In 2006, for example, despite sparse data to support its safety and effectiveness, Merck introduced and aggressively marketed Gardasil, a new vaccine designed to protect girls and young women from cancer-causing strains of the human papillomavirus (HPV). Among their questionable marketing tactics, the firm gave hundreds of thousands of dollars in "grants" to medical associations to develop educational materials promoting the vaccine. Even worse, Merck made substantial campaign contributions to state legislators -- as it lobbied them to make Gardasil mandatory for girls attending public schools.
Yet, this vaccine doesn't vanquish a deadly disease such as polio or smallpox. Rather it protects against four viruses that comprise 70% of the HPV strains that cause cervical cancer -- and even if they've received the vaccine, women still require regular screening for the disease. While study results published in the August 2009 issue of Journal of the American Medical Association (JAMA) note that Gardasil has a safety record in line with that of other vaccines, serious complications (including an increased risk for potentially fatal blood clots) have been reported. Gardasil is also painful and painfully expensive. The three-shot series costs $400 to $1,000, which is only sometimes covered by insurance, and last year brought in $1.4 billion in sales for Merck... amazing, given that there's no evidence yet how long immunity will even last or whether booster shots will prove necessary. Thus far, the vaccine has been successful in preventing HPV infections that precede cervical cancer, but since this type of cancer takes years to develop, only time will tell whether Gardasil protects against cervical cancer itself.

Moving Forward: The Debate Continues
Even in the face of a pandemic, it remains impossible to reach a consensus regarding vaccines and whether they should be mandatory. Consumer advocates argue for greater regulation and higher standards (e.g., for new vaccines and other drugs, medical devices and procedures), while industry insists that government should keep its hands off. As for the vaccine shield protecting Big Pharma from liability, some legislators talk of getting rid of it while others say it should be strengthened.

Dr. Sasich told me that he personally believes that vaccines have the potential to do enormous good for society and that the vaccine shield enables science and technology to move forward faster and more efficiently. While I agree that many immunizations save lives, I am skeptical about some of the more recent entries into the vaccination arena, such as Gardasil. Perhaps manufacturers need a stick as well as a carrot -- financial responsibility for failures as well as windfall profits for success -- to motivate them to ensure that vaccines are safe, necessary and effective before introducing them on a large-scale basis to the American public, much less making them mandatory.
Source(s):

Larry Sasich, PharmD, MPH, pharmacist and assistant professor of pharmacy practice, Lake Erie College of Osteopathic Medicine (LECOM) School of Pharmacy, Erie, PA.

--
Hollecrest & Associates Inc   -"Turnaround Consultants" http://www.ic.gc.ca/ccc/search/cp?l=eng&e=123456239975 .


Back to Eden communities
Sunridge -261 Oakhill Drive, Brantford
backtoeden.ontario@gmail.com
www.backtoeden.bravehost.com
"Building elder peer communities that are cozy,caring and comfortable" -quality 24/7 care