2007-12-31 00:00:00

Taking a Child to the Emergency Room? Read This Book First

emergency exits book
Rather than waste energy on outreach to low numbers of ER “frequent flyers” who are unlikely to change behaviors any time soon, several health plans are getting more mileage out of an Institute for Healthcare Advancement (IHA) publication called What to Do When Your Child Is Sick. As detailed in Emergency Exits: Reducing Emergency Room Utilization by Retooling Care-Seeking and Care Access Options, both Neighborhood Health Plan (NHP) of Massachusetts and WellPoint make this publication available to patients and members (sometimes via primary care providers), hoping they’ll read this first before taking their child to the ER for treatment of a routine condition.

Dr. James Glauber, NHP’s medical director, says the book is one of several self-care resources NHP makes available to members, either at time of enrollment or after a non-emergent ER visit. He also cites the success another health plan has had with this resource:

Molina Healthcare of Michigan undertook a project where they mailed approximately 21,000 copies of What to Do When Your Child is Sick to all members with children under 2 years old. [Molina] conducted pre- and post-surveys with that population and found that 82 percent of the members or families at baseline stated that they did not have any resource guide that they used when their child was sick or injured. The follow-up survey showed that a similar percentage ??? slightly over 80 percent ??? reported that they used the book at least once when their child was sick. In addition, they asked parents in the follow-up interviews, ???What would you do if your child was sick and couldn???t be seen by their primary care physician (PCP) on the same day???? In the pre-survey group, 24 percent said they would go to the ER. In the post-survey group, only 9.6 percent said that they would go to the ER, with some corresponding increases in respondents saying that they would treat their child at home, make a doctor???s appointment or go to an urgent care center. This provides evidence that by providing appropriate materials to members and families, you can expand their knowledge and improve self-care behavior

For its efforts in saving parents and children trips to the emergency room, Molina Healthcare took top Pinnacle Award honors in the Michigan Association of Health Plans’ Clinical Service Improvement and Community Outreach categories.

According to the IHA Web site, What To Do When Your Child Gets Sick is the most popular book in its “What To Do For Health” series. Available in English, Spanish, Vietnamese, Chinese and Korean, it covers the management of more than 50 common childhood illnesses, injuries, and health problems. It is written in easy-to-read language for parents and caregivers of children from birth to 8 years of age, and quantity pricing discounts are available.

Filed under: — @ 2007-12-31 00:00:00
2007-12-27 00:00:00

Small Neurological Attacks Predict Stroke, Dementia

While PCPs often overlook brief attacks of confusion or fainting and consider them to be benign, a new study published in the Journal of the American Medical Association suggests that patients who experience such transient neurological attacks (TNAs) may be at a higher risk for stroke and dementia.

A TNA is defined as are episodes that last less than 24 hours and invovle temporary neurological symptoms of the nonfocal or focal nature, or a mixture of both.

According to the study’s author, Michiel J. Bos, M.D., M.Sc.:

Our findings challenge the strong but unfounded conviction that nonfocal TNAs are harmless. On the contrary, our findings suggest that nonfocal TNAs are not only a risk factor for stroke, but also for dementia.

Filed under: — @ 2007-12-27 00:00:00
2007-12-27 00:00:00

Disease Management Update: Stroke

According to the American Heart Association, stroke is the third largest cause of death and a leading cause of serious and long-term disability in the United States. This week’s Disease Management Update takes a look at factors that may reduce as well as increase one’s risk of stroke.

Filed under: — @ 2007-12-27 00:00:00
2007-12-19 00:00:00

Health Disparities between Racial and Ethnic Groups

Here’s a shocking statistic: As many as 83,500 deaths could have been avoided in the year 2000 if disparities in health were eliminated in the past century.

According to David Satcher, M.D., Ph.D., the nation’s fight against disparities in healthcare has not made much progress because it has not been made a priority within the government, despite the Department of Health and Human Services’ (HHS) and Center for Disease Control and Prevention’s (CDC) efforts to better adjust the nation’s focus on disparities. According to Satcher, such efforts have not be adequately empowered to do their jobs properly.

“We keep getting back to the fact that these [HHS’s Office of Minority Health, CDC’s Office of Minority Health and Disparities, the National Disparities Report] are very important efforts, but are we serious when we don’t fund them?,” asks Sachter.

Sachter is the director of Satcher Health Leadership Institute at the Morehouse School of Medicine and also served as former U.S. Surgeon General. He makes some interesting points during the Kaiser Family Foundation’s webcast entitled “Today’s Topics In Health Disparities - What Are the Current Federal Legislative Efforts to Address Health Disparities between Racial and Ethnic Groups.”

Satcher speaks of several initiatives geared toward eliminating health disparities among different segments of the population. One is Healthy People, a 467-objective initiative. Nearly 200 of these objectives are specific to health disparities, however, to date, only 24 of these have been addressed since the programs inception in 1999.

Another program aimed at eliminating heatlh disparities in the U.S. is REACH, or Racial and Ethnic Approaches to Community Health. REACH is a national, multi-level program that advances CDC???s efforts to eliminate racial and ethnic disparities in health.

So what steps can be taken toward eliminating disparities in healthcare? Satcher calls on government organizations to better target social conditions that lead to poor health. He also says that access to healthcare is related to this problem, as poor social conditions tend to equal little or no access to proper care.

“I think it was really critical to set the goal for eliminating disparities in health, said Satcher. “It’s really critical because it’s really a matter of life and death.”

Filed under: — @ 2007-12-19 00:00:00
2007-12-19 00:00:00

Keeping Kids Heart-Healthy

A recent study from University of Michigan found that babies born with severe heart defects are much less likely to die before leaving the hospital if they are treated at the centers that treat the largest numbers of these patients.

And another report from the University of Florida found that some stimulant medications used to treat children with attention-deficit hyperactivity disorder (ADHD) may be landing more kids in the ER due to cardiac symptoms.

Heart health is paramount for children, and here are some tips from the American Heart Association (AHA) that medical professionals can pass onto their patients to keep kids heart healthy.

  • Monkey see, monkey do: Advise parents to help their children develop good physical activity habits at an early age by setting a good example themselves.
  • Too much of a good thing: Suggest that parents limit their children’s television, movies, videos and computer games to less than two hours a day to help to increase physical activity.
  • Make exercise a family affair: Encourage family outings and vacations that involve vigorous activities such as hiking, bicycling, skiing, swimming, etc.
  • Don???t be lazy: Suggest walking or riding bikes to nearby destinations whenever possible as well as using stairs instead of elevators and escalators when at shopping malls.
  • Playtime first: Discourage homework immediately after school to let children find some diversion from the structure of the school day. Kids should be active after school and before dinner.
  • No more boring sweaters for birthday gifts: Recommend that parents choose fitness-oriented gifts — a jump rope, mini-trampoline, tennis racket, baseball bat, a youth membership at the local YMCA or YWCA.

    Click here for a complete list of tips from the AHA.

  • Filed under: — @ 2007-12-19 00:00:00
    2007-12-18 00:00:00

    More ER Management Advice, This Time for Patients

    We have been focusing a great deal on how health plans and hospitals are working together to keep non-urgent cases out of the ER. Educating patients on what constitutes an emergency figures prominently in this strategy. But this week in Movin Meat, a self-described “semi-accidental ER doc living in the Pacific Northwest” has more advice for seriously ill patients headed to the ER: If you have a complex illness, make sure you head to the hospital where your doctors are. This will seriously improve the quality of care you receive.

    It’s not that we don’t want to see you. We would love to, but the fact is that we willnot be able to care for you properly at our hospital, so don’t come here. It’s that simple. We are not bad doctors here, nor are we unused to to complex patients. Believe me, we have lots of cancer patients here, and our surgeons have lots of complications of their own, etc, etc, etc. But your doctors are not here. And your records are not here. I may not be able to get your records, and even if I do, it will take me hours and I will probably not get everything I wanted. Your care will be delayed and possibly harmed.

    This is a common sense strategy that health plans should include in their patient education literature, especially in urban areas where patients might have a choice of ERs. It’s also another argument for interoperable EHRs so providers can easily access patient records.

    Filed under: — @ 2007-12-18 00:00:00
    2007-12-17 00:00:00

    Week in Review: Tips for Physician Engagement

    A perennial question at our provider-focused programs is how to engage physicians in new initiatives. As CMS’ Physician Quality Reporting Initiative (PQRI) builds momentum in 2008, your organization may be facing this challenge. Manuel Lowenhaupt, M.D., national practice leader at CapGemini, advises healthcare organizations to “build that aligned, shared vision of the future. Think about what you can do together in the next five to 10 years that would bring value to the lives of patients, doctors, nurses and the organization.” More of Dr. Lowenhaupt’s advice can be found in one of this week’s stories, “Seven Keys to Bringing Physicians On Board.”

    You can also read about the Transformation Transfer Initiative, the latest initiativefrom the Substance Abuse and Mental Health Services Administration (SAMHSA) to improve the capacity and effectiveness of mental health systems that foster recovery and meet the multiple needs of consumers in 10 states and Puerto Rico.

    Filed under: — @ 2007-12-17 00:00:00
    2007-12-17 00:00:00

    ISO: Kidney Donor

    During this season of giving, Dr. Sally Satel offers a compelling account of her nearly two-year wait for a healthy kidney in the New York Times Magazine. The psychiatrist and lecturer at the Yale School of Medicine describes the actions of some potential donors who give, then take away, and offers some insights into donor psychology:

    Donors can have their own agendas, too. The academic literature on donor psychology offers many examples, like a man who sought the adulation of his community by offering a kidney to his minister, a daughter who competed with her own mother to be the rescuer of another family member and a woman who told researchers that her motive for wanting to give a kidney to a stranger was to become ??????Daddy???s good girl.??? Then there is the ???black-sheep donor,??? a wayward relative who shows up to offer an organ as an act of redemption, hoping to reposition himself in the family???s good graces. For others, donation is a sullen fulfillment of familial duty, a way to avoid the shame and guilt of allowing a relative to suffer needlessly and even die.

    Dr. Satel also cites a review of published surveys on donor attitudes by Mary Amanda Dew, a psychologist as the University of Pittsburgh Medical Center, which found that about 95 percent of donors say they would do it again. Dr. Satel received a kidney from a “fond acquaintance” in March 2006, and today spends much of her time championing the need for healthy organ donation:

    Theoretically, kidneys should be in booming supply. Virtually everyone has two, and healthy individuals can give one away and still lead perfectly normal lives. Yet people aren???t exactly lining up to give. At the beginning of 2005, when I put my name on the list, there were about 60,000 people ahead of me; by the end of that year, only 1 in 9 had received one from a relative, spouse or friend. Today, just under 74,000 people are waiting for kidneys.

    She proposes incentives to spur donation among the living:

    Altruism is a beautiful virtue, but it has fallen painfully short of its goal. We must be bold and experiment with offering prospective donors other incentives for giving, not necessarily payment but material reward of some kind ??? perhaps something as simple as offering donors lifelong Medicare coverage. Or maybe Congress should grant waivers so that states can implement their own creative ways of giving something to donors: tax credits, tuition vouchers or a contribution to a giver???s retirement account….In short, we should reward individuals who relinquish an organ to save a life because doing so would encourage others to do the same.

    Filed under: — @ 2007-12-17 00:00:00
    2007-12-13 00:00:00

    State of Depression: Report Reveals Link Between Mental Health and Treatment Access

    Turns out where you live might have just as much to do with your health as any other factor. A new report released by Mental Health America suggests a link between a state’s mental health status and the level of treatment access available to its residents.

    Some key findings of the study include:

  • The greater the number of psychiatrists, psychologists and social workers per capita in a state, the lower the suicide rate.
  • The lower the percentage of the population reporting that they could not obtain healthcare because of costs, the lower the suicide rate and the better the state’s depression status.
  • The lower the percentage of the population that reported unmet mental healthcare needs, the better the state’s depression status.
  • The higher the percentage of the population receiving mental health treatment, the lower the suicide rate.
  • The more educated the population and the greater the percentage with health insurance, the lower the suicide rate. The more educated the population, the better the state’s depression status.
  • The more generous a state’s mental health parity coverage, the greater the number of people in the population that receive mental health services.
  • According to study’s results, Utah is the “most depressed” state, followed by West Virginia, Kentucky, Rhode Island and Nevada. South Dakota ranked number one as the “least depressed” state, and Hawaii, New Jersey, Iowa and Maryland rounded out that top-five countdown.

    Where does your state rank?

    Filed under: — @ 2007-12-13 00:00:00
    2007-12-13 00:00:00

    Disease Management Update: Depression

    This year alone, more than 17 million American adults were affected with some type of depression, and approximately 20 percent of the U.S. population reports at least one depressive symptom in a given month.

    This week’s Disease Management Update takes a look at how depression is related to other diseases like diabetes and Parkinson’s disease.

    Filed under: — @ 2007-12-13 00:00:00
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