The Efficient MD describes how the Ambient Orb, a “glancable internet appliance,” can be configured to monitor the number of patients waiting in the ED. One hospital has already installed the orb, which glows color-coded updates on ED waiting room occupancy.
I always look forward to the annual New York Times Magazine “Year in Ideas” issue, which appeared on Sunday. Of the 70 ideas presented this year, at least seven have direct applications for health coaches, disease managers and caregivers:
Alzheimers’ 50-Question Telephone Screening
This year, researchers completed work on a 50-question telephone quiz to help them identify Alzheimer???s patients long before they exhibit typical symptoms. Such a quiz may soon become part of regular medical care.
The Appendix Rationale
For years, the appendix got no respect. Doctors regarded it as nothing but a source of trouble: It didn???t seem to do anything, and it sometimes got infected and required an emergency removal. Plus, nobody ever suffered from not having an appendix. So human biologists assumed that the tiny, worm-shaped organ is vestigial ??? a shrunken remainder of some organ our ancestors required. In a word: Useless.
Now that old theory has been upended. In a December issue of The Journal of Theoretical Biology, a group of scientists announce they have solved the riddle of the appendix.
Hope Can Be Worse Than Hopelessness
People often display a remarkable ability to adapt to adversity, bouncing back to their usual levels of happiness despite extreme hardships. But people don???t always rebound, and scientists have long wondered what factors might account for the difference. In a talk at Harvard in September, a team of researchers suggested that one obstacle to emotional recovery, oddly enough, is hope ??? the belief that your current hardship is temporary.
Simply by telling 44 hotel maids that what they did each day involved some serious exercise, the Harvard psychologist Ellen Langer and Alia J. Crum, a student, were apparently able to lower the women???s blood pressure, shave pounds off their bodies and improve their body-fat and ???waist to hip??? ratios. Self-awareness, it seems, was the women???s elliptical trainer.
Quitting Can Be Good for You
But new research suggests that success ??? or more specifically, the persistence required to achieve hard-to-reach goals ??? may not be worth it. In a paper published in the September issue of the journal Psychological Science, Gregory Miller of the University of British Columbia and Carsten Wrosch of Concordia University found that teenage girls who are unable to disengage themselves from trying to attain hard-to-reach goals exhibited increased levels of the inflammatory molecule C-reactive protein (C.R.P.), which in adults is linked with diabetes, heart disease and early aging.
Right to Medical Self-Defense
Citing the concept of ???medical self-defense,??? U.C.L.A. law professor Eugene Volokh contended that a dying American should have the right to buy any drug that has passed the F.D.A.???s preliminary safety tests. Currently, the F.D.A. insists that most terminally ill patients await, like everyone else, full proof of a drug???s safety and efficacy.
Two Birds with One Stone Resistance
To kill two birds with one stone ??? what could be better? But it turns out that if you have just one goal in mind, chances are you???ll actually be less inclined to take a path that also happens to serve other goals. Foolishly, you???ll resist the more advantageous approach…What happens, the researchers showed through other studies, is that connecting one tool or method to multiple goals weakens the mental association between that means and any one goal. Take jogging, for instance. Participants in one study were informed that jogging both strengthens muscles and increases the body???s level of oxygen. But after the researchers subliminally reinforced the participants??? association between jogging and one of those goals ??? strengthening muscles ??? participants irrationally deemed jogging less effective for boosting oxygen.
We routinely receive releases on “The 100 Best Hospitals” as ranked by this organization or that.
But CMS’ publishing last week of its list of 52 poor-performing nursing homes should have healthcare organizations not sufficiently quality-focused squirming in their C-suites. While the list is intended
to support consumers’ quest for quality long-term care, inclusion is somewhat of a virtual scarlet letter for the 52
“special focus facilities” that will be subject to more intense scrutiny and more frequent inspections from CMS until there
is clear long-term evidence of compliance.
Could there one day be a “52 Poor-Performing Hospitals” or “52 Poor-Performing Providers” list? This type of publicity means
consumers won’t have to dig as deep for provider and hospital quality rankings. In related news analysis this week, Dr. Dale Bratzler of the Oklahoma Foundation for Medical Quality Inc. ponders the potential unintended consequences of public reporting and pay for performance that could lead to patient harm in both direct and indirect ways.
My hair salon can now print me a listing of my appointments for the coming months and will soon launch an e-mail appointment reminder service. Now if only my healthcare providers would do the same.
Much has been written/blogged about the adoption rate among physicians of electronic health records. Depending on who you talk to or read, anywhere from 30 percent to 50 percent of physicians already use or soon plan to adopt this technology in their offices. While cost and IT support still pose barriers, it’s pretty much a foregone industry conclusion that most providers will use them eventually. From EHRs it’s only a small step to other IT-enhanced customer services.
But who’s prepping patients for this eventuality? I recently came across this survey from Allen L. Pelletier, MD, FAAFP, Greggory R. Sutton and Raymond R. Walker, MD, MBA at the American Academy of Family Physicians site. The survey, downloadable as a PDF and easily adaptable to a physician’s practice, is designed to help providers gauge patients’ readiness for EHRs.
The sample survey, which can be mailed to patients’ homes, asks patients whether and how they access the Internet and e-mail, if they would like to receive medical information via e-mail, and if so, which types (appointment reminders, e-newsletters, medication refills, test results, physician responses to simple health-related questions, etc.).
The survey is a great starting point and can be tailored to the practice’s (and patients’) needs. Health plans might administer it to members as well. Beyond the questions suggested in this survey, you might also target Gen-X and Gen-Y patient needs by asking if they use Health 2.0 tools such as social networking sites, and whether they’d like information and reminders via text messages sent to their cell phones.
The AAFP survey was well received at the doctors’ practice. Here’s what the doctos said about it:
The results of our survey convinced us that patients are ready to begin using the Internet to communicate with our practice. The patients we surveyed were enthusiastic about receiving appointment reminders by e-mail, scheduling appointments online and receiving test results electronically, and we are planning to offer each of these services in the near future.
If your practice hasn’t begun using the Internet to connect with patients, a survey such as ours is a great starting point. If you already use electronic communication with patients, a patient survey can help you refine your approach. You might be surprised, as we were, to discover that many of your patients use public Internet and e-mail resources or share them with others. It’s important to know this so that you can design protocols for dealing with private or protected health information in electronic communication. Your survey results will also help you identify the services your patients want (e.g., online appointment scheduling versus an electronic practice newsletter).
You can conduct the survey again in the future to see whether their interests have changed. By doing so, you will stay up-to-date on your patients’ level of comfort with the Internet and encourage them to cross the digital divide.
It may take a village to raise a child, but according to healthcare professionals like Gregg Lehman, president and CEO of HealthFitness, and David Chenoweth, president of Chenoweth & Associates Inc., it takes a workplace to maintain good health. Whether it is support and participation from the C-suite or competition from fellow co-workers, such measures are proven to drive participation and results in wellness and disease management programs.
This week’s Disease Management Update showcases a recent HIN interview with Lehman and reports what one health and wellness company is doing to promote workplace wellness.
Thanks to The Consumerist for alerting us to CMS’s release of its list of the 52 worst nursing homes in the country. These are the poorest performers of the 128 current Special Focus Facilities— (SFF) Medicaid- and Medicare-qualified nursing homes that have a history of serious health and safety problems and that are subject to additional CMS scrutiny and inspections. Once a facility has made significant improvements in quality of care—and those improvements are continued over time—the nursing home “graduates” from the SFF list.
Besides the obvious step of visiting a nursing home, CMS recommends the use of its Nursing Home Compare tool to review ratings for these and other nursing homes under consideration. Don’t hesitate to talk to administration and staff about any issues mentioned in the CMS rating, and follow up with your local state ombudsperson, Administration on Aging, and local groups to find out more about the nursing home.
CMS’s Nursing Homes brochure and Guide to Choosing a Nursing Home are also useful publications during this process.
Transitions in care, whether from a hospital to home or hospital to nursing facility, are stressful times for the patient’s family and caregivers. The extra few minutes to retrieve this easily available information can save loved ones from an unpleasant and potentially life-threatening experience.
In this day and age it is unrealistic to think that anyone is exempt from the dangers of natural or man-made disaster.?? As a result, it is crucial for families to take some simple steps to make sure they are prepared in the event of an earthquake, flood, tsunami, wild fire, terrorist attack or other catastrophic event.?? Find out what disasters are likely in your area and put together a Family Evacuation Plan.
If earthquakes are common in your area, it is a good idea to have bag under each person???s bed with a flashlight, change of clothes and pair of sturdy shoes, so it is easy to grab and leave quickly.?? In the event of a fire, families should have two exit strategies for each room in their home.?? Whether your Family Evacuation Plan is to exit using a window or a door is up to you, but the best way to make sure everyone is prepared is to take 15 minutes as a family to go into each room and discuss the possibilities.?? While you do this, make sure you take notes and after your initial home tour, make a diagram to post in the kitchen or other high traffic area.
Another important element of the Family Evacuation Plan is to establish meeting places outside of the home where everyone will meet up if an evacuation is in order.?? The first meeting place should be directly outside of the home, for example on the sidewalk or in front of the next-door neighbor???s house.?? The second meeting place is an out of area location, one that is outside of your immediate neighborhood.??
As part of the Family Disaster Plan, you will need to practice duck, cover and hold (for earthquakes or tornados) and stop, drop and roll (for fire) drills with anyone over the age of 2 in your home.?? The more prepared you are for the worst case scenario, the better off your family will be in an actual disaster.??
All of this information should be recorded and discussed regularly, so that parents, grandparents and anyone who might be taking care of your children will know the plan as well.?? Find out what school and workplace evacuation plansare and record all of this in your Family Emergency Plan folder.?? Make sure you include local and out of area contact names, phone numbers and addresses with this information.?? Again, place this information in a folder and place it in an area that is easy to find.??
At all times, each family member should carry a card with the above listed contact info and evacuation sites.?? After a disaster, each person in the family should contact the same out of area contact and let that person know their location and physical condition as soon as possible.
Disaster Kit Supplies
The most important components of the Disaster Kit are 3 days of food, water, medical supplies, sturdy shoes, blankets, flashlights, batteries and cash.?? All of these items should be stored in durable, easy-to-carry containers such as backpacks, duffel bags, or covered trash containers.?? I recommend plastic containers as we have had little critters eat through our duffle bags to get to our food supplies.?? Don???t forget to put together kits for your car and work as well.?? The following list of supplies is recommended by the Office of Homeland Security:
* A three-day supply of water (one gallon per person per day) in non-breakable containers.
* A three-day supply of nonperishable food per person.
* Food, water and supplies for pets
* One or two changes of clothing per person, and sturdy shoes. Also
include rain gear, hats and gloves.
* One blanket or sleeping bag per person.
* A first aid kit that includes your family’s prescription medications.
* Emergency tools and supplies including a battery-powered radio,
waterproof matches, compass, whistle, non-electric can opener,
utility knife, map, flashlight, and plenty ofextra batteries.
* Special items for infants (formula, diapers, bottles), the elderly
(prescriptions, denture needs, eyeglasses) or disabled family
members (special equipment, hearing aid batteries.)
* Important family documents stored in a waterproof container. These
can include wills, insurance policies, passports, immunization histories, and other family records.
***?? Keep in mind that if you feel like this is more than you have time to assemble, there are companies that provide pre-assembled kits for you.?? Here are a few links for you:
??One more thing you might want to consider assembling is recommended by FEMA:
Kids Activity Survival Kit
* Favorite books
* Crayons, pencils or marking pens and plenty of paper
* Scissors and glue
* Two favorite toys such as a doll or action figure
* One or two board games
* A deck of cards
* A puzzle
* Small people figures and play vehicles that you can useto play out?????????? what is happening during your disaster — such as ambulance, fire truck, helicopter, dump truck, police car, small boats.
* Favorite stuffed animal or puppet
* Favorite blanket or pillow
* Pictures of the family and pet