CRHC at IHI’s 15th Annual International Summit on Improving Patient Care

At the Institute for Healthcare Improvement’s (IHI) International Summit on Improving Patient Care this March, CRHC will have the opportunity to present some of the work it and clinics throughout the state have been doing in the areas of improving operations and quality improvement. CEO, Michelle Mills will present about CRHC’s Improving Communication and Readmissions (iCARE) program and the work clinics throughout the state have been doing through this initiative to work with Critical Access Hospitals to improve communication in transitions of care, improve clinical processes, and reduce readmission rates.  At the Storyboard exhibit, CRHC will also have the opportunity to showcase some of the work being done across the state though Healthy Clinic Assessments, which work with clinics to improve efficiencies and workflow in their basic business operations.  For a sneak peak at the Storyboard, click here.

Colorado launches effort to grow health and wellness industry

Colorado officials plan to make the state a hub for wellness and digital health companies -- a strategy fraught with potential hurdles, but one they believe can put them at the leading edge of a new movement in health care. Ken Lund, executive director of the Colorado Office of Economic Development and International Trade, announced the plan Wednesday at a gathering of state business and health care leaders. Click here to read the full article by Ed Sealover at the Denver Business Journal.

Study Examines Transport Time of TBI Patients

Transporting directly to trauma centers is a bit of a hot topic lately. For urban providers, it’s a simple decision, but for rural providers, a trauma center may not be nearby, even by air transportation. Last month we discussed the national field triage decision scheme, which recommends all critical trauma patients go to the closest Level I or II trauma center. Although the benefits of immediate surgical intervention are well documented for most trauma patients, there’s little research correlating transport time with the condition of traumatic brain injury (TBI) patients. Click here to read the full article by Alexander Trembley and Davide Page.

Two Case Studies of Regional Extension Centers Serving Rural Practices

• Minnesota & North Dakota
• North Carolina

These two case studies focus on the experiences of HIT Regional Extension Centers working with rural physicians in their respective service areas. They are intended to serve as companions to our recent article in The Journal of Rural Health, which examined the national impact of the REC program and the role of the RECs in helping rural physician practices achieve “meaningful use” of Electronic Health Records. The two RECs were selected for these case studies based on their high rankings among the 62 RECs nationwide on the number of rural providers that had signed up for REC services, implemented EHRs, and attained meaningful use as of May 2012.

The case studies feature commentary and advice from key staff at the RECs as well as selected physician practices serving rural areas. For further information contact Michelle Casey, MS, University of Minnesota Rural Health Research Center at 612.624.6151or mcasey@umn.edu.

New AHRQ evidence-based guide helps implementation of health assessments in primary care settings

AHRQ has published an evidence-based guide designed to help primary care doctors, nurses and other staff successfully select, adopt and implement health assessments, which help primary care providers evaluate a patient’s health status and risks. The information is used to identify potentially problematic but treatable health behaviors and factors such as anxiety, alcohol use, depression, unhealthy eating and sedentary lifestyle that patients often don’t bring up during a medical visit. 

Research shows that many patients do not receive an assessment of health risks or a plan to address those risks. However, the Affordable Care Act authorizes Medicare coverage of annual wellness visits and specifies that a health risk assessment be included as part of those visits.

The AHRQ guide, Health Assessments in Primary Care: A How-to Guide for Clinicians and Staff, provides evidence-based methods to implement health risk assessments and ultimately to engage patients in making lifestyle changes to improve their health. It employs the best current evidence for successful implementation of health assessments in the primary care setting and includes tools to help clinicians decide which health assessments to use, how to integrate them into their daily workflow and how to maintain the process. The guide is designed for practices that use electronic health records as well as those that use paper charts. The guide gives clinicians sample health assessment questions for seniors, adults, adolescents and children. It also provides a crosswalk of health assessments related to incentive and quality programs. Sample health assessment information for patients and a patient feedback survey are included.

One Colorado hospital makes list of top facilities

The Leapfrog Group on Tuesday named the top hospitals in the United States, including one in Colorado. The Washington-based group, which earlier this year graded hospitals on patient safety, picked the recipients of its top hospitals honor after surveying 1,324 facilities nationwide. The hospitals were divided into three categories: urban, rural and children's. The only hospital in Colorado included on this year's list is East Morgan County Hospital, a 25-bed rural hospital in Brush. The complete list can be viewed here. Click here to read the full article from the Denver Business Journal.

10 WARNING SIGNS OF ALZHEIMER’S DISEASE

KNOW THE 10 WARNING SIGNS OF ALZHEIMER’S DISEASE:

EARLY DETECTION MATTERS

Unfortunately, most Americans are unaware of the symptoms associated with Alzheimer’s Disease, the most common form of dementia.  Specifically, and in addition to memory loss, behavioral changes like decreased judgment, difficulty in completing tasks, and withdrawal from activities may all be signs of Alzheimer’s.

The Alzheimer’s Association “Know the 10 Signs: Early Detection Matters” campaign is designed to heighten awareness of the warning signs of this horrific disease and explain the benefits of early diagnosis.

This campaign encourages all Coloradoans to seek a diagnosis from a doctor if they exhibit any of the warning signs.  Early diagnosis provides individuals the access to prescribed medications, the chance to enroll in clinical trials of new treatment alternatives, and the opportunity to plan their own future as well as receive support from the Alzheimer’s Association. Early detection begins with awareness.   

Doctors can now diagnose Alzheimer’s with 90% accuracy. To understand what to look for, a thorough review of these 10 Warning Signs is essential.

10 Warning Signs of Alzheimer’s:

1.    Memory changes that disrupt daily life; e.g., forgetting important dates, or asking for the same information over and over.

2.    Challenges planning and solving problems; e.g., unable to keep track of monthly bills, or unable to follow a familiar recipe.

3.    Difficulty completing familiar tasks; e.g., not being able to remember the rules of a familiar game, or having trouble driving to a familiar place.

4.    Confusion with time and place; e.g., not knowing the season, or not remembering how to get home.

5.    Trouble understanding spatial relationships or visual images; e.g., having difficulty reading, driving, or telling time.

6.    New problems with speaking or writing; e.g., calling objects by the wrong word, or not being able to complete a conversation.

7.    Misplacing things and losing the ability to retrace steps; e.g., finding car keys in the oven, or becoming paranoid that others may be stealing.

8.    Decreased or poor judgment; e.g., mismanaging money, or paying less attention to grooming and hygiene.

9.    Withdrawal from work or social activities; e.g. not attending club meetings or church, or no longer having an interest in a favorite sports team.

10. Changes in mood or personality; e.g., becoming more confused, suspicious, fearful or agitated.

For those individuals reaching the age of 65, when one in eight will be diagnosed, there are things that may reduce the risk of developing Alzheimer’s and other forms of dementia. While we can’t prevent Alzheimer’s Disease, here are a few tips for “brain health” as we age:

·         adopt a diet of low fat, high antioxidants, and high omega-3 foods;

·         exercise your brain with puzzles, Sudoku, math, and socializing with others;

·         stay active and physically fit;

·         lower your cholesterol;

·         maintain a normal blood pressure;

·         reduce your risk for stroke;

·         watch your sugar levels, and reduce your risk for diabetes;

·         promote good circulation; and

·         manage your stress -- find effective ways to relax. 

Every single day, science unlocks more mysteries of the brain.  But, we do not have all the answers yet.  What we do know is, like other parts of the body, the brain may lose some agility as we get older.  And, it can deteriorate even more without care.  A good rule to remember:  WHAT’S GOOD FOR YOUR HEART IS GOOD FOR YOUR BRAIN. 

For anyone with questions or concerns, the Alzheimer’s Association provides free counseling, information and resources, educational classes and community presentations, and assistance.  In Colorado, please feel free to call our 24-hour Helpline at 800-272-3900 and via our Website at www.alz.org/co. 

Serving all metropolitan, suburban, and rural areas in the state, the Colorado Chapter of the Alzheimer’s Association has office locations which include Denver, Colorado Springs, Durango, Grand Junction, Evans for Northeast Colorado, and Pueblo for Southern Colorado.

No one has to take this journey alone. Individuals, family caregivers, and professionals are all encouraged to reach out for help. 

Submitted by:

Ann Carter, MPA, Regional Director, Southern Colorado / Alzheimer's Association Colorado Chapter / 4104 Outlook Boulevard, Bldg. B, Pueblo, Colorado 81008 / 719-544-5720 / 800.272.3900 HELPLINE / alz.org/co 

November is National Alzheimer’s Disease Awareness Month and National Caregiver Month. In the United States, there are more than 15 million Alzheimer's and dementia caregivers. 

Post a tribute for a caregiver in your life: www.alz.org/nadam

CRHC releases issue paper “Improving Communications and Readmissions”

Click here to read the CRHC’s latest issue paper on Improving Communications and Readmissions.

Increasing hospital concerns prompt new security measure

Violent crime isn’t limited to schools and major public-gathering areas. Hospitals across Colorado and American are seeing an increase in attacks made by patients on workers and by outsiders on patients. As such, many are adding metal detectors and offering staff security training in order to empower them. But one Denver hospital’s plans demonstrates the newest wave of security and how it can allow hospitals to react more nimbly and quickly to high-alert situations. Click here to read the full article by Ed Sealover with the Denver Business Journal.

Colorado survey reveals disparities in medical care for minorities

Black Coloradans see the doctor less frequently, get less preventive care and report being in worse health than other residents of the state, according to a recent health survey.

The biennial Colorado Health Access Survey, which polled 10,224 households between April 15 and July 27, provides one of the most comprehensive snapshots of how Colorado residents experience the health care system. Read the full article here.

CMS unveils tool allowing researchers to access federal healthcare data

Health services researchers eager for cheaper, timelier and more accessible federal healthcare data had reason to celebrate Tuesday, when the CMS unveiled a tool to make such information much more readily available. Read the full article here.

NCQA Medical Homes Pass 6,000 Mark

The National Committee for Quality Assurance (NCQA) passed a major milestone in September, as the 6,000th medical practice earned NCQA Recognition as a Patient-Centered Medical Home (PCMH). “One benefit of PCMH has been fewer costly emergency department and hospital admissions. Patients get the access, personal attention and care coordination from their primary doctor that they need and deserve.”

Starting from 38 practices in 2008, when the NCQA PCMH program debuted, there are now 29,505 recognized clinicians in 49 states, or roughly 15 percent of all primary care practices nationwide. Government and private sector initiatives in 38 states have used the NCQA model to support the spread of medical homes. Click here to read the full article published on Enhanced Online News.

RWJF awards grants to 2 new scope of practice studies

Two new studies examining the regulations, policies and practices that affect nurses’ ability to practice to the full extent of their education and training will receive nearly $500,000 in grants, according to a Robert Wood Johnson Foundation news release.

The funds will come from RWJF’s Future of Nursing National Research Agenda, which was created in 2011 to support research informing implementation of the recommendations in the Institute of Medicine’s groundbreaking “The Future of Nursing: Leading Change, Advancing Health” report. The project is coordinated by RWJF’s Interdisciplinary Nursing Quality Research Initiative, and the new grants bring the total number of projects funded through this initiative to seven. Click here to read the full article.

AMA survey results should ease worries about demise of private medical practice

A report recently released by the AMA provides a timely look at physician practice arrangements in the United States and concludes that, despite some media reports to the contrary, private practice remains a strong business model for U.S. physicians.

Researchers did report, however, statistical "shifts" toward hospital employment.

The report, titled "New Data on Physician Practice Arrangements: Private Practice Remains Strong Despite Shifts Toward Hospital Employment,"(www.ama-assn.org) is based on data drawn from the AMA's 2012 Physician Practice Benchmark Survey (PPBS).

Among the report's major findings are that 53.2 percent of all physicians surveyed were self-employed, and 60 percent of physicians worked in practices wholly owned by physicians. Twenty-three percent of all survey respondents worked in practices at least partly owned by a hospital, and 5.6 of respondents said they were hospital employees. Click here to read the full article.

Dental Professionals in Non-Dental Settings

This report focuses on nine oral health innovations seeking to increase access to preventive oral health care in nondental settings. Two additional reports in this series describe the remaining programs that provide care in dental settings and care to young children. The nine innovations described here integrate service delivery and workforce models in order to reduce or eliminate socioeconomic, geographic, and cultural barriers to care. Although the programs are diverse in their approaches as well as in the specific characteristics of the communities they serve, a common factor among them is the implementation of multiple strategies to increase the number of children from low-income families who access preventive care, and also to engage families and communities in investing in and prioritizing oral health. Click here to read the full report.

Causes and Consequences of Rural Pharmacy Closures: A Multi-Case Study

The RUPRI Center for Rural Health Policy Analysis completed case studies in six rural communities that lost their only remaining retail pharmacy since 2007. In five of the six communities, residents now either drive to the nearest pharmacy or use mail- order to receive their prescriptions and, in some instances, receive their prescriptions through a courier service from a pharmacy in a nearby town. Access to pharmacy services in these communities is of most concern for individuals with limited mobility and those who lack a support system that can pick up and deliver their prescriptions (e.g., the elderly and people with acute conditions). Rural communities will need to continue exploring options for delivering pharmacy services given the financial difficulties inherent in the traditional model of the local independent pharmacy. Click here to read the full report written by RUPRI Center for Rural Health Policy Analysis.

Additional Resource of Interest:

Rural Pharmacy Closures: Implications for Rural Communities
Independently Owned Pharmacy Closures in Rural America
More information about the RUPRI Center for Rural Health Policy Analysis

Project ECHO Brings Pain Expertise to Rural Docs

Rural areas typically are underserved by pain specialists, so primary care doctors may be on their own when caring for patients with chronic pain or may have to refer patients long distances for a pain consultation. To address this problem in New Mexico, doctors at the University of New Mexico in Albuquerque created a telementoring program in 2009 called Project ECHO (Extension for Community Healthcare Outcomes) Chronic Pain. Project ECHO Chronic Pain Program is co-directed by Joanna G. Katzman, MD, a neurologist, and George D. Comerci, Jr., MD. Dr. Katzman, Director of the UNM Pain Center, spearheaded creation of the program “as a way to leverage scarce pain resources for primary care providers working in rural and underserved areas” where their patients had to wait many months for a specialty pain consultation. Click here to read the full article by Jody Charnow, published September 5th.

Trends in cancer care near the end of life

Even though most patients with advanced cancer prefer care that minimizes symptoms, many still receive intense treatment and are not admitted into hospice care until their last three days of life, according to research from the Dartmouth Atlas Project. Although hospice care for Medicare patients with advanced cancer is increasing, so are the rates of treatment in intensive care units.

Since the last Dartmouth Atlas report, the trends in end-of-life cancer care across the country have been mixed. While patients are spending fewer days hospitalized in the last month of life, the number of days in ICUs has increased. Hospice days have also increased, but a growing proportion of patients begin receiving hospice services in the last three days of life, a time period often too short to provide patients the full benefit of hospice care. Find out what the key finds where here.

Transdisciplinary collaboration and endorsement of pharmacological and psychosocial evidence-based practices by medical and psychosocial substance abuse treatment providers in the United States

Transdisciplinary collaboration refers to the work of diverse service providers – physicians, nurses, social workers, psychologists and paraprofessionals – with distinct training and specializations (McCallin, 2001). Transdisciplinary collaboration has been shown to improve both the management and quality of care (Orchard, Curran, & Kabene, 2005; Pinto, Wall, Yu, Penido, & Schmidt, 2012), and is particularly relevant in substance abuse treatment which often requires the concurrent use of psychosocial and pharmacological interventions (Anton et al., 2006; Volkow, Fowler, Wangand, & Swanson, 2004). Regrettably, research is lacking about how substance abuse service providers compare in terms of their endorsement of pharmacotherapy and psychosocial interventions. Read the full length article here.

Financial Factors and the Implementation of Medications for Treating Opioid Use Disorders

Opportunities to effectively treat opioid use disorders (OUDs) are enhanced by the availability of pharmacological treatments. Unlike substance use disorders (SUDs) associated with stimulants or cannabis where such treatments are not yet available, there are effective pharmacological treatments for OUDs, namely methadone, buprenorphine, tablet naltrexone, and, most recently, a depot formulation of naltrexone. The diffusion of buprenorphine and naltrexone has been remarkably slow, in part because of the financial resources required to implement pharmacotherapies.

For the past 40 years, specialized opioid treatment programs (OTPs) offering methadone have been the primary setting for treating opioid-dependent patients. Historically, the nation’s OTPs have been inadequate in number to meet the demand for treatment. In 2000, before the Food and Drug Administration’s (FDA’s) approval of buprenorphine, OTPs constituted just 9% of US treatment facilities for SUDs, and methadone was included in the treatment plans of just 40% of all opioid treatment admissions (Substance Abuse and Mental Health Services Administration, 2002). The combination of the FDA’s approval of newer medications (Ling and Smith, 2002; Saxon and McCarty, 2005) and regulatory changes allowing for the prescription of buprenorphine in non-OTP settings (Jaffe and O’Keeffe, 2003) has increased the potential of expanding medications for addiction treatment (MAT) throughout the treatment system (Roman et al., 2011). Read the full article here.