The IdeaCare BlogFresh Ideas, News & Updates From Stone Health Innovations
Evidence based decisions.
Popular media is full of the newest medical app, telehealth is touted as a solution in popular media. However providers need to act on evidence based medicine not mainstream media. A recent study demonstrated that telehealth interventions decreased emergency admissions and mortality for individuals who need chronic care (e.g. diabetes, COPD). Additionally, the telethealth patients (intervention group) who were admitted had reduced hospital bed days. Providers exchanged information with the patients in the intervention group as part of diagnosis and disease management. This group also received usual care, which the control group also received. What makes this study so potent is that it used a randomized control paradigm, and had an enormous sample size, over 3,000 patients.
As this study demonstrates usual care visits will still be important. However their number may decrease with the increase of telehealth. Of course more research may be needed, but providers may see for themselves if a patient is experiencing improvement.
A similar study undertaken with veterans who had comorbidities of diabetes and hypertension and were primary care patients. The intervention group received nurse managed telehealth care. During the six months of the study the intervention patients had both decreased A1c and SBP relative to the control. Six months after the study was withdrawn A1c levels return to the pre-intervention levels, SBP saw the same process but in 12 months.
Is this a magic bullet to lower mortality and improve the lives of all patients?
Probably not all patients, since there are some outliers. Some are at very high risk may not necessarily benefit from the lower mortality rates that the data demonstrate. However, at the very least the provider can ensure that their patients are receiving the best care and are compliant. It may decrease the gaps of information between usual care visits. Additionally, patients can experience increased care at convenience of their own homes.
These results demonstrate that it telehealth is worth looking into for providers, at the very least to dig deeper to see how it can improve patient outcomes. Transmission of education and keeping an eye on clinical symptoms can detect problems early. Most of this work can be done by nurses will be relatively inexpensive. Most importantly, patients have better access to care, and better outcomes. Please let us know what you think or what your experience may be in telehealth below.
Works Cited in this blog:
Steventon, Adam, et al. “Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial.” Bmj 344 (2012).
Wakefield, Bonnie J., et al. “Effectiveness of home telehealth in comorbid diabetes and hypertension: a randomized, controlled trial.” Telemedicine and e-Health 17.4 (2011): 254-261.
Many of us are aware about the risks that older and elderly people face when they fall. DEXA scans can be a strong clinical tool to assess the risk for fragility fractures but not necessarily fractures related to poor movement strategies. These movements are used to compensate for lack of strength or flexibility and may inadvertently cause vertebral compression fracture (VCF) when an osteoporotic spinal column is inappropriately loaded. The prevalence for a VCF is 25% for women. Shockingly, many are undetected clinically even when shown on a x-ray, only 30% of VCFs are reported.
Deficits in physical performance contribute to the risk for VCF regardless of history. A group took a systematic look at these issues. MacIntyre, a PT/researcher and a group of clinicians from United Osteoporosis Centers have been working with a test that can predict the risk of VCF. Using simple movements that are based on daily household activities such as picking up a newspaper they can predict a patient’s risk for a VCF. It is known as Safe Functional Motion test (SFM). A SFM test can suggest a VCF along with an x-ray to confirm.
SFM test can predict the risk of a VCF. The group looked at men and women over the age of 50 who attended a specialty osteoporosis clinic and saw that the higher the SFM score was the less risk the patient had for a VCF in one year and even less of a risk in three years. So to look at it another way, the less mobile an osteoporotic individual was in the activities of daily living, the higher chance they had for a VCF. The group suggests that the way the spine is stressed and loaded is a better predictor of VCF than predictors currently used for a fall risk would be.
So what does this all this mean? This simple and inexpensive test can serve as an early warning for modifiable interventions for patients who are at risk for VCF. Interventions could prevent osteoporotic fracture and the associated clinical and poor quality of life issues down the line. Of course there are other risks like low bone mineral density or not taking bone-sparing medication that can contribute to the prediction. But even when these latter covariates are controlled for SFM is still a strong predictor, suggesting there are highly modifiable physical movements that can alter the risk for the better. Additionally, the SFM test can be preformed by a certified technician (no MD required) and the intervention can be done with a PT or perhaps a nurse, making it relatively inexpensive. Although more research is needed on which specific interventions are most effective at preventing a VCF, we now may have a simple test to prevent osteoporotic fractures. Since movements that contribute to the risk are ingrained by habit, they can be unlearned as well.
Please let us know your thoughts below.
Sources cited in this blog:
MacIntyre, N. J., et al. “Scores on the Safe Functional Motion test predict incident vertebral compression fracture.” Osteoporosis international 25.2 (2014): 543-550.
Recknor, Chris P., et al. “Scores on the Safe Functional Motion test are associated with prevalent fractures and fall history.” Physiotherapy Canada 65.1 (2013): 75-83.
New Medicare Rules to Help Patients
Only recently has Medicare announced (January 2015) that they will reimburse clinicians for non face- to- face care coordination (e.g. telehealth). The opportunity for expanding the benefits for comorbid and chronic patients has exponentially increased. However, an article published in JAMA, states that any clinician can provide coordinated care, but many may not have the requisite skills. So new challenges in implementation and coordination arise for those clinicians who want to get involved. This is where coordinated care services companies can come in and partner with providers.
What Does the Evidence for Coordinate Care Show?
The evidence demonstrates that using EHR improves care coordination. A study led by Graetz looked at the association of EHR use and how adult primary care clinicians assessed improvements in coordinated care. This project demonstrated that outpatient EHR use allowed clinicians to better access to complete and timely information. Additionally, it was easier for clinicians to agree on what should be done with patients who were being treated by multiple clinicians (i.e. comorbid, chronic ones). So that the silos that exist between clinicians today can finally start breaking down. Similar results were seen with integrated outpatient-inpatient EHR, clinicians were able to agree on treatment plans for patients transferred across multiple delivery sites. This data is refreshing news for individuals who have to see multiple providers and try to assess the different medical opinions they encounter.
Another study used a randomized controlled trial paradigm. Telefamilies, demonstrated that a full-time Pedriatic Nurse Practitioner acting as a telehealth care coordinator for children with complex special health care needs was able to decrease the amount of contacts parents had to make to multiple providers. The clinician used telephone and video conferencing to do this. This decreases the burden for family members, especially parents who have to take time out of their day to essentially become a medical concierge for their children. Additionally, the Nurse Practitioner was able also able to decrease the amount of clinical visits a child needed to make all together, suggesting that care coordination can improve outcomes. More importantly, this is even better news for those patients who are not so fortunate to have someone in their family to be a care advocate.
It’s a great time to get started with providing chronic care management to your patients. You are doing a lot of the management already but not optimizing your reimbursement. Stone Health Innovations makes a great partner in your move toward optimizing your CMS chronic care management reimbursement. Stone Health Innovations’ complete chronic care coordination program includes our cloud-based care coordination management system, IdeaCare. IdeaCare transcends the continuum of care to insure your patient’s receive the coordination in services they deserve.
Stone Health has years of experience in integrating healthcare and financial management systems. Our goal is always to work in the best interest of our providers and patients. For many providers, integrating with EMR systems is often a difficult, cost-prohibitive and time consuming process. The provider wants to move forward quickly and effectively with a system that is quick to learn, easy to implement and coordinates care across the continuum. With such, Stone Health offers IdeaCare as a simple-to-integrate care management, stand alone IT adjunct to your office operations or the integration of IdeaCare with your current EMR. The choice is yours.
Please stay tuned to our blog as we post more news and analyses on coordinated care using peer review journals. As always, please post your comments below. Only together can we coordinate care well.
Works Cited in this Blog: