The issue of safety and its relationship to quality is finally getting the recognition it deserves. Safety is the theme of this October issue of Home Healthcare Nurse. Falls are an ongoing concern for older adults, and a CE article entitled "Falls Risk Assessment Begins With Hello: Lessons Learned From the Use of One Home Health Agency's Fall Risk Tool" authored by Patricia J. Flemming and Katherine Ramsay discusses a tool to help assess falls and lower their occurrence. Orthostatic hypotension has been associated with falls for some people and Diane Mager addresses this complex topic in an article titled "Orthostatic Hypotension: Pathophysiology, Problems, and Prevention."
A home care specialty area that demands a grounded knowledge of technology, medications, and specific standards is home infusion. In "Infusion Therapy in the Home Care Setting: A Clinical Competency Program at Work," Denise Martel presents one model of collaboration among six community-based nonprofit agencies in two states to share best practices and maintain staff competence. This program has been in existence for 12 years and may have lessons for others seeking to collaborate with peers to offer and support education in numerous specialty areas. Mellisa Hall addresses another potential safety issue in her article "Alcoholism and Depression." The Research Briefs column by Xiomara M. Dorrejo and Paula Wilson is titled "Research on Culturally Tailored Interventions Aimed at Improving Chronic Disease Risk Factors and Management."
In the first part of a two-part series on constipation, "Evidence about the Prevention and Management of Constipation: Implications for Comfort," Deborah Fritz and Matthew Pitlick discuss evidence-based nonpharmacological interventions for constipation. This constipation article is the Hospice and Palliative Care feature and the second CE for this month.
"Geriatric Care Management: Role, Need, and Benefits" by Marilyn Wideman explains this holistic care model that supports older adults across time and care settings-while advocating for their care needs. Wideman explains this role and why the need will grow.
In an interesting new book, authored by Rosemary Gibson and Janardan Prasad Sing, "The Battle Over Health Care: What Obama's Reform Means for America's Future," the authors address what the healthcare reform law did and did not do-and takes some lessons from the banking and financial system debacle. Written for consumers and those interested in healthcare reform and its implications, they present exemplars as well as areas in healthcare that need major improvement related to safety and quality.
Discussions of the aviation world where safety is "in the DNA" of progress is where healthcare needs to go. This is the time perhaps to think of being/staying a nurse but perhaps acquiring another degree-in engineering. We need this kind of information to improve safety and efficiencies. And I think we all know that sometimes specialization is needed, but to care for patients holistically we need more primary care clinicians and fundamental prevention-focused interventions.
The changes continue and this is a good thing-especially for our older adult patients with comorbidities, on numerous medications, and other complexities. One person coordinating care is important to having one's wishes heard, as well as for safety reasons. In July 2012, "the Centers for Medicare & Medicaid Services (CMS) ... issued a proposed rule that would increase payments to family physicians by approximately 7 percent and other practitioners providing primary care services between 3 and 5 percent" (CMS, 2012). For fiscal year 2013, the CMS is proposing for the first time to explicitly pay for the care required to help a patient transition back to the community following a discharge from a hospital or a skilled nursing facility stay. Other parts of the proposed rule include a proposal to include additional Medicare-covered preventative services on the list of services that can be provided via an interactive telecommunications system; a proposal to implement a durable medical equipment (DME) face-to-face requirement as a condition of payment for certain high-cost Medicare DME items; a proposal to collect data on patient function to improve how Medicare pays for physical and occupational therapy, and speech language pathology services; and others. For the full final rule, visit http://www.ofr.gov/(X(1)S(m5ipgircoqautlgeimkp3zr0))/inspection.aspx?AspxAutoDet.
Either way, we have a long way to go. October is also National Sudden Cardiac Awareness Month (see http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a5.htm)-we have so many specialty healthcare problems and "months" in 1 year! Interestingly, I saw President Bill Clinton being interviewed on television about his changed eating habits and lifestyle, related to his heart disease. Because of this, I also became interested in Caldwell B. Esselstyn Jr., MD, a surgeon at the Cleveland Clinic, and I got online and found out about his book, Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure. I read this book, and for those of you who might have seen the movie Forks Over Knives, the premise is the same: heart disease can be prevented through the adoption of a lifestyle that excludes meat and dairy products. I even signed up and, with my husband, went to Cleveland and attended a full-day session presented by Dr. Esselsteyn at the Wellness Institute. They are so busy that I made my reservations last fall for a summer session. Besides patients, who were "too sick" to have heart interventional surgeries, there were many doctors in the session who were there to learn so they can teach this lifestyle and diet to their patients. Some doctors that we met and spoke to were from Canada and other countries. It is hard to believe there could be a way to prevent so much of the pain and costs related to heart disease-and the diet and lifestyle are not for the faint of heart (excuse the pun). Simply put, it is "nothing with eyes or a mother"!
I tell you this because I think none of the current, proposed "fixes" for improved health seem to get us there, and I believe we must have "skin in the game" to get to where we need to be. With so much money, with change being so hard, and with our healthcare systems so entrenched in "more is better" (even though we know that is not true) there will be lots of intellectual violence going on to rework and reset healthcare to support real health (i.e., preventative and primary health). Together we can work on these efforts, and, as always, I love to hear from readers and your thoughts!
New Community-Based Care Transitions Program Sites Announced
The Centers for Medicare & Medicaid Services (CMS) announced 17 sites selected to participate in the Community-based Care Transitions Program (CCTP). Together with the first 30 participants, the CCTP now includes 200 acute care hospitals partnering with community-based organizations across 47 sites to provide care transitions services for an estimated nearly 185,800 Medicare beneficiaries annually residing in 21 states.
The CCTP is a 5-year program created by the Affordable Care Act. Participants sign 2-year program agreements with CMS, with the option to renew each year for the remainder of the program, based on their success. As of the date of this announcement, CMS continues to accept applications and approve participants on a rolling basis as long as funds remain available. Future panels may be announced as funding permits.
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