"There's no limit to how complicated things can get, on account of one thing always leads to another." - -E.B. White
We all learned "complicated" (read: more) when the home health agency Medicare "refinements" were operationalized at the start of the new year[horizontal ellipsis]the changes and subsequent hoops needed for resolutions (for payers and providers alike!!) make some of us pine for the "old days." We think of complications and complicated not only in the billing and coding realms, but also in terms of patients and their care.
According to the National Vital Statistics Report, "in 2004 [the most recent data reported], the 10 leading causes of death were [in rank order] Diseases of the heart; Malignant neoplasms; Cerebrovascular diseases; Chronic lower respiratory diseases; Accidents (unintentional injuries); Diabetes mellitus; Alzheimer's disease; Influenza and pneumonia; Nephritis, nephritic syndrome and nephrosis; and Septicemia and accounted for about 78% of all deaths occurring in the United States" (Centers for Disease Control and Prevention, 2007). A review of these statistics makes us think of our patients and all the complexities and complications of care they have with a "single" diagnosis. One example is the cancer patient with multiple site involvement or the cardiac patient who has recurrent cardiac problems necessitating emergency room or primary care visits and even hospitalizations. An article in the December 4 issue of Annals of Internal Medicine entitled "Medication Use Leading to Emergency Department Visits for Adverse Drug Events in Older Adults" (Budnitz et al., 2007) found that 3 common drugs triggered the most emergency room visits by older adults. These drugs were warfarin (Coumadin), insulin, and digoxin. Think of home healthcare patients; they are often on one or all 3 of these medications!! The authors reviewed surveys of emergency room visits from 2004 and 2005. This interesting article has implications for home healthcare, and readers are encouraged to review it. This may be the time to think in a way that truly helps to promote health and avoid complications.
To that end, this issue of Home Healthcare Nurse offers the theme of technology as one way to monitor and intervene early on in complications. Madeline M. Lorentz's "Telenursing and Home Healthcare: The Many Facets of Technology" explains the fundamentals of the options, which are very important for organizations that do not yet offer or have just started using this technology in patient homes. Lisa M. Canady's "One Organization's Experience Implementing a Home Telemonitoring Program" offers practical insight and lessons learned from the process. Paula Suter's "Home-Based Chronic Care: An Expanded Integrative Model for Home Health Professionals" provides information on one innovative program.
Maryjo Prince-Paul and Barbara J. Daly's Hospice & Palliative Care column discusses the practical aspects of moving knowledge forward, into practice and to the patient. "Moving Beyond the Anecdotal: Identifying the Need for Evidence-Based Research in Hospice and Palliative Care" is a must-read for those seeking answers to the many questions posed in care.
Along with chronic disease come complexities and sometimes, complications. Bonnie Lauder and Nina Gabel-Jorgenson bring us "Recent Research on Health Literacy, Medication Adherence, and Patient Outcomes," concerning components of successful chronic disease management.
Together, we can think of new ways to improve these complexities and provide better care for patients, with research as the rationale for the choices and processes. Please send me an e-mail at [email protected] if you have an idea you would like to develop and write about or have a submission that you believe would help your colleagues in home care and hospice. I welcome your thoughts!!
TINA MARRELLI, MSN, MA, RN
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