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Educating for Success: How We Prepare Our Nurses For House Calls

Posted 5/13/2015 Categories: nurses, home health

By Kate Jones, RN, MSN, CCM, Amedisys Chief Clinical Officer

During National Nurses Week, I would like to share some of the attributes that make health care at home nurses – like the compassionate clinicians here at Amedisys – so special.

Nurses who deliver health care at home function differently from nurses in hospitals, nursing homes, assisted living facilities and other practice settings. That’s why we at Amedisys educate our nurses accordingly. And why all home health care organizations should do likewise.

The differences with care given in institutions are numerous. A home health nurse, for example, may average five or six personal patient visits a day, driving several miles from one home to another, rather than staying in a single place, sometimes facing bad weather, slow traffic and mean dogs. They may need to be on call after hours and on weekends, instead of logging only specific shifts.

But beyond such logistics, home health nurses must be prepared to operate independently, without immediate access to other health care practitioners only a few doors down the hall. They should be infinitely adaptable, no matter what the situation, always ready to solve a given problem, whether ensuring mobility in each environment or safeguarding medication compliance. They should also be well organized, precise in documenting every visit electronically, and communicate effectively with other members of the home health team, including physicians, primary caregivers and families.

Above all, home health nurses are uniquely privileged. They are more than clinical experts focused on the best possible care to patients. They’re also guests, trusted advisors, teachers and caring visitors all rolled into one.

At Amedisys, as industry leaders, we’ve designed an orientation program expressly to prepare our home health nurses to bring care right to the front door. We teach the rules that are applicable for home care in general and for Medicare patients in particular. We educate our nurses in the multiple special demands involved. We used a blended learning approach of computer based learning and preceptor support. Nurses who are new to home care face a steep learning curve, but they’re always open to learning and improving. And in order to support such success, we make sure all our lessons are driven home.

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The Big Talk Every Physician Owes Older Patients

Posted 2/17/2014 Categories: hospice, long-term, home health

All too often, physicians decide against initiating a conversation with elderly patients about long-term care without an urgent need to do so.
But talking the talk literally comes down to a matter of life and death.
What to do?
For starters, medical education should be improved. Universities should adopt training in long-term care, including how to talk with patients about it. As it happens, Amedisys conducts two Continuing Medical Education programs for physicians about long-term care, one focused on healthcare at home, the other on hospice.
Second, conduct peer-reviewed research into physician and patient attitudes toward long-term care. Explore outcomes, too, to foster a better understanding of the issues at hand and develop potential solutions.

Third, advocate for the creation of guidelines, policies and protocols about physician-patient conversations about long-term care. Right now a recommendation of long-term care is seen as a negative metric. But we’ve got it exactly backwards. It’s actually a step in the right direction.
Fourth, pass the torch. Encourage other medical professionals – nurse practitioners, physicians’ assistants, therapists and social workers – to likewise talk the talk.
So think long-term. Only then will every patient you see get his or her due.
Please see my new commentary piece about this topic – about why this issue exists in the first place and more of my blueprint on how physicians should start this conversation – in the latest issue of Modern Healthcare: http://www.modernhealthcare.com/article/20140201/MAGAZINE/302019979
Michael Fleming, MD, FAAFP is the Chief Medical Officer for Amedisys, and Past President of the American Academy of Family Physicians and the Louisiana Academy of Family Physicians. Dr. Fleming has served as Speaker of the Congress of Delegates of the AAFP and as Board Chair of the AAFP Board of Directors. He serves as an assistant clinical professor in the Department of Family Medicine at the LSU Health Science Center and in the Department of Family and Community Medicine at Tulane University Medical School.
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Medication Management Interventions Reduced Avoidable Hospital Readmissions

Posted 11/6/2013 Categories: medication management, readmission rates, hospitalizations, research, home health

At Amedisys, we're dedicated to identifying post-acute care interventions that can help reduce avoidable hospital readmissions. That's why we worked with Purdue University and HealthStatRx to conduct a study that highlights a medication therapy management intervention to help patients better manage their medications and prevent unnecessary admissions and readmissions.

Our results showed that the patients in the moderate-risk category had a readmission rate that was eight percentage points lower than the patients in the control group.

The medication therapy management study focused on:

  • Risk-stratifying of patient population and modeling the probability of hospitalization during the home health episode of care.
  • Engaging a pharmacist to review patient charts for any possible triggers; with the pharmacist proactively notifying the Amedisys care team including the physician and home health caregivers if any issues were identified.
  • Having the pharmacist directly engage the patient via a phone call immediately upon admission to home health to educate them on their evaluation of their medication/s and also conducting follow-up calls directly with the patient between day seven and day 30.
  • Collaboration between the pharmacist, physician, patient and the Amedisys care team to resolve any identified problems.

“Our findings indicate that patients in risk level 1, who can take medications independently and have fairly good functional health, benefit from this type of intervention,” stated Dr. Alan J. Zillich, PharmD, Associate Professor of Pharmacy at Purdue University and lead investigator on this study.

“This study also shows that a strong relationship exists between the probability of hospitalization, the patient risk score and the total number of medications a patient is on,” stated Julie Lewis Sutherland, vice president of research and development for Amedisys. “Just as we hypothesized, post-acute care interventions can make a positive impact on preventing issues the elderly may have with their complicated medication regimes; ultimately resulting in lower readmissions.”

More than 40% of people over the age of 65 take five or more medications, and each year, about one-third of them experience a serious, adverse drug event, like a bone-breaking fall, disorientation, inability to urinate or even heart failure.

Read the full case study to learn more on how post-acute medication management can help reduce preventable hospitalizations and readmissions.

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Longitudinal Chronic Care Needed to Reduce Burden of Disease

Posted 12/20/2012 Categories: heart health, home health, diabetes, chronic care

Last week an important new study drove home a point that deserves wider attention. It is this: managing chronic disease requires an effort that is sustained 24 hours a day, seven days a week, 365 days a year. And no approach is better equipped to achieve that objective than the new, ever-evolving discipline of healthcare at home.

The study, published in the British journal, The Lancet, took a look at the global burden of disease over the last 10 years. It came as no surprise to me that the single biggest contributor to this burden is chronic disease. As life expectancy climbs in the U.S., so, too, does the number of years people will live with chronic diseases ranging from diabetes and high blood pressure to heart disease and mental health disorders. This shift in longevity calls for the U.S. healthcare delivery system to change its paradigm, and dramatically so.

That overarching shift in strategy can only be accomplished through a model that truly integrates and coordinates care – and that, more specifically, partners primary care physicians, nurse practitioners, therapists and other healthcare professionals with providers of high-quality healthcare at home. Healthcare delivery should no longer consist, for example, of a twice-a-year check for a blood pressure or a four-day hospital visit for pneumonia. That kind of episodic engagement, though highly valuable, ultimately represents short-term thinking.

Rather, healthcare has to be practiced year-round, and even minute-by-minute. Managing patients with chronic disease should involve daily monitoring of the most vital criteria, including blood pressure, diet and physical activity. Only then can our patients meet the daily functional goals of day-to-day living.

Others have made this argument before. Dr. Ed Wagner and colleagues at the MacColl Center pioneered a model of chronic care management that incorporates these principles. Susan Dentzer, editor-in-chief of the policy journal Health Affairs, said this model “delivers superior patient care and health outcomes.” In short, primary care teams everywhere must reorient themselves. They must team up ever-more with the highly skilled clinicians who are increasingly deployed to care for patients at home.

You can read the entire Global Burden of Disease study at The Lancet.

About the Author

Michael Fleming, MD, FAAFP is the Chief Medical Officer for Amedisys, and Past President of the American Academy of Family Physicians and the Louisiana Academy of Family Physicians. Dr. Fleming has served as Speaker of the Congress of Delegates of the AAFP and as Board Chair of the AAFP Board of Directors. He serves as an assistant clinical professor in the Department of Family Medicine at the LSU Health Science Center and in the Department of Family and Community Medicine at Tulane University Medical School.
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Discuss Patient Goals of Care for Home Health and Hospice Month

Posted 11/19/2012 Categories: chronic care, home health, patient goals of care, hospice, caregiving

As patients age and develop chronic medical conditions, they usually begin to modify their medical care goals. The burden of chronic illness and its associated debility causes many people to want to alter their medical treatment to meet their goals.

Unfortunately many health care professionals neglect to ask patients about their goals of care. In the haste to provide state-of-the-art complex medical care, whether in the hospital, clinic or home environment, many practitioners simply don’t think about asking patients what is important to them. Sometimes it’s assumed that the patient’s goal of care is obvious or the same as our goal. This assumption can lead to scenarios in which elderly patients receive care that is overly burdensome and undesired.

Most physicians and nurses don’t need to think long to recall patients we know who received medical care they didn’t want. In my primary care and hospice practice I encountered numerous elderly patients who had been treated in the intensive care unit with intravenous infusions, ventilators, dialysis and invasive monitoring devices, and after discussion with the patient and family it became clear that this treatment was never desired by the patient. The problem, of course, was that the physicians and clinicians involved didn’t take the time to ask the patient about his or her wishes.

As we celebrate National Home Health and Hospice Month and Amedisys’ 30th birthday, we urge the health care community to give patients and their families the best gift we can: a discussion with them about their goals of care. Whether you are a physician, nurse, social worker or other caregiver, take the time to sit down with your patients and ask them about what they want in their care plan.

You might ask questions like these:

  • In terms of your medical treatment, what is most important to you at this point? For example, are you interested in getting stronger, reducing the medications you take or strengthening relationships with your family? Is symptom control most important to you or is living as long as possible most important to you?
  • In what setting do you want to be treated? Do you want to go to the hospital or would you rather be treated at home if possible? If needed do you want to go to an assisted living facility or nursing home?
  • What treatment burden are you willing to accept? Would you agree to dialysis if your doctor ordered it? Are you willing to have surgery or be placed on a ventilator?

We must acknowledge several realities when asking patients these questions. First, some patients have goals that are unrealistic. Patients may want to stay at home even when they are unsafe at home or have family members who are unable to care for them. Patients may want their medical problems treated without making necessary lifestyle changes. Second, as patients’ conditions change their goals may change. Finally, patients may not be able to easily answer these questions.

Even though these issues are real, it doesn’t mean we shouldn’t ask the questions. Oftentimes the most difficult discussions are the most important ones to have in health care (learn a helpful technique for difficult medical conversations here). Excellent clinicians will repeatedly discuss these issues with patients so they can continue to clarify and reach realistic goals over time. Only then can patients receive the type of medical care they want in the location of their choice and in a way that will help them reach their goals of care.

Five Wishes Advanced Care PlanningFor detailed advanced planning that patients and their families can work on together, you might suggest Five Wishes. The Five Wishes workbook is a clear, simple way to talk about plans for care at the end of life, and is legally valid in 42 states. Download a copy of Five Wishes »

About the Author

Kevin Henning, MD, FAAFP, FAAHPM, is chief medical director of Amedisys Home Care and Hospice. He is a nationally recognized leader in hospice and palliative medicine.

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