Tag Archives: diabetes

8 ways hospitals are cutting readmissions

Written by Megan Knowles | August 15, 2018 | Print  | Email

As hospitals work to reduce readmissions, healthcare experts are looking at why patients return to the hospital and strategizing ways to keep discharged patients from becoming inpatients again, according to U.S. News & World Report.

1. Rapid follow-up. Congestive heart failure patients are some of the patients who have the highest risk of early hospital readmission, and patients who see a physician soon after their hospital stay or receive a follow up from a nurse or pharmacist are less likely to be readmitted, a study published in Medical Care found.

graph of top causes for hospital readmissionAfter researchers looked at about 11,000 heart failure patients discharged over a 10-year period, they found the timing of follow-up is closely tied to readmission rates, said study co-author Keane Lee, MD. “Specifically, it should be done within seven days of hospital discharge to be effective at reducing readmissions within 30 days,” Dr. Lee said.

2. Empathy training. When clinicians are trained in empathy skills, they may better communicate with patients preparing for discharge, and encouraging two-way conversations may help patients reveal their care expectations and concerns. Providers at Cleveland Clinic, for example, receive empathy training to better engage with patients and their families.

3. Treating the whole patient. When a patient suffers from multiple medical conditions, catching and treating symptoms of either condition early may prevent an emergency room visit. Integrated care models make it easier to give patients all-encompassing, continuous care, said Alan Go, MD, director of comprehensive clinical research at the Kaiser Permanente Division of Research in Oakland, Calif.

4. Navigator teams. A patient navigator team of a nurse and pharmacist can help cut heart failure patient readmissions. Patients who are discharged may be overwhelmed by long medication lists and multiple outpatient appointments. A patient navigator team of a nurse and pharmacist can help cut heart failure patient readmissions.

One study examined results of these teams at New York City-based Montefiore Medical Center. The navigator team helped reduce 30-day readmission rates by providing patient education, scheduling follow-up appointments and emphasizing patient frailty or struggle to comprehend discharge instructions.

5. Diabetes home monitoring. For high-risk patients with diabetes and coronary artery disease, home monitoring can help avoid readmissions. In a study examining a Medicare Advantage program of telephonic diabetes disease management, nurses conducted regular phone assessments of patients’ diabetes symptoms, medication-taking and self-monitoring of glucose levels. The study found hospital admissions for any cause were reduced for the program’s patients.

6. Empowered patients. It is critical for patients to understand their care plan at discharge, including medications, physical therapy and follow-up appointments, said Andrew Ryan, PhD, professor of healthcare management at the University of Michigan School of Public Health in Ann Arbor. “Patients don’t want to be readmitted, either,” Dr. Ryan said. “They can take an active role in coordinating their care. Ideally, they wouldn’t have to be the only ones to do that.”


Eric Topol’s Top 10 Tech Advances Shaping Medicine


January 11, 2018

Each year, I look back at the top 10 tech advances that made headlines the previous year, and these technologies promise to revolutionize medicine in the coming year. Here they are, not in any particular rank order.

1 and 2. Gene Therapy and Gene Editing

These two biotechnologies are being used in clinical trials for diseases that once were deemed untreatable but now are believed to be curable someday, largely due to these important new tools. First, let me differentiate the two because there is considerable conflation and confusion about what they mean.

Gene therapy scored some rapid-fire successes this past fall[1,2,3] after a 20-year “winter” during which things looked pretty bleak and even some advocates feared that there might never be a comeback. On December 19, 2017, the US Food and Drug Administration (FDA) approved the first gene therapy that targets a disease caused by mutations in a specific gene. The treatment, voretigene neparvovec-rzyl (Luxturna™; Spark Therapeutics), is delivered surgically via subretinal injection to treat a rare form of inherited vision loss that can lead to blindness.

As for genome editing, ex vivo manipulation of T cells for leukemia[4] and HIV[5] has been used for several years, but the first case of in vivo editing was performed just this past November in a 44-year-old man with Hunter syndrome. We do not yet know the outcome.

3. Deep Learning of Skin Cancers

Esteva and colleagues at Stanford University created a deep-learning algorithm to diagnose skin cancer, and then tested it against 21 board-certified dermatologists. As they reported in Nature ,[6] the algorithm matched the clinicians’ ability to correctly identify malignant and benign lesions.

This represents an “in silico” demonstration or computer modeling of a biological process; a prospective real-world study in patients will be necessary to assure that the very high accuracy of the deep-learning algorithm is clinically validated. If it is, the developers hope that it can then be transitioned to mobile devices and that the visual diagnosis technology will be used in other fields as well.

4. “Panoromic” Cancer Evaluation

Last year I was able to visit Tempus Labs, a Chicago enterprise operated by Eric Lefkofsky, the co-founder of Groupon. He launched Tempus in 2015 after his wife developed breast cancer and they were unable to find a place for her to undergo a comprehensive evaluation.

Now, Tempus is collaborating with most of the National Cancer Institute’s comprehensive cancer centers in the United States and providing across-the-board cancer testing: sequencing of patients’ tumors and germline DNA; liquid biopsy of cell-free DNA; RNA sequencing of tumors; immune system characterization of tumors and patients; organoid cultures of tumor cells with drug testing; machine learning of all of these layers of information with the electronic medical record; pathology reports; and all medical imaging.

Previously, some companies offered isolated tests, but this is the first one to do them all. We await publications that spell out whether this rigorous, multilayered information approach will change patient outcomes.


Strengthening Workplace Health, One Resource at a Time

Use CDC Workplace Health Resource Center to help employees improve their health.

Isabel Kurita of the Boise School District in Idaho promotes healthy lifestyles among employees to lower risks like obesity that may lead to chronic diseases like diabetes. “We have the same concerns as everyone else in the country when it comes to health risks. We want to make sure we have behavior change programs to reach as many people as possible.”

The wellness coordinator for 3,200 employees and retirees, Kurita was happy to find a new place for good ideas and tools to improve her team’s health.

photo of employees in break room for article, Strengthening Workplace Health, One Resource at a TimeIt’s the Workplace Health Resource Center (WHRC), a new website CDC launched in August 2017 with more than 200 tools to help employers build their wellness programs—from breakroom posters to guides on how to reduce heart disease and stroke.

WHRC offers these free resources for organizations to help employees with high blood pressure, high cholesterol, diabetes, depression, obesity, smoking, and other health concerns.

CDC introduced the new website at the Public Health Grand Rounds, a monthly series created to encourage discussion on major public health issues like workplace wellness.

Worksite Health Scorecard logoCDC Worksite Health ScoreCard has science-based strategies to help prevent heart disease, stroke, and other conditions.

New Workplace Health Resource Center

CDC and other health and wellness experts continually screen new information to add to the website. A one-stop shop for workplace health promotion and wellness tools, the WHRC includes:

  • Tutorials on how to start a workplace health promotion program that fits each organization’s needs
  • Webinars
  • Videos
  • Case studies on what has worked for other employers when it comes to fitness, obesity, stress management, quitting smoking, and work/life balance strategies.[SEE FULL STORY HERE]

Want to Decrease Disability by 53%?

According to a recent issue of Health Affairs, all we have to do is completely eliminate five risk factors: smoking, obesity, diabetes, high cholesterol, and hypertension.

Easy, right?

 graph showing risk factors ofsmoking, obesity, diabetes, high cholesterol, hypertension leading to disabilitiesI find it amazing that these risk factors contribute to (potentially, depending on the credibility you lend the study) more than half of all disability in this country.

And given that the study (Preventing Disability: The Influence of Modifiable Risk Factors On State and National Disability Prevalence) is written from a non-work comp perspective, I view this as more of challenge in our industry (where we accept the whole person and have relatively little influence over pre-injury behavior).

If the theoretical elimination of all five risk factors is a bridge too far for you, consider a more conservative analysis contained in the study: If each risk factor was reduced to the level of the “best performing” state (i.e., if all states mirrored the nation’s lower obesity rate of Colorado), we would observe a decline in disability prevalence of approximately 7%. And disability rates in regions where prevalence is highest (South, Appalachia, and Great Lakes) would drop more than 10% under such a scenario.

But our starting point is grim. In the 18-54 age cohort, nearly 70% of US adults have more than one of the five risk factors. In the 55-64 cohort, it’s about 90%. And in the 65-79 category, about 95%.

This isn’t just clinical, it’s cultural.


Poor Health and Safety Practices Hurt Job Performance

 06/01/17   Simply Work Comp

How do you reduce absenteeism and presenteeism in your employees?

Simpsons workplace safety posterMaintaining a safe workplace and encouraging health and wellness in the workplace may be part of it, according to two recent studies.

CDC measures the cost of chronic conditions

In an October 2016 CDC report, researchers measured the costs of absenteeism in employees with five conditions – hypertension, diabetes, smoking, physical inactivity and obesity.

How costly were the missed workdays? In the billions of dollars.

The researchers estimated that each of the conditions cost employers more than $2 billion per year in excess absenteeism. The most expensive of these, obesity, was calculated at $11.2 billion. In their findings, hypertension caused the most missed workdays per employee and cost nearly $300 per employee per year.

For each condition, employees missed an estimated one to two workdays per year. Those with multiple conditions had more missed days.

Study finds workplace safety impacts job productivity

Another study, published in Health Affairs, measured productivity losses from another angle and found similar results to the CDC report.

The researchers looked at factors such as previous workers’ compensation claims, chronic health conditions and how physically or cognitively demanding a job was to measure health-related productivity losses. They then calculated the predicted costs of absenteeism and presenteeism per person per year.

The study, “Chronic Conditions, Workplace Safety, and Job Demands Contribute to Absenteeism and Job Performance,” found that these factors contributed to both absenteeism and presenteeism. The study was conducted by the Integrated Benefits Institute, Segue Consulting and the Colorado School of Public Health Center for Health, Work and Environment.

While absenteeism was measured in the number of sick hours taken in the last four weeks, the study authors acknowledge that presenteeism can be difficult to measure. They asked employees to rate their poor job performance on a scale from 0 (best) to 10 (worst) and converted the metrics into annual costs. They write, “There is

They write, “There is good reason to believe that presenteeism—when employees come to work but perform at lower levels than usual because of health reasons—often accounts for more lost productivity than absenteeism.”

Study findings:

  • Chronic health conditions and previous workers’ compensation claims contribute to higher absenteeism and presenteeism.
  • Workers with more chronic health conditions had proportionally more cases of absenteeism and presenteeism.
  • Employees with physically demanding jobs reported higher absenteeism, while more cognitively demanding jobs were linked to presenteeism, and “presenteeism is highest when jobs are both physically and cognitively demanding.”
  • The combination of multiple risk factors often led to increased absenteeism and presenteeism, such as employees who had both physically demanding jobs and a workers’ comp claim in the past year.
  •  Employees with none of these factors had lower presenteeism and absenteeism


Apple Watch Engineers Working On Way To Read Glucose Levels,

But Let’s Be Realistic.

Dr. Iltifat Husain’s physician take is at the end of this article

The Apple Watch could soon be used as a tool for glucose monitoring that could change the lives of millions who are managing diabetes, according to CNBC. The news organization reported that Apple engineers have been developing a way to read glucose levels continuously without puncturing the skin by using lights and sensors on the Apple Watch.

SCREENSHOT: continuous glucose monitoring appLast year, Apple hired Dr. Rajiv Kumar, a leading pediatric endocrinologist from Stanford, which caused a lot of excitement in the medical community, including iMedicalApps.com, and maybe offered a clue to the company’s long game.

Whether or not Dr. Kumar’s hire was a hint, for the past five years, 30 researchers have allegedly been secretly exploring the noninvasive technology in a “remote location.” While that intriguing detail might seem to be out of a biotech spy story, it has every reason to be. If true, this would be a groundbreaking next step for mobile health and telemedicine.

There are already diabetes management apps on the market, including “smart” socks and continuous glucose monitoring apps. A nonintrusive continuously monitoring device seems to be the holy grail in Silicon Valley. Google has prototyped a contact lens, and Dexcom is working with Verily to create smaller glucose-monitoring devices.

Dr. Iltifat Husain’s take

While having the Apple Watch monitor glucose levels would be fascinating, we need to be realistic as well. There are massive regulatory and also clinical situations that would need to be taken into consideration before the Apple Watch could try to read glucose levels in a noninvasive manner. A project like this would require clinical trials to test efficacy, along with a slew of discussions and testing by the FDA. Frankly, this isn’t realistic for a company like Apple.  Apple in the past has done everything possible to make sure they don’t fall under FDA scrutiny — so I don’t think this is something they would come to market with first. I compare this to Apple trying to create a self driving car — it sounds cool, and they might create a “concept car” in 5 years or so, but we all know they aren’t going to be selling cars anytime soon.


Pop Quiz; Are Soda Taxes Changing America?

By Judge David Langham 12/06/2016

illustration of soda equal to eathing 22 packs of sugarA few years back, I introduced the sugary soda debate in Get Me a Huge Soda Please. There is co-morbidity in workers’ compensation. One that has attracted discussion and attention is obesity.

It turns out that those of us with a few extra pounds can be more challenging to treat following an injury. Months later, New York encountered legal issues with its effort to tax soft drinks, noted in Can I get a Team Gulp with that Please.

In the last election, voters in four cities were confronted with whether to impose a tax on soft drinks and other “sugar-sweetened beverages. According to CNN, in early November, ballot initiatives were proposed in “San Francisco, Oakland and Albany, California; and Boulder, Colorado.”

The purported drive behind the taxation effort is to discourage consumption. If the cost of the soft drink is increased sufficiently by the taxation, then people will consume less of the soft drink. CNN says that “soda beverages have been associated with an increased risk of obesity, type 2 diabetes, heart disease and possibly heart failure.” Proponents claim that their efforts are not directed at revenue from taxes, but at improved health. There are claims that such taxation detriment works in that regard.
Continue reading Pop Quiz; Are Soda Taxes Changing America?

More Direct-to-Consumer Telehealth Coming in 2016

More direct-to-consumer telehealth coming in 2016, says Wen Dombrowski

February 09, 2016 | Tom Sullivan – Executive Editor, HIMSS Media

Dr. Wen Dombrowski, MD
Dr. Wen Dombrowski, MD

Wen Dombrowki, MD, has been in the field of clinical informatics since the 1990’s. Back then, her work involved building diabetes databases for community health centers.

Today, she’s a geriatrics physician executive at Resonate Health, a role that sees her combining technology, social media, and business solutions to help patients with complex conditions.

Dombrowski is also one of only a fistful of social media influencers to sit in the top slot of the #HIT100 list.

We reached out to Dombrowski ahead of HIMSS16 to discuss what she’s hoping to find at this year’s conference, what trends she expects to see taking hold in 2016, and what she sees as the untold benefit of social media for healthcare.

Q: What’s something about you that even your devout followers likely don’t know?
A: My early days in Clinical Informatics were in the 1990’s building diabetes registry Access databases for community health centers in inner-city of Chicago. As part of an IHI (Institute for Healthcare Improvement) Diabetes Learning Collaborative, I learned to track key clinical measures and use the data to identify and reach out to patients with gaps in care.

Q: One health IT prediction for 2016?
A: In 2016 we will see more direct-to-consumer telemedicine and other digital health services. Mainly because consumers are increasingly demanding easy-access user experience of healthcare, and also because technologies are maturing while state and federal payment policies are starting to cover telehealth. I really like this recent quote: “The digital strategy of a healthcare organization must be aligned with everyday consumer experiences in other industries,” from @dchou1107.


Beating Fat Employees with a Stick


Employee Wellness program graphic chartThe increasing girth of the average American is becoming a pretty weighty issue, and employers tired of having paint scraped off door frames are beginning to take notice. Some are beginning to turn away from incentive based health programs to efforts that actually punish employees or restrict benefits for those who do not participate. Excessive weight in America, it turns out, is a really big fat problem.

7 in 10 Americans are now overweight, with more than one third classified as obese. It is a surprising and disturbing statistic. I’ll tell you, I almost dropped my Tootsie Roll when I read it.

For a number of years many employers have been offering wellness programs in the hope that the tubbo’s on their payroll (statistically most of us, including yours truly) would participate and develop a healthier and less expensive (or expansive?) lifestyle. Alas, it was not to be. I maintain they would have had better success if they had offered ice cream and pizza to encourage people to get with the program, but what do I know? It just seems that dropping pounds and getting healthy is too hard to be attempted just because it is good for us.

No, we need to be beaten with a stick to get the point across. Continue reading Beating Fat Employees with a Stick

Apple Watch Could Revolutionize Diabetes Care

by David Ahn, MD (@AhnCall), Iltifat Husain, MD

David Ahn MD is currently finishing his fellowship in Endocrinology

AppleWatchOne of the most impressive takeaways of the recently announced Apple Watch was its individuality: a unique interface, brand new input methods, and a whole new ecosystem for innovative third party apps.

I immediately thought of my patients with diabetes who currently carry up to four separate electronic devices in their pockets to manage all their technology: a smartphone, a glucometer, an insulin pump controller, and a continuous glucose monitor receiver.

As diabetes companies are already scrambling to make their next generation of products compatible with the iPhone to eliminate the bulk of extra devices, the Apple Watch could provide glanceable information and eliminate the need to reach into your pocket or purse. With its Taptic engine that can produce a “tactile sensation that’s recognizably different for each kind of interaction,” you won’t even have to glance at your wrist.

The Current Problem: Too Many Devices

Continue reading Apple Watch Could Revolutionize Diabetes Care