Tag Archives: Hypertension

Remote patient monitoring cuts hospital admissions, ER visits, report finds

Doctor conferring with patient and on-screen specialist for article, Remote patient monitoring cuts hospital admissions, ER visits, report findsDive Brief:

  • One-fourth of healthcare organizations say remote patient monitoring reduces emergency room visits and hospital readmissions, while 38% say the technology results in fewer inpatient admissions, according to a new KLAS Research report.
  • The industry-backed American Telemedicine Association and the research group looked at how RPM is impacting providers and payers, talking with 25 organizations that used RPM products from seven different vendors.
  • The key use cases for remote patient monitoring were heart disease and chronic obstructive pulmonary disease, though interest in using RPM for other conditions like diabetes and hypertension is starting to pick up. RPM is also seeing some limited use in mental health, surgical recovery, dementia and cancer.

Dive Insight:

Remote patient monitoring is a growing sector in the digital health space, with an aging population and the opportunity to better manage chronic conditions. There is a potential windfall for companies with the right idea and clinical evidence to back it up, and investors are lining up to get a piece of the action. Disease monitoring was among the top-funded value propositions in last quarter, with $781 million across 38 deals, according to Rock Health.

RPM also holds potential to improve health outcomes. In a 2017 study, breast reconstruction patients with access to a mobile app that allowed them to submit photos and report information to their doctors had fewer post-surgery follow-up appointments than patients without the app. Patients using the app also rated their follow-up care higher on convenience.

Payers are recognizing its benefits and incentivizing its use, too. In its physician fee schedule final rule  for 2018, CMS unbundled a code for RPM, allowing physicians to seek reimbursement for collecting and interpreting health data generated remotely by patients, digitally stored and sent to providers, with a minimum of 30 minutes.

The move marked a “huge win” for RPM and a “big step forward for Medicare’s ability to deal with chronic conditions,” Gary Capistrant, the ATA’s chief policy officer, told Healthcare Dive earlier this year. He noted that several years ago when Medicare covered a code for chronic care but didn’t cover remote monitoring, the result was a tepid uptake.

Use of RPM is growing across all use cases, but is particularly robust for hypertension, mental health and cancer, where there is a lot of room for growth, according to KLAS.

According to the report:

  • 13% of organizations report RPM improves medication compliance;
  • 8% say it lowered A1c levels, an indication of how the body is maintaining blood glucose levels;
  • 13% say it improved patient health;
  • 25% report greater patient satisfaction; and
  • 17% cite quantified cost reductions.


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


To Bring Down Stubbornly High Blood Pressure, It Helps To Have A Team

5/4/2017     Science : NPR     Wendy Rigby

Patient getting team approach to high blood pressure treatment
Ann Mazuca has diabetes and glaucoma that can be aggravated by high blood pressure. The support shown by clinic staff at the University Family Health Center Southeast, in San Antonio, helps her do what’s needed to reduce hypertension, she says. “The fact that they care makes me care.”
Wendy Rigby/TPR

You’ve probably heard the phrase “it takes a village” to get things done. Many clinics across the U.S. are finding that’s true for effectively controlling their patients’ high blood pressure.

“It’s not just medications that are required to treat hypertension,” explains Kirk Evoy, a clinical assistant professor at the University of Texas Health Science Center in San Antonio and pharmacist at University Family Health Center Southeast. “It’s also things like lifestyle changes,” he says. “What do you eat? Do you exercise? Do you smoke?”

A quick prescription and an annual lecture from a doctor aren’t always enough to get ahead of this quiet killer, specialists say. Some patients need extra coaching — and from different kinds of coaches.

Take Ann Mazuca, for example. She’s 63, has diabetes, is developing glaucoma and really struggles to keep her blood pressure down.

“I know that I have to try to help myself,” Mazuca says, but weekly check-ins with the staff at University Family Health Center Southeast help keep her on track in juggling her various conditions. “The fact that they care makes me care,” Mazuca says. “People want me to live. And that gives me a lot of hope.”

Continue reading To Bring Down Stubbornly High Blood Pressure, It Helps To Have A Team

Michael O’Riordan

Types of wellness programs used by employers based on number of employeesAugust 29, 2012 (Munich, Germany) — Preliminary data from a work fitness program suggests that prevention strategies might be more effective if they target individuals in the workplace rather than the doctor’s office. The program, started in 2005, reduced the rates of smoking, improved blood pressure control, reduced the incidence of metabolic syndrome, and improved the 10-year predicted risk of cardiovascular disease, according to researchers.

“The workplace is the ideal setting for primary and secondary prevention, because there we can get access to all patients at risk,” said Dr Johannes Scholl (Prevention First, Ruedesheim, Germany) during a presentation closing out the European Society of Cardiology 2012 Congress. “Close cooperation between respective departments of occupational medicine and specialist prevention clinics is the basis for good compliance and success.”

For Scholl, the workplace is better suited for primary and secondary prevention, as many younger patients, including those with undetected hypertension and elevated cholesterol levels, are not frequent users of primary-care physicians. As a result, many of their cardiovascular risk factors go untreated.

Fit in Life, Fit on the Job

Initiated in 2004 and known as the “Fit in Life, Fit on the Job” program, Boehringer Ingelheim employees in Germany were enrolled through the department of occupational medicine. During their index visit, physical examinations and family-history assessments were performed, and all biometric data recorded. Two weeks later, employees went to the Prevention First clinic for a more complete assessment, including baseline carotid intima-media thickness (IMT) measurements, fitness testing to maximal exhaustion, and a full cardiovascular risk assessment. After these examinations, individuals were shown their 10-year and longer-term risk of cardiovascular disease and prescribed comprehensive nutritional and exercise recommendations. Continue reading

Drinking Fewer Sugar-Sweetened Beverages May Lower Blood Pressure

photo of man with over-sized Big Gulp soda cup and straw
Time for Little Gulp?

ScienceDaily (May 25, 2010) — Drinking fewer sugar-sweetened beverages — a leading source of added sugar in the U.S. diet — may lower blood pressure, according to research published in Circulation: Journal of the American Heart Association. Increased consumption of sugar-sweetened beverages (SSB) has been associated with an elevated risk of obesity, metabolic syndrome, and type 2 diabetes, according to previous research. However, the effect of sugar-sweetened beverages on blood pressure is uncertain, said lead author Liwei Chen, M.D., Ph.D., assistant professor at Louisiana State University Health Science Center School of Public Health in New Orleans, La.

“Our findings suggest that reducing sugar-sweetened beverages and sugar consumption may be an important dietary strategy to lower blood pressure and further reduce other blood pressure-related diseases,” Chen said. “It has been estimated that a 3-millimeters of mercury (mm Hg) reduction in systolic blood pressure should reduce stroke mortality by 8 percent and coronary heart disease mortality by 5 percent. Such reductions in systolic blood pressure would be anticipated by reducing sugar-sweetened beverages consumption by an average of 2 servings per day.”

Researchers used data on 810 adults, ages 25 to 79, with prehypertension (between 120/80 and 139/89 mm Hg) and stage I hypertension (between 140/90 and 159/99 mm Hg ) who participated in the PREMIER study, an 18-month behavioral intervention study with a focus on weight loss, exercise, and a healthy diet as a means to prevent and control high blood pressure. At the start of the study, the participants drank an average 10.5 fluid ounces of SSB/day, equivalent to just under one serving. At the study’s conclusion, average consumption had fallen by half a serving/day and both systolic blood pressure (the pressure when the heart beats), and diastolic blood pressure, (the pressure between beats), had declined significantly.
After controlling for known risk factors of blood pressure, the analysis found that a reduction of one serving/day of SSB was associated with a 1.8 millimeters of mercury (mm Hg) drop in systolic pressure and a 1.1 mm Hg decline in diastolic pressure over 18 months. Researchers noted that this association was partially because of weight loss, but even after controlling for weight loss, the change in blood pressure was statistically significant.
Chen noted that American adults consume an average of 2.3 servings (28 ounces) of sugar-sweetened beverages per day. In this study, sugar-sweetened beverages were defined as drinks sweetened with sugar or high-fructose corn syrup including regular soft drinks, fruit drinks, lemonade and fruit punch.
Diet drinks were excluded. The study potentially has important public health implications, because even small reductions in blood pressure are projected to have substantial health benefits on a population level, according to Chen. Continue reading Drinking Fewer Sugar-Sweetened Beverages May Lower Blood Pressure