Category Archives: Dr. Clancy

Health law at 3: Coverage, cost, quality improvements – Viewpoint

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Dr. Carolyn Clancy

Dr. Carolyn Clancy

By Dr. Carolyn Clancy
Director, US Agency for Healthcare Research and Quality

When the Affordable Care Act was signed into law 3 years ago, many Americans paid attention to popular features like letting young adults stay on their parents’ health insurance until age 26 or closing the “donut hole” gap for Medicare prescription drugs.

These portions of the health care law help a lot of people.

As of December 2011, 3.1 million more young adults had health insurance coverage as a direct result of the law, according to a national survey from the U.S. Department of Health and Human Services (HHS).

Gains in coverage among young adults took place in every State. Big jumps (over 75,000 young people) were seen in California, Florida, Georgia, Illinois, Michigan, New Jersey, New York, and Texas.

And starting in 2011, the health care law gave an automatic 50 percent discount on brand-name drugs to Medicare patients who hit the “donut hole.”

(The donut hole refers to a coverage gap that happens once a patient’s drug plan hits a certain limit in a given year. After that point, the patient has to pay all costs for covered drugs on their own for the rest of the year.)

In 2011, the 50 percent brand-name drug discount helped patients get more than $2.1 billion in savings, or $604 per person, according to HHS. (The law changes the brand-name discount each year until the donut hole is closed in 2020). Some patients who had high drug expenses got rebate checks from HHS for $250.

Other parts of the health care law aren’t as well-known, but they also are working to make sure your health care is high quality, safe, and affordable.

I’m particularly excited about one part of the law that is working to keep patients from returning to the hospital soon after they are discharged.

Each year, about 1 in 5 Medicare patients, or 2.6 million seniors, are readmitted within 30 days after they’ve been discharged from the hospital, a major study found.

Being readmitted to the hospital can slow down a patient’s ability to recover or can cause new health problems. This is very expensive, costing the Medicare program about $17 billion per year and causing unneeded problems for patients and families.

Just as worrisome, many of these readmissions can be prevented. Often, patients recover when they understand how to take any new medicines they’ve been given and schedule follow-up appointments.

For example, patients might go their emergency room if they have a bad reaction to new drugs, if there was a miscommunication about medication, or if they could not get to a follow-up appointment with their primary care doctor.

Patients need – but don’t always get—follow-up care that’s better coordinated across the entire care team, including physicians, nurses, pharmacists, physical therapists, and other health professionals.

The Affordable Care Act is working with hospitals with high readmission rates to improve. Hospitals with high readmissions for three conditions (heart attack, pneumonia, and heart failure) now get paid less than hospitals with fewer preventable readmissions.

And we’re starting to see positive results. In 2012, the national rate of hospital readmissions for Medicare patients dropped to about 17.8 percent, compared with 19 percent for the past 5 years. This drop translates to more than 70,000 preventable readmissions each year.

In addition, the Agency for Healthcare Research and Quality (AHRQ) has funded the development of tools to help hospitals reduce preventable readmissions.

The tools include a free brochure for patients and families called Taking Care of Myself: A Guide for When I Leave the Hospital that is available in English and Spanish by calling 1-800-358-9295.

Our ability to reduce hospital readmissions has never been higher, which is good news for patients.

In its 3-year history, the Affordable Care Act has made big strides in expanding coverage, reducing costs for patients, and improving safety and quality of care. While plenty of work remains, it’s exciting to see how far we’ve come.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Navigating the Health Care System: Helping You Avoid Return Trips to the Hospital
http://www.ahrq.gov/news/columns/navigating-the-health-care-system/20120904.html

Re-Engineered Discharge (RED) Toolkit
http://www.ahrq.gov/professionals/systems/hospital/toolkit/index.html

Taking Care of Myself: A Guide for When I Leave the Hospital
http://www.ahrq.gov/patients-consumers/diagnosis-treatment/hospitals-clinics/goinghome/index.html

U.S. Department of Health and Human Services
Healthcare.gov
State-Level Estimates of Gains in Insurance Coverage Among Young Adults
http://www.healthcare.gov/news/factsheets/2012/06/young-adults06192012a.html

Healthcare.gov
Stronger Benefits for Seniors, Billions in Savings This Year
http://www.healthcare.gov/blog/2012/05/medicare052412.html

Centers for Medicare & Medicaid
Community-based Care Transitions Project
http://innovation.cms.gov/initiatives/CCTP/?itemID=CMS1239313

Health Affairs
The Affordable Care Act At Three: Paying for Quality Saves Health Care Dollars
http://healthaffairs.org/blog/2013/03/20/the-affordable-care-act-at-three-paying-for-quality-saves-health-care-dollars/    

Jencks SF, Williams MV, Coleman EA. Rehospitalizations among Patients in the Medicare Fee-for-Service Program.N Engl J Med 2009; 360:1418-1428.

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New tools help health providers reduce patients’ risk of falls

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warning-signBy Carolyn M. Clancy, M.D.

For older adults, falls are serious, whether they take place in the home or in a health care setting.

More than one-third of adults over age 65 fall each year. Falls can cause bone fractures, disability, and even death. Among people 75 and older, falls are far more likely to cause admissions into a long-term care facility than for adults 10 years younger, Federal data show.

An estimated 500,000 falls  happen each year in U.S. hospitals, causing 150,000 injuries. Patients have a higher risk of falls if they—

  • Have weak muscles or problems walking.
  • Take drugs or a combination of drugs that make them sleepy.
  • Use a cane or walker.
  • Have chronic conditions.
  • Need to use the bathroom frequently.

Health care providers have known for a long time that falls among patients are a serious problem. But they haven’t always agreed on the best way to prevent them.

This is changing, which means you or your loved ones may be safer from falls in the future.

Today, many hospitals and long-term care settings use new programs based on scientific evidence of what works best. The goal is to make sure clinicians understand the risk of falls, identify which patients have the higher risk, and take steps to reduce patients’ risk.

One program is an AHRQ-funded project (PDF File, Plugin Software Help) from a Wisconsin health system, a health technology company, and a university-based school of nursing.

They developed a computerized program with four individual care plans, based on patients’ risk for a fall and their ability to follow instructions on how to prevent one.

The program helps nurses develop fall-prevention plans that match patients’ needs and that can go in patients’ electronic health records.

For example, the program identifies patients who are usually at low risk for falls but who may have an injury or condition that increases their risk.

For these patients, steps to reduce falls include—

  • Making sure they are carefully watched the first time they get out of bed after surgery or a procedure.
  • Making sure they or a family member understand the need to call and wait for help before doing something that could cause a fall.
  • Helping them identify hazards or behaviors that make a fall more likely.
  • Learning safer approaches before they leave the hospital.

Some patients are at a high risk of falling but can follow steps on how to prevent a fall.

For these patients, steps to reduce falls include—

  • Making sure they understand why they should use a walker or other device to help them move safely.
  • Consulting with the pharmacist or physician to be careful about drugs that can increase the risk of falls.
  • Using an alert system, such as wristbands, signs, or other communication to warn of the risk of falls.

We know that communication and teamwork among health care providers are important to reduce errors and improve patient safety. In fact, up to 70 percent of medical errors, including falls, are due to breakdowns in communication among health care teams.

To address this need, AHRQ and the Department of Defense have developed a teamwork system specifically for long-term care settings.

Known as TeamSTEPPS®, the system is based on more than 20 years of research into how teamwork improves safety. It is used in hundreds of hospitals across the United States.

Early results show that TeamSTEPPS improves safety and quality in long-term care settings. For example, staff using teamwork skills reduced the rate of serious pressure ulcers among nursing home residents by 48 percent.

Reducing the risk of falls in hospitals and long-term care settings is an important goal. New tools can help health providers—and their patients—attain it.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Using a Computerized Fall Risk Assessment Process to Tailor Interventions in Acute Care
http://www.ahrq.gov/downloads/pub/advances2/vol1/Advances-Hook_25.pdf [Plugin Software Help]

TeamSTEPPS Long-Term Care Version
http://www.ahrq.gov/teamsteppstools/longtermcare/

Centers for Disease Control and Prevention
Falls Among Older Adults: An Overview
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

National Patient Safety Foundation
Key Facts about Patient Safety
http://www.npsf.org/for-patients-consumers/patients-and-consumers-key-facts-about-patient-safety/#Fal

Current as of February 2013


Internet Citation:

New Tools Help Health Providers Reduce Patients’ Risk of Falls. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, February 5, 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc020513.htm

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Make good on your resolution to quit smoking

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Cigarette thumbBy Carolyn M. Clancy, M.D.

For people who smoke cigarettes, the New Year is a popular time to try to quit.

And it’s no wonder why.

Tobacco use kills about 443,000 people in the United States each year or about 1 in 5 deaths annually. It is the Number One cause of preventable deaths, according to the Centers for Disease Control and Prevention.

Quitting smoking is one of the best things you can do for your health and for the health of your loved ones. Within just 12 hours of your last cigarette, the carbon monoxide levels in your blood return to normal.

Within 1 year of quitting, the excess risk of heart disease is half that of a person who continues to smoke, according to the U.S. Surgeon General.

Quitting smoking helps protect the health of people around you, especially babies and children. Secondhand smoke has more than 50 chemicals that are known to cause cancer in adults.

It can also cause lung disease and heart disease in people who have never smoked. Parents who quit smoking provide a great role model to their children and teens.

Within 1 year of quitting, the excess risk of heart disease is half that of a person who continues to smoke.

And contrary to what some people say, smokeless tobacco isn’t a safe option.  It includes chewing tobacco, dip, and snuff.  It causes cancer of the esophagus, mouth, and pancreas.

Like many New Year’s resolutions, deciding to change a behavior isn’t as easy as actually doing it. In fact, many smokers or tobacco users try to quit several times before they succeed.

How can you follow through on your plan to stop smoking for good in 2013?

A great place to start is BeTobaccoFree.gov. The new, comprehensive Web site gives one-stop access to the latest information from the Federal government on tobacco-related information, including evidence-based methods on how to quit.

The Web site includes interactive features, mobile apps, and tools and resources designed specifically for parents, educators, and teens.

For example, people who are getting ready to quit smoking now will find resources and tools to help them.

You can START the process by—

  • S = Setting a quit date. Pick a date within the next 2 weeks. That gives you enough time to get ready, but not so much time that you lose your determination.
  • T = Telling others about your plan to quit. Quitting is easier to do with support from others. Tell family, friends, and co-workers how they can help you.
  • A = Anticipating the challenges you will face. Most people who return to smoking do it within the first 3 months. Be prepared for situations when you will be tempted to smoke and plan for how you will deal with them.
  • R = Removing cigarettes from your home, car, and work. Getting rid of things that remind you of smoking will help you get ready to quit. Clean your car, get rid of lighters and ashtrays, and have your teeth cleaned to get rid of smoking stains.
  • T = Talking to your doctor about getting help to quit. Some people need help to manage the withdrawal from nicotine. Ask your health care provider if a medicine might help you. You can buy some of these medicines on your own, like the nicotine patch or nicotine gum. Others require a prescription.

Another section of the Web site called SmokefreeTeen helps teenagers recognize the pressures they face and how they typically handle them, including whether to start or stop smoking.

Using interactive quizzes, SmokefreeTeen looks at important topics such as depression, stress, and relationships. Answers can help teens understand their behavior style and the role that smoking, or trying to quit, may plan in it.

Another feature for teens is a mobile service called SmokefreeTXT. The service sends text messages with advice and tips on how to stop smoking for good.

Quitting smoking is one of the best New Year’s resolutions you can make to protect your health. The BeTobaccoFree Web site can help you turn your wish into reality.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Centers for Disease Control and Prevention 
Fact Sheet: Fast Fact—Smoking and Tobacco Use
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/

U.S. 2010 Surgeon General’s Report—Smoking and Tobacco Use
http://www.cdc.gov/tobacco/data_statistics/sgr/2010/index.htm

BeTobaccoFree.gov
http://betobaccofree.hhs.gov/index.html

Quit Now: BeTobaccoFree.gov
http://betobaccofree.hhs.gov/quit-now/index.html

Smokeless Tobacco and Your Health
http://betobaccofree.hhs.gov/health-effects/smokeless-health/index.html

SmokefreeTeen
http://teen.smokefree.gov/about.aspx

SmokefreeTeen: SmokefreeTXT
http://teen.smokefree.gov/smokefreeTXT.aspx

Current as of January 2013


Internet Citation:

Make Good on Your Resolution To Quit Smoking. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, January 8, 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc010813.htm

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Seven Pillars: Admitting medical errors to improve patient safety

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Revealing Medical Errors Helps Chicago Hospitals Build a Safer Health System

By Dr. Carolyn Clancy
Director of the Agency for Health Care Research and Quality 

A preventable medical error happened when Michelle Malizzo Ballog had surgery in 2008. Worse, it was followed by tragedy–her death at age 39.

When her family tried to find out what happened, officials at the University of Illinois Hospital in Chicago didn’t dodge questions or have the family talk to the hospital’s lawyers, according to the Chicago Tribune .

Instead, the officials looked into their hunch that a fatal error occurred during Ms. Ballog’s surgery. When they confirmed that information, they met with the family and apologized. The hospital system also provided a financial settlement for Ms. Ballog’s two young children.

But the hospital did more. The hospital changed its process for giving anesthesia so the same error wouldn’t happen again.

This process, called “Seven Pillars ,” was adopted by the Chicago hospital system in 2006. Today, it is getting attention from hospitals in other States. (A similar program at the University of Michigan has cut costs per claim in half since 2001.)

The process is based on openness about medical errors or near-misses so health care providers can fix and prevent them.

Seven Pillars consists of these steps:

  • Report incidents that could harm patients.
  • Investigate those cases and fix problems before an error happens.
  • Communicate when an error occurs, even if no harm was done.
  • Apologize and “make it right” by waiving hospital and doctors’ fees.
  • Fix gaps in the system that can cause things to go wrong.
  • Track data from patient safety reports and see if changes make things safer.
  • Educate and train staff how to make care safer.

How well has the Seven Pillars process worked?

Only 2 years after it started, the process led to more than 100 investigations and nearly 200 specific improvements. It was also the basis for 20 full disclosures of inappropriate care that caused patient harm.

Even though Seven Pillars works at the University of Illinois, can it help in other places?

To find out, the Agency for Healthcare Research and Quality (AHRQ) is funding a 3-year project in 10 Chicago-area hospitals. The entire process is now being tested at five hospitals; the other five will report data only and compare their results to the hospitals using Seven Pillars.

Early indicators are positive. Hospital staff are reporting patient safety incidents, and talking to patients when near-misses or errors take place. In cases where inappropriate care has taken place, patients aren’t stuck paying fees.

The final results of this project are still a year away. But AHRQ is excited about the early results.

And others have noticed. The State of Maryland, the Wyoming Medical Society, and a group of western States are figuring out how to use many elements of the Seven Pillars process. In Washington, DC, the program will begin at MedStar Health in October 2012.

The Seven Pillars process works because it spells out and follows steps that we know make a lasting difference in building a safer health system. Reporting, communicating, creating a culture of learning, and other improvements move us closer to identifying and fixing patient safety gaps, rather than simply assigning blame.

These changes for patients and clinicians will be watched carefully around the country. My hope is that changes like these will build lasting improvements in the safety of our health system.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
AHRQ Innovations Exchange. Full Disclosure of Medical Errors Reduces Malpractice Claims and Claim Costs for Health System
http://www.innovations.ahrq.gov/content.aspx?id=2673

Medical Liability Reform and Patient Safety Initiative Progress Report
http://www.ahrq.gov/qual/liability/medliabrep.htm

McDonald TB, Helmchen LA, Smith KM at al. Responding to patient safety incidents: the “seven pillars.”
BMJ Quality & Safety. Published online March 1, 2010.
http://qualitysafety.bmj.com/content/early/2010/02/26/qshc.2008.031633

Shelton DL. Family of woman who died after medical error joins hospital’s safety panel.
Chicago Tribune, October 7, 2011.
http://articles.chicagotribune.com/2011-10-07/health/ct-met-medical-errors-20111007_1_medical-errors-safety-panel-patient-advocates

Current as of July 2012


Internet Citation:

Revealing Medical Errors Helps Chicago Hospitals Build a Safer Health System. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, July 10, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc071012.htm

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X-ray of a broken hip

Avoid broken bones: Learn about low bone density

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X-ray of a broken hip

Broken hip

By Carolyn M. Clancy, M.D.
Director, Agency for Health Care Research and Quality

Until you or a loved one has broken a wrist or hip, it’s easy to downplay the risks that come with low bone density. But these risks are serious, and the consequences can cause big life changes.

Low bone density occurs when our bodies lose bone tissue faster than it can be replaced. It is a major cause of broken bones, especially at the spine, hip, and wrist.

People with low bone density have either osteopenia, a mild form of this condition, or osteoporosis, a more severe type.

Low bone density affects about 52 million Americans, both men and women. Osteoporosis is more common in women who have gone through menopause.

An estimated 1 in 5 U.S. women over age 50 has osteoporosis. Ten percent of these women have osteoporosis of the hip, according to the Centers for Disease Control and Prevention.

While a broken bone is not a major concern when we’re young, it is a serious health issue as we get older.

A broken hip, for example, usually requires surgery, takes a long time to heal, and can require that a person need ongoing care.

Fortunately, some of these problems can be prevented. Today, more treatments are available to help reduce the risk of breaking a bone and to build new bone tissue faster. They include medicines, nutritional supplements, and exercise.

To help understand your options, a new consumer summary from the Agency for Healthcare Research and Quality’s Effective Health Care Program describes the latest research findings on these treatments.

It also helps you think about the kinds of questions to ask your doctor about a diagnosis of low bone density.

The summary covers:

  • Medicines: Researchers looked at five types of drugs for women with osteoporosis who have gone through menopause. They “graded” each medicine based on whether it reduced the risk of breaking a bone in the wrist, spine or hip, or whether the evidence is still unknown. Possible side effects of the medicines are also listed, along with additional information about how to deal with these side effects.
  • Nutritional supplements: Taking calcium and Vitamin D on its own or with prescription medicines may reduce the risk of developing osteoporosis. However, researchers are not sure if taking calcium or Vitamin D reduces the risk of breaking a bone in people who already have osteoporosis. The summary lists foods that are high in calcium and Vitamin D.
  • Exercise: Your doctor may recommend exercise as a way to strengthen bones, improve balance, and reduce the risk of falling. In particular, weight-bearing exercises like walking, lifting weights, and climbing stairs help make bones stronger.
  • Making a Decision: There are several factors to keep in mind as you decide which treatment is right for you. These include:
    • Your risk for breaking a bone, based on results of a bone density test.
    • Whether you need to start taking medicine now or if you can wait.
    • The benefits and side effects of different medicines, your out-of-pocket costs for each option, and whether you can take a generic version.

A chart in the summary lists the wholesale prices of osteoporosis medicines, brand names, and price per month for a generic version. Your cost will depend on your health insurance, how much medicine you need, and whether the medicine comes in a generic form.

A new online decision aid called “Healthy Bones” was developed as part of this summary for women who have gone through menopause.

It helps you calculate the risk of breaking a bone, gives detailed information about medicines to prevent a break, and lets you print information and questions to take to your doctor.

People used to think that the effects of low bone density couldn’t be prevented. Today, we’re learning that we have good treatment options that can lower risks and improve health outcomes.

But for the best results, it’s up to us to get educated about our choices and find the one that best fits our needs.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Reducing the Risk of Bone Fracture: A Review of the Research for Adults with Lone Bone Density
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1049

Effective Health Care Program
http://www.effectivehealthcare.ahrq.gov/index.cfm

Healthy Bones: About Osteoporosis
http://www.effectivehealthcare.ahrq.gov/ehc/decisionaids/osteoporosis/

Centers for Disease Control and Prevention
FastStats: Osteoporosis 
http://www.cdc.gov/nchs/fastats/osteoporosis.htm

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New processes help hospitals spot—and stop—drug errors

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By Carolyn M. Clancy, M.D.

You might think that your doctor would know if a new drug would cause bad side effects in combination with one you already take. Or that your pharmacist could tell if a prescription you thought was for Darvon, (a painkiller), really should be for Diovan (a blood pressure drug).

But with thousands of drugs (prescription and over-the-counter) of different strengths on the market, you could be wrong. When important information about medicines isn’t communicated correctly at the right time, errors can happen.

Some of them can be very serious, even deadly.

Errors involving drugs are the most common type of medical errors, harming about 1.5 million people each year, according to the Institute of Medicine . Treating drug-related injuries that occur in hospitals costs $3.5 billion per year, according to its 2007 report.

recent example shows how easily these errors can happen.

A 90-year-old woman was brought to a hospital emergency department (ED) after falling and breaking her hip. The woman’s daughter gave a nurse her mother’s medication bottles from home, including one for high blood pressure.

Using that information, the nurse prepared a list of drugs for the woman’s hospital stay.

Before the patient woman had hip surgery, a physician noticed that her blood pressure was too high. He increased the dosage of her blood pressure medicine from 75 mg to 100 mg.

Shortly before her surgery, the woman went into cardiac arrest. She was successfully resuscitated, but her surgery had to be postponed.

Only when the woman was moved to the intensive care unit did another nurse notice that the dose level of the blood pressure medicine brought from the patient’s home was actually 25 mg, not 75 mg. (The nurse in the ED had written the wrong dosage.)

Fortunately, the woman recovered. Several days later, she was able to have the surgery to repair her hip and was discharged.

After identifying the error, the hospital staff did the right thing: They fixed the mistake, apologized to the patient, and launched a review to find out how similar mistakes could be prevented in the future.

One way the hospital might have avoided this error was to involve a hospital pharmacist. A pharmacist would have recognized that the type of blood pressure drug this patient brought from home did not come in the higher dose that was incorrectly listed on her chart.

More hospitals are working to reduce the chance of drug-related injuries with processes that involve pharmacists, doctors, and nurses. One process is known as “medication reconciliation.”

This involves comparing a patient’s current drug routine to any changes a physician makes when a patient is admitted, transferred, or released from the hospital. (Maintaining and communicating this information correctly is a national patient safety goal for 2012 of the Joint Commission , which accredits hospitals and health care organizations.)

In the case of the 90-year-old patient’s blood pressure drug, medication reconciliation would have verified the patient’s home medication list. The process would have also caught the difference between the real dose and the dose listed by the nurse in the ED.

To help hospitals with this process, the Agency for Healthcare Research and Quality (AHRQ) has funded research for a new toolkit based on a successful program at Northwestern Memorial Hospital in Chicago.

Known as MATCH, the toolkit provides a step-by-step method so hospitals can review and improve current processes or create new ones. It can be used in both hospital and outpatient settings.

Even though more hospitals are working to prevent medication errors, patients have a role, too. Here’s a checklist of tips that can help:

Checklist:

  • Bring a list or a bag with all your medicines when you go to your doctor’s office, the pharmacy, or the hospital.
  • Ask questions. Ask your doctor or pharmacist to use plain language so that you understand the answers.
  • Make sure your medicine is what the doctor ordered. Many drugs look alike and have names that sound alike. Check with your doctor or pharmacist to be sure you have the right medicine.
  • Learn how to take medicine correctly. Read the directions on the label and other paperwork you get with your medicine. Ask your pharmacist or doctor to explain anything you do not understand.
  • Find out about possible side effects. Many drugs have side effects. Some side effects may bother you at first but will improve with time.

If a side effect does not get better or you get a different one from what you’ve read about, talk to your doctor to see if you need a different medicine or dose.

Medicines can help you, but they can also harm you. Better medication reconciliation processes and smart questions from patients will reduce the chance of harm.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

References

Agency for Healthcare Research and Quality

AHRQ Web M&M: Morbidity and Mortality Rounds on the Web
http://www.webmm.ahrq.gov/case.aspx?caseID=213

Medications at Transition and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation
http://www.ahrq.gov/qual/match/

20 Tips to Help Prevent Medical Errors
http://www.ahrq.gov/consumer/20tips.htm

National Academies of Science

Preventing Medical Errors: Quality Chasm Series
http://www.nap.edu/catalog.php?record_id=11623

Joint Commission

National Patient Safety Goals 
http://www.jointcommission.org/standards_information/npsgs.aspx

Current as of March 2012


Internet Citation:

New Processes Can Help Hospitals Spot—and Stop—Drug Errors. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, March 6, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc030612.htm

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Five-year campaign seeks to use prevention to cut heart disease

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Million Hearts Campaign Aims to Lower Risk, Improve Care

By Carolyn M. Clancy, M.D.

February 7, 2012

With Valentine’s Day around the corner, hearts shapes are everywhere – on cards, candy, and clothing. But every day of the year, your heart plays a big role in your health and well-being. And conditions or habits that harm our hearts, like high blood pressure or smoking, put our hearts at risk.

The risk is serious. Heart disease and strokes kill more than 800,000 Americans each year and cost $445 billion each year, according to the Department of Health and Human Services (HHS) (PDF File, PDF Help). People with heart disease are often unable to work or enjoy normal activities. They are also at higher risk of early death.

To help combat heart disease, especially heart attack and stroke, HHS recently joined several groups that include doctors, nurses, pharmacists, insurance companies, and drug stores in a campaign called Million Hearts.

Over the next 5 years, the partners aim to help millions of Americans improve their heart health by preventing and treating high blood pressure, high cholesterol, and tobacco use.

The goals are ambitious. But the good news is that heart disease can be prevented or reduced with two approaches.

The first is making healthy choices, like quitting smoking (or never starting), and lowering the amount of salt and trans fats we consume. Today, 19 percent of the U.S. population smokes; in 5 years, the partnership aims to cut that to 17 percent.

The second approach is making treatment for heart disease available for people who need it. Simple but effective techniques, known as the “ABCS,” help focus these efforts. The ABCS stand for: Aspirin for people at risk, Blood pressure control, Cholesterol management, and Smoking cessation.

We have good tools to treat heart disease, but they’re not used enough. Today, less than half (47 percent) of people at risk for heart disease take a daily aspirin. The Million Hearts campaign hopes to increase that to 65 percent by 2017. Reducing salt intake, a factor in high blood pressure, by 20 percent, is another goal.

HHS is working with partners to help attain the Million Hearts goals. The partners include:

  • America’s Health Insurance Plans  and its members are hosting programs to reduce heart disease with programs that promote fitness, lower obesity and manage chronic disease.

My Agency, the Agency for Healthcare Research and Quality (AHRQ), supports the Million Hearts campaign and has tools and knowledge that can support its goals.

For example, one AHRQ-funded resource that highlights innovative practices describes how pharmacists can help people lower their risk for heart disease.

In the HealthyHeartClub.com program, pharmacists educate patients to lower their heart risk by changing their diet, exercising more, and taking the right medicines. Working with primary care doctors, pharmacists meet with patients, email them weekly, and provide access to classes and tools that support their goals. It works! After 3 months, patients’ weight, blood pressure, and daily activity all improved.

AHRQ’s Effective Health Care Program produces free, plain-language booklets that can help you learn about treatment options for high blood pressure and high cholesterol. They describe treatment options, discuss risks and benefits, and identify areas where more research is needed.

All these resources for the Million Hearts initiative have one thing in common—they are an excellent source of information to share with your health care provider. Together, you can discuss steps you need to take to be sure you’re healthy for many more Valentine’s Days in the future.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

U.S. Department of Health and Human Services: Million Hearts

New public-private initiative aims to prevent 1 million heart attacks and strokes in five years
http://millionhearts.hhs.gov/docs/Million_Hearts_Press_Release.pdf [PDF Help]

Million Hearts
http://millionhearts.hhs.gov/

Heart Disease Prevention: Million Hearts
http://millionhearts.hhs.gov/about-hd-prevention.shtml

Agency for Healthcare Research and Quality

AHRQ Innovations Exchange: Innovation Profile
http://innovations.ahrq.gov/content.aspx?id=3182

Effective Health Care Program

Choosing Medications for High Blood Pressure: A Review of the Research on ACEIs, ARBs, and DRIs
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=75

Treating High Cholesterol: A Guide for Adults
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=351

American Heart Association

AHA
http://www.heart.org/HEARTORG/

American Heart Association/American Stroke Association 

My Life Check
http://50.56.33.51/mlc01/main_en_US.html

America’s Health Insurance Plans (AHIP)

AHIP Statement on Million Hearts Initiative
http://www.ahip.org/News/Press-Room/2011/AHIP-Statement-on-Million-Hearts-Initiative.aspx

The Y

The Y Joins CDC, HHS, CMS in Million Hearts Initiative
http://www.ymca.net/news-releases/20110913-cdc.html

Current as of February 2012


Internet Citation:

Million Hearts Campaign Aims to Lower Risk, Improve Care. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, February 7, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc020712.htm


 

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MRI of the knee

Baby boomers trigger jump in knee replacement surgeries

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MRI of the knee

Credit: Wikipedia - Creative Commons License

By Carolyn M. Clancy, M.D.

January 3, 2012

Whether it’s music, lifestyles, or a refuse-to-age outlook, Baby Boomers think of themselves as trailblazers.

Now, that generation born between 1946 and 1964 can claim credit for another “first”—a dramatic increase in knee replacement surgeries.

Women and men between the ages of 45 and 64 were more than twice as likely to have had knee replacement surgery in 2009 than in 1997, recent data from the Agency for Healthcare Research and Quality (AHRQ) show. The rates among women were even higher.

Knee replacement surgery is most common in people whose knees have been damaged by osteoarthritis (OA), rheumatoid arthritis, or injury.

Due to their age and fondness for sports, Baby Boomers fit neatly into each category.

The percentage of people who have osteoarthritis, the most common type of arthritis, grows with age. About 27 million Americans have this condition, and, after age 45, it is more common in women. Osteoarthritis occurs when the cartilage that coats the end of each bone breaks down. This can cause the bones to rub against each other, causing pain and stiffness.

Knee pain may also be caused by rheumatoid arthritis, a less common form of arthritis that occurs when the membrane surrounding the joint becomes inflamed. Over time, inflammation damages cartilage, resulting in pain and stiffness. Rheumatoid arthritis affects about 1.3 million people—more women than men. It often begins in middle age, but can occur in children and young adults.

Arthritis after a serious knee injury or repeated stress is another reason for knee replacement surgery. Pain caused by ligament tears or bone fractures caused by sports injuries, for example, may be managed non-surgically for years. Over time, however, pain and limited knee function causes some patients to consider knee replacement surgery.

If you have knee pain from one of these causes, you’ve probably heard about treatments that are intended to relieve pain and even postpone the need for surgery. Some, but not all, of these options work, a review of 86 research reports funded by AHRQ has found.

What has been shown to work?

  • Exercise. Becoming more active—whether through walking, swimming, or water aerobics—can reduce pain and make movement easier. Physical therapy may also help, so ask your doctor if you would benefit.
  • Maintain a healthy weight. A 10 percent weight loss combined with a moderate exercise program reduced knee pain in patients with knee osteoarthritis by 50 percent, a recent study  by Wake Forest University researchers has found.
  • Pain medicines. Medicines can relieve osteoarthritis pain, AHRQ’s research review concluded. Your doctor or nurse may prescribe an over-the-counter or prescription medicine. Learn more about choosing pain medications for osteoarthritis in this guide developed by AHRQ.

What has been shown not to work?

  • Glucosamine and chondroitin. Some people take nutritional supplements to help build new cartilage. Studies have found that people who take these supplements report less pain, but people who don’t take the supplements report the same result.
  • Joint lubrication shots. This treatment is a gel-like substance given by a shot into the knee. Studies have found that most people who get the shots do not improve very much.
  • Arthroscopic knee surgery. In this procedure, a flexible tool is inserted into the knee, which is used to rinse the joint. It can be helpful for other types of knee problems, but not for knee osteoarthritis.

If conservative treatments don’t provide relief from pain, it may be time to consider knee replacement surgery. The good news is that this procedure has been shown to give a better quality of life that makes it worth the cost, a Government-funded study has found.

The benefits of this procedure are even better if the surgery is done at a hospital that does a large number of knee replacement procedures.

Before you have surgery, prepare yourself for the best possible outcome by asking questions of your surgeon. You will feel more in control of your health if you have a good idea of what to expect before, during, and after surgery.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Healthcare Cost and Utilization Project

Statistics on Hospital-Based Care in the U.S., 2009
http://www.hcup-us.ahrq.gov/reports/factsandfigures/2009/TOC_2009.jsp

Effective Health Care Program

Osteoarthritis of the Knee: A Guide for Adults
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=132

Choosing Pain Medicine for Osteoarthritis
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageAction=displayProduct&productID=4

Having Surgery? What You Need to Know
http://www.ahrq.gov/consumer/surgery/surgery.htm

National Institute of Arthritis and Musculoskeletal and Skin Disease

Handout on Health: Osteoarthritis
http://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp

Handout on Health: Rheumatoid Arthritis
http://www.niams.nih.gov/Health_Info/Rheumatic_Disease/default.asp

Total Knee Replacement Found Cost-Effective for End-Stage Knee OA
http://www.niams.nih.gov/News_and_Events/Spotlight_on_Research/2009/knee_OA_replacement.asp

American College of Rheumatology

Weight Loss Best Medicine for People with Knee Osteoarthritis
http://www.rheumatology.org/about/newsroom/2011/2011_ASM_21_weightloss.asp

Current as of January 2012


Internet Citation:

Baby Boomers Trigger Major Increase in Knee Replacement Surgeries. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, January 3, 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc010312.htm

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Questions are the Answer: How to get doctors and patients talking

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The U.S. Agency for Healthcare Quality and Research wants to get you to start asking your doctors more questions about your care.

Good doctor-patient communication is a key to improving the quality of your care, the agency says. and a good way to start the conversation is with a question.

But because so many doctor’s visits are so brief, the agency is providing tools to help you prepare their questions before your appointments.

The tools are available online at the agency’s website “Questions are the Answer“. The site also provides brochures, videos and other tools providers can use to encourage their patients to speak up.

The website provides:

  • A 7-minute video featuring patients and clinicians who discuss the importance of asking questions and sharing information – this tool is ideal for a patient waiting room area and can be set to run on a continuous loop.
  • Notepads to help patients prioritize the top three questions they wish to ask during their medical appointment.

To promote the initiative, the agency is also offering providers the opportunity to co-brand the materials so that providers can add their organization’s name and logo to the brochures and notepads.

Providers interested in learning more about the initiative can contact the agency by phone at 1-800-358-9295 or by email AHRQpubs@ahrq.hhs.gov.

To learn more:

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An umbrella sheltering medicines - credit Microsoft

How to get a good value when choosing a health plan

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By Carolyn M. Clancy, M.D.1

An umbrella sheltering medicines - credit MicrosoftWelcome to November—with its shorter days, cooler weather, and, for many, decisions about choosing a health insurance plan for the coming year.

Whether you’re covered by an employer’s plan, by Medicare, or you are self-employed or unemployed, doing homework during “open enrollment” can help you get the best value for your money.

You may find that you have more options for 2012.

Overall, employers that offer health coverage are providing more choices, according to recent data from my agency, the Agency for Healthcare Research and Quality (AHRQ).

Large firms that offer health insurance are more likely to offer workers two or more plans now than they were 10 years ago. Unfortunately, our report also found that the percentage of employees who are offered health coverage is less today than it was a decade ago.

When you know your options and how they work, you can better decide which option fits your personal situation. Your choice may be different depending if you have a spouse or dependent children or if you need certain medicines.

Getting Started

To help people covered by Medicare review their options, the Federal Government expanded its open enrollment period for 2012. Open enrollment continues through December 7, 2011, which is the deadline to pick a new Medicare plan. (You don’t have to do anything if you want to keep the one you have.)

Compare your choices using Medicare’s Plan Finder. This tool will help you find and compare the different kinds of Medicare Advantage health plans (or Part C) and Medicare prescription drug plans (Part D). An online demonstration of this tool is available on YouTube.

If you’re self-employed or unemployed, finding a health plan takes more work. Healthy individuals who can afford out-of-pocket expenses might consider a high-deductible plan.  Under these plans, you will have to pay much more yourself before the plan covers any expenses.

The advantage is that premiums are lower than other types of coverage. The National Association of Insurance Commissioners offers tips  to help you understand and apply for individual coverage.

If you’ve lost health coverage due to a job loss, you may be able to continue it for 18 months. You will pay higher premiums, however. A Federal law known as COBRA lets workers who have lost group coverage continue those benefits. Select for more information on how this law works.

If you are uninsured because of a pre-existing condition, you may be able to receive insurance through a temporary high-risk pool created under the Affordable Care Act. The program is funded by the Federal government, but States can choose how or if they want to participate. The program began on July 1, 2010, and ends on January 1, 2014.

Understanding how different health plans work can make it easier to choose wisely. You may prefer to pay more to get a wider choice of doctors, for example, or to use generic medicines instead of brand-name ones to save money.

Keep in mind that not all health plans pay for the same services or pay the same amounts for services. (One exception is Medicare, which is required by the Affordable Care Act to pay for certain preventive benefits.)

Plans also vary in how much you’ll pay before your insurance covers you. These are called out-of-pocket costs, and they usually are in the form of deductibles or coinsurance. The deductible generally is an annual amount that is not covered by your health plan. It must be paid before your health plan starts to pay for your care.

Coinsurance is the percentage of your health insurance bill that you must pay when you file a claim. You must usually pay this percentage in addition to the deductible.

The Alphabet Soup of Health Plans

Health plans differ in what they offer and the providers you can choose. You are likely to pay more for a plan that gives you many options for choosing doctors and hospitals. Health plans typically fall into one of these groups:

  • Conventional indemnity: The least restrictive type of coverage, indemnity plans allow you to see any health provider without affecting what you pay. These plans are not common in populated areas, but still exist in rural areas.
  • Preferred provider organizations (PPO): A form of indemnity insurance where coverage is provided through a network of selected providers. You can go to providers outside of the network, but you will pay a larger portion of the costs.
  • Exclusive provider organizations (EPO): This is a more restrictive type of PPO. It covers services only if you go to doctors, specialists, or hospitals in the plan’s network, unless it’s an emergency.
  • Health maintenance organizations (HMO): The most restrictive type of health plan, HMOs provide medical services to members in exchange for a fixed fee. They stress preventive care as a way to keep patients healthy and save money.
  • Medicare Advantage Plans (Part C): These private insurance companies contract with Medicare to provide you with Part A (hospital) and Part B (doctor, outpatient care, home health) benefits. Many, but not all, of these plans include the Medicare prescription drug benefit (Part D).

Readers of this column know I am passionate about making health care better. That’s why I urge you to pay attention to the information about the quality of health plans , including Medicare Advantage plans. This can help you understand what a plan does well, what it needs to do better, and whether it’s a good fit for you.

Of course, choosing a good health plan is no guarantee against getting sick. But a wise choice will make it easier for you to continue to take an active role your health.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality

Medical Expenditure Panel Survey, Statistical Brief No. 344: The Number of Health Insurance Plans Offered by Private Sector Employers in 2000 and 2010
http://www.meps.ahrq.gov/mepsweb/data_files/publications/st344/stat344.shtml

MEPS Insurance Component: Glossary of Health Terms
http://www.meps.ahrq.gov/mepsweb/survey_comp/ic_ques_glossary.shtml

Center for Medicare and Medicaid Services

Medicare Plan Finder for Health, Prescription and Medigap Plans
http://www.medicare.gov/find-a-plan/questions/home.aspx

Medicare Plan Finder at a Glance (YouTube)
http://www.youtube-nocookie.com/embed/iQQJ7ry_H6k

U.S. Department of Health and Human Services

Temporary High Risk Pool Program
http://www.healthcare.gov/news/factsheets/2010/07/temp-high-risk-pool-program.html

Medicare Preventive Services: HealthCare.gov
http://www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html

National Association of Insurance Commissioners

Consumer Alert: Limited Benefit Plans, High Deductible Plans and Health Savings Plans
http://www.naic.org/documents/consumer_alert_high_deductible_plans.htm

Health Insurance: What You Need to Know When Applying for an Individual Health Insurance Policy
http://www.naic.org/documents/consumer_alert_ind_health_insurance.htm

U.S. Department of Labor

An Employee’s Guide to Health Benefits Under COBRA
http://www.dol.gov/ebsa/publications/cobraemployee.html

National Committee for Quality Assurance

Report Cards: Choosing Quality Care
http://www.ncqa.org/tabid/60/Default.aspx

Current as of November 2011


Internet Citation:

How to Get a Good Value When Choosing a Health Plan. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, November 1, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc110111.htm

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Hip Thumb

Guides to help women make informed treatment choices

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By Dr. Carolyn Clancy
Director of Agency for Healthcare Research and Quality 

As individuals, we want choices that reflect who we are and what’s right for our situation. Getting the right health care is no different.

Until recently, information that showed which treatments work best for certain groups of patients, especially women, was hard to find.

Illustration from Managing Pain From a Broken Hip

Now women’s health research is a growing field. The Women’s Health Initiative (WHI), a long-term study launched by the late National Institutes of Health (NIH) Director Bernadine Healy, MD, has provided important information on preventing and treating heart disease, breast and colorectal cancers, and osteoporosis in women aged 50 to 79.

The WHI and the Office of Research on Women’s Health, led for two decades by Vivian Pinn, MD, helped to ensure that women are fairly represented in NIH-sponsored studies. Before the WHI began, very few studies focusing solely on women had been conducted.

Today, far more research is helping to identify which groups of patients will benefit from which kind of treatment. My Agency, the Agency for Healthcare Research and Quality (AHRQ), sponsors patient-centered outcomes research that asks just that question. The goal of this research is to help you make better, more informed treatment choices.

Several recent consumer guides developed from this research focus on conditions that affect women. Written in plain language, these guides can help you understand the benefits and potential risks of treatments for different conditions.

One such guide helps women talk to their doctor or nurse about medicines to reduce their risk of breast cancer. Two medicines can lower the risk for women who are at high risk but have not had breast cancer before.

However, both of these drugs have side effects, some of them serious. If you are at high risk for breast cancer or if you’re unsure, talk to your doctor or nurse. They can help you decide whether a medicine to reduce the risk of breast cancer is a good choice.

Some questions included in this guide include:

  • Is my risk of breast cancer higher or lower than other women my age?
  • What if I don’t want to start medicine at the age I am now? Can I start later?
  • Is my risk for blood clots higher than usual?
  • Can I do anything else to lower my risk for breast cancer?

Another very helpful guide examines how to manage pain from a broken hip. Both men and women are at risk, but women are twice as likely as men to suffer a broken hip by age 80.

The guide describes why it is important to manage pain, outlines medicines that may help you, and provides risks and benefits on other ways to manage pain.

To help you make a decision on how to manage pain, the guide suggests key questions to ask, such as:

  • Which options do you think are best to manage my pain?
  • How quickly can I expect relief from my pain?
  • How long do you think I will need to manage my pain?
  • Are you concerned about the side effects from any of these options?

Other consumer guides from AHRQ that address women’s health issues cover breast biopsy, osteoporosis treatments, gestational diabetes, and induced labor. They provide helpful background on health conditions. Some even include basic price information on medicines. Select for a complete list of patient and consumer guides.

A new consumer guide to help women over age 50 learn which screening tests, medicines and daily steps to follow to stay healthy is also available.

We have made remarkable progress in understanding how treatments affect different groups of patients. Make sure to use that information when you talk to your health care team about the right treatment for you.

I’m Dr. Carolyn Clancy, and that’s my opinion on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Explore Your Treatment Options
http://www.effectivehealthcare.ahrq.gov/options/

Managing Pain From a Broken Hip: A Guide for Adults and their Caregivers
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=677

Reducing the Risk of Breast Cancer with Medicine: A Guide for Women
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=389

Effective Health Care: Guides for Patients and Consumers
http://www.effectivehealthcare.ahrq.gov/index.cfm/guides-for-patients-and-consumers/

Women: Stay Healthy at 50+
http://www.ahrq.gov/ppip/women50.htm

Office of Research on Women’s Health
http://orwh.od.nih.gov/

Women’s Health Initiative: Participant Web site
http://www.whi.org

Current as of September 2011

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Young woman holds an older woman's hand

Resources to help you be a better caregiver

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Young woman holds an older woman's hand

Photo by Sanja Gjenero

By Dr. Carolyn Clancy
Director of the U.S. Agency for Healthcare Research and Quality 

Many of us are—or will become—a caregiver to a parent, spouse, child, or other loved one.

When that happens, you will need to find out a lot about a disease or condition, ask good questions about treatment options, and make the best decisions you can. But don’t be surprised if, like me, you also learn some things you wished you had known earlier.

For the past few years, I was an intermittent “virtual” caregiver to my 82-year-old father, Patrick, who died last fall. Even though he lived 450 miles away, we kept in close touch with regular phone calls and visits.

Like many people his age, my father had several chronic illnesses and previous surgeries. These included lung disease, early Alzheimer’s disease, heart problems, and a knee replacement.

He took 18 different medicines and was on oxygen at home during his last year of life. He was extremely fortunate to have a terrific wife who helped him manage his medications and appointments—and was essential to his enjoying his life beyond dealing with health issues.

One of challenges my family faced was learning how to manage things that became part of my father’s daily routine, like his oxygen machine. Other caregivers may have challenges in organizing weekly medicines or arranging transportation to and from various medical appointments. These relatively simple tasks can quickly become more complex when you are caring for a loved one with several ongoing medical needs.

There are resources that help caregivers meet some of these challenges. But finding help can take time and effort at a time when you already have a lot on your plate. Local connections—your friends, church, or workplace—are an important place to look for help.

Many doctors—myself included—were trained to think that a “good patient” is one who doesn’t complain or ask too many questions.

In our situation, the visiting nurses and aides were very helpful to my father and stepmother. This was especially true after he came home after a hospital stay. Your local Visiting Nurse Association  may be a good place to start if you need nursing help in your home.

Another challenge in my father’s care was more serious, but all too common. On one occasion, my father needed to be re-admitted to the hospital because of a miscommunication about his blood thinner drug. Instead of taking a 2 milligram dose of his blood thinner, he was taking 2 pills that were 2 milligrams each, or double the correct dose.

Readers of this column know that my agency, the Agency for Healthcare Research and Quality (AHRQ), has funded many projects to identify and prevent medical errors, including taking blood thinner medications safely. We have developed a video and an easy-to-read brochure, which are available in English and Spanish.

In my father’s case, the miscommunication that caused his overdose might have been prevented if his nurse had asked my stepmother to repeat the blood thinner instructions back to her. This type of feedback can be as simple having the nurse say, “Tell me what you heard. Say it back to me, so I know we’re on the same page.”

One project that AHRQ funded and is being used by hospitals across the United States does just that. Project RED consists of an 11-step checklist, including a phone call from a clinician a day or two after a patient goes home from the hospital to find out if the patient or the caregiver has any questions about medicines.

In a study at Boston University Medical Center , patients who took part in the Project RED education had 30 percent fewer hospital re-admissions than patients who did not.

guide developed as part of Project RED helps patients when they leave the hospital. It has space for patients to list their medications, follow-up appointments, and phone numbers for who to call if they have questions once they get home.

My recent experiences have truly strengthened my belief that patients and their caregivers should ask questions about their care. Many doctors—myself included—were trained to think that a “good patient” is one who doesn’t complain or ask too many questions. In fact, people who ask questions and get answers they understand are more likely to fare better overall.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

PHOTO CREDIT: Sanja Gjenero

Resources

Caregivers’ Resources: U.S.A.gov

Find a nursing home, assisted living or hospice services; check eligibility for benefits; get resources for long-distance caregiving; review legal issues; and find support for caregivers.
http://www.usa.gov/Citizen/Topics/Health/caregivers.shtml

Visiting Nurse Associations of America

http://www.vnaa.org/vnaa/siteshelltemplates/homepage_navigate.htm

Boston University Medical Center

Project Red: Re-Engineered Discharge: A Randomized Controlled Trial at Boston Medical Center
http://www.bu.edu/fammed/projectred/index.html

Agency for Healthcare Research and Quality

Blood Thinner Pills: Your Guide to Using Them Safely
http://www.ahrq.gov/consumer/btpills.htm

Educating Patients Before They Leave the Hospital Reduces Readmissions, Emergency Department Visits and Saves Money
http://www.ahrq.gov/news/press/pr2009/redpr.htm

Taking Care of Myself: A Guide For When I Leave the Hospital
http://www.ahrq.gov/qual/goinghomeguide.htm

Questions are the Answer: Get Involved With Your Health Care
http://www.ahrq.gov/questionsaretheanswer/

Current as of July 2011


Internet Citation:

Resources to Help You Be a Better Caregiver. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, July 5, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc070511.htm


 

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Group

Resources to help you be a better caregiver

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By Carolyn M. Clancy, M.D


Photo: Sigurd Decroos

Many of us are—or will become—a caregiver to a parent, spouse, child, or other loved one.

When that happens, you will need to find out a lot about a disease or condition, ask good questions about treatment options, and make the best decisions you can. But don’t be surprised if, like me, you also learn some things you wished you had known earlier.

For the past few years, I was an intermittent “virtual” caregiver to my 82-year-old father, Patrick, who died last fall. Even though he lived 450 miles away, we kept in close touch with regular phone calls and visits.

Like many people his age, my father had several chronic illnesses and previous surgeries. These included lung disease, early Alzheimer’s disease, heart problems, and a knee replacement. He took 18 different medicines and was on oxygen at home during his last year of life. He was extremely fortunate to have a terrific wife who helped him manage his medications and appointments—and was essential to his enjoying his life beyond dealing with health issues.

One of challenges my family faced was learning how to manage things that became part of my father’s daily routine, like his oxygen machine. Other caregivers may have challenges in organizing weekly medicines or arranging transportation to and from various medical appointments. These relatively simple tasks can quickly become more complex when you are caring for a loved one with several ongoing medical needs.

There are resources that help caregivers meet some of these challenges. But finding help can take time and effort at a time when you already have a lot on your plate. Local connections—your friends, church, or workplace—are an important place to look for help.

In our situation, the visiting nurses and aides were very helpful to my father and stepmother. This was especially true after he came home after a hospital stay. Your local Visiting Nurse Association  may be a good place to start if you need nursing help in your home.

Another challenge in my father’s care was more serious, but all too common. On one occasion, my father needed to be re-admitted to the hospital because of a miscommunication about his blood thinner drug. Instead of taking a 2 milligram dose of his blood thinner, he was taking 2 pills that were 2 milligrams each, or double the correct dose.

Readers of this column know that my agency, the Agency for Healthcare Research and Quality (AHRQ), has funded many projects to identify and prevent medical errors, including taking blood thinner medications safely. We have developed a video and an easy-to-read brochure, which are available in English and Spanish.

In my father’s case, the miscommunication that caused his overdose might have been prevented if his nurse had asked my stepmother to repeat the blood thinner instructions back to her. This type of feedback can be as simple having the nurse say, “Tell me what you heard. Say it back to me, so I know we’re on the same page.”

One project that AHRQ funded and is being used by hospitals across the United States does just that. Project RED consists of an 11-step checklist, including a phone call from a clinician a day or two after a patient goes home from the hospital to find out if the patient or the caregiver has any questions about medicines.

In a study at Boston University Medical Center, patients who took part in the Project RED education had 30 percent fewer hospital re-admissions than patients who did not.

guide developed as part of Project RED helps patients when they leave the hospital. It has space for patients to list their medications, follow-up appointments, and phone numbers for who to call if they have questions once they get home.

My recent experiences have truly strengthened my belief that patients and their caregivers should ask questions about their care. Many doctors—myself included—were trained to think that a “good patient” is one who doesn’t complain or ask too many questions. In fact, people who ask questions and get answers they understand are more likely to fare better overall.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

PHOTO CREDIT: Sigurd Decroos

Resources

Caregivers’ Resources: U.S.A.gov

Find a nursing home, assisted living or hospice services; check eligibility for benefits; get resources for long-distance caregiving; review legal issues; and find support for caregivers.
http://www.usa.gov/Citizen/Topics/Health/caregivers.shtml

Visiting Nurse Associations of America

http://www.vnaa.org/vnaa/siteshelltemplates/homepage_navigate.htm

Boston University Medical Center

Project Red: Re-Engineered Discharge: A Randomized Controlled Trial at Boston Medical Center
http://www.bu.edu/fammed/projectred/index.html

Agency for Healthcare Research and Quality

Blood Thinner Pills: Your Guide to Using Them Safely
http://www.ahrq.gov/consumer/btpills.htm

Educating Patients Before They Leave the Hospital Reduces Readmissions, Emergency Department Visits and Saves Money
http://www.ahrq.gov/news/press/pr2009/redpr.htm

Taking Care of Myself: A Guide For When I Leave the Hospital
http://www.ahrq.gov/qual/goinghomeguide.htm

Questions are the Answer: Get Involved With Your Health Care
http://www.ahrq.gov/questionsaretheanswer/

Current as of July 2011


Internet Citation:

Resources to Help You Be a Better Caregiver. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, July 5, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc070511.htm

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Aqui

Campaign urges Hispanics to talk with their doctor

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By Carolyn M. Clancy, M.D.

Hispanics are less likely to see a doctor or other health professionals regularly than other ethnics groups. The data from the Agency for Healthcare Research and Quality is startling. Half (47 percent) of adult Hispanics reported that they did not see a doctor in 2008, compared with 29 percent of adults in other ethnic groups.

Why is there such a gap? One reason is the lack of health insurance. One in three, or 33 percent, of Hispanics under age 65 did not have health insurance coverage in 2009, according to the Centers for Disease Control and Prevention.

Another is language. Nearly half (49 percent) of Hispanics who are not comfortable speaking English do not have a regular source of health care, compared to two-thirds (63 percent) who are fluent in English, according to AHRQ data.

Our recent report on disparities in health care also found that, compared with whites, the proportion of Hispanics who said they had poor communication with their health providers is growing. And the percentage of Hispanics who regularly get important screening tests to check for diabetes or cancer is not improving.

However, Hispanics do seek out information on their care, but research shows that that they are more likely to consult other people—even casual acquaintances—instead of a doctor when they have health concerns.

To address these problems, AHRQ and the Ad Council have created a new Spanish language campaign called Conoce las Preguntas, or Know the Questions. Through TV, radio, print and Web ads, the new campaign encourages Hispanics to get more involved in their health care and to talk with their doctors.

For example, one ad shows a middle-aged man with a backache asking for treatment advice from his barber, a woman in a Laundromat, and a friend at the gym. Each offers different—and sometimes conflicting—remedies: use heat to relieve the ache, use cold, and exercise. Finally, in the last part of the ad, the man asks his doctor what he should do about his aching back.

The PSAs also offer tips to help Hispanics prepare for medical appointments by thinking about questions to ask during doctors’ visits. Additional tips include talking to the doctor about all symptoms, habits, and treatments; making sure you understand what your doctor tells you; and following instructions about medicines or follow-up visits.

The PSAs direct audiences to visit AHRQ’s Spanish-language Web site at http://www.ahrq.gov/preguntas for important health information.

This is only one effort to improve health and health care for Hispanics. Federal health clinics offer a range of health services, even if patients don’t have health insurance. They provide checkups, treatments if you’re sick, care for pregnant women, and immunizations for children. These clinics are located in most cities and in many rural areas. Select to find one in your area.

Today, many hospitals, doctor’s offices and pharmacies have staff who speak Spanish fluently. And many Web sites for patients, such as AHRQ’s and Healthfinder.gov, offer information in Spanish.

AHRQ and the Ad Council’s new campaign support the Department of Health and Human Services’ (HHS) Action Plan to Reduce Racial and Ethnic Health Disparities. This represents HHS’ first strategic plan to reduce health disparities among racial and ethnic minorities in the United States.

Making our health system better will happen only when everyone can reap the benefits of good medical information and timely care.

I’m Dr. Carolyn Clancy and that’s my opinion on how to navigate the health system.

Resources

Agency for Healthcare Research and Quality

Conozca Las Preguntas (Know the Questions)
Available at: http://www.ahrq.gov/preguntas/

2010 National Healthcare Quality & Disparities Reports
Available at: http://www.ahrq.gov/qual/qrdr10.htm and
http://www.ahrq.gov/qual/nhdr10/Chap9.htm

AHRQ News and Numbers: Problems with English Help Block Many Hispanics from Medical Care
Available at: http://www.ahrq.gov/news/nn/nn032608.htm

U. S. Department of Health and Human Services

Espanol: Healthfinder.gov. Su guia a la informacion confiable de la salud
Available at: http://www.healthfinder.gov/espanol/

HHS Action Plan to Reduce Racial and Ethnic Health Disparities
Available at: http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=285

HHS Office of Minority Health

Hispanic/Latino Profile: The Office of Minority Health
Available at: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=54

Centers for Disease Control and Prevention

FastStats: Health of Hispanic or Latino Population
Available at: http://www.cdc.gov/nchs/fastats/hispanic_health.htm

Health Resources and Services Administration

Find a Health Center at: http://findahealthcenter.hrsa.gov/Search_HCC.aspx

Current as of June 2011


Internet Citation:

New Public Service Campaign Urges Hispanics To Talk With Their Doctor. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, June 7, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc060711.htm

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Operating Room

Creating a culture of safety can improve hospital care

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Safety Culture Creates Better Care for Patients

By Carolyn M. Clancy, M.D.

May 3, 2011

The more we know about safety, the better.

That’s why a landmark report on medical errors from the Institute of Medicine remains as important today as it did when it came out 10 years ago. Called “To Err is Human,”  the report urged hospitals to develop a “culture of safety” to reduce risks and improve care for patients.

Today, safety culture plays a big role in health care. Doctors, nurses, and other health care workers are learning that a positive safety culture can improve patient care.

What does safety culture in a hospital look like?

A survey developed by the Agency for Healthcare Research and Quality (AHRQ) allows hospitals and other health care settings to measure safety by asking staff to rate things like teamwork and communication about errors. The survey launched in 2004. Since then, more than 338,000 employees from 855 hospitals have used the survey.

Employees give responses to statements such as “Staff feel like their mistakes are held against them,” and “Staff feel free to question the decisions of or actions of others with more authority.” They also give feedback on whether they report mistakes that could hurt a patient, even if no harm was done.

These responses help hospitals recognize what works well and where they need to improve. Sixty percent of hospitals that have taken the survey repeat it to see if their safety culture has changed.

When clinicians feel that they can talk openly about conditions that could harm patients, care improves.

As evidence, hospital units that have open communication have fewer medication errors, a new study from the University of North Carolina finds.

In this study, nurses at 148 hospitals were surveyed over a five-month period. They were asked questions about their willingness to report errors, whether their unit talked openly about errors, and how often they thought about whether an error might occur. Nursing units averaged 3.7 medication errors within 6 months. But nursing units with more open communication had fewer such errors.

Dr. Carolyn Clancy

How can you tell if your hospital has a good patient safety culture? Surveys and training tools that address safety culture are relatively new, so most hospitals are still learning about how they can improve.

But other tools can indicate a hospital’s overall quality.

For example, Hospital Compare, an online tool from the Federal government, lets you compare the quality of care at hospitals. Hospital Compare includes results from a survey that asks patients about their recent hospital stay. Patients tell about communication with doctors and nurses, how they rate the hospital, and whether they would recommend the hospital.

Many hospitals are learning how to create a culture of patient safety. Their patients will benefit from this effort.

I’m Dr. Carolyn Clancy, and that’s my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Surveys on Patient Safety Culture: Hospital Survey on Patient Safety Culture
Available at: http://www.ahrq.gov/qual/patientsafetyculture/hospsurvindex.htm#Toolkit

Effects of learning climate and registered nurse staffing on medication errors. [Nurs Res 2011 Jan-Feb].
Available at: http://www.ncbi.nlm.nih.gov/pubmed/21127452

Department of Health and Human Services
Medicare Hospital Compare Information for Consumers—Overview
Available at: http://hospitalcompare.hhs.gov/staticpages/for-consumers/for-consumers.aspx

Medicare Hospital Compare Information for Consumers—Patients’ Survey
Available at: http://hospitalcompare.hhs.gov/staticpages/for-consumers/hcahps/patients-hospital-experiences.aspx

Institute of Medicine
To Err is Human: Building a Safer Health System. November 1999.
Available at: http://www.iom.edu/Reports/1999/To-Err-is-Human-Building-A-Safer-Health-System.aspx

Current as of May 2011


Internet Citation:

Safety Culture Creates Better Care for Patients. Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy, May 3, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/consumer/cc/cc050311.htm

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