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Long COVID-19, Just One Aftereffect of COVID-19

Long COVID-19, Just One Aftereffect of COVID-19

With continued COVID-19 surges occurring worldwide despite the availability of a number of variations of vaccines, some patients continue to experience what is now being dubbed as “Long COVID-19” or “Post COVID-19 Syndrome”. Symptoms that are commonly experienced include a persistent cough, dyspnea, chest and/or joint pain, neuralgia, and headaches. These symptoms can last up to 12 weeks and in some cases, even longer. The more people that develop long COVID-19, the greater the strain on the healthcare system and need for appropriate diagnosis and treatment options.

A recent paper by A.V. Raveendran from January 2021 proposed diagnostic criteria to help confirm a diagnosis of long COVID-19. Depending on clinical symptomology, duration criteria and the presence or absence of a positive swab or antibodies, a long COVID-19 diagnosis can be categorized as confirmed, probable, possible or doubtful. Having an appropriate diagnosis will allow the practitioner to prescribe the relevant treatment plan.

In the United Kingdom, where the number of people exhibiting long COVID-19 continues to increase, a guideline has been developed by the National Institute for Health and Care Excellence to provide recommendations to help identify, assess, and manage the effects. As more evidence is collected, the plan is to update the document on a continuous basis to maintain its validity. The guideline takes into consideration clinical symptomology, duration criteria, and the presence or absence of a positive SARS-Cov-2 test. It also provides guidelines for suggested referrals, and a plan of care with follow-up and monitoring.

While the guideline manual has many useful suggestions, there are a number of gaps where further detailed information will be needed.  As new information is discovered, the goal is to include comprehensive reviews of symptomology, and pathology of the disease process and a better understanding of the variation in impact. Simultaneously, there needs to be an increase in rehabilitation and community resources to allow for individualized evidenced based care for those suffering from the debilitating effects of long COVID-19.

The Michigan Value Collaborative continues to assess data related to COVID-19 and will be sharing a dedicated COVID-19 push report with members in the coming months. If you would like access to the MVC registry, please request it here or via email michiganvaluecollaborative@gmail.com

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Learning Health Systems and Quality Improvement

Learning Health Systems and Quality Improvement

The mission of the Michigan Value Collaborative (MVC) is to improve the health of Michigan through sustainable, high-value healthcare with a vision to help provide the right care, at the right time, at the right cost. As part of this, MVC helps its members better understand their performance using robust multi-payer data, customized analytics, and at-the-elbow support. In addition, MVC fosters a collaborative learning environment to enable providers to learn from one another and share best practice. All of this is designed to help members respond to change, drive quality improvement, and improve performance.

Improving performance is often easier said than done – a phenomenon often referred to as the “60.30.10 Challenge”. Following the review of health learning systems in Australia, this phenomenon was identified as a key challenge that the healthcare system has faced for three decades. Despite change and areas for improvement being identified throughout healthcare, only 60% of evidenced based care is provided to patients, 30% of care is identified as waste or duplication, and at least 10% of patients experience adverse events or medical harm. With this in mind, can the current healthcare system embrace the many new technologies and advancements in medicine on the horizon?

While these new advances in technology have the ability to improve care and prolong life, there is conversely an addition of complexity and increased risk with utilizing them. It is important to understand that healthcare systems are complex and typically do not respond in a linear way to change. A collaboration of healthcare providers set up in Australia realized some key activities for improvement   initiatives within health care systems . These activities were included in the setting up of the collaborative known as the Translational Cancer Research Network and involved incentives, resources, administrative support to provide encouragement, collaboration and reduced constraints, data support, and expertise in implementation science. A number of new projects such as increased consumer engagement and improvement in diagnosis for various cancers came out of involvement in this network.

While root-cause analysis has long been used to identify medical failures, this may not be the best method to effectively establish safety protocols to prevent further harm due to the complex pathways within healthcare that are infrequently repeated. Instead, healthcare needs to take a different approach by introducing models of care that promote collaboration, exceed independent specialties, and advocate for combining hospital, primary care, community agencies, and elder care to navigate well-informed patients through evidenced based healthcare pathways along the continuum of care. There is a need to shift the paradigm and learn from what is going well and those that are successful. By spreading good practices across all healthcare systems, allowing healthcare teams to effectively improve processes in real time, and teaching clinicians to manage data and understand continuous improvement methods, a learning system can be developed.

By creating a learning system, efforts to improve care can be better aligned. Drivers of the system include a commitment to improvement, being ready and prepared for change, being aware of the capacity of and barriers to progress, knowledge of implementation strategies, and lastly providing leverage and resources to learning. In addition, data can be utilized by these fluid learning systems to aid patient and clinician decision-making. It is hoped that a flexible system with relevant information and data to make the right decision, and the ability to adjust processes will help to reenergize clinicians, enabling them to provide increasingly appropriate, safer, and higher quality care with less waste.

The Michigan Value Collaborative (MVC) can help you by providing claims data across 40 different medical and surgical conditions. Additionally, we have regular workgroups that meet to share best practices. If you are interested in custom analytics for your institution, joining a workgroup or want to learn more about what MVC has to offer, please contact the Coordinating Center at michiganvaluecollaborative@gmail.com.

 

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Building Resilience

Building Resilience

Following on from last week’s blog discussing burnout in the healthcare profession, this week we look at resilience and how to build it in the workforce, particularly during times of high stress. Resilience can be defined as “the capacity to recover quickly from difficulties” (Oxford Languages), while the American Psychological Association believe resilience to be “the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress”. Due to recent events, resilience among healthcare workers has become a highly publicized topic and is often in the forefront of the news. Currently, everyone has a need to build resiliency and be treated with compassion and empathy.

Although a number of articles have depicted an increase in anxiety, depression and substance use, studies done following other traumatic events such as the attacks on the World Trade Center and the Severe Acute Respiratory Syndrome (SARS) outbreak have shown a common outcome to be long-term resilience in the majority of those impacted rather than post-traumatic stress disorder (PTSD). Resilience is not a one size fits all and everybody will respond to an event in their own way. However, taking steps to adapt behavior while struggling and experiencing intense grief, fear or anxiety will impact a person’s resilience. It is continuing to show up and move forward even while facing adversity.

Additionally, resilience is not something one has or not, it is an acquired and learned behavior that is constructed actively and created through dynamic behavioral, cognitive, and environmental processes. Resilience can be cultivated through the influence of individuals and communities. By propagating togetherness and behaviors that are beneficial to others, resilience can be built within a neighborhood and each other.

Building resilience within a community takes individuals, but how can resilience be nurtured within these individuals? In a systematic literature review looking at the factors affecting resilience, the following themes were identified:

  • Influence of individual factors such as a sense of purpose, identifying the need for self-care, and holding a positive outlook
  • Influence of environmental and organizational factors indicated by workplace culture, and including identification and measurement of resilience especially within high-risk groups
  • Individual approaches to professional circumstances covering workload management, work-life balance, social support, and use of coping strategies
  • Educational interventions

Effective educational interventions may include resilience workshops along with cognitive behavioral training, stress reduction programs using mindfulness techniques, and healthcare simulation.

While we continue to undergo challenges and face adversity, it is important we take the time for self-care and also to support work colleagues and neighborhoods to build individual and community resilience. The MVC Coordinating Center is available to support, please feel free to reach out at michiganvaluecollaborative@gmail.com