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Monitoring Chronic Disease Utilizing Social Media and Sensors

Monitoring Chronic Disease Utilizing Social Media and Sensors

According to the Centers for Disease Control and Prevention, “treating individuals with chronic diseases accounts for 86% of health care costs.” While the number of those living with chronic conditions and the associated costs may be increasing, the Michigan Value Collaborative (MVC) is committed to providing you with current data around providing the right care, at the right time, at the right cost. Technological advances in healthcare are changing how and where chronic disease care is being delivered, how these patients interact with providers, and how organizations exchange information.

Both diabetes and abnormal blood pressure (BP) are extremely common in chronic disease patients and cause various complications, including an increased risk of cardiovascular events. When thinking about the way in which these chronic diseases should be managed moving forward after the COVID-19 pandemic, technological advances offer promising solutions.  Most devices in the healthcare industry have been digitalized. This advancement allows for routine monitoring using various devices that some patients may already own, such as a smart phone or a smart watch. These devices contain sensors that can be used to obtain information that can then be transmitted straight into the electronic health record (EHR). Other devices that can be used to collect patient information include a glucometer sensor, pulse oximeters, temperature sensors, scales, and many more. However, this method is not without its limitations.

The amount of data that is generated from these devices is vast and not all systems are capable of storing and processing it efficiently for precise and real time monitoring. In order to negate this issue, a framework was recently published that can be seen in Figure 1 below. This framework utilizes the cloud environment along with a large analytics engine layer to help store and process the data. The recently published study identifies the importance of utilizing wearable sensors and social networking platforms in collecting patient data, but identifies the challenges that come with this such as issues with data storage and running correct analyses.

Figure 1. Layers in the proposed healthcare monitoring framework

Chronic disease management patients may use social media platforms in order to seek support or learn new ways in which they may be able to reverse certain symptoms. Other ways in which monitoring is done through social networks include patient and provider conversations through application programming interfaces (APIs). Through these APIs, providers can pick up on tone or social connection status. Through this proposed framework of social media and sensor monitoring, providers can closely monitor chronic disease management patients.

MVC hosts chronic disease management workgroups where collaborative members discuss their current initiatives and connect on ways in which they can work together to better the health of Michigan. If you have any questions about upcoming chronic disease management workgroups, please feel free to contact the coordinating center at michiganvaluecollaborative@gmail.com

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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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Telehealth Use: Maintaining Access to Surgical Care During the COVID-19 Pandemic.

Telehealth Use: Maintaining Access to Surgical Care During the COVID-19 Pandemic.

The COVID-19 pandemic created a unique situation which led to the high use of telehealth in caring for the medical patient population. However, it was unknown whether these same patterns would transfer to surgical care. The Michigan Value Collaborative (MVC) registry allows health systems to leverage administrative claims data from a variety of sources and better understand trends in telehealth use. Using MVC BCBSM data, the Telehealth Research Incubator at Michigan Medicine found in their study that telehealth was a viable way for patients to access surgical care.

Historically, surgery is the medical field least likely to use telehealth. However, with in-person care constraints resulting from the pandemic and updated policies making it feasible for telehealth visits to be eligible for reimbursement, a large uptake in telehealth among surgeons was witnessed.

Approximately 60% of active surgeons used telehealth in some capacity during the pandemic. Specifically, our study examined telehealth use for new patient visits. We were curious if surgeons were able to use telehealth to evaluate new patients, and the results proved that this was a viable and beneficial option to provide care. Significantly,  27% of all active surgeons used telehealth for new patient visits.

As shown in Figure 1, at peak use, we found over a third of visits for new patients were performed using telehealth. This is in contrast to the fewer than 10 telehealth new patient visits in 2019.

 

Figure 1

In addition, the study indicated that telehealth was successfully used for many surgical visits across multiple different surgical specialties, with urology and neurosurgery being the highest utilizers. This is shown in Figure 2.

Figure 2

There were two distinct periods of telehealth use: an early pandemic (fast uptake) and late pandemic period (slow decline). The slow decline that occurred during the late pandemic period indicated the reopening of clinics in June, and an increase in more in-person visits being used again. These are shown as Period 2 and Period 3 in the preceding figures.

Of note, our study looks at new patient visits because of the way that claims data is collected. Anecdotal evidence suggests that surgeons used telehealth even more for their established patients and for follow-up visits post-surgery. Although telehealth might save patients time and money in traveling to clinic, needing child care, and missing work, this type of consultation would be most appropriate for patients without post-operative complications.

It was noticed that telehealth provided access to surgical care for a significant proportion of patients during the COVID-19 pandemic. Any sustained use of telehealth will require ongoing updated policies and infrastructure to ensure patients have continued access to this option for their care.

Please reach out to the Michigan Value Collaborative at michiganvaluecollaborative@gmail.com for further information.

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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

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Healthcare Burnout and Possible Solutions

Healthcare Burnout and Possible Solutions

More recently than ever, healthcare workers may be faced with the potential for burnout and a decreased quality of life. The Agency for Healthcare Research and Quality defines burnout as “a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment”. From the busy work days, to the intense pace and time sensitive pressures, the healthcare environment places individuals at a high risk. All of this has the potential to impact the delivery of high-quality, compassionate care within an institution. The risk for staff to develop burnout may increase as changes to the work environment result in a poor fit for healthcare workers. :

  • Technological advances
  • Compliance with regulatory measures
  • Difficult electronic medical records (EMRs)
  • Issues with insurance coverage and reimbursement
  • Increased volume and patient acuity

In order to help decrease the risk of burnout, a quality improvement project was put into place in a 37-bed ICU between February and June 2019. Registered nurses, medical assistants, and physician assistants were the targeted population. The Mini-Z Burnout survey was given to those participating in the study to assess for factors contributing to burnout, as well as job related stress and job satisfaction. After completing the survey, interventions were put into place in order to address such risks. These interventions included:

  • Identifying scheduling opportunities (e.g. stacking days when possible)
  • Determining special needs for patients while in the ICU setting
  • Identifying staff backup based on acuity of assignments
  • Staff events to foster a positive team culture and increase collaboration

After three months of applying the above interventions, the Mini-Z Burnout survey was administered again. The findings revealed a higher percentage of staff reporting no burnout after the intervention (57.7% vs. 75%). Additionally, “satisfaction with current job” went from 70.6% pre-intervention to 82.8% post intervention. Finally, open ended questions revealed that stressors that still remained focused heavily on staffing and patient ratios. The sustainability and long-term impact of these interventions on preventing burnout continue to be monitored.

Overall, implementing quality improvement initiatives in order to promote staff wellbeing has the potential to impact the delivery of high quality and compassionate care. The Michigan Value Collaborative (MVC) is committed to helping our collaborative members implement quality improvement projects in order to increase patient and provider satisfaction. If you have any questions or wish to learn more, please reach out to the collaborative at michiganvaluecollaborative@gmail.com