Harmonised care: The key to reducing variability in care
In every patient encounter, clinical decisions represent the finely balanced combination of patient preferences, evidence, and clinician experience. Those individual decisions can contribute to care variability in a region, among a population, or for a particular condition. Clinical decision support (CDS) solutions can play a key role in harmonising clinical decisions across care teams, thus addressing care variability and improving clinical effectiveness.
CDS Can Help Align Care Team Decisions
As care teams have expanded, clinical decisions are being made across several roles, introducing the risk of misaligned decisions. But care teams who use an evidence-based CDS solution are more likely to make consistent decisions, thus standardizing care and improving outcomes. CDS resources provide clinicians with the right information right when they need it, whether at the point of care or in between patient appointments.
CDS resources not only save time with quick access to answers, but also empower care teams with the knowledge and confidence they need for clinical decision-making in familiar and unfamiliar scenarios.
From a healthcare management perspective, CDS resources can also help promote a culture of collaboration amongst care team members.
Targeting Errors: New Research on CDS
A recent study found that clinicians using a CDS resource have notably lower rates of diagnostic errors when compared to a control group of doctors without CDS. The study, “Effectiveness of a clinical knowledge support system for reducing diagnostic errors in outpatient care in Japan: A retrospective study,” was published in the January 2018 issue of International Journal of Medical Informatics. Researchers evaluated how computer-based systems might help to prevent and reduce diagnostic errors. To use a well-established and far-reaching CDS resource, the study selected UpToDate from Wolters Kluwer.
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The study identified 100 patients from an outpatient department in a community-based hospital in Tokyo, Japan over a one-year period. The exposure group of fifty patients received care by doctors with access to UpToDate, while a control group of fifty patients were seen by doctors without it.
Researchers found the diagnostic error rate was significantly lower in the group using UpToDate compared with a control group without access to UpToDate (2% versus 24%). If that reduction was extrapolated out across a healthcare organisation, think about the substantial impact on patient safety and cost-savings that could be achieved.
How to Achieve Harmonised Care?
CDS is playing a critical role not only in reducing errors, but in reducing variability in care. This can be achieved by empowering nurses, doctors, pharmacists, and the entire care team to harmonise their care decisions, resulting in better patient care and improved clinical effectiveness.
Viewing over 480mn topics a year, clinicians depend on UpToDate around the world at thousands of healthcare organisations, from individual practices to national ministries of health. Feedback from CMOs and CMIOs at large health systems validates the strategic need to reduce unwanted care variability, not only because it optimises patient care, but also because it reduces costs and waste.
To address variability, some organisations are building guidelines for standardised care authored by multidisciplinary clinical committees. However, it quickly becomes challenging to keep these guidelines updated and to promote adoption at the point of care. CDS resources like UpToDate, when used by care teams on a large scale, can be a more effective approach for harmonising care and reducing care variability
The Future of CDS
Reducing variability in care at a population level is not simple and requires that we align the decisions made by care teams and their patients. Today’s CDS capabilities already demonstrate the ability to substantially reduce diagnostic errors and improve patient outcomes. As we look ahead, with capabilities to leverage SMART on FHIR, AI, and more closely aligned care teams, CDS moves closer towards closing the gaps in care so patients can have a more consistent and effective healthcare experience
Long haul Covid, the brain and digital therapies
It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain.
Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain.
What is long Covid exactly?
Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.
How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!
When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover.
If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus.
The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.
What symptoms does this cause?
These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.
In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.
This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.
How does long-haul Covid affect mental health?
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.
How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.”
We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain.
We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and running half marathons again.
At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response.
The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival.
What digital therapies or apps are proving effective at treating long-haul Covid?
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy.
What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.