Six ways Hospitals can improve Chronic Care
Written by Haleigh
As many as 133 million Americans, or about one in two Americans, live with a chronic illness. About 75 percent of American health care costs are generated by chronic illnesses, which cause seven out of every 10 deaths in the U.S.
The U.S. health care system is moving from a fee-for-service model toward an accountable-care model with a focus on prevention. Today's health care policy and administration graduate students — click here to learn moreabout these programs — will develop policies designed to prevent chronic illness and reduce complications. One health care delivery model to explore is the Chronic Care Model, which combines effective care, community involvement and patient education to tackle America's chronic illness epidemic. Better chronic care can cut health care costs and improve quality of life for many Americans.
Make Chronic Care a Business Priority
Chronic care that provides good results for patients will require health care leaders to change the way they do business. For example, hospitals and health care systems may start compensating doctors according to patient outcomes. They may also provide patient data to doctors so that doctors can examine their own performance in real time. In addition to making hospital procedures more efficient, health care leaders need to facilitate care coordination between multiple providers. They also need to coordinate with caregivers and community organizations to support patients post-discharge.
Utilize Community Resources
Preventing chronic illness and reducing complications requires health care policies that support community organizations. Hospitals can create partnerships with employers, insurance companies and effective organizations within their communities. For example, an employer's insurance company could set up preventive screenings at a local hospital, or a hospital could sponsor free cholesterol screenings at a community center.
Give Patients Tools to Manage and Prevent Chronic Illness
Since most chronic conditions are preventable, patient education and empowerment are crucial to cutting chronic care costs. For example, patient-centered programs could focus on the following:
· Smoking.Despite widespread knowledge of the dangers of tobacco smoking, one in five Americans still smokes cigarettes. In addition to teaching Americans about the dangers of smoking, hospitals could provide smoking cessation support groups and easy access to nicotine patches and other supports.
· Physical exercise.One-third of Americans fail to meet minimum daily recommendations for aerobic activity, and only one in three high school students attends a daily physical education class. Hospitals could sponsor exercise classes, and they could partner with employers and insurers to offer personal trainer sessions. They could also connect patients with mobile device apps to track daily physical activity.
· Nutrition. Only 24 percent of U.S. adults and 20 percent of U.S. high school students eat five servings of fruits and vegetables per day, and 60 percent of children eat more than the recommended daily amount of saturated fat. In partnership with community organizations, hospitals could sponsor healthy cooking classes, send out nutrition newsletters and connect patients with mobile apps that allow them to track their diets.
Tie Doctor Visits to Specific Goals
Patients don't always keep follow-up appointments, but their compliance may improve when visits are tied to specific goals. Doctors may schedule follow-ups out of habit, but they may not be checking the right patient health metrics. Having a reason for each visit keeps costs down and ensures that doctor visits are actually producing positive outcomes.
Use Evidence-Based Treatment, Preventive Screenings and Telemedicine
Doctors continue to offer some procedures even after the procedures are proven to be ineffective. Hospitals should reward doctors both for delivering evidence-based treatments and for holding off on unnecessary or ineffective tests. When doctors aren't sure which treatment is best, hospitals should provide access to specialists through telemedicine.
Take Advantage of Data
Doctors need to see how effective they are at treating chronic illness. For example, when doctors observe a drop in readmissions and mortality rates, they know that the treatments they're recommending are producing good outcomes for their patients. In addition to tracking treatment outcomes, hospitals can use data to enhance patient safety, encourage efficient test ordering and promote cost-saving practices. Doctors who monitor their data can change their behavior more quickly, resulting in more profitable hospitals and better results for chronically ill patients.
Hospitals play vital roles in treating chronic illness, and those roles can range from sponsoring prevention programs to dealing with diabetes complications. New health care policies that promote evidence-based care, community involvement and patient empowerment are the keys to addressing the skyrocketing cost of chronic care in America.
Doctor talking to couple image by monkeybusinessimages from iStockPhoto.com
Community health center image by Christiana Care from Flickr Creative Commons
COVID-19 "causing mass trauma among world’s nurses"
Healthcare providers are facing ongoing nursing shortages, and hospitals are reporting high rates of staff turnover and burnout as a result of the COVID-19 pandemic. In June a report found that levels of burnout among staff in England had reached "emergency" levels.
Registered nurses Molly Rindt and Erika Haywood are nurse mentors on US recruitment platform Incredible Health. In this joint Q&A they tell Healthcare Global about their own experiences of burnout and what can be done to tackle it.
What does it mean to be suffering from burnout?
Some of the most common reasons for nurse burnout include long work hours, sleep deprivation, a high-stress work environment, lack of support, and emotional strain from patient care.
While every profession has its stressors, the nursing industry has some of the highest burnout rates. The massive influence on patients’ lives, the long hours, and many other factors put nurses at risk of severe burnout. And with the rise of COVID-19, many healthcare professionals feel the strain more than ever.
Burnout in nurses affects everyone — individual nurses suffer, patients are impacted, and employers struggle with enormous turnover. This is why it’s crucial for healthcare systems and management to watch for signs of nurse burnout and take steps to provide a healthier workplace. Employers should be careful to watch for burnout symptoms in their healthcare staff — and not ignore them.
Symptoms include constant tiredness, constant anxiety related to work, emotional detachment and unexplained sickness.
How widespread is this problem?
Unfortunately, burnout affects approximately 38% of nurses per year and even the WHO recently labelled burnout as an official medical diagnosis. To put this statistic into perspective, nearly 4 out of 10 nurses will drive to work dreading their shift. Burnout is a reason nurses leave their positions.
Other top reasons for leaving included a stressful work environment, lack of good management or leadership, inadequate staffing, and finding better pay or benefits elsewhere.
Even before the pandemic, demanding workloads and aspects of the work environment such as poor staffing ratios, lack of communication between physicians and nurses, and lack of organisational leadership were known to be associated with burnout in nurses.
Have either of you experienced burnout?
Rindt: I have experienced burnout as an RN. I was constantly fatigued, never felt like I was off work, and would frequently dream I was still at work taking care of patients. In my particular situation, I needed to take a step back and restructure my work schedule to allow for more time off. After doing this, I was able to reduce burnout by deciding to work two shifts back-to-back and then have 2-3 days off.
Haywood: I definitely experienced constant anxiety related to work - so much so it would impact the days I wasn’t at work. At one point, I was even on medication to help combat the anxiety and stress I was facing on the job.
I had heart palpitations, chest pain, and wouldn’t be able to sleep before working the next day, which slowly started to impact other aspects of my life. I knew I couldn’t continue to live this way, it wasn’t sustainable. Because of this, I began to focus on my needs and prioritising self-care, especially during the beginning of the pandemic. Putting my needs first and not feeling guilty were necessary for me to overcome burnout.
What impact is COVID-19 having on nurses' wellbeing?
Some nurses have suffered devastating health consequences. Many nurses have dealt with excessive on-the-job stress, fears of becoming infected, and grief over seeing patients succumb to COVID-19 while isolated from their families.
New evidence gathered by the International Council of Nurses (ICN) suggests COVID-19 is causing mass trauma among the world’s nurses. The number of confirmed nurse deaths now exceeds 2,200, and with high levels of infections in the nursing workforce continuing, overstretched staff are experiencing increasing psychological distress in the face of ever-increasing workloads, continued abuse and protests by anti-vaccinators.
However, other small silver linings that came from the pandemic include increased professional autonomy, leadership opportunities and career growth potential.
How much of the cause of burnout is due to the hospitals or healthcare providers, and what can they do to address it?
Nurse fatigue poses serious problems for healthcare organisations, and a recent survey from Kronos found 63% of nurses say their job has caused burnout. The survey also found that more than 4 out of 5 nurses think hospitals today are losing good staff because other employers offer a better work/life balance.
Nurse burnout not only contributes to staff turnover, but it can impact the facility’s quality of care, patient satisfaction, and even medical outcomes.
Strategies to address burnout include training improving nurse-to-patient ratios, include nurses in policy discussions, and prioritise fostering a healthy work culture in hospitals.
What does your role mentoring nurses on the Incredible Health platform involve?
Rindt: My role can vary based on the needs of the nurses. The nurses love knowing they have someone in their corner who can give interview preparation advice or provide suggestions on how to improve their resume. Knowing that there is someone who is well-versed in the job process and can help set expectations on what to anticipate, really helps to remove a layer of uncertainty.
Haywood: When screening nurses, it is customised to what their individual RN or nurse practitioner needs, and at a time that is most convenient for them. Nurses are busy and often aren’t thought of first. Being able to provide support from the very beginning of their career advancement journey helps tremendously. We also provide resources such as resume templates and tips that can help nurses be successful and feel supported.