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Anchor lead: Should you as a patient be able to enter data into your electronic health record? Elizabeth Tracey reports

The jury is out on whether you as a patient should be able to enter data into your own health record, but with the plethora of monitoring devices for blood sugar, blood pressure and other body functions the day can’t be far off. Timothy Niessen, an internal medicine expert at Johns Hopkins, examines what’s known.

Niessen: How often does patient entered data provide new value? And it does at least in one in five of the cases. For many diseases there’s a lot of interest in patient reported outcomes as an important way to understand how effective are our treatments. Many of us care about life and death, hospitalization, but maybe those really aren’t the outcomes that matter to our patients. Maybe having things like patient reported outcomes and having those directly entered into our medical record would be of great importance.   :30

Niessen says such a practice could be adopted on a limited, provisional basis to see how the additional data may help. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What’s the best role for electronic assessment tools in patient care? Elizabeth Tracey reports

Electronic devices are increasing being used to monitor hospitalized patients, and their capabilities are constantly expanding, a recent study showed. Alicia Arbaje, a geriatrics expert at Johns Hopkins, says their role should be scrutinized carefully.

Arbaje: Certainly there’s a role for telemedicine or wearable technology or motion sensors or those kinds of things, but I do not think that the role of technology is to substitute for human care. It’s really to complement care from a human being. There is a potential for cost savings but it cannot be at the substitution of human touch. I think there we are going in the wrong direction.  :21

Arbaje says she has seen some clever applications of technology for hospitalized older patients.

Arbaje: Have family members record their voices, and then you play it back to the person when they’re in the middle of an episode of delirium, it helps to calm the person down. I thought now there’s an interesting use of technology where you’re creating some humanity, you’re putting some humanity back.  :14

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Keeping people with heart failure out of the hospital may not be a good choice, Elizabeth Tracey reports

People with heart failure whose hospitals took measures to keep them from being readmitted died at higher rates than those who came back to the hospital, a recent study in the Journal of the American Medical Association found. Alicia Arbaje, a geriatrics expert at Johns Hopkins, says her own research points to a likely reason.

Arbaje: When we try to keep people at home we may not be as effective. In our own work studying home health care services after hospital discharge what we found it that one of the top three challenges that nurses face when they see a patient at home is that the patient is actually not appropriate for home-based level of care. That really they should have gone to a higher level of care like a skilled nursing facility or what they really needed was hospice care, and so nurses are finding that it’s not within their score of work as currently organized to care for these people with really complex issues. :30

Arbaje notes that heart failure is increasingly common among older people so coming to terms with this issue of home care is important. At Johns Hopkins, I’m Elizabeth Tracey.

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Pulse November 2017

November 27, 2017

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Program notes:

 

0:16 High value care and inHealth

1:20 Increasing value of care delivered

2:19 More precisely define subsets of disease

3:17 Precision medicine center of excellence

4:18 Genetics is a test but not the only test

5:20 Forum in the Senate building

6:14 Quality and cost

7:16 We’re looking to bring in an array of disciplines

8:08 End

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Anchor lead: Does a common blood thinner reduce cancer risk? Elizabeth Tracey reports

Warfarin, or Coumadin, is a very common blood thinner. Now a new study has linked use of Coumadin to a decreased risk for breast, prostate and lung cancers. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says not so fast. Use of Coumadin may be simply a place holder for some other factor in those who are being treated with the drug.

Nelson: What biases are there among people who are taking Coumadin versus people who are not? The first obviously is if you’re taking Coumadin you have some kind of an illness. It’s related to blood clotting or the worry for blood clotting and that does two things. One, it engages you tightly with the health system cause you’re forever going in figuring out whether your blood clotting or warfarin levels effect on blood clotting is too much or too little, and then the health system is going to make decisions with this vigilance, about how hard they’re going to look for cancer.  :31

Nelson says this study does point toward another assessment of the cancer/Coumadin relationship, as well as discernment of how it might work. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Most of those undergoing care for cancer are concerned about costs, Elizabeth Tracey reports

Many people really aren’t aware of cancer risk factors, even common ones, a recent Gallup survey showed. The same survey also demonstrated just how financially burdensome cancer treatment is. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, describes the findings.

Nelson: They or their family member had tried to intentionally reduce the costs of the healthcare burden of suffering cancer in some way. It was roughly seven to nine percent each had either skipped doctor’s appointments, not filled prescriptions, skipped taking a medicine, cut pills in half to extend them, some kind of tactic to reduce the financial burden. Clearly there is a burden of cancer and cancer care what you see is people remarking in a survey like this that they’re taking steps, and maybe not very good ones, for cancer outcomes. :32

Nelson says cancer patients and their loved ones should bring financial concerns to their caregiver, since such stresses can impact treatment. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can medication regimens be simplified to achieve patient goals? Elizabeth Tracey reports

Seniors with serious illness are troubled by their medication and healthcare regimens more than any other aspect of their care, a recent report from the Kaiser Family Foundation asserts. Alicia Arbaje, a geriatrics expert at Johns Hopkins, says one response by caregivers may be to simplify things, based on the patient’s goals.

Arbaje: So if the person’s goal is to be able to get to church on Sundays and be mobile enough to be with their grandchildren then maybe we don’t want to be giving them medications for their blood pressure that might make them dizzy or fall. Even though we would like to see their blood pressure lower, I think having those really important conversations about what are your goals, what is it that we can best help you with. What are your top three concerns? And then let’s streamline the medications to really meet those concerns. I think that tailored approach is really what will get people on board to get them to take the medications we do want them to take.  :32

Arbaje applies this lens of patient concerns as primary in deciding which medicines are reasonable. At Johns Hopkins, I’m Elizabeth Tracey.

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