Blog post by Colin Hung
Last week I had the opportunity to attend the National Association for Home Care & Hospice (NAHC) Annual Meeting. It was the first time at this conference and I was excited to be going. I was anxious to see the latest innovations for patient self-care at home and the latest evolution of aging-in-place technologies. I should have read the prospectus better.
The target audience for the NAHC15 event wasn’t patients at all. The 2,500 attendees were mostly from organizations that provide in-home care to patients. Many were from companies that send clinicians, nurses, caregivers and social workers to paitents’ homes. Because of that, many of the vendors in the exhibit hall had tools and technologies that were designed to help manage this type of mobile and remote workforce.
Although I was initially disappointed, I found NAHC15 to be eye-opening. Being a newbie, I spoke to as many people I could. I learned a lot. My biggest take-away is the complexity of the issues facing this growing area of healthcare:
- High burn-out rates amongst in-home nurses and caregivers
- Safety and risk concerns related to travel to residential buildings
- Fraud related to non-visits (when someone says they visited a patient when in fact they did not)
- Lack of patient support tools after operations, procedures and doctor visits
This last issue was especially surprising. Almost everyone I spoke to talked about how patients go home with woefully inadequate knowledge of the recovery process. I met one nurse who had been providing in-home care for over 20 years who told me that things had gotten worse now that everyone was using EHRs. “Hospitals and surgical clinics nowadays just print off templated instructions from their EHRs that are so generic and contain so much jargon that you might as well hand over a blank piece of paper. It’ll be about as effective. No patient reads that stuff and those that do will need the Internet to figure out what it says.”
If I were to synthesize all the NAHC15 comments into a “top 5” it would look like this:
- Patients need more than a printed piece of paper. They need/want to talk to someone – especially when they have questions.
- Not all patients have access to smartphones and ready access to the Internet so all the innovative apps and websites are helpful only to a certain segment of patients
- Social aspects of healing are completely neglected. Common questions posed to in-home care providers include: Is it okay for me to see my friends? Is there someone I can talk to who went through the same procedure as me? When is it okay to engage in intimacy again?
- Instructions are not written at the literacy level of patients. Many contain clinical jargon and measurements that are not commonly understood. Patients are especially confused over the term “as needed” when it comes to medications.
- No thought is given to environmental concerns in patient homes (aka social determinants of health). In-home health providers are often surprised by the conditions some patients live in. From apartments without sufficient heat to unhygienic rooms (can you really expect an elderly patient who had hip surgery to clean their own home?).
There are signs of hope. On October 30th, just after the conference, John Lynn posted this blog about a “new look” patient instruction given to Jess Jacobs. There is also the wonderful Cleveland Clinic website which has a ton of helpful resources for patients recovering from surgery. Here is a link to their breast cancer surgery page. In 2013 a study was done to determine patient acceptance of telehealth as a means of post-procedure follow-up. The study found that most patients were positive and appreciated this form of communication with their provider after their procedure.
This week on #hcldr I want to discuss the post-procedure/post-visit void. I’d love to hear your opinions on why this aspect of healing has been so neglected and I’m excited to see what ideas the community will come up with to solve it. Please join us Tuesday November 3rd at 8:30pm ET (for your local time click here) as we discuss:
- T1 Why is healing/post-procedure so neglected?
- T2 What needs to happen before more attention is placed on patients healing at home? Policies? Payment changes? Technology advancements?
- T3 How would you feel if a healthcare provider offered to connect you with a fellow patient for support? Cop-out vs welcome help?
- T4 What can we do to improve the healing/post-procedure process for patients at home?
Resources
“A New Look at Plan of Care and Patient Instructions”, John Lynn, EMR and EHR, October 30 2015, http://www.emrandehr.com/2015/10/30/a-new-look-at-plan-of-care-and-patient-instructions/, accessed November 1 2015
“Follow-up Care After Cancer Treatment”, National Cancer Institute, http://www.cancer.gov/about-cancer/coping/survivorship/follow-up-care/follow-up-fact-sheet, accessed November 1 2015
“Telehealth Follow-up in Lieu of Postoperative Visit for Ambulatory Surgey”, Kimberly Hwa and Sherry M Wren, JAMA Surgery, September 2013, http://archsurg.jamanetwork.com/article.aspx?articleid=1710512, accessed November 1 2015
“Principles of monitoring postoperative patients”, Cathy Liddle, Nursing Practice Review, May 6 2013, http://www.nursingtimes.net/Journals/2013/05/31/g/l/a/050613-Principles-of-monitoring-postoperative-patients.pdf, accessed November 1 2015
“8 Technologies Changing Home Healthcare”, Alison Diana, InformationWeek, December 18 2014, http://www.informationweek.com/healthcare/patient-tools/8-technologies-changing-home-healthcare/d/d-id/1318200, accessed November 1 2015
“Real-time Health Monitoring Will Revolutionize Patient Home Care in 2015”, Robert Herzog, HIT Consultant, January 5 2015, http://hitconsultant.net/2015/01/05/real-time-health-monitoring-revolutionize-patient-home-care/, accessed November 1 2015
“In-home health monitoring to leap six-fold by 2017”, Lucas Mearian, ComputerWorld, January 22 2013, http://www.computerworld.com/article/2494451/healthcare-it/in-home-health-monitoring-to-leap-six-fold-by-2017.html, accessed November 1 2015
Image Credit
Rouse House – Christope Rober Hervouet- https://flic.kr/p/vaGSx3
hcldr 
Colin, Thank you so much! Your comments about “inadequate patient recovery information” are spot on! And the failure of discharged patients — and family caregivers — knowing proper self-care for recovery is also a big reason for the high number of 30-day readmissions!
To that end, we recently created a set of short, easy-to-understand “behavioral modeling” videos that SHOW patients and their family caregivers exactly what the patient needs to do to recover successfully from congestive heart failure after leaving the hospital. These are NOT the typical “talking head” videos.
Informed by social cognitive theory research and tailored to individual patients, they are now being used at Duke University Medical Center Heart Clinic (Durham, NC) and being piloted at 19 other hospitals, medical centers, heart clinics and home care services nationally. The response from both patients and healthcare providers to these patient-recovery videos has been overwhelmingly positive.
Please take a look and tell us what you think: http://www.WellflixCHF.com Each of the 8 videos is only 3 to 5 minutes. And, per your comments, these are also available to patients on DVD, for those patients and families less tech savvy.
I eagerly seek your feedback.
Best,
Peter Orton, PhD
Chief Science Officer
http://www.Wellflix.net
Reblogged this on Shereese's Blog and commented:
Colin, this sadly, is all true. There used to be discharge planning meeting that were patient-centered. The scope of these meetings, if they still occur, has changed. Socio-economic issues are never a consideration and often the planning participants are talking over the patient & family’s head. There are ways to change this; we just have to be mindful of the problem.