Neighborhood health in RI; nursing homes need to focus on quality; prioritizing medicine over older patients’ health
April 16, 2015
In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.
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As Director of Health, Michael Fine, MD, had a vision for improving public health while reducing healthcare spending in Rhode Island by providing primary care to all Rhode Islanders. The Rhode Island Primary Care Trust, which is described on RIFuture.org and on the Rhode Island Department of Health website, would establish dozens of Neighborhood Health Stations sprinkled throughout the tiny state, equipped with physicians from all disciplines and a bank of allied healthcare providers. The team would not only provide world class care to community residents, but also focus on the health needs of every community, such as healthy activities like Zumba and nutrition counseling. By the state’s estimates, such robust community-based care would reduce the need for hospitalization, and the number of expensive hospital beds would decrease by some 45 percent. But with a new governor and new director of health, the proposal has been put on the back burner. Fine, who is also a Lown Institute board member, remains passionate. “If we don’t (implement this plan),” he said, “all we’re doing is perpetuating a costly infrastructure that doesn’t work.” Since he stepped down, the state has chosen to focus on its Reinventing Medicaid working group, which is considering cutting Medicaid spending as the solution to its healthcare mess. We’re wondering how that might be of greater health benefit to Rhode Islanders. But Fine continues to work with the city of Central Falls, and expects the first Neighborhood Health Station in the United States to be operational by the beginning of 2016.
Nursing homes occupy a challenging place in the healthcare system. Ideally, they’re an important step in helping patients recover from hospital stays and transition back to independent living, and a supportive environment for patients who require consistent access to care outside the hospital. But often, nursing homes fall far short of that ideal. In the New York Times, Katie Thomas writes that many homes seem more focused on their own finances than on providing quality care. Nursing homes tend to pursue patients who will need short-term stays; the reimbursement for their stays are higher than long-term care for patients on Medicaid. That faster turnover means homes are constantly working to recruit new patients. Like hospitals, nursing homes are increasingly investing in pleasant-looking lobbies and attractive amenities. Patients would be better off if the industry devoted less time to marketing and paid more attention to performing the basic tasks needed for high-quality care.
In a Washington Post piece, Louise Aronson, a geriatrician, writes about a chance meeting with an elderly woman whom she felt compelled not only to drive home after a clinic appointment, but also to become involved with her medical care. Aronson discovers the patient was seeing multiple physicians and taking 17 medications, but the care was not coordinated. To complicate matters, the patient lived alone, had no family and had excruciating arthritic pain and mobility issues. Additionally, no one was addressing the patient’s other pressing needs, like the 49 steps she would have to climb to get into her apartment or the necessary medications she had failed to take because she couldn’t get to the pharmacy. Aronson saw to it the patient got in to her geriatrics practice and started receiving better management of care and even home visits, when appropriate. “Those who argue healthcare consists primarily of prescriptions and procedures, or treatment of body parts and diseases, have created a system that prioritizes medicine to the detriment of patient health,” said Aronson. “It’s time we took a broader view of healthcare, one that puts the well-being of patients first and trains and rewards clinicians who work with patients, caregivers, and other health professionals to achieve that goal.”
Remote Area Medical, a documentary about the personal stories of patients without access to healthcare and the effort to treat them at a three-day free clinic in Tennessee, will be shown at Harvard Medical School, 260 Longwood Ave, Boston on Wednesday, April 29, beginning with a meal at 6:30 pm and concluding with a film discussion. Hosts are Lisa Simon, DMD and Stephen Martin, MD. RSVP.
The Lown Institute is developing a national survey on physicians’ perceptions of medical overuse and seeks pilot survey takers in cardiology, oncology, orthopedics, psychiatry and primary medicine for the cognitive testing phase. Physicians will be compensated for their participation. To learn more, please contact Carissa Fu at cfu@LownInstitute.org.