Effect of a Telephone Health Coaching Intervention on Hypertension Control in Young Adults: The MyHEART Randomized Clinical Trial

“[Introduction] [..] MyHEART is a multicomponent, patient-centered, and theoretically based; it includes 4 evidence-based self-management components: (1) telephone-based health coaching with adult education specialists to teach and monitor self-management skills, (2) documentation of coach-patient telephone contacts, (3) individualized hypertension education materials, and (4) home BP monitoring. [..] The primary aim of this study was to evaluate the effect of MyHEART on clinical outcomes, ie, the change in systolic and diastolic BP (primary) and hypertension control (secondary) after 6 and 12 months, compared with usual care. [..] [Methods] [..] The inclusion criteria included (1) aged 18 to 39 years at enrollment; … Read More

The New Hospital at Home Movement: Opportunity or Threat for Patient Care?

Select Key Findings Policy Issues Debating the Future: Does H@H Save Costs and Improve Patient Care? “[..] Recent studies of cost savings from H@H programs range from 20 percent (Reese 2021) to 40 percent (Brigham and Women’s Hospital in Boston, Levine et al. 2020). But these findings are not generalizable as they are based entirely on single case studies of highly structured programs involving small samples of very carefully selected patients. For example, the study of Brigham and Women’s program examined 91 adults who were admitted to the hospital’s ED and randomly assigned to the hospital vs home for treatment. [..] While … Read More

Telehealth Best Practices: Dr Geoff Rutledge Of HealthTap On How To Best Care For Your Patients When They Are Not Physically In Front Of You

“[Authority Magazine’s Jake Frankel] can you articulate for our readers a few of the main benefits of having a patient in front of you? [Co-founder and CMO of HealthTap Geoff Rutledge] The most important point to emphasize is that the essential physician–patient interaction is direct face-to-face communication that allows a doctor to connect with their patient, engage with them, and enable them to share in detail what is going on with their lives and their health. And that this critical face-to-face communication can occur equally well either in an in-person, in-office setting or via high-resolution video and audio consultation. It’s … Read More

Internal Memo: Amazon Care to shut down, ‘not a complete enough offering’ for corporate customers

Excerpt – Amazon will stop offering its Amazon Care primary health-care services at the end of this year, according to an internal memo, after determining that it wasn’t “the right long-term solution for our enterprise customers.” The surprise move Wednesday is a major course correction in Amazon’s broader foray into healthcare. Amazon says the decision impacts only Amazon Care, and not its other health-care initiatives. “This decision wasn’t made lightly and only became clear after many months of careful consideration,” said Neil Lindsay, Amazon Health Services senior vice president, in the email to Amazon Health Services employees. “Although our enrolled … Read More

Small Solutions for Primary Care Are Part of a Larger Problem

“At a time when patients require whole-person care to improve their overall health and well-being, efforts to improve the quality of narrow processes in the primary care setting may instead lead to fragmentation of care and clinician burnout. We believe that truly patient-centered, integrated, whole-person care in the primary care setting would comprehensively address patient concerns during any given office visit, whether those concerns include chronic disease management, acute issues, or preventive health care. [..] The annual wellness visit exemplifies a piecemeal initiative focused on specific components of care that fails to meet patient expectations of comprehensive care. [..] Widely … Read More

The Telehealth Era is Just Beginning

“Having analyzed health outcomes data from the independent National Committee for Quality Assurance, health plan member satisfaction surveys from J.D. Power, and internal data from our own organizations, we are confident that full implementation of five opportunities would improve clinical quality nationwide by 20%, increase access to care by 20%, and reduce health care spending by 15% to 20%. Reduce expensive and unnecessary trips to the ER – [..] Kaiser Permanente members in Virginia, Maryland, and Washington, DC [..] can access a 24/7 video health center that connects them with a doctor who can quickly assess the problem and offer … Read More

Value-based payment has produced little value. It needs a time-out

“The concept of value-based payment became widespread among U.S. health policymakers and analysts during the 2000s. It collectively refers to interventions that offer doctors and hospitals financial incentives that, in theory, induce them to improve both components of health-care value — cost and quality — without generating the hostility provoked by managed care insurance companies during the HMO [health maintenance organization] backlash of the late 1990s. [The Center for Medicare and Medicaid Innovation reviewed 54 models of value-based payment. Only four were certified to be expanded:] The Home Health Value-based Purchasing Model demonstration cut Medicare spending by 1% with mixed … Read More

FDA rule would facilitate prescription-to-OTC switches but nix a third class of drugs

“The proposed rule would establish an Additional Condition for Nonprescription Use [ACNU] category for prescription products the FDA says consumers currently can’t appropriately self-select and use without a prescription. This is somewhat analogous to the Risk Evaluation and Mitigation Strategies, which allow certain prescription drugs with potential safety issues to be approved for patients with additional requirements for use, such as verifying a negative pregnancy test for a drug that can cause birth defects or requiring a monthly lab test before the drug can be dispensed. With an ACNU, a drug company must meet several FDA-approved conditions to ensure that … Read More

The Telehealth Era is Just Beginning: More gains in quality, affordability, and accessibility are on the way

“Having analyzed health outcomes data from the independent National Committee for Quality Assurance, health plan member satisfaction surveys from J.D. Power, and internal data from our own organizations, we are confident that full implementation of five opportunities would improve clinical quality nationwide by 20%, increase access to care by 20%, and reduce health care spending by 15% to 20%. Reduce Expensive and Unnecessary Trips to the ER Reverse America’s Chronic-Disease Crisis – For members of large multispecialty medical groups such as Kaiser Permanente [KP], high blood pressure is a much more manageable problem [outside of KP, control rates hover around … Read More

Checklists work well for complicated health care problems. But they don’t work to solve complex ones, like pandemics

Excerpt – In 2001, I developed a checklist for health care workers to reduce infections from catheters, tubes that are widely used to deliver fluids and critical medicines to people who have been hospitalized. At the time, catheter infections resulted in approximately 31,000 deaths a year in the U.S, putting it in the top 15 leading causes of death. The checklist included measures such as washing hands and wearing masks. When tested at Johns Hopkins, where I worked at the time, and then adopted in Michigan, and overseen by a diligent nursing staff, use of the checklist eliminated almost all … Read More