‘Putting All the Pieces Together’: Data Drives Work to Improve Home Health Care

University of Colorado | By Mark Harden

As a Medicare program to incentivize home care quality goes nationwide, Judith Ouellet, PhD, MPH, crunches the numbers to report on the program’s results.
 
Medicare’s parent agency has expanded a program that seeks to improve the quality and efficiency of home health care services, and Judith Ouellet, PhD, MPH, a University of Colorado Department of Medicine researcher, is helping in the effort to assess home health quality under the program.
 
Ouellet is a senior instructor in the Division of Health Care Policy and Research, a division made up of interdisciplinary researchers who design and conduct health outcomes research, economic analysis, and evaluate efforts to improve the quality of health care services.
 
She is the division’s lead on a project to assess the implementation of the Home Health Value-Based Purchasing Model program, or HHVBP, now being rolled out nationwide by the U.S. Centers for Medicare & Medicaid (CMS), the agency that runs Medicare.
 
Just as a primary care doctor regularly uses a stethoscope and a surgeon employs a scalpel, Ouellet’s medical tool of choice is data. It’s the tool she’s using to help protect homebound patients.
 
‘Inadequate, uncoordinated care’
 
Home health care encompasses a variety of services provided for those with an illness or injury outside of a hospital or skilled nursing facility. Medicare generally pays for certain home health care services – such as medically necessary part-time or intermittent skilled nursing care, physical and occupational therapy, and medical social services – if a doctor certifies a patient needs the care and if a patient has difficulty leaving home for care.
 
The home care usually is provided by a Medicare certified home health agency. There are more than 11,000 home health agencies nationwide – 84% of them operating for profit – serving roughly 3 million patients in a typical year, the National Center for Health Statistics says.
 
→ Research Shows Impact of Caregiving on Parents’ Employment, Health
 
When it works the way it should, home health care can be less expensive, more convenient, and as effective as care provided at a hospital or skilled nursing facility. But a CMS report on home care before the start of the HHVBP model said that “Medicare beneficiaries who qualify for home health care often receive inadequate, uncoordinated care for their chronic health conditions, resulting in more visits to the emergency room, more admissions to the hospital, or more placements in a skilled nursing facility.”…

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Novel Method Able to Predict if, When, Dementia Will Develop

Medscape | Pauline Anderson

Novel, noninvasive testing is able to predict dementia onset with 80% accuracy up to 9 years before clinical diagnosis.

The results suggest resting-state functional MRI (rs-fMRI) could be used to identify a neural network signature of dementia risk early in the pathological course of the disease, an important advance as disease-modifying drugs such as those targeting amyloid beta are now becoming available.

"The brain has been changing for a long time before people get symptoms of dementia, and if we're very precise about how we do it, we can actually, in principle, detect those changes, which could be really exciting," study investigator Charles R. Marshall, PhD, professor of clinical neurology, Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London, England, told Medscape Medical News.

"This could become a platform for screening people for risk status in the future, and it could one day make all the difference in terms of being able to prevent dementia," he added.

The findings were published online on June 6, 2024, in Nature Mental Health.

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We Won't Solve Long COVID Until We Decide What It Is

Medscape | By F. Perry Wilson

Welcome to Impact Factor, your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson of the Yale School of Medicine.

I want to help people suffering from long COVID as much as anyone. But we have a real problem. In brief, we are being too inclusive. The first thing you learn, when you start studying the epidemiology of diseases, is that you need a good case definition. And our case definition for long COVID sucks. Just last week, the National Academies of Sciences, Engineering, and Medicine (NASEM) issued a definition of long COVID with the aim of "improving consistency, documentation and treatment." Good news, right? Here's the definition: "Long COVID is an infection-associated chronic condition that occurs after SARS-CoV-2 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems." 

This is not helpful. The symptoms can be in any organ system, can be continuous or relapsing and remitting. Basically, if you've had COVID — and essentially all of us have by now — and you have any symptom, even one that comes and goes, 3 months after that, it's long COVID. They don't even specify that it has to be a new symptom.

I'm not saying that long COVID doesn't exist. I'm not saying it isn't weird or that it can't present in diverse ways. But a case definition like this hinders our ability to figure out exactly what is going on and to identify good treatments. It mixes people with real long COVID with a ton of other people, diluting our power to do science on the condition. And I have sort of a case study in this problem today, based on a paper getting a lot of press suggesting that 1 out of every 5 people have long COVID.

We are talking about this study, "Epidemiologic Features of Recovery From SARS-CoV-2 Infection," appearing in JAMA Network Open this week. While I think the idea is important, the study really highlights why it can be so hard to study long COVID. 

As part of efforts to understand long COVID, the National Institutes of Health (NIH) leveraged 14 of its ongoing cohort studies. The NIH has multiple longitudinal cohort studies that follow various groups of people over time. You may have heard of the REGARDS study, for example, which focuses on cardiovascular risks to people living in the southern United States. Or the ARIC study, which followed adults in four communities across the United States for the development of heart disease. All 14 of the cohorts in this study are long-running projects with ongoing data collection. So, it was not a huge lift to add some questions to the yearly surveys and studies the participants were already getting.

To wit: "Do you think that you have had COVID-19?" and "Would you say that you are completely recovered now?" Those who said they weren't fully recovered were asked how long it had been since their infection, and anyone who answered with a duration > 90 days was considered to have long COVID.

So, we have self-report of infection, self-report of duration of symptoms, and self-report of recovery. This is fine, of course; individuals' perceptions of their own health are meaningful. But the vagaries inherent in those perceptions are going to muddy the waters as we attempt to discover the true nature of the long COVID syndrome…

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Advocates Rally in DC for the Future of Hospice: NHPCO and HAN Amplify Provider Voices on Capitol Hill

NHPCO 

HHAC Was There! 

(Alexandria, VA) – More than 100 hospice and palliative care advocates from across the country met with over 150 congressional offices this week to discuss key legislative and regulatory priorities for ensuring and expanding access to hospice and palliative care. The meetings were part of Hospice Action Week, hosted in Washington, DC by the National Hospice and Palliative Care Organization (NHPCO) and its advocacy affiliate, the Hospice Action Network (HAN).

Hospice Action Week brings together leaders, advocates, and supporters from across the country to unite as one voice to drive positive, legislative change for the betterment of the Medicare Hospice Benefit. This year’s events included a virtual component, giving advocates who were not able to attend in person the opportunity to write letters of support to their Members of Congress on key policy priorities including program integrity measures, telehealth flexibilities, workforce issues, and more.

“The cornerstone of effective advocacy is storytelling. It’s about sharing why hospice holds personal significance and why serious illness and end-of-life care policy should resonate with our lawmakers,” said Logan Hoover, NHPCO’s VP of Policy & Government Relations. “From Hawaii to Rhode Island, advocates from 35 diverse states came to DC this year. The relationships they’re building with Members of Congress hold the potential to shape the future of the healthcare landscape.”

This year, advocates focused on a variety of key issues during their congressional meetings:

• Protecting care for patients and families through program integrity efforts, fixes to the hospice Special Focus Program to ensure proper identification of poor-performing hospices, telehealth flexibilities, expansion of bereavement services, and ensuring access to care for our nation’s Veterans.
  
  
• Making meaningful benefit improvements to increase access and advance health equity by addressing workforce crisis by allowing practitioners to perform at the top of their licensure, reforming the outdates six-month prognosis barrier, enabling concurrent care, and advancing health equity by removing structural barriers to care.
  
  
• Innovation in serious illness care delivery and payment by building upon previous, successful demonstration models through a community-based palliative care benefit and ensuring a seamless ending to the hospice VBID component through support for providers.
  
  
• Protecting access and expanding quality by ensuring providers can offer the right care at the right time by securing an adequate level of reimbursement and ensuring resources are going directly to patient care by eliminating burdensome regulations that jeopardize access while strengthening effective program integrity measures to increase care quality.

In addition to advocate meetings with congressional offices on Wednesday, Hospice Action Week also featured various other meetings of hospice and palliative care leaders from across the country…

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