Every issue of Case in Point magazine contains four contact hours approved by the Commission for Case Manager Certification and the Certification of Disability Management Specialists. There are currently 18 hours available in the following documents at the Case in Point website:

The December/January, February/March and April/May issues of Case in Point, along with the Independent Case Management Supplement and the valuable supplement titled Working Together Toward Cultural Competency.

NTOCC offers new tools, features with enhanced website

The National Transitions of Care Coalition (NTOCC) announced on May 2 the launch of an enhanced website. The redesigned site contains a variety of new downloadable tools and information to help address transition of care challenges and to raise awareness about transitions of care. Click here for the revamped and redesigned website.

Common drugs linked to complications for elderly

Researchers have found that some common drugs for treating incontinence, allergies or high blood pressure that block acetylcholine have been linked to problems with walking and cognitive function in the older population. Click here for the story.

Home monitoring program improves outcomes for heart patients

A new study by Connected Cardiac Care Program shows that patients with heart failure who were monitored remotely with tele-monitoring equipment showed improvement and had lower average hospital readmission rates. Click here for the story.

Experts debate guidelines for treatment in event of flu pandemic, disaster

An article in the Baltimore Sun introduces a plan developed by a special physician task force, which has developed recommendations for healthcare providers about which patients should not be treated during a flu pandemic or other disaster in order to ensure scarce medical resources are used in an objective and uniform way. Click here for the story.

What to call them? Retail clinics? Convenient care clinics? MinuteClinics? These and other names were thrown around the auditorium at a conference I attended on retail and employee clinics two weeks ago in a small town in southern New Jersey. The name of the conference offers a generic and well-suited answer to this question. But it is the second half of the conference’s title that is more striking: It infers the potential and power for a reconfiguring of an industry, as well as the ambivalence surrounding this new, albeit rapidly emerging, trend. Retail and Employee On-Site Clinics: Flash in the Pan or Big Bang? goes the name of the conference. And the more one learns about this topic, the more it is clear that the question is poignant.

On-Site clinics are, simply put, “small healthcare facilities located in convenient, accessible settings,” as Tine Hansen-Turton describes them. These clinics are normally staffed by a nurse practitioner and intended to provide non-emergency care.

Ms. Hansen-Turton is the executive director of the Convenient Care Association (CCA), an organization that came into being in 2006. Its stated mission is to “strengthen and advance the Convenient Care model of health care.” Some 900 on-site clinics are currently in operation in sites such as drug stores and supermarkets across the country. The CCA projects that total number to reach close to 1,600 by the end of this year alone. That 78 percent growth arrives on the heels of a more staggering figure: Between 2006 and 2007, the number of on-site clinics exploded by about 400 percent.

The question now seems to be: Can this expansion continue? It is impossible to answer, but a look at the services that these clinics provide can go a long way toward formulating an accurate glimpse into whether the trend can endure.

According to Ms. Hansen-Turton, on-site clinics offer a trifold set of services that can set it as a bedrock in the healthcare delivery system: They are accessible, they are affordable and they perform at a high quality level. With the current shortage of primary care physicians and a very high positive patient-response rate, on-site clinics have the potential to resound like a big bang across the healthcare sector.

All of this has been said without a mention of on-site employee clinics, an equally formidable movement toward increased access and reduced costs. With major companies setting up on-site clinics for their employees’ use, and with positive results coming in, it does not appear this development is at risk of vanishing.

So, a flash in the pan or a big bang? It may be too early to say. But don’t be surprised if you find yourself strolling down the aisle of your local supermarket when you want to receive your next flu shot. (To find out more about this exciting trend, the CCA’s website is a good place to start. If you would like to share an experience with on-site clinics, please e-mail Anne Llewellyn at allewellyn@contexomedia.com. Also, stay tuned for a much more extensive look at this topic in the October issue of Case in Point magazine.)

Have a great week!

Two studies have found that a brain pacemaker developed by Medtronic was able to improve the conditions of patients with major depressive behavior and obsessive-compulsive disorder. Researchers did not uncover any serious adverse events linked to the device, which is being evaluated by the FDA for approval for treatment of OCD. Click here to read more.

Heart failure hospitalizations tied to secondary factors

Research that included almost 49,000 patients shows pneumonia, irregular heartbeat and obstructed blood-flow to the heart are the most common reasons U.S. heart failure patients are hospitalized. More than 60 percent of heart failure patients hospitalized had at least one of these factors, and the study’s authors point out that early interventions – such as immunizations for flu and pneumonia – could help reduce hospital admissions. Click here to read more.

CDC reports rates of hepatitis A, B cases down; hepatitis C up slightly

New data from the CDC show rates of new hepatitis A and B infections have fallen to the lowest levels ever recorded, which experts attributed to routine childhood vaccination. However, the data also found infection with hepatitis C has increased slightly each year since 2003, leading one CDC expert to call for more effective interventions. Click here for the report.

Providers, payers and patients like virtual visits

Virtual doctor visits are becoming more popular throughout the United States. For the patient, “seeing” the doctor becomes simpler, less time-consuming and less expensive. It’s also more convenient for doctors, and it’s generally less expensive for insurance companies. Click here to read more.

IOM calls healthcare industry to prepare for the Boomers

The healthcare community needs to start making preparations for aging baby boomers, says a report by the Institute of Medicine. The report warns of serious breakdowns if the healthcare system is not adequately prepared for the 20 percent of the population that will be over 65 years of age by the year 2030. The report calls for more healthcare workers and changes to the fundamentals of the system. The changes involve re-thinking everything from education and training to models of care and private and public insurance programs. Click here for the report.

One of the OWH’s programs is the Annual National Women’s Health Week. The campaign, which runs May 11-17, encourages women to get healthy by taking action. The nationwide initiative encourages women to make their health a top priority and take simple steps, such as:

• Engaging in physical activity most days;
• Making healthy food choices;
• Visiting your healthcare provider to receive regular check-ups and preventive screenings; and
• Avoiding risky behaviors, like smoking and not wearing a seatbelt.

The theme this year is It’s Your Time: Get Inspired, Get Healthy. I would like everyone reading this e-editorial, every single one of the more than 12,000 readers of Across My Desk, to take a moment for you to make that appointment for the mammogram that you have been putting off because you have been too busy, or to schedule that Pap test that is now two years overdue, or to make an appointment with your PCP to make sure your health is on track. Traditionally, women are caretakers. But this week calls for all women to think about themselves, and to take the time to ensure that you stay healthy so you can continue to care for those you love.

There is a wealth of information on the National Women’s Health Week page that you can share with your family, friends and colleagues to encourage others to join the campaign to Get Inspired, Get Healthy. To learn more, click here.

You do a great job educating and empowering your patients, so take the challenge and make the pledge to take care of yourself!

Till next week, get inspired, get healthy,

The aptly named Health Care Innovations Exchange is an Agency for Healthcare Research and Quality (AHRQ) program designed to support healthcare professionals in sharing and adopting innovations that improve the delivery of care to patients. Explore this site to find innovative strategies and quality-related tools, and learn how to improve your organization’s ability to innovate and adopt new ideas, and interact with innovators and adopters. Click here to delve into the innovations.

Report: Measuring the ominous future of health care

The U.S. health care system is on an unsustainable path. Health plan providers must help shape and lead the health care transformation or risk being marginalized. Click here for the future-trending report.

One size does not fit all: Meeting the health needs of diverse populations

In a new report released April 21, the Joint Commission suggests that hospitals should assess patients’ cultural and language needs and then improve policies to meet those needs. The report includes a framework for practices that address diverse needs, as well as a self-assessment tool that hospitals can use to evaluate how well their practices are working. Click here for the report.

Dental hygienists seek to expand role

Dental hygienists want dentists to loosen supervisory controls to let them provide a broader range of care and alleviate an acute shortage of oral health services in poor and underserved areas. State lawmakers and policy experts are starting to agree, and a Maryland bill passed this session gives hygienists the ability to provide preventive care — such as cleanings, sealants and fluoride treatments — in public health settings. Click here for the story.

Stay current with election bloggers

As the primary campaign winds down to a single candidate, hopefully the political rhetoric will turn to how both the Republican and Democratic candidates will lead our country IF they are elected in November. One way to stay connected is to check out a new site that Weekend Edition Sunday’s Host Liane Hansen introduced last week. The site brings together reporters that are covering the election. Click here to stay informed on this essential topic.

The morning started with an address by the University’s President, Dr. Donna Shalala. I have admired Dr. Shalala since her days as Secretary of Health and Human Services under the Clinton administration and was excited to hear her words. Her opening address talked about the challenges of today’s health care system and the vital need of providing access to the health care system, at the right time and the right place, to every American. She also encouraged those in the audience to make a commitment to make the changes in their lives that will help them achieve wellness. She said that we need to work together to improve health care, and that it is up to each of us to do our part. I was able to catch her as she left the hall and provide her with a copy of the April/May issue of Case in Point. I wanted her to see that there is a host of professionals dedicated to making her comments come to life. From here we moved to the various breakout sessions. The choices were:

• Can Cancer Be Prevented?
• Men’s Health
• Surviving Cancer
• Women’s Health: The First Half of Life

I chose “Can Cancer Be Prevented?” which was presented by Dr. W. Jarrard Goodwin, Director of UM/Sylvester. I have never heard a physician give such a down-to-earth presentation and communicate very complicated information in a way that held both the lay public’s attention as well as those from the healthcare community. Dr. Goodwin said that Sylvester is committed to merging wellness and science. The organization is engaged in various studies meant to demonstrate how treatments like music therapy, Yoga, relaxation and other alternative forms of medicine have an impact on patients being treated for cancer. They are finding important outcomes that prove the effectiveness of the combination of alternative and traditional medicine. Dr. Goodwin reviewed the latest studies that point to the importance of early identification of problems and the latest treatment options that are being used in Phase III clinical trials to treat those with various forms of chronic conditions, like congestive heart failure and cancer.

The next choice of session included:

• Genetics, Cracking the Code
• Raising Healthy Children and Proactive Parents
• How to Feel Better: Mind over Matter
• New Directions in Research
• Looking Healthy & Beautiful in Florida

I should have gone to “Looking Healthy & Beautiful in Florida” to learn some important tips, but I chose “How to Feel Better: Mind over Matter.” This was a panel presentation presented by three diverse speakers, including Dr. Michael Antoni, co-leader, UM/Sylvester Bio-behavioral Oncology and Cancer Epidemiology Program, who discussed the science behind bio-behavioral oncology and some of the impressive advances they are seeing with mind/body approaches. Next, Rosa Caiseda, MSW, Director of Social Work for Sylvester, talked about the role the social workers play in working with patients to ensure that they have access to the treatment and resources they need. She talked about the caring approach provided to all patients and the outcomes they are seeing among the diverse populations that come to the center. Last, Nancy Frehling, a cancer survivor, gave an inspiring and personal presentation of her journey with wellness and how it assisted her in coping with breast cancer. She was an inspiration to all.

Lunch was up next with a very special keynote speaker. Deepak Chopra, M.D., took the stage and captivated all 600 attendees. He took us on his journey of how he found his way to the field of mind-body medicine, peppering the journey with humor, insight and interesting personal details. I had never heard him speak, but made a beeline to the bookstore where I purchased his latest book, The Third Jesus. If you ever have the chance to see him, please don’t miss it. He is a true visionary.

Following lunch, the afternoon sessions offered a third round of breakout sessions that included such topics as Creating Your Personal Health Record, Women’s Health: The Second Half of Life, and Advocating for Good Health. Unfortunately, I had to leave during this session, but was glad to learn that all of the slides from the day will be posted on the Well Being/Being Well website.

It was an interesting day that taught me the importance of well being and being well.

Until Next Week, Be Well!

The initiative’s activities include conducting inpatient avoidable admissions data analysis, developing intervention strategies, and implementing pilot programs to reduce avoidable admissions. In 2005, according to the Planning Council website, there were approximately 24,000 avoidable admissions at tax-assisted hospital facilities in Broward County. As a result of avoidable admissions, emergency departments struggle with increased volume and strained capacity, which create backlogs and delays in care. Further, avoidable admissions through the ED result in patients receiving care in inappropriate and high-cost settings. By identifying avoidable admissions in Broward County, high quality, community-based primary care interventions for ambulatory sensitive conditions can be developed to alleviate avoidable admissions, target resources and track programmatic and policy intervention impact.

The program is made possible through a new program from the Agency for Health Care Research and Quality (AHRQ) that allows de-identified data from hospitals to be put into a database that will produce Prevention Quality Indicators. This information provides valuable information that allows public health officials and hospital administrators to look critically at the quality of the health care system outside of the hospital setting and determine what programs need to be put in place to better meet the needs of those most at risk. In addition, the data provides a benchmark to determine if the educational programs that are put into place are making an impact on avoidable admissions. To learn about the program, visit AHRQ’s website here.

This is an excellent example of how collaboration between the Public Health Department and local hospital systems can create ways to use and analyze data, address access issues for those at risk, implement programs that address those issues, and evaluate the effectiveness of the programs. As we continue to learn how to use data more effectively, it will be exciting to see the improvements that can be made in addressing cost, quality and access for all users of our health care system.

Have a great week!

Michael Mason, a fellow case manager from Brookhaven Hospital in Tulsa, Okla., has written a book on traumatic brain injury. The book was released last week and is receiving good reviews from the mainstream press. Take time to read the review in the New York Times and then head out to your local bookstore to get your own copy. Congratulations, Michael! Click here for the review.

Leadership, as defined by women of Generation Y

An article in Fast Company shares a story of why Generation Y women don’t relate to the traditional notion of leadership. They’re more interested than previous generations were in making the world a better place, and they want to work for socially responsible companies. Click here for the story.

Home visits keep elderly, disabled independent

House calls are making a comeback in Boston to help the elderly, disabled and chronically ill retain their independence. Nurse practitioners make many of the visits and often bring a laptop computer to connect to support services at their clinic or hospital. Click here for the report.

U.S. health care not ready for baby boomer surge

The Institute of Medicine issued a new report that says the U.S. health care workforce is not ready for the coming surge of aging baby boomers and must urgently find ways to increase the number and training of workers. The report calls for the federal government to require more training for direct-care workers and for Medicare to raise reimbursement rates for geriatric specialists to attract and keep people in the specialty. Click here for the report.

Community clinics struggle with increased patient load

A weakening economy, a higher cost of living and job losses have created long lines at community clinics that offer free health care. Read the article on a clinic in Florida that shares its experience with meeting the needs of the uninsured and underinsured. Click here for the story.

Pharmacies and walk-in health clinics are opening at more airports across the country, according to a report in USA Today. Click here.

Report: Hospital capacity behind states’ health care cost variation

A Dartmouth Medical School study of end-of-life care costs for Medicare patients found a wide variation among the states, attributed primarily to patients getting more hospital care — but not necessarily better care — in areas with a higher supply of hospital beds. The report shows the lack of comprehensive standards for measuring health care quality and determining when and how to provide medical care. Click here.

Philadelphia schools’ weight-loss initiative shows results

Five Philadelphia elementary schools that started initiatives to educate children about nutrition and limit unhealthy food options have shown remarkable results. Since their two-year effort began, only 7 percent of their students were overweight, less than half the 15 percent found in other schools. Click here.

Congress funds NIH research on brain injury, infant screening

The House of Representatives and the Senate have passed a bill that authorizes funding for NIH programs through fiscal year 2011 and mandates the CDC to undertake a study on countrywide trends in the area of traumatic brain injury. The House also sanctioned legislation allotting $45 million this year to help boost newborn screening programs in all states. Click here.

Some say that e-mail has made them more productive and efficient. Others say that e-mail has taken control of their lives, and still others feel that it is a tool that allows them to hide behind an impersonal communication device instead of taking the time to actually talk to people. Recently there has been a movement to get back to the basics and simplify life. “E-mail Free Fridays,” a concept crossing the nation, is an attempt to help people move away from their computers and, literally, return to conversing with people face to face. It is an interesting concept that may be worth a shot for better production and solidarity. In addition to E-mail Free Fridays, here are some other tips that might help you manage your e-mails better:

• Don’t check your inbox as often. You can set your e-mail program to check for new messages as often as you want. Many people set their systems to check once every four hours to eliminate distractions.
• Delete or file messages you’re done with. Create folders for related messages you want to save and delete the rest.
• Use a calendar to help you. Set an appointment in your calendar and cut and paste the message of an e-mail you need to follow up on in the “notes” section of your appointment. This way you can delete the original message and address the task when it comes due.
• When sending an e-mail, use an appropriate subject line or change it if you have a message you want to keep that has a vague headline. An example of a specific emendation is “Project due on Friday 5/16/08.”
• Don’t answer e-mails after hours. Doing so alerts people that you are working and invites them into your private time.

Let me know if your organization has tried E-mail Free Fridays and how it impacted your productivity and interpersonal relationships with your colleagues, your customers and your friends and family. If you have not tried this and you think it may work in your organization, e-mail this week’s edition of Across My Desk to those charged with decisions in your organization. Just don’t do it on a Friday.

Have a great week!