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STROKE: Patients who receive physical therapy (PT) services are less likely to be readmitted

Our findings clearly demonstrate that higher intensity of rehabilitation services in the acute setting has a major impact on downstream outcomes, such as hospital readmission.”

Older patients who have suffered an ischemic stroke are less likely to be readmitted to the hospital within 30 days if they participate in physical therapy while in the hospital for the stroke.  This was a study of nearly 89,000 Medicare fee-for-service patients who were hospitalized nationwide in 2010.  Overall, the 30-day readmission rate was found to be 14 percent.

Source: Kuman, A., Resnik, L., Karmarkar, A., and others. (2019, July). Archives of Physical and Medical Rehabilitation, 100(7), 1218-1225. Click here for free full text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599551/pdf/nihms-1013343.pdf   Posted by AHA Resource Center (312) 422-2003, rc@aha.org

VALUE: Americans are lousy patients

Could the problem with America’s health-care system lie not only with the American system but with American patients?”

Americans do not take prescribed medications.  We make poor lifestyle choices.  We demand expensive tests and scans and procedures.  All of these factors contribute to making the American health care system costly while failing to produce very good outcomes, compared to other developed nations.

Source: Freedman, D.H. (2019, July). The worst patients in the world. The Atlantic, 324(1), 28-30.  Click here for text: https://www.theatlantic.com/magazine/archive/2019/07/american-health-care-spending/590623/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PEDIATRICS: Kangaroo mother care for preterm infants in neonatal intensive care units

To improve the NICU experience for mothers and promote the health of preterm infants, social supports, such as improved maternity leave policies and reliable hospital access through child care, accommodation, and transportation supports are required, even for parents with insurance coverage.”

This is a small study based on interviews with 20 mothers who gave birth to preterm infants in 2016 at Tufts Medical Center (Boston).  The objective was to evaluate how these mothers of infants in the neonatal intensive care unit viewed the practice of kangaroo mother care – which involves skin-to-skin contact and frequent breast feeding.  Barriers to use of this practice are explored.

Source: Lewis, T.P., Andrews, K.G., Shenberger, E., and others. (2019). Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy and Childbirth, 19:227. Click here for free full text:     https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2363-y#Abs1  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

POPULATION HEALTH: You have to keep after prevention interventions or positive effects decrease

Perhaps the most critical loss was the cessation of computer entry systems, reversion to paper data monitoring, and associated inability to reliably measure individual and population outcomes against past results and future targets.

Residents of rural Franklin County, Maine, were compared with the rest of the state on mortality and smoking rates in this decades-long study.  An association was found between improved outcomes and the availability of risk factor improvement programs.  The study looked at the impact of program cutbacks.  The authors found that decades of health gains “were lost within 5 to 10 years of cutbacks of leadership and other programmatic support.”

Source: Onion, D.K., Prior, R.E., Record, N.B., and others. (2019, June 14). Assessment of mortality and smoking rates before and after reduction in community-wide prevention programs in rural Maine. JAMA Network Open, 2(6).  Click here for free full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2735767  Posted by AHA Resource Center (312) 422-2050, rc@aha.org





HEALTH INSURANCE: 30.4 million uninsured in US as of 2018 according to NCHS estimates

In 2018, 30.4 million persons of all ages (9.4%) were uninsured at the time of interview – not significantly different from 2017, but 18.2 million fewer persons than in 2010.”

The number of people without health insurance in 2018 was 30.4 million, or 9.4 percent of the civilian noninstitutionalized population, according to national estimates from the U.S. National Center for Health Statistics.  This compares with estimates of 48.6 million uninsured, or 16 percent of the population in 2010, when the Affordable Care Act was passed.  During the same period, the number of uninsured children decreased by 2 million or a decrease from 7.8 to 5.2 percent of children.

Source: Cohen, R.A., Terlizzi, E.P., and Martinez, M.E. (2019, May). Health insurance coverage: Early release of estimates from the National Health Interview Survey, 2018. National Health Interview Survey Early Release Program. Click here for free full text:  https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

State Telehealth Laws & Reimbursement Policies

The Center for Connected Health Policy, the National Telehealth Policy Resource Center, has released its latest biannual update on state telehealth laws, regulations, and policies, with a primary focus on Medicaid fee-for-service programs. However, managed care/private payer laws are also covered when available.

Telehealth policy trends are briefly summarized from a national perspective, followed by detailed state profiles. Each state profile on telehealth reimbursement includes:

  • Key state agencies/organizations
  • State policy overview
  • Definitions
  • Live video, store-and-forward, and remote patient monitoring
  • Eligible providers, sites, geographic limits, facility/transmission fees, services/specialties
  • Consent
  • Professional regulation/health and safety, including cross-state licensing and online prescribing

States vary considerably on telehealth policies. Overall, the report noted live video Medicaid reimbursement is far more prevalent than reimbursement for store-and-forward and remote patient monitoring. Other trends noted for some states are specific documentation and/or privacy and security guidelines; the addition of home and schools as eligible originating sites; and the inclusion of teledentristy and substance abuse services as qualifying specialties.

State telehealth laws & reimbursement policies; a comprehensive scan of the 50 states & the District of Columbia. Center for Connected Health Policy, Spring 2019. https://www.cchpca.org/sites/default/files/2019-05/cchp_report_MASTER_spring_2019_FINAL.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

MOBILE DEVICES: How wearable technology will change cancer care

The advances in the development of wearable and remote monitoring devices are growing exponentially.”

Monitoring symptoms of cancer patients and their participation with oncologist-recommended physical activity are two potential uses of wearable devices, according to this literature review by the authors – physicians affiliated with the MD Anderson Cancer Center, the Mayo Clinic and other institutions.  Among the challenges related to the collection of data from these devices is how to manage and store the large amounts of information involved.

Source: Liao, Y., Thompson, C., Peterson, S., Mandrola, J., and Beg, M.S. (2019, January). The future of wearable technologies and remote monitoring in health care. American Society of Clinical Oncology Educational Book, 39, 115-121.  Click here for abstract in PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31099626  AHA staff members can access full text using the AHA Document Library via RightFind on Inside AHA.  Posted by AHA Resource Center (312) 422-2050, rc@aha.org