ANN ARBOR, Mich. — A unique University of Michigan
Health System program that helps older patients transition from the
hospital to sub-acute care facilities has significantly reduced hospital
stays and readmissions, according to new findings published in the
Journal of the American Medical Directors Association.
Creating seamless patient transfers between hospitals and long-term
care facilities has become a growing national concern. Previously
reported studies have shown that these patients are particularly
vulnerable to medication errors, hospital readmissions and other adverse
effects on their care.
The six-year-old UMHS Sub-Acute Care Service –
which coordinates care between the hospital and care facilities
commonly called nursing homes – has proven a successful model of
providing safe transitions for hospitalized patients. The average length
of stay at UMHS before transfer to a skilled nursing facility dropped
from 10.6 days to eight days, and hospital inpatient stays for patients
in the program were reduced by nearly 2,908 days a year, authors say.
The findings come as new Medicare data released this month show that
hospital readmission rates are stubbornly stagnant, costing Medicare
$17.5 billion in inpatient spending. In October, Medicare will begin to
penalize hospitals with higher than expected readmission rates, a
mandate of new federal health laws.
The UMHS paper – whose lead author is U-M geriatric physician Darius K.
Joshi, M.D.,– appears alongside a JAMDA editorial that lauds the U-M
transition program.
“The data presented by Joshi and colleagues are compelling and the
program ought to be monitored as a potential model for other health
systems,” reads the editorial, titled “Climbing out of the Black Hole of
Subacute Care.”
The UMHS sub-acute care program involves a close partnership between
UMHS and selected skilled nursing facilities in the Ann Arbor area. It
has dramatically changed the relationship between the hospital and
facilities by deploying U-M physicians and nurse practitioners to
skilled nursing facility partners. This U-M team follows patients after
discharge and manages their care on-site.
“These patients are often elderly with chronic illness and other health
concerns and require medical care and rehabilitation in skilled nursing
facilities after hospitalization,” says Joshi, who is director of the
sub-acute program and a clinical instructor in the geriatric medicine
division of the U-M Medical School’s Department of Internal Medicine.
“We aimed to break down the silos that are such a big problem in
healthcare and improve the continuity of care. We found that an
investment like this by a large health system does produce returns by
improving the overall quality of coordinated care for patients
discharged to care facilities.”
Another critical piece of the sub-acute service is enhanced
communication. The slower-paced setting of the care facility grants
patients and their families more face time with physicians, whereas
conversations may seem “rushed” in hospitals, Joshi says. This helps
prevent misunderstandings over patient care.
The UMHS program also coordinates access to electronic health records
between the hospital and facility, including inpatient notes, consultant
reports, medication lists and allergies to avoid errors that could lead
to hospital readmissions. When there is a “bounce back” – a readmission
to the hospital from the nursing facility - easy access to data avoids
confusion among hospital physicians on why the patient may have
returned, the authors note.
“Previously, the post-discharge care off-site was a black hole,
invisible and fragmented,” says co-author Tony Denton, executive
director of University Hospitals and U-M Hospitals and Health Centers
chief operating officer.
“But now, these private nursing facilities are key to safe, timely and
coordinated placement of our patients. These carefully selected
sub-acute providers are a valuable extension of the excellent care
provided inside our hospitals.
“We are bridging communication gaps between the hospital and sub-acute providers, sharing a commitment to quality care.”
Additional Authors: Rick A. Bluhm, J.D.; Preeti N.
Malani, M.D., MSJ; Steve Fetyko, MPA, CPA;, JD; Caroline S. Blaum, M.D.,
M.S. All are of the U-M Health System.
Citation: “The Successful Development of a Sub-Acute
Care Service associated with a large academic health system:”
doi:10.1016/j.jamda.2012.03.001.
By Dr. Joel Warshosky, author of How Behavioral Optometry Can Unlock Your Child’s Potential
Children presenting with behavior disorders often have associated
reading/learning difficulties and are commonly characterized as being
difficult children by their teachers and parents. ADD (attention deficit
disorder), ADHD (attention deficit disorder hyperactivity), LD
(learning disabilities), ODD (oppositional defiant disorder) and
Dyslexia (difficulty deciphering symbols) are a few of the diagnosis
that have been used to identify these children. Typically, it’s the
child’s pediatrician, pediatric psychiatrist and/or neurologist who
routinely prescribe medications: Ritalin, Concerta, Adderall and/or
Prozac to name a few, used to create order and quiet in a child’s
behavior.
Understandably, professionals are pressured to find answers for these
children with behavioral and associated reading/learning problems. The
school system and individual teachers are also pressured to create an
environment where these children labeled as lazy, a class clown, day
dreamer, slow, or uncooperative, can become socially and academically
functional within the mainstream classroom. Medication may promote a
child’s behavior to be more predictable and even appear to cause a child
to stay on task better. However, if the underlying problems children
experience are not medical in nature, these children will not learn or
read any easier. In fact, they may become frustrated because they don’t
feel right not knowing what’s wrong with them. Side effects of
medications may create additional change in how children feel resulting
in fatigue, restlessness, loss of appetite and a feeling of despair.
Medicating without success reinforces a child to feel unstable about
them self.
Medications may seem to cause less disruption in class and children may
appear to better stay on level. However, if what was thought to be a
chemical imbalance is truly a behavioral vision disorder, he will still
not be comfortable processing visual information.
Children suffering from a behavioral vision disorder commonly have
difficulty converging their eyes inward (inefficiency turning eyes
inward), have difficulty focusing (inefficiency identifying) and are not
be able to track (follow from one point to another). Misdiagnosis may
not only support visual inaccuracy, it can diminish self esteem and even
develop into the “Failure Syndrome.” Children with this syndrome
believe that in not being able to perform a task correctly, they are
incorrect.
Misdiagnosed children may not be considered “at risk” because
medication has appeared to ease the situation. However, they will most
likely be affected by a lack of self worth that the misdiagnosis has
instilled within them. This may ultimately lower a child’s professional
expectation and cause him to accept a vocation or profession lower than
his actual potential.
What would have happened had these children been introduced to a
behavioral vision approach? Not only could they have achieved success in
reading and learning but they may have actually reached their life’s
potential and subsequent joy.
Parents and child study team members may feel a false sense of security
believing that they’ve taken the child to the eye doctor who said, your
child’s eyes are fine, they see “20/20.” Seeing with clarity is
important and yet a child’s visual concerns may have nothing to do with
eyesight and everything to do with efficient, effective and effortless
eye coordination, focus and tracking ability.
A lack of visual coordination results in two sets of eye muscles not
working together. One muscle system controls focus, for clarity, while
the other system controls seeing single, not double. These two systems
are linked. Inaccuracy in one system will typically create a mismatch in
the other creating inefficiency between the two. Classical symptoms of
a motivated child trying to overcome visual dysfunction is eye strain
associated with excessive eye rubbing/burning, headaches after visual
activities and blurred vision during near activities. Symptoms of eye
avoidance, typical of an unmotivated child, are double vision,
omissions, or substituting words while reading, difficulty finishing
school work and the most common symptom loss of place while reading.
Nonreaders have no symptoms at all simply because they avoid any
situation which calls for them to read for any considerable length of
time.
The success of vision therapy depends on the motivation of the team:
inclusive of the child, parents and Behavioral Optometrist. If the
condition is recent and academic lags have not yet occurred, the program
is quite simple often resulting in complete remediation. When the
condition is long standing, academic and/or emotional concerns can
become secondary problems which must be addressed along with the primary
visual. The more complex the situation the more involved the treatment
strategy. When secondary issues are evident the team must include the
appropriate professionals. With academic involvement, reading, learning
and special education professionals need to be resourced. Social
workers/psychologists consulted if emotional concerns have surfaced.
Occupational and Physical therapists utilized for the development of
fine and gross motor skills and Speech and Language therapists
responsible for treatment of receptive and/or expressive language delay.
Parents, teachers and school administrators have the power to advocate
for our children especially when they realize that symptoms of these
labeled children can mimic behavioral vision dysfunction. Throw open
your child’s door of opportunity and success and advocate for your
bright and intelligent child’s ability to read, write and learn
accessing the freedom of visual self-discovery through the benefits of a
vision therapy program.
One of the most common and enthusiastic statements parents in my office
make is “guess what, my child just picked up a book to read all by
herself.”
Early and appropriate intervention is essential when changing a child’s
course of development from one of frustration and lack of ability to
one which encourages belief in oneself through success in a task.
About Dr. Warshowsky:
Joel H. Warshowsky is a behavioral and developmental Optometrist. He is
Associate Clinical Professor and founding Chief of Pediatrics at SUNY
State College of Optometry, where he has taught for over 35 years. He
served as Optometric Consultant to numerous schools for child
development throughout New York and New Jersey. Dr. Warshowsky has
lectured internationally and is published widely in the field of
optometry, and is a Fellow of the American Academy of Optometry and
College of Optometrists in Vision Development. He maintains two
pediatric practices in New York and New Jersey.
Dr. Warshowsky is available for speaking engagements
Website: http://www.drjoelwarshowsky.com
How Behavioral Optometry Can Unlock Your Child’s Potential:
Identifying and Overcoming Blocks to Concentration, Self-Esteem and
School Success with Vision Therapy can be purchased from www.amazon.com, www.barnesandnoble.com, www.jkp.com and through all major booksellers.
San Francisco broker Tara-Nicolle Nelson lists six hidden expenses and how to handle them.
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Exercising but aren't losing weight? Obsessed with counting each and every calorie you put in your mouth?
You might be caught in the 'numbers game.'
“Our society is obsessed by numbers, rules and strict diet plans, all
so we can fit into the ‘accepted’ body image, size and look,” says
Angela Lutz, a personal trainer and life coach with more than a decade
of experience in the health and fitness industry. “And it really only
leads to a society of people suffering from negative body images and
beliefs. We have to break free from that outlook."
Lutz explains her philosophy - as well as other tips on avoiding "disorderly eating" in her new health guide, Bound by Numbers.
Bound by Numbers is a thoughtful approach to healthy living
that begins by addressing internal issues first. Based on extensive
research and real-life examples, readers will learn how to jump off the
treadmill of harmful ideas and jump into a brand-new life free from the
past.
