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January 2018 • Vol.9 No.1

SEPSIS: Deadly without

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CONTENTS »» JANUARY 2018

4 Care coordinator: Quarterback of the post-acute-care team 10 SEPSIS: Deadly without rapid intervention 14 Nutrition: The ‘forgotten element’ of wound healing 20 Quickbytes Technology News 22 Health Hints

The Journal of Healthcare Contracting is published bi-monthly

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The Journal of Healthcare Contracting (ISSN 1548-4165) is published bi-monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153.

Copyright 2018 by Share Moving Media All rights reserved.

Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

The Journal of Healthcare Contracting | January 2018

3

TRENDS

Care coordinator: Quarterback of the post-acute-care team Here’s an acronym you’ll want to remember: CCTM. It

helps patients navigate the maze of spe-

stands for “Care Coordination and Transition Management.” In

cialists, hospital departments, outpatient

a world of post-acute care, population health and care contin-

appointments, tests, procedures, medica-

uum, chances are you’ll be serving more people – often, regis-

tions, and follow-up appointments.

tered nurses – whose name is followed by CCTM.

4

AAACN – in conjunction with Medical-

Care coordination and transition management (CCTM) is a

Surgical Nursing Certification Board –

way for the healthcare team to involve patients and their families

created the CCTM™ credential in 2015. As

in organizing the patient’s care activities among several health-

of Nov. 15, 2017, 499 people were CCT-

care team members, healthcare services, and settings of care,

Ms. But care coordination goes back a lot

says the American Academy of Ambulatory Care Nurses. CCTM

further than 2015.

January 2018 | The Journal of Healthcare Contracting

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TRENDS

“Care coordination has existed in some form since the early

The care coordinator may be found in a

1900s, when nurse Lillian Wald founded the Visiting Nurse

variety of environments – “anywhere there

Service of New York, addressing the needs of individuals and

is an opportunity to leverage resources

communities while containing costs,” says Diana Harmon, MSN,

available through a health system, the

MHA, RN, CCCTM, clinical instructor and continuing education

community, the patients themselves,” says

planner, Emory University’s Neil Hodgson Woodruff School of

Harmon. The care coordinator may be em-

Nursing. “As healthcare costs skyrocketed, care coordination

ployed by a hospital, health system, payer,

evolved into case management, which was not owned by any

outpatient clinics, etc.

one discipline, and which considered costs over the needs of the patient.

“A typical day for the RN-CCTM might include the use of informatics – data ex-

“We have come full circle, with nurses once again taking the

trapolated from electronic healthcare re-

appropriate role of patient advocate and team leader, who co-

cords to identify individuals in high-risk

Care coordination or case management?

The Medical-Surgical Nursing Certification Board makes the following distinction between care coordination and case management: “CCTM, in its broadest sense, deals with populations of patients over time, especially those with chronic illnesses/diseases such as diabetes, heart disease, asthma, etc. Case management, on the other hand, deals more with the utilization of resources. For example, helping the patient with insurance and payment issues and health resources needed when they return home (e.g., home health nurse, supplies).” ordinates care of populations of individuals, resulting in a reduction of healthcare dollars spent,” says Harmon, who serves

“We have come full circle, with nurses once again taking the appropriate role of patient advocate and team leader.”

as chair of two AAACN committees in the Care Coordination and Transition Management program: test development and

populations who would benefit from

item writers.

early intervention. This intervention most

A day in the life

6

likely would begin with a phone call to interact with the patient and family and

An RN is particularly well-suited to coordinate care for patients

perform a baseline assessment. Follow-

who are at high risk for hospital readmission or in deteriorat-

ing that, personal encounters – either

ing health, adds Harmon. “He or she typically works as part of a

home visits or office visits – allow the RN-

team, with the physician, the pharmacist, informatics, etc. But

CCTM to coach, educate, and evaluate

the care coordinator is the quarterback, pulling it all together.”

continuing needs.

January 2018 | The Journal of Healthcare Contracting

TRENDS

“The RN-CCTM would communicate with other members of

through structured education pro-

the health team as appropriate – pharmacist, physician, etc.

grams for RN-CCTM nurses, available

The RN-CCTM might also assist patients in identifying commu-

either through health systems or as

nity resources for help with needs such as nutrition, mental

continuing nursing education activi-

support or transportation. Documentation and communica-

ties, with the ultimate confirmation of

tion can be the most challenging aspect when working within

expertise demonstrated through cer-

an EHR that is not highly interoperable.”

tification in CCTM.”

Training It takes a high level of education to give good care to high-risk, high-cost patients, says Harmon. “Sometimes a nurse can develop those competencies through experience, but I feel very strongly that we need a structured training and certification program in place, to cultivate individuals who are going to pursue care coordination/transition management.” Some health systems already have such programs.

“ The [care coordinator] might also assist patients in identifying community resources for help with needs such as nutrition, mental support or transportation.”

The AAACN Care Coordination and Transition Management course offers 13 online modules covering a variety of competencies and activities, including: • Advocacy.

• Education and engagement of patients and families.

• Coaching and counseling of patients and families.

• Patient-centered care planning.

• Support for self-management.

• Teamwork and collaboration.

• Population health management.

• Care coordination between acute care and ambulatory care. “ Right now the domain of care coordination is fluid and rapidly evolving,” says Harmon. “In the future, I believe that the role will become more clearly defined as one that belongs to nursing, with delineated and quantifiable compe-

Care coordination by any title Nurses who practice in a care coordination/transition management role may carry any number of titles, including • Care coordinator.

• Transitions manager.

• Care manager.

• Nurse navigator.

• Transitional care manager.

• Health coach.

• Discharge planner.

• Patient care coordinator.

• Patient care facilitator.

Source: Medical-Surgical Nursing Certification Board

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January 2018 | The Journal of Healthcare Contracting

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SEPSIS: Deadly without rapid intervention

Every year more than 1.5 million people develop sepsis in the United States, and at least 250,000 die as a result, according to the Centers for Disease Control and Prevention. While deadly, sepsis is treatable – but only if caregivers’ response is rapid.

Sepsis is the body’s extreme response to an infection – in the skin, lungs, urinary tract or somewhere else – which triggers a chain reaction throughout the body. It begins outside of the hospital for nearly 80 percent of patients. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death.

10

January 2018 | The Journal of Healthcare Contracting

The signs and symptoms of sep-

Post-sepsis syndrome

sis can include:

Half of sepsis survivors suffer physical and/or psychological long-term

• Confusion or disorientation.

effects, according to the Sepsis Alliance, an advocacy organization

• Shortness of breath.

founded in 2007. Those effects include:

• High heart rate.

• Insomnia, difficulty getting to sleep or staying asleep.

• Fever, or shivering,

• Nightmares, vivid hallucinations and panic attacks.

or feeling very cold.

• Disabling muscle and joint pains.

• Extreme pain or discomfort.

• Extreme fatigue.

• Clammy or sweaty skin.

• Poor concentration.

• Decreased mental (cognitive) functioning.

The most frequently identi-

• Loss of self-esteem and self-belief.

fied germs that cause infections that develop into sepsis are Staphylococcus aureus (staph),

Treatment delays costly

Escherichia coli (E. coli) and some types of Streptococcus.

Although sepsis typically develops in the community, people with sepsis are treated in the hospital, says CDC. Research shows that rapid, effective sepsis treatment, which includes

giving

antibiotics,

maintaining blood flow to organs, and treating the source of infection, can save lives.

Doctors treat sepsis with antibiotics as soon as possible.

Many patients receive oxygen and intravenous fluids to maintain blood flow and oxygen to organs. Other types of treatment, such as assisting breathing with a machine or kidney dialysis, may be necessary. Sometimes surgery is required to remove tissue dam-

The real opportunity for sepsis survival lies in identifying and treating sepsis before it becomes severe, according to the University of Kansas Health System. “In some cases, we identify the potential for sepsis early and prescribe antibiotics, but we don’t get them into the patient quickly enough,” reports the health system on its “Management of the Sepsis Patient” web page. “The answer can be as simple as issuing a STAT order or following up with the hospital’s inpatient pharmacy and the patient to ensure rapid delivery. When we see a patient with a severe injury – say a bleeding artery – we don’t delay.

We take immediate action to stop the bleeding.

“Similarly, if a patient enters the emergency room with an infection, he is probably sick enough to warrant STAT antibiotics.”

Some key statistics from the University of Kansas: • Every hour we delay treatment, we add 7 percent to the mortality rate.

• Elevated creatinine levels increase mortality dramatically.

• Mortality for severe sepsis without rapid response is 30-50 percent.

• If the patient develops shock, the mortality rate rises to 60-80 percent.

• Sepsis is not just a community hospital problem. Even in major academic medical centers, the mortality rate for sepsis is 50 percent if treatment for septic shock is delayed more than four hours.

Source: University of Kansas Health System: http://www.kansashealthsystem.com/for-professionals/publications-resources/ newsletters/read-innovations-review/sepsis-may

aged by the infection.

The Journal of Healthcare Contracting | January 2018

11

SEPSIS: DEADLY WITHOUT RAPID INTERVENTION

PSS can affect people of any age, but a study from the University of Michigan Health System, published in 2010 in the medical journal JAMA, found that older severe sepsis survivors were at higher risk for long-term cognitive impairment and physical problems than others their age who were treated for other illnesses. Their problems

Doctors treat sepsis with antibiotics as soon as possible.

Many patients receive oxygen and intravenous fluids to maintain blood flow and oxygen to organs.

The study’s authors wrote, “Sixty percent of hospitalizations for severe sepsis were associated with worsened cognitive and physical function among surviving older adults. The odds of acquiring moderate to severe cognitive impairment were 3.3 times higher following an episode of sepsis than for other hospitalizations.”

ranged from not being able to walk, even though they could before they became ill, to not being able

For information on sepsis and on

to do everyday activities, such as bathing, toileting, or preparing meals.

the CDC’s “Get Ahead of Sepsis” ini-

Changes in mental status can range from no longer being able to perform

tiative, go to https://www.cdc.gov/

complicated tasks to not being able to remember everyday things.

sepsis/get-ahead-of-sepsis/

Early recognition, early intervention Ohio hospitals achieved a 13.4 percent statewide reduction in sepsis mortality, representing an estimated 1,486 lives saved over the first 18 months of an Ohio Hospital Association initiative, which began in June 2015.

The initiative rests on two key strategies: 1) early recognition, and 2) early, appropriate intervention with the incorporation of the Surviving Sepsis Campaign’s three-hour sepsis bundle (i.e., blood cultures, broadspectrum antibiotic agents, and lactate measurement).

Participating hospitals reported the following activities: • Coordinating with EMS/ambulance services to provide sepsis education and early appropriate intervention protocols.

• Incorporating national Sepsis Alliance templates for discharge instructions of sepsis patients.

• Reviewing rapid response team protocols and activation process to treat sepsis patients.

• Improving recognition and treatment before rapid response team is needed.

• Implementing Focused Assessments to determine condition of septic patient.

• Creating and distributing education materials (signs of sepsis) for the community and partners.

• Assigning a dedicated “sepsis coordinator” to work with clinical team on policies and protocols.

• Expanding education for staff orientation.

• Distributing a sepsis alert page throughout the hospital when a patient arrives or is identified as septic, creating a mandatory consult for a critical care physician and ensuring information is passed, including the time for the six-hour focused exam and the location of the patient.

• Developing marketing materials such as radio ads and billboards to educate the community on the signs of sepsis.

Source: Progress Report 2017: OHA Statewide: https://www.ohiohospitals.org/OHA/media/Images/ News%20and%20Publications/Reports/OHA-Sepsis-2017-Progress-Report-FINAL.pdf

12

January 2018 | The Journal of Healthcare Contracting

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1 CIN: Computers, Informatics, Nursing: Eliminating Errors in Vital Signs Documentation, FIELER, VICKIE K. PhD, RN, AOCN; JAGLOWSKI, THOMAS BSN, RN; RICHARDS, KAREN DNP, RN, NE-BC, 2013. The paper vital signs recording had an error rate of 18.75%.

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MC14605

POST-ACUTE

By Lisa Logan, R.D., CNSC

Nutrition:

The‘forgotten element’ of wound healing

The role of nutrition in pressure injury (PI) prevention

industry need to understand how they

and treatment is a well-recognized factor and an essential com-

can provide solutions for customers to

ponent of wound management. Unfortunately, proper nutri-

help prevent and treat wounds.

tional support is often the “forgotten element” that is necessary

14

in maintaining all phases of wound healing. Wounds will not

High-risk individuals

heal without proper nutrition, and malnutrition is a key risk fac-

Clinicians require evidence-based tools

tor in the development of wounds.

that help identify residents who are at

Protein Energy Malnutrition will result in a marked increase

risk, so that prompt attention is direct-

in the incidence of pressure injuries. According to the National

ed on the nutritional status of patients.

Pressure Advisory Panel (NPUAP), the prevalence of wounds

High-risk individuals can be identified

or any chronic, non-healing wound, such as a PI, surgical site

by screening for nutritional risk fac-

wound, trauma, or burn injury is a serious healthcare problem.

tors, along with understanding pressure

Therefore, employees that work in the supply and distribution

injury triggers.

January 2018 | The Journal of Healthcare Contracting

The Future of Non-Acute Care – Is your supply chain ready to perform?

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Imaging Center

Orthopedic

Urgent Care

Primary Care Practice

Long Term Care

Dialysis & Infusion

CHC Home Health Agency

Ambulatory Surgery Center

Home Medical Equipment

As care shifts to non-acute facilities*

85%

of patient visits happen beyond the hospital

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Visit mms.mckesson.com or call 866.MCK.ANSWer. *Source: Health, United States, 2015. US Department of Health and Human Services, Centers for Disease Control and Prevention. © 2017 McKesson Medical-Surgical Inc. All rights reserved.

POST-ACUTE

Examples of some PI triggers include the following: unintend-

• Vitamins and minerals are necessary

ed weight loss >10 percent in 180 days, BMI (Body Mass Index

for all phases of wound healing. A

<18.5 or >30), poor oral intake, dehydration, diagnoses impact-

supplement is needed when dietary

ing cognition (such as dementia and Alzheimer’s Disease), and/

intake is poor or deficiencies are

or urinary or fecal incontinence, etc. Advanced wound care pro-

suspected. (E.g., vitamin C supports

grams are now available through various distributors, suppliers

formation of new blood vessels and

and/or manufacturers. These programs provide comprehensive

wound strength, and zinc is required

tools and guidelines to help customers develop strategies in ar-

for protein synthesis and immunity.)

eas relating to wound care prevention and treatment.

Oral and tube feeding

The management of pressure injuries requires a collaborative, interdisciplinary team approach that includes not only the individual, family, and/or caregiver, but also the suppliers, manufacturers and distributors that service post-acutecare facilities.

Patients benefit from fortified and/or

adequate calories, protein, fluid, vitamins and minerals, as well

and Centers for Medicare and Medicaid

as to understand their role in wound healing. Some important

Services (CMS) develop, and frequently

components are as follows:

revise, interpretative guidelines and

Medical Nutrition Therapy (MNT) treatment plans are an essential component to wound management. The nursing staff and registered dietitian (RD) are primarily responsible for developing a treatment and prevention plan, as well as documenting nutrition and nursing assessment plans. Routine monitoring and validated assessment tools need to be integrated into a patient’s care plan and an organization’s clinical protocols. The goal is to provide

• Protein is important to help repair damaged tissue and pro-

tein oral supplements between meals when nutritional requirements can’t be achieved by dietary intake. This strategy can help combat unintended weight loss, anorexia and malnutrition. These supplements may be delivered orally or through a feeding tube. It is important to consider alternatives like enteral (tube) feeding or parenteral (IV) feeding, when oral consumption remains suboptimal.

Tube feeding is the preferred route, if the gastrointestinal tract is functioning. Depending on the clinical condition, tube feeding necessity will vary in terms of length of need. The Joint Commission

compliance standards relating to tube

mote healing. (Protein requirements are markedly increased,

feeding administration. This helps sur-

as collagen – the most abundant protein – is a critical compo-

veyors determine if a facility has clinical

nent of collagen synthesis needed for wound healing).

deficiencies in this area, which need to

• Fat is an essential component of all cell membranes.

16

high-calorie foods, as well as high pro-

be remedied.

• Other semi-essential amino acids like arginine, the build-

Enteral nutrition formulas are foods

ing blocks of protein, are required for tissue repair and to

intended for the specific dietary manage-

help transport oxygen delivery to the wounds.

ment of a disease or condition. Products January 2018 | The Journal of Healthcare Contracting

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POST-ACUTE

vary with respect to macronutrient and micronutrient composition, concentration, fiber, and added nutrients which have been shown to improve immune function and help promote wound healing. These wound-healing formulas contain additional essential nutrients that are required for optimal skin integrity and repair. Often, the resident is offered oral nutritional supplements to provide additional nutrients that are lacking from the diet. Standard polymeric formulas are widely used and tolerated in patients requiring enteral support. These formulas mimic what is in a typical diet and contain a variety of nutrients consumed by healthy individuals to meet the recommended dietary needs. It is the clinicians’ responsibility to evaluate enteral products for clinical efficacy and to develop formularies to

Clinicians require evidencebased tools that help identify residents who are at risk, so that prompt attention is directed on the nutritional status of patients.

meet the needs of their health care setting.

Post-Acute Care Transformation (IMPACT) Act of 2014 requires reporting of quality measures – including skin integrity and changes in skin integrity – using standardized patient assessment data across post-acute settings to help improve quality of patient care and outcomes.

Although the development of wounds arises from a complex set of circumstances,

proper

nutritional supplementation can positively affect

the outcome. Therefore, it is important The primary food ingredients in both oral and tube feeding

for distributors and sale representatives

products include these:

to understand their product offerings

• Carbohydrates, usually in the form of corn syrup solids and maltodextrin.

relating to wound care and treatment.

Utilizing clinical resources within your

• Protein, usually in the form of soy protein and casein.

company can familiarize customers with

• Fat, typically canola, soybean or safflower oil.

guidelines, such as those published by

• Fiber – soluble or insoluble.

the NPUAP in 2016, as well as by other

Quality standards

national organizations that specialize in pressure injury prevention and treat-

Considerable evidence exists regarding the seriousness of pres-

ment. The management of pressure in-

sure ulcers and the relationship between pressure ulcers and

juries requires a collaborative, interdis-

pain, decreased quality of life, and increased mortality in aging

ciplinary team approach that includes

populations. Therefore, state and regulatory agencies like CMS

not only the individual, family, and/or

have funded quality measure projects like National Quality Forum

caregiver, but also the suppliers, manu-

(NQF), established in 2008. These quality standards are tightly

facturers and distributors that service

regulated by federal and state agencies. The Improving Medicare

post-acute-care facilities.

Lisa Logan, Registered Dietitian (R.D.) and Certified Nutrition Support Clinician (CNSC), is enteral program manager/ nutrition support clinician for the extended care-clinical resource team, McKesson Medical-Surgical.

18

January 2018 | The Journal of Healthcare Contracting

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QUICKBYTES Editor’s note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, The Journal of Healthcare Contracting will profile the latest developments in software and gadgets that reps can use for work and play.

Technology News One in a million

devices will overtake smartphones by 2021

The probability that a random person in the population could

as a share of deployed connect IoT devices.

look at your iPhone X and unlock it using Face ID is approximately 1 in 1,000,000 (versus 1 in 50,000 for Touch ID), says Ap-

One word for you: Graphite

ple in its Face ID Security white paper. Face ID allows only five

Electric vehicle manufacturers and battery

unsuccessful match attempts before a passcode is required to

makers have long been searching for the

obtain access to your iPhone. The probability of a false match

“Holy Grail” technology that could lower

is different for twins and siblings that look like you as well as

the cost of batteries while also extending

among children under the age of 13, because their distinct fa-

their range, according to SafeHaven.com.

cial features may not have fully developed. If you’re concerned

One material that could actually lead to

about this, we recommend using a passcode to authenticate.

cheap, long-range and fast-charging electric vehicles is graphite. Within graphite is

Smiling faces

graphene, the world’s thinnest material.

Are you surprised? Younger

Graphene is durable and tough – 200 times

millennials

18-24)

stronger than steel – yet ultra-light weight.

take more photos than any

It is also transparent, and conducts electric-

other age group in the Unit-

ity substantially better than copper, says

ed States – averaging 439

SafeHaven.com. Electrons can travel using

photos every six months,

graphene with virtually zero resistance and

according to new research

no heat loss, nearly qualifying it as a su-

from the Consumer Tech-

perconductor. These virtues have singled

nology

it out as one of candidates most likely to

(ages

Association. The

study, “Focus on Digital Imaging Industry Drivers: Apps, Outputs

take lithium-ion batteries to the next level,

and Storage,” also shows that among the 81 percent of Americans

potentially leading to a breakthrough for

who take photos and use apps, more than half (53 percent) have

electric vehicles. The only problem is that

used a dedicated digital imaging (DI) tool or service app, such pho-

production of graphene is still low. Graph-

to editing, management, output or kiosk services.

ite itself is still cheap, but the trick is render-

The smart home

20

ing out the graphene. Scientists were only able to separate out graphene in 2004,

The smart home is likely to become a major generator of connect-

and researchers and entrepreneurs are still

ed and IoT (Internet of Things) device deployment growth during

looking for ways to mass-produce the ma-

the 2020s, according to research by Strategy Analytics. Smart home

terial at low cost.

January 2018 | The Journal of Healthcare Contracting

HEALTH HINTS

Good for the heart? Good for the brain.

sleeping—is called static posture. Dy-

A long-term study suggests that middle-aged Americans who

namic posture is how you position your

have vascular health risk factors, including diabetes, high blood

body while you’re moving, like walking

pressure and smoking, have a greater chance of suffering from

or bending over to pick something up.

dementia later in life. The study, published in JAMA Neurology,

It’s important to consider both static

was funded by the National Institutes of Health (NIH). “This

and dynamic components of posture,

study supports the importance of controlling vascular risk fac-

says NIH. Keep in mind these methods to

tors like high blood pressure early in life in an effort to prevent

maintain posture:

dementia as we age,” said Walter J. Koroshetz, M.D., director of

• Be mindful of your posture during ev-

NIH’s National Institute of Neurological Disorders and Stroke

eryday activities, like watching televi-

(NINDS), which partially funded the study and created the Mind

sion, washing dishes or walking.

Your Risks® public health campaign to make people more aware of the link between cardiovascular and brain health. “What’s good for the heart is good for the brain.”

Sit up straight!

moving your body in different ways.

• Stay active.

• Maintain a healthy weight.

• Make sure work surfaces are at a com-

Posture isn’t just about how you look. How you position your-

fortable height for you, whether you’re

self can help or hurt your health over your lifetime, according to

working in an office, doing a hobby,

the National Institutes of Health. How you hold yourself when

preparing dinner, or eating a meal.

you’re not moving—such as when you’re sitting, standing, or 22

• Take frequent breaks for stretching and

• Wear comfortable, low-heeled shoes.

January 2018 | The Journal of Healthcare Contracting

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HEALTH HINTS

Diet and eye damage

questions researchers supported by the

Near the center of the retina, at the back of the eye, is a small

National Institute of Diabetes and Di-

area known as the macula. It is needed for sharp, central vision,

gestive and Kidney Diseases (NIDDK),

such as for seeing straight ahead to drive, read, and recognize

part of NIH, will seek to answer as they

faces. More than 2 million Americans have age-related macular

begin recruiting participants for a two-

degeneration (AMD). Itâ&#x20AC;&#x2122;s a leading cause of vision loss among

year clinical trial at four sites across the

people aged 50 and older. Previous population studies have

country. Scientists will test whether us-

found that a high glycemic diet is associated with AMD onset

ing a smart water bottle that encour-

and progress. Carbohydrates with a high glycemic load, such as

ages people to drink more water, and

white bread, can be quick-

therefore urinate, will reduce the recur-

ly digested and so cause spikes in blood sugar. Carbohydrates with a low glycemic load, such as wholegrain bread, take longer to digest. With funding in part from the National Eye Institute, a team led by Drs. Allen Taylor and Sheldon Rowan of Tufts University explored the impact of dietary carbohydrates on retinal damage in mice, a sign of AMD. The team hypothesized that switching middle-aged mice from a high glycemic diet to a

Scientists will test whether using a smart water bottle that encourages people to drink more water, and therefore urinate, will reduce the recurrence of kidney stones.

rence of kidney stones. The randomized trial will enroll 1,642 people, half in an intervention group and half in a control group. The studyâ&#x20AC;&#x2122;s primary aim is to determine whether a program of financial incentives, receiving advice from a health coach, and using a smart water bottle will result in reduced risk of kidney stone recurrence over a two-year period. The water bottle, called Hidrate Spark, monitors fluid consumption and connects to an app.

Back to basics Skeptical of fad diets? The Washington Post lists five bits of practical advice that have stood the test of time, and prob-

low glycemic diet would delay or stop retinal damage. In fact,

ably will continue to do so for years

mice fed a high glycemic diet developed signs of retinal dam-

ahead: 1) Choose a variety of foods (no

age. Although the retina of a mouse lacks a macula, these signs

one superfood can provide your body

were similar to those in people with dry AMD. When the mice

with the 40 nutrients it requires; 2) eat

were switched from a high to low glycemic diet, the build-up

your vegetables (need we say more?); 3)

of certain harmful metabolic factors in eye tissue was delayed,

get enough fiber (helps avoid constipa-

stopped, or even reversed.

tion, reduces colon cancer risk, and can help prevent heart disease and Type

24

Water bottles vs. kidney stones

2 diabetes); 4) cut down on junk food

Can a high-tech water bottle help reduce the recurrence of

(again, need we say more?); and 5) drink

kidney stones? What about a financial incentive? Those are

alcohol in moderation (ditto).

January 2018 | The Journal of Healthcare Contracting

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HEALTH HINTS

Pain management, 21st century style

each day, one question is whether some

The U.S. Department of Health and Human Services, the U.S.

kids are so stimulated or stressed that

Department of Defense, and the U.S. Department of Veterans

they are unable to sleep as much or as

Affairs announced a multi-component, $81 million, six-year re-

well as they should.”

search project focusing on nondrug approaches for pain management addressing the needs of service members and veter-

Heading off asthma

ans. Approaches being studied include mindfulness/meditative

Got a baby in the house? Let him or her

interventions, movement interventions (e.g., structured exer-

mix it up with some pets or pest aller-

cise, tai chi, yoga), manual therapies (e.g., spinal manipulation,

gens. That’s because a study published in September in the Journal of Allergy and Clinical Immunol-

Identify and avoid behaviors that might harm your voice, cautions the National Institutes of Health. For example, instead of speaking loudly when talking to a large group, arrange for a microphone.

ogy reports that shows that infants exposed to high indoor levels of pet or pest allergens have a lower risk of developing asthma by 7 years of age.

Previous studies have established that reducing allergen exposure in the home helps control established asthma, but the new findings suggest

massage, acupuncture), psychological and behavioral interven-

that exposure to certain allergens early

tions (e.g., cognitive behavioral therapy), integrative approach-

in life, before asthma develops, may have

es that involve more than one intervention, and integrated

a preventive effect.

models of multi-modal care.

A simple answer to ADHD?

26

The Velvet Fog Identify and avoid behaviors that might

Educators, policymakers and scientists have referred to attention-

harm your voice, cautions the National

deficit/hyperactivity disorder, or ADHD, as a national crisis and

Institutes of Health. For example, instead

have spent billions of dollars looking into its cause, reports the

of speaking loudly when talking to a

Washington Post. But what if, as a growing number of researchers

large group, arrange for a microphone.

are proposing, many kids today simply aren’t getting the sleep

On days that your voice sounds raspy or

they need, leading to challenging behaviors that mimic ADHD?

hoarse, protect it by not straining or over-

Several studies have linked ADHD with the length, timing and

using it. Choose a quiet restaurant when

quality of sleep. According to the newspaper, “In an era in which

meeting someone for a meal. Drinking

even toddlers know the words Netflix and Hulu, when demands

plenty of water and using your voice less

for perfectionism extend to squirmy preschoolers and many el-

should help relieve hoarseness from mis-

ementary-age students juggle multiple extracurricular activities

use or overuse.

January 2018 | The Journal of Healthcare Contracting

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