Austin Medical Times by Rick Delarosa

June Edition 2021

Inside This Issue

Informed Consent: Substance and Signature By Robert Morton, CPHRM, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management The Doctors Company

F New, State-of-the-Art Dell Children’s Medical Center North will have 4 levels for Specialized Pediatric Care See pg. 9

INDEX Oncology Research......... pg.3 Mental Health...................... pg.6 Healthy Heart....................... pg.8 Hospital News.................... pg.10

Adults With Cognitive Impairment Who Use Pain Medication Have Higher Falls Risk See pg. 13

or decades, consent documents have helped protect physicians against the claims of dissatisfied patients. Times have changed, however, and modern medicine requires a more complex and complete acknowledgment of both the patient’s and the physician’s rights and responsibilities to each other. True informed consent is a process of managing a patient’s expectations; it is not just a signature on a document. Achieving an accurate diagnosis requires the patient to provide accurate information to the physician. The physician must then provide sufficient information to the patient so that he or she can make a reasonable and informed decision regarding a comprehensive plan for medical or surgical treatment. This physician responsibility cannot be delegated. A successful exchange of information between the doctor and the patient accomplishes two things. First, when the physician explains diagnoses, treatment alternatives, expected outcomes, and potential risks to the patient, it demonstrates that the physician recognizes the patient’s rights and will remain responsive to them. Second, it shifts the decision-making responsibility from the physician alone to a mutual responsibility of both

physician and patient. At its best, informed consent should protect and inform the patient and the doctor.

the recovery process and the expected short- and long-term effects on the patient. Identify any uncertainty and risk involved with a specific treatment plan, including the probability factors, if possible. Discuss reasonable assumptions the patient may make about the treatment plan. Whenever possible, supply reading materials and the consent document for the patient to take home and discuss with his or her family. Encourage questions. Questions provide a better understanding of the patient’s comprehension of the information and facilitate the dialogue between the patient and the physician. If time permits, consider scheduling a second visit with the patient to review the consent form, clarify expectations, and ensure patient comprehension of the proposed treatment—especially with elective procedures. Documentation Documentation is another key component of the informed consent process that cannot be entirely delegated to a nurse or another member of the healthcare team. If the doctor-patient discussion proceeds

Times have changed... modern medicine requires a more complex and complete acknowledgment of both the patient’s and the physician’s rights and responsibilities to each other. Litigation often results from a discrepancy between the patient’s expectations and the outcome of treatment. Informed consent cannot eliminate malpractice claims, but an established rapport between the patient and the physician based on robust exchanges of information can prevent patient disappointment from ripening into a claim. Physician-Patient Dialogue Avoid medical jargon when discussing diagnoses, treatment plans, risks, and expected outcomes with the patient. Define and explain medical words and concepts using simple pictures and analogies. If there are alternative treatment options, discuss them in detail. Also, outline

see Informed Consent...page 14

PERMIT# NO PERMIT 11491 AUSTIN TXTX HOUSTON PRSRT STD US POSTAGE PAID

Austin Medical Times

Page 2

IS IT TIME TO EXAMINE

your malpractice insurance? Unlike other Texas medical liability insurers, which are investor-owned companies, The Doctors Company remains fiercely independent and dedicated to your interests. Ask yourself, “Do I want an insurer founded by and for physicians that’s guided by my peers? Or do I want a profit-focused insurer that’s directed by Wall Street?” Join us and discover why delivering the best imaginable service and unrivaled rewards is at the core of who we are.

7990_TX_HoustonMedTimes_NORCAL_Jun2021_v4.indd 1

June 2021

5/13/21 3:10 PM

austinmedtimes.com

Austin Medical Times

Page 3

Oncology Research Three Questions to Ask Your Oncologist About Clinical Trials By Mika Cline, M.D., Texas Oncology– Austin Midtown

hen it comes to cancer, advancements in clinical trials and research are our greatest hopes for eliminating the disease. Discoveries like new drug therapies or combinations of drugs, innovations in radiation therapy, and better screening and diagnosing methods come from clinical trials – research studies that examine the safety and effectiveness of different cancer treatments and reveal insights into the disease and ways to deliver better care. Breakthroughs that advance prevention and treatment of cancer are made possible by the courageous patients who volunteer to participate in clinical trials. Yet less than 5% of adult cancer patients participate

in clinical trials, according to the National Center for Biotechnology Information. Clinical trials follow strict compliance with federal, state, and local regulatory requirements. Each patient is carefully evaluated to ensure the patient is a strong fit for a particular clinical trial. Here are three questions to ask your oncologist about participating in a clinical trial. What types of clinical trials are available? Patients are encouraged to play an active role in their cancer care. This includes being informed of all treatment options available. Ask your oncologist about clinical trial availability. At any given time, there are hundreds of active clinical trials at various stages of evaluation. For example, prevention trials focus on preventing cancer or the recurrence of cancer, and might focus on diet and nutrition or the use of different medications or vitamins to determine if risk of developing cancer is lowered. Similarly, treatment trials are designed to answer questions about

new treatments, vaccines, therapies, or surgical procedures. What are the benefits and risks of participating in a clinical trial? The benefits and risks of clinical trials vary by trial. And, just as every patient experiences symptoms and side effects differently, this is true for clinical trial participants as well. Some of the benefits of participating in a clinical trial include treatment that may be more effective than other available treatment options and access to treatments often not available to the public. Patients enrolled in clinical trials also receive the same standard of treatment and care as those not participating in trials. While there are inherent risks with participating in research, the benefits often outweigh them. For example, in some cases, the risks

include side effects that are not dissimilar from those experienced with traditional forms of treatment like chemotherapy and radiation therapy. Am I eligible for a clinical trial? Not all patients are eligible for clinical trials, even when it seems like you may be a good fit. Factors considered before approving a cancer patient for a clinical trial depend on such criteria as age and sex, cancer type, stage of cancer, previous treatments, and medical history. If you’re interested in a trial but not eligible for trials currently available, discuss your interest in participating with your oncologist. New clinical trials open regularly. see Oncology Research...page 14

Give the gift that lasts a lifetime this Father's Day!

austinmedtimes.com

June 2021

Austin Medical Times

Page 4

How IDEOlogy Health is Changing Health Education Following COVID-19 By Mike Gramling, CEO IDEOlogy Health.

hen COVID-19 first hit, the world rallied in support of our healthcare professionals working tirelessly on the frontlines of treating this pandemic. Here at IDEOlogy Health, we are committed to supporting doctors and researchers by changing the way they receive health education and ensuring they can collaborate and share knowledge on the latest advancements and breakthroughs post COVID-19. IDEOlogy Health’s mission has always been to improve patient outcomes by ensuring that healthcare professionals are up-to-date on all the latest scientific developments and breakthroughs. It was challenging enough for physicians to stay up-to-date on the latest treatments pre-COVID as the pace of innovation is moving so quickly these days. COVID-19 has only compounded those challenges. Although IDEOlogy Health was launched before COVID-19, we have since seen a dramatic increase in the use of our Digital and online learning platform and database that allows

thought leaders and physicians to safely collaborate and share the latest advancements in medicine. In continuing with our mission, we are thrilled to announce a new collaboration with Texas Oncology that will connect more than500 physicians with access to the suite of IDEOlogy Health’s live and online events, seminars and training sessions offered through our flagship channels. This new collaboration signals a significant shift in the health education industry. Texas Oncology is one of the largest community oncology practices in the country. With a geographic footprint spanning most of Texas and a part of Oklahoma with 210 locations, the ability to disseminate new clinical information is paramount to their physicians’ ability to deliver high quality care to their patients. The independent private practice has played a role in the development of more than 100 FDA-approved therapies. Meeting the oncology needs of Texans for more than 35 years, the practice includes Texas Center for Proton Therapy, Texas Breast

Specialists, Texas Oncology Surgical Specialists, Texas Urology Specialists, and Texas Center for Interventional Surgery. This new collaboration will enable Texas Oncology to remain at the forefront of innovation in care. As new treatments Mike Gramling and president and chairman of Texas Oncology R. Steven Paulson, M.D. discussing the collaboration and the overall industry shift. come to market, IDEOlogy Health is helping Texas Oncology adapt to a Oncology are working together to “real-time” learning model. evolve and adapt to the direction that IDEOlogy’s model is leading the medicine is headed post-COVID-19. way in health education by staying With this new collaboration, medical as close to real-time with medical education delivery is changing to information as possible. A new meet this new environment. We know development in practice can be shared that successfully sharing information quickly across our network of physicians credibly, accurately, and efficiently will and experts without them having to help physicians make the best decisions even leave their homes or offices. It is possible for their patients. reliable, efficient, and allows our health The value of connecting professionals to receive the most current providers with thought leaders and updates at no cost. IDEOlogy Health medical education in near “real-time” also offers the tools and capabilities to can make a real difference for patients help physicians and thought leaders and IDEOlogy Health is thrilled to help connect via technology in real-time. enhance the skills and expertise of Texas Our ultimate goal is to help physicians Oncology’s highly trained physicians positively impact patient outcomes across the country. This collaboration by sharing up-to-the-minute medical represents a new wave of medical advancements. education in the post-COVID-19 era. IDEOlogy Health and Texas

HELP US BUILD A HEALTHIER AUSTIN

Access to nutritious food is essential for a healthy, thriving community. Learn about how we’re leading the fight against hunger at centraltexasfoodbank.org. June 2021

austinmedtimes.com

Austin Medical Times

Page 5

We have a whole suite for maternal health. F E AT U R E D COU R S E S

PRENATAL HEALTH SCREENING AND INTERVENTION: 1.25 AMA PRA Category 1 Credit(s)™

POST PARTUM HEALTH SCREENING AND INTERVENTION: 1.25 AMA PRA Category 1 Credit(s)™

MATERNAL SUBSTANCE USE: Quick Course

Join more than 100,000 medical professionals who get free CME with Texas Health Steps Online Provider Education. Choose from a wide range of courses relevant to your practice, including short tutorials and quick courses on topics like Medicaid guidelines, ethics and mental health—available 24/7. Learn more at TXHealthSteps.com.

Content on the Texas Health Steps Online Provider Education website has been accredited by the Texas Medical Association, American Nurses Credentialing Center, National Commission for Health Education Credentialing, Texas State Board of Social Worker Examiners, Accreditation Council for Pharmacy Education, UTHSCSA Dental School Office of Continuing Dental Education, Texas Academy of Nutrition and Dietetics, Texas Academy of Audiology, and International Board of Lactation Consultant Examiners. Continuing Education for multiple disciplines will be provided for some online content.

austinmedtimes.com

June 2021

Austin Medical Times

Page 6

Mental Health Latinx Young Adults Who Worry About Heart Conditions at Higher Risk for Mental Health Disorders Heart-Focused Anxiety a Significant Predictor of Depression By Laurie Fickman

THE STRENGTH TO HEAL and get back to what I love about family medicine Do you remember why you became a family physician? When you practice in the Army or Army Reserve, you can focus on caring for our Soldiers and their Families. You’ll practice in an environment without concerns about your patients’ ability to pay or overhead expenses. Moreover, you’ll see your efforts making a difference.

To learn more about the Army or Army Reserve, call MAJ Tamela Mitchenor at 210-692-7376, or tamela.l.mitchenor.mil@mail.mil

June 2021

or coffee drinkers, a common scenario might involve drinking an extra cup only to end up with a racing heart and a subtle reminder to themselves to cut down the caffeine. But for those who have a different thinking pattern, one that includes heart-focused anxiety, the racing heart might conclude with the fear of a heart attack and a trip to the emergency room. It turns out young Latinx adults who experience heart-focused anxiety could be at greater risk for mental health disorders. “We have empirical evidence that individual differences in hea r t-focu sed anxiety are related to more severe co-occurring anxiety a nd d e p r e s sive symptomatology among a particularly at-risk segment of the Latinx population,” reports Michael Zvolensky, Hugh Roy and Lillie Cranz Cullen Distinguished University Professor of psychology at the University of Houston, in the Journal of Racial and Ethnic Health Disparities. The population segment to which Zvolensky refers is Latinx young adults with previous trauma who were born in the United States. Their trauma might include racism related and transgenerational stress. This is only the second study on heart-related anxiety in the Latinx community, both conducted by Zvolensky. “In our first study, we assessed middle aged adults, presumably more concerned about their health. This study is unique, however, because even among a group generally too young to experience mounting health concerns, we are seeing a similar pattern, which tells us it’s probably relevant to the whole Latinx population,” said Zvolensky. According to previous research, the Latinx population can somaticize mental health problems, meaning they don’t view them as mental health issues, but rather turn them into physical symptoms and report them as

austinmedtimes.com

such. As examples, anxiety might be reported as a headache or a problem with breathing. “This population also struggles with a lot of chronic physical health co-morbidities including heart disease and obesity, so this research is a good fit for a population who tends to blame mental health issues on physical ailments, which generates greater mental health risk,” said Zvolensky, who is also director of the Anxiety and Health Research Laboratory/Substance Use Treatment Clinic at UH. To make matters worse, treatment for mental health conditions among Latinx populations is often limited or nonexistent.

“Latinx persons underutilize mental health services compared to non-Latinx whites and are more likely to use primary care for the delivery of mental health services which are often inadequate for successfully addressing mental health problems,” said Zvolensky, who created and assessed reports from 169 college aged, Latinx college students who had been exposed to trauma. “Results indicated that heart-focused anxiety was a statistically significant predictor for general depression and overall anxiety,” said Zvolensky. Clinically, the results of the study could ultimately guide the development of specialized intervention strategies. “We can screen for heart-focused anxiety and that’s much more efficient and precise than screening for a whole range of mental health problems,” said Zvolensky. “If you reduce heart-focused anxiety, you do that person a great service because you’re likely decreasing their risk for a whole range of mental health problems. And that’s called precision medicine.”

Austin Medical Times

Page 7

Hands-Only CPR CPR CAN DOUBLE OR EVEN TRIPLE A PERSON’S CHANCE OF SURVIVAL

Learn the two simple steps: 1

Call 911

Push hard & fast in the center of the chest

To learn, watch the 90-second Hands-Only CPR video at heart.org/handsonlycpr

#CPRSAVESLIVES

www.heart.org/handsonlycpr

austinmedtimes.com

June 2021

Austin Medical Times

Page 8

Healthy Heart

MARINE MILITARY ACADEMY

New Designation in EMS Continuing Education Accreditation Achieved American Heart Association Digital Resuscitation Portfolio’s Adaptive Learning to Aid CPR Training Amid Pandemic

REPARE FOR COLLEGE

CONQUER LIFE!

By The American Heart Association

At Marine Military Academy, challenge leads to growth, and growth leads to success. By providing a college-preparatory curriculum in a structured, disciplined and focused setting, our cadets rise to new heights as scholars and leaders. No other school can unlock a boy’s potential like MMA.

NOW ENROLLING FOR 2019-2020

MMA-TX.ORG »» 956.423.6006 ADMISSIONS@MMA-TX.ORG MMA »» A College-Prep Boarding School for Boys in Grades 7-12 MMA »» 320 Iwo Jima Blvd. »» Harlingen, TX 78550

June 2021

he American Heart Association — the world’s leading voluntary organization dedicated to a world of longer, healthier lives — has announced Resuscitation Quality Improvement® (RQI®) and HeartCode® 2025 courses in the Association’s digital resuscitation portfolio have achieved a newly approved accreditation status for emergency medical services (EMS) continuing education. The Commission on Accreditation for Prehospital Continuing Education (CAPCE), a nonprofit body charged with reviewing and accrediting EMS continuing education, instituted an F4 designation in mid-2020, which describes the requirements for classifying a course as adaptive learning and broadens the definition of classroom instruction. With more than 700 F4 course completions to date, the Association becomes the first, and only, CAPCE-accredited continuing education provider to issue course completions with the new designation. EMS professionals in the U.S. must complete continuing education for license and certification renewal every two years with hours originating from a combination of distributed learning or multimedia instructional delivery and classroom or live, online courses, as mandated by the National Registry of Emergency Medical Technicians. “Adaptive learning is a truly novel education delivery platform that allows students to interact with a simulated patient or patient care scenario,” said Jay M. Scott, executive director, Commission on Accreditation for Prehospital Continuing Education. “Through integrated testing, critical decisions and case-based actions supplant the need for a traditional post-test. The interactive nature is dynamic for students, and educators can infuse more excitement, sensitivity and specificity into the learning process. The Commission on Accreditation for Prehospital Continuing Education enthusiastically endorses adaptive learning programs for EMS education.” The CAPCE designation

austinmedtimes.com

signifies a course or program where students’ actions, performance and choices guide the direction of learning activities, including virtual programs using adaptive learning technology and patient simulations. CAPCE now recognizes courses rooted in adaptive learning — a core component in RQI and HeartCode programs — as

equivalent to classroom instruction, which helps advance EMS continuing education and CPR training amid the COVID-19 crisis. Launched last October, the Association and Laerdal Medical, a global company providing healthcare solutions, co-developed RQI and HeartCode 2025 courses affording healthcare professionals with the True Adaptive™ learning experience. Artificial intelligence is used to deliver a customized, personalized and efficient approach that is driven by an individual’s specific knowledge level and unique needs. The courses respond to each learner’s competence, actions and performance. RQI and HeartCode 2025 courses verify competence and validate performance in Basic Life Support, Advanced Life Support/ Advance Cardiac Life Support and Pediatric Advanced Life Support. The Association must report course completions to CAPCE monthly to maintain the F4 continuing education designation and accreditation status. For more information about the RQI program, HeartCode portfolio and True Adaptive learning, visit RQI Partners, the partnership between and service provider for the Association and Laerdal Medical, at www.rqipartners. com.

Austin Medical Times

Page 9

The Frame Work Dell Children’s Medical Center North Breaks Ground

ell Children’s held a groundbreaking ceremony for the new, state-of-the-art Dell Children’s Medical Center North in Williamson County. Totaling more than 187,000 square feet, the hospital will include 36 beds and emergency and trauma services, with two operating rooms, endoscopy and procedure rooms, sleep labs, and

shelled space for future growth. Dell Children’s Medical Center North is expected to open in November 2022. Dell Children’s Medical Center North will have four levels for specialized pediatric care. • First level: emergency department offering level III trauma care

Rendering of Dell Children’s Medical Center North

• 2nd Floor: two operating rooms • 3rd Floor: 36 beds and Ronald McDonald suite, with a lounge, kitchen and bedrooms • 4th Floor: dedicated to future growth and expansion for a capacity of 72 more beds The north campus will also include a 60,000 square foot medical office building that will provide North

Austin with outpatient subspecialty services closer to home. Dell Children’s partnership with Dell Medical School at The University of Texas will continue to focus on ambitious growth to become a destination for all levels of pediatric care by strengthening existing specialties and developing additional pediatric complex care programs.

Dell Children’s breaks Ground

cookiedelivery.com

cookie d

cookiedelivery.com

cookie d

Warm cookies, delivered.

austinmedtimes.com

June 2021

Austin Medical Times

Page 10

Hospital News St. David’s HealthCare facilities recognized by Healthgrades for Excellence in Patient Safety and Patient Experience

t. David’s HealthCare announced today that all of its Austin hospitals received a Healthgrades 2021 Patient Safety Excellence Award™. This distinction – which recognizes hospitals for excellent performance in safeguarding patients from serious, potentially preventable complications and adverse events – places St. David’s Medical Center (including Heart Hospital of Austin and St. David’s Georgetown Hospital), St. David’s South Austin Medical Center and St. David’s North Austin Medical Center among the top 10% of all short-term acute care hospitals in the nation reporting patient safety data to Healthgrades. St. David’s Medical Center was also recognized with a Healthgrades 2021 Outstanding Patient Experience Award™ for the eighth consecutive year. This award, which uses Hospital Consumer Assessment of Healthcare

Providers and Systems (HCAHPS) patient survey data, recognizes the top 15% of eligible hospitals in the nation with the highest overall patient experience scores. “These awards underscore our commitment to providing safe, high-quality care to every patient every day,” David Huffstutler, president and chief executive officer of St. David’s HealthCare, said. “We applaud the extraordinary efforts of our doctors, nurses and staff who helped us earn this recognition, especially during this critical time of need.” Healthgrades evaluated more than 4,500 hospitals and recognized 84 elite hospitals that achieved both patient safety and patient experience distinctions. This places St. David’s Medical Center in the top 2% of eligible hospitals in the nation to receive both awards.

Age Well, Live Well Celebrate Older Texans By Claire Irwin Age Well Live Well Coordinator

lder Americans Month was created in 1963 to showcase the many contributions of older adults. The 2021 Older Americans Month theme, Communities of Strength, underscores the importance, value and expertise that older adults contribute to their communities. Older Texans are a crucial element of what makes Texas the diverse, strong state it is. Texas has one of the fastest-growing populations of older adults. According to a 2019

June 2021

report from the U.S. Census Bureau, approximately 5 million older adults age 60 and older currently live in Texas, and that population is expected to grow to 7.2 million by 2030. When older Texans are engaged in their communities — working, teaching, learning, volunteering, etc. — the whole community benefits. It’s no understatement to say that 2020 was a difficult year. Because of the COVID-19 pandemic, safely gathering and connecting with others in our communities has been a challenge, with virtual social opportunities

Healthgrades 2021 Patient Safety Excellence Award™ During the study period (2017 through 2019), Healthgrades 2021 Patient Safety Excellence Award recipient hospitals demonstrated excellent performance in safeguarding Medicare patients, as measured by objective outcomes—risk-adjusted patient safety indicator (PSI) rates— for 13 PSIs defined by the Agency for Healthcare Research and Quality (AHRQ). A 14th PSI included in the evaluation is that the hospital system has not left foreign objects in the body during a surgery or procedure. If all hospitals in the country performed at the level of award recipients for each of the PSIs evaluated by AHRQ, 106,052 patient safety events could have been avoided. In addition, Healthgrades found that patients treated in hospitals receiving the Patient Safety Excellence Award achieved better outcomes than those treated in non-recipient hospitals. On average, patients are*: • 50.3% less likely to experience a collapsed lung due to a procedure or surgery in or around the chest • 60.3% less likely to experience a hip fracture following surgery

• 66.5% less likely to experience pressure sores or bed sores acquired in the hospital • 65.4% less likely to experience catheter-related bloodstream infections acquired at the hospital Healthgrades 2021 Outstanding Patient Experience Award™ In addition to being recognized as a Healthgrades 2021 Patient Safety Excellence Award recipient, St. David’s Medical Center also out-performed peer hospitals in providing outstanding patient experience. Healthgrades evaluated performance by applying a scoring methodology for 10 patient experience measures using data collected from a 29-question experience survey from the hospital’s own patients. The survey questions focus on patients’ perspectives of the care they receive in a hospital, ranging from cleanliness and noise levels in patient rooms to factors such as provider communication and responsiveness to patients’ needs. The measures also include whether a patient would recommend the hospital to friends or family, as well as their overall rating of the hospital.

becoming the norm. As a higher-risk population, older adults have been heavily impacted from the pandemic, according to the Centers for Disease Control and Prevention. They have experienced significant losses of loved ones, safety concerns and isolation, according to the National Center for Biotechnology Information. Early in the pandemic, the Texas Health and Human Services Commission (HHSC) accessed federal Civil Money Penalties (CMPs) funding to help long-term care facility residents stay better connected with their loved ones. HHSC announced in May 2020 that nursing facilities could apply for up to $3,000 in CMP funds to purchase communication devices — such as

tablets, webcams, headphones and other accessories — to hold virtual visits with loved ones. In October 2020, HHSC announced it was making an additional $3.5 million in CMP funding available for nursing facilities to purchase plexiglass barriers, tents and other equipment to allow these visits to be safe and comfortable both indoors and outdoors. “This federal funding enhanced the health and safety of residents and their families as facilities across the state welcomed essential caregivers and other visitors, who are now providing much-needed support to their loved ones in the facilities we regulate,” said David Kostroun, HHSC Regulatory Services Division deputy executive commissioner. This May is a great time to recognize older Texans for the vital roles they play in our communities. Reach out or connect virtually to older loved ones or neighbors using the HHSC Know Your Neighbor campaign, which encourages and provides tips and resources on connecting and engaging with older neighbors, all while remaining safe during the pandemic. For more information on the campaign, visit https://hhs.texas.gov/ about-hhs/community-engagement/ age-well-live-well/age-well-live-well-beconnected.

austinmedtimes.com

Austin Medical Times

austinmedtimes.com

Page 11

June 2021

Austin Medical Times

Page 12

New Study Seeks to Prove Innovative Model of Whole-Person Health Care For Osteoarthritis Philanthropic Support Drives Critical Research into Health System Transformation Breaks Ground

ew research from Dell Medical School at The University of Texas at Austin aims to demonstrate the value of an innovative health care model that incorporates a whole-person approach to treating osteoarthritis. Developed by clinicians dedicated to transforming health care, the team-based approach focuses on improving patients’ health with a goal of lowering the costs of their care. Developed by a team at the Musculoskeletal Institute at UT Health Austin, the clinical practice of Dell Med, this innovative approach is referred to among clinicians as an integrated practice unit (IPU). It is designed to provide “360-degree care” to meet the physical, emotional and social needs of patients with a variety of common conditions: back pain, fractures, ligament tears, and hip and knee osteoarthritis. In a three-year study, researchers will examine care and related costs for

hip and knee osteoarthritis patients at the Musculoskeletal Institute. A chronic, slowly progressing condition that affects more than 32 million U.S. adults, osteoarthritis can severely affect mental health and quality of life. The institute’s multidisciplinary care team considers a patient’s psychosocial issues and weighs other treatment options along with total joint replacement surgery. “Core to the mission of Dell Medical School is developing, implementing and disseminating innovative models of care that align with the interests of patients and society,” said Kevin Bozic, M.D., MBA, chair of Dell Med’s Department of Surgery and Perioperative Care. “This study gives us the opportunity to fulfill that mission by further disseminating a new model of care that could impact millions of people who suffer from disabling arthritis of the hip or knee.” High-Tech Measurements Aimed

at Illustrating Value to Patients Specifically, the team will use advanced technology to continuously monitor clinician and patient movements and interactions to calculate the costs of caring for patients with osteoarthritis of the hips and knees. A real-time location system will collect and compare data from the Musculoskeletal Institute and a more traditional orthopaedic care provider. The study will track costs relative to patient outcomes, including activity levels and general health — along with more traditional metrics such as readmissions and use of services. The study is being funded by a $2.26 million gift from Eric and Shanna Bass of Houston. Eric Bass, an investment professional, earned a bachelor’s in business administration from UT Austin in 1998. The gift will fund technology, support personnel, data collection and analysis. “Cost effective delivery of quality

health care is a critically important policy concern for the country and the world,” said Eric Bass. “We are excited to partner with Dell Med to perform groundbreaking work which has the potential to improve patient outcomes coupled with meaningful cost reductions.” Leading the Dialogue on Health Care Transformation Clinical leaders from the Musculoskeletal Institute are contributors to the national conversation on achieving high-value, low-cost care. Bozic, along with colleagues Karl Koenig, M.D., M.S., medical director of the Musculoskeletal Institute; and Prakash Jayakumar, M.D., Ph.D., director of value-based care and outcome measurement, serve as invited experts to the Center for Medicare and Medicaid Innovation see New Study ...page 14

Subscribe to Our Digital Issue Now you can get the Austin Medical Times delivered straight to your inbox. Never miss an Issue of Austin’s Leading Local Healthcare News Online.

austinmedtimes.com June 2021

austinmedtimes.com

Austin Medical Times

Page 13

St. David’s South Austin Medical Center Offers Minimally Invasive Valve Replacement Procedure to Patients with Severe Aortic Stenosis

t. David’s South Austin Medical Center recently began offering a minimally invasive aortic valve replacement procedure known as transcatheter aortic valve replacement (TAVR) to patients with symptomatic severe aortic stenosis. Aortic stenosis is a narrowing of the aortic valve which restricts blood flow. “This approach to valve replacement offers an effective alternative to traditional, open-chest surgery in some patients,” Devry Anderson, M.D., chief medical officer

of St. David’s South Austin Medical Center, said. “Additionally, it can decrease complications and shorten recovery time since it eliminates the need to open the patient’s chest and use a heart bypass machine.” TAVR involves inserting a compressed valve via a catheter (a flexible tube) through the groin or neck. After the catheter is guided through the aorta and aortic valve, the new valve is positioned into the existing valve. It is then opened,

replacing the existing diseased valve. Severe aortic stenosis occurs when the aortic valve flaps become stiff and thickened, making it difficult for them to open and close. This causes the heart to work harder to pump blood to the rest of the body. Symptoms of severe aortic stenosis may include dizziness or fainting, chest pain, fatigue or discomfort. If left untreated, this condition is often fatal. Patients with severe aortic stenosis should discuss the risks and benefits of TAVR with their physician

to determine if the treatment is right for them. St. David’s HealthCare’s cardiovascular specialty facility, Heart Hospital of Austin, has provided the TAVR therapy since 2012. The physicians who comprise the Heart Valve Clinic at Heart Hospital of Austin have performed more than 1,300 successful TAVR procedures to date.

participants in the study, 8.3 percent had possible dementia while 8.2 percent had probable dementia. “Although there was no significant difference in being bothered by pain by cognitive status, people living with dementia took medication for pain more frequently than those with no dementia,” Yoshikawa said. “Older age, not non-Hispanic white race/ethnicity, lower levels of education, living alone, and having more chronic conditions were associated with people living with dementia versus those with no dementia. People living with dementia were more likely to report at least one fall in the past month and worry about falling down and balance/ coordination.” In addition, researchers found increased likelihood of recent falls was associated with pain medication among persons with probable dementia, and that taking pain medication two days a week or more was also associated with an increased risk of falls among those with probable dementia.

“These results support that the risk of falls associated with pain medication is elevated among those with higher levels of cognitive impairment,” Yoshikawa said. “The different relationships of pain medication with falls by cognitive status can be partly explained by the severity of cognitive impairment among older adults.” Finally, the researchers note that the findings in this study have practical implications for falls prevention strategies and programs. “To address the risk of falls associated with pain medication, especially for probable dementia, it is essential to conduct screening and medication reconciliation in the health care system. The provision of education about pain medication and alternative pain management programs is critical to preventing falls,” Yoshikawa said. “There is need for fall prevention programs that encourage both exercise training for improving one’s balance and reducing worry about falling down through fall management strategies.”

Adults With Cognitive Impairment Who Use Pain Medication Have Higher Falls Risk By Lauren Rouse

lder adults with cognitive impairment are two to three times more likely to fall compared with those without cognitive impairment. What’s more, the increasing use of pain medications for chronic pain by older adults adds to their falls risk. Risks associated with falls include minor bruising to more serious hip fractures, broken bones and even head injuries. With falls a leading cause of injury for people aged 65 and older, it is an important public health issue to study in order to allow these adults increased safety and independence as they age. Although elevated risk of falls due to use of pain medication by older adults has been widely studied, less is known about how pain medication use affects falls risk of older adults living with cognitive impairment. In a study recently published in Age and Ageing, researchers at Texas A&M University examined a national sample to identify the relationship between pain medication use and falls among older adults based on their cognitive status. The team included Texas A&M Health Center for Population Health and Aging postdoctoral research associate, Aya Yoshikawa, DrPH; center co-director Matthew Lee Smith, PhD, MPH; and center founding director

Marcia G. Ory, PhD, MPH. Using data from the National Health and Aging Trends Study (NHATS), the team analyzed associations between pain medication use and recent falls by cognitive status. The data used were self-reported measures except for cognitive test scores, which were derived from the NHATS validated algorithm based on physician diagnosis, cognitive domain (memory, orientation and executive function) test scores, and AD8 Dementia Screening Interview test scores. Falls were identified as “yes” or “no” answers to the definition of “any fall, slip, or trip in which you lose your balance and land on the floor or ground or at a lower level” in the past month. Frequency of taking pain medication in the past month was identified as seven days a week, five to six days a week, two to four days a week, once a week or less, and never. Information about specific pain medications was not identified in this study. Additional measures included age, race/ethnicity, education, living arrangement, balance or coordination problems, being bothered by pain, and number of chronic conditions. The researchers found that among the 7,491 community-dwelling

austinmedtimes.com

June 2021

Page 14

Informed Consent

Continued from page 1 successfully and the patient requests treatment, the doctor is required in some jurisdictions to write a note in the patient’s record. Additionally, the consent document must include the patient’s name, doctor’s name, diagnosis, proposed treatment plan, alternatives, potential risks, complications, and benefits. To some extent, physicians who use an informed consent document can protect themselves further by including a statement to the effect that the form only covers information that applies generally and that the physician has personally discussed specific factors with the patient. The consent document must be signed and dated by the patient (or the patient’s legal guardian or representative). Many consent forms also require a physician signature. Consent forms should include statements to be signed by the patient and the physician. The patient attests that he or she understands the information in the treatment agreement. The physician attests that he or she has answered all questions fully and believes that the patient/ legal representative fully understands the information. These statements help defend against any claim that the patient did not understand the information. Some states have specific requirements for informed consent forms, procedure-specific disclosures, and legal standards for disclosure of risks. For example, Texas maintains lists of procedures and attendant risks and hazards through the Texas

Oncology Research

Continued from page 5 These three questions are the beginning of open and ongoing

New Study

Continued from page 12 to further its work on condition-based bundled payments for osteoarthritis of the hip and knee. “This study is the next step in measuring the true impact of Dell Med’s pioneering shift in our approach to health through innovation,” June 2021

Austin Medical Times Medical Disclosure Panel. Check your state for requirements. Informed Consent in Special Situations The informed consent process for same-day surgery patients may occur in the physician’s office before scheduling the procedure. That will allow the patient time to think about the information, ask questions, and make an informed decision. Hospitalized patients must be informed as far in advance of the procedure as practicable. If time permits in an emergency in which the patient is unable to provide consent, the physician must contact a legally authorized representative to obtain an informed consent. If the nature of the emergency does not permit time to contact a legally authorized representative, consent is implied. Consent may be waived under emergent conditions that threaten life, limb, eyes, and the central nervous system. If the patient is incompetent or otherwise cannot consent, the physician is legally bound to obtain informed consent from the incompetent patient’s authorized representative, except in an emergency. This type of consent should be thoroughly documented in the medical record. Additional Tips and Suggestions • Develop and use procedure-specific forms that the patient can sign when the informed consent discussion takes place. • Obtaining consent from the patient after a sedative or sleep-inducing medication is administered is not recommended. However, when a change in the patient’s condition requires a change in treatment, secure the patient’s consent. Thoroughly document in the medical record the facts and

conditions surrounding the need for the revised consent. • Additions or corrections to the consent form must be dated, timed, and signed by both parties. • Any member of the healthcare team may sign as a witness to the patient’s signature, although this serves only to verify that it was the patient who signed the form. The witness does not obtain consent or verify the patient’s competency to give consent. • A patient’s questions or obvious lack of understanding about the procedure should be referred to the attending physician as soon as possible. • Translate consent forms to the most common non-English languages that you encounter in your practice, and verify that the form is translated correctly. Patient Safety Measures Every physician should develop his or her own style and system for the informed consent process, making it easier to avoid omissions and—more importantly—ensuring consistency of application. Do not speed through the process. Give the patient and the family time to absorb and comprehend the information. Preprinted materials are extremely helpful for patient understanding and will serve as a trigger for other questions. Assess the patient’s level of understanding just before documenting the process. One way of doing this is to ask the patient to repeat back to you his or her understanding of the information you have communicated. This will increase the likelihood that you will be able to manage the patient’s expectations effectively.

discussions about your cancer care with your physician. The American Cancer Society recommends evaluating all treatment options before deciding to participate in a clinical trial, and taking into consideration travel, time, medical coverage, and any potential costs, among others.

Texas Oncology has helped develop more than 100 FDA-approved cancer therapies through research and clinical trials. I’m proud to work with our patients and oncology care teams who, together, are helping others by supporting medical research.

Koenig said. “It has the power to transform how people get better, not just for our practice but for clinicians and policymakers across the nation. The Bass family’s foresight and philanthropy will both advance the science and help guide broad-reaching improvements for modern health care.” The Musculoskeletal Institute has already partnered with Central

Health and Ascension Seton to eliminate wait lists for musculoskeletal care among Travis County’s medically underserved population, while simultaneously establishing and growing a center for the treatment of all Central Texans with musculoskeletal problems. 

austinmedtimes.com

Published by Texas Healthcare Media Group Inc. Director of Media Sales Richard W DeLaRosa Senior Designer Jamie Farquhar-Rizzo Web Development Lorenzo Morales Distribution Brad Jander Accounting Liz Thachar Office: 512-203-3987 For Advertising advertising@ medicaltimesnews.com Editor editor@medicaltimesnews.com

Austin Medical Times is Published by Texas Healthcare Media Group, Inc. All content in this publication is copyrighted by Texas Healthcare Media Group, and should not be reproduced in part or at whole without written consent from the Editor. Austin Medical Times reserves the right to edit all submissions and assumes no responsibility for solicited or unsolicited manuscripts. All submissions sent to Austin Medical Times are considered property and are to distribute for publication and copyright purposes. Austin Medical Times is published every month P.O. Box 57430 Webster, TX 77598-7430

Austin Medical Times

austinmedtimes.com

Page 15

June 2021

Austin Medical Times

austinmedtimes.com

ade In M

EXA