Volume 5 | Issue 3
Inside This Issue
March Edition 2022
Large-Scale Events: Assessing Your Risk
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Cannabis Use by Female Adults Associated With Lower Incidence of Diabetes See pg. 10
INDEX Legal Matters....................... pg.3 Oncology Research......... pg.4 Mental Health...................... pg.6 The Framework.................... pg.9 Age Well, Live Well.......... pg.12
s COVID-19 cases are steadily decreasing in Houston, large-scale events are happening in the community. A Baylor College of Medicine expert discusses the risk factors associated with attending large events, such as concerts, sporting events and the Houston Livestock Show and Rodeo “We are doing much better and our viral numbers are improving rapidly and dramatically, so that’s very encouraging,” said Dr. James McDeavitt, executive vice president and dean of clinical affairs at Baylor. “However, we’re still in a very high prevalence environment. People need to continue to be cautious, particularly if they’re in relatively high-risk groups or routinely exposed to people at high risk.” Large-scale events vary in terms of size and location. Because the Houston Livestock Show and Rodeo consists of different events, indoor and outdoor, he recommends considering the risks: • Outdoor: The carnival is one of the safest parts of the rodeo because it is outdoors. Eating outside also is safer than eating inside. • Indoor: Consider masking if you are in a crowded indoor environment. Shopping venues and other exhibits at the rodeo are in a large indoor space, so wearing a mask is safest. The concerts are in a very large indoor space, but you sit in close proximity to strangers, unaware of their viral status. You should be wearing a mask in that
setting. If you plan to attend the rodeo or other large events, make a personal choice about whether attending the event is worth the risk. McDeavitt suggests assessing your risk based on
Responsibly look at the risk of the people around you: family, friends, colleagues and anyone else you come in contact with regularly. Maintain a higher degree of caution if those around you are at risk. If you are healthy, vaccinated and boosted and contract COVID-19, it will likely be a minor annoyance. If you live with or are frequently exposed to an elderly relative, someone who has a serious medical condition or someone that is chronically immunosuppressed, those people are still at risk. Consider avoiding large events or remaining masked to prevent potentially spreading the virus back to them. Be cautious if you work in an environment where you are routinely exposed to people at high risk, such as nursing homes, healthcare settings or retirement centers. If you carry it to someone at higher risk, it could be extremely serious. Look at the community disease prevalence Check the CDC website to find
If you have symptoms, don’t go...You should not visit crowded places if you have COVID-19 symptoms. You do not want to spread your illness...
A Local Partnership Offers Help for the Elderly See pg. 11
your health and surroundings: Maximize your vaccination status If you are not vaccinated and boosted, get the vaccine and booster to protect yourself. If you plan to go to a large event with a group, ask the group if they are vaccinated and boosted and encourage others around you to get vaccinated. During the recent omicron wave, people who became critically ill were disproportionately unvaccinated. Those who were vaccinated and boosted were largely protected against getting critically ill. Assess the people around you
see Events...page 14
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Legal Matters CMS Innovation Center Releases New Strategic Priorities To Set Course for Second Decade of Operations
Michael T. Flood, J.D. David E. Bird, J.D. Polsinelli, PC
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he Center for Medicare and Medicaid Innovation (“CMMI”) was established as part of the Affordable Care Act and gives the Secretary broad discretion to develop and implement payment models with the goal of achieving higher quality in the delivery of high value services at a lower cost to the Medicare and Medicaid programs. CMMI is responsible for administering many popular programs, including the Bundled Payments for Care Improvement Advanced, ESRD Treatment Choices Model, the Oncology Care Model, Expanded
Home Health Value Based Purchasing Model, Million Hearts, and other value-based demonstration programs. Through the years, CMS has made attempts to implement reforms to Part B drug payments through CMMI. This year, CMMI chose not to implement the Most Favored Nation Model Interim Final Rule (MFN Model) after several delays. The MFN Model was aimed at lowering the amount Medicare Part B pays for 50 high-cost drugs to the lowest price that drug manufacturers receive in similar countries. CMMI recently announced it rescinded the MFN Model as it “explore[s] all options to incorporate value into payments for Medicare Part B drugs, improve access to evidence-based care, and reduce drug spending for consumers and throughout the health care system.” No new Part B drug payment models have been proposed to replace the MFN Model. Despite the ongoing implementation of demonstration models, perhaps the most notable development for CMMI
was its release of a new strategic plan entitled the Innovation Center Strategy Refresh (“Strategic Plan”). The Strategic Plan is intended to guide CMMI’s health care payment and delivery model development and design priorities over the next decade. According to CMMI’s proposed timeline, the first three to six months of this plan’s implementation would be dedicated to stakeholder engagement. Although CMMI’s overarching goal continues to be expansion of successful models that reduce program costs and improve quality and outcomes for Medicare and Medicaid beneficiaries, the Strategic Plan establishes the following objectives for CMMI:
1. Increase the number of Medicare and Medicaid beneficiaries in value-based care models by 2030. CMMI has a goal that all Medicare Part A and Part B enrollees and the vast majority of Medicaid enrollees will participate in care relationships with accountability for quality and total cost of care by 2030. 2. Advance Health Equity. Embed health equity in all models through mandatory reporting of demographic and social determinants of health data as appropriate. Ensure participation of historically underserved see Legal Matters...page 14
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Oncology Research Colorectal Cancer Screening: It’s Worth It!
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By Mika Cline, M.D., Texas Oncology– Austin Midtown and Texas Oncology Marble Falls
T
here are several things on our “to do” list that we’re all really good at putting off. They need to be done, but we don’t like disrupting our routines or taking time away from other activities to make them happen. However, when it comes to cancer screenings, it’s worth a little disruption. It can give you peace of mind. Or if cancer is detected, the earlier it’s found, the more treatment options are available.
the disease typically lacks symptoms in the early stages. The American Cancer Society estimates that 151,030 people will be diagnosed with colorectal cancer, and 52,580 people will die from colorectal cancer in 2022. We spend a lot of time protecting our health by staying active and eating right, and it only makes sense to protect our health by getting the proper colorectal cancer screenings. Men and women age 45 and older with an average risk for developing colorectal cancer should discuss the most appropriate screening test with their physician. Screening tests include annual guaiac-based fecal occult blood test (gFOBT) or fecal immunochemical test (FIT); multi-targeted stool DNA
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Colorectal cancer screenings are a great example of something many would prefer not to do and therefore often delay. Colonoscopies, in particular, get the worst rap of all the cancer screenings, and it’s not hard to see why. We generally don’t discuss it at the dinner table, and it might be a bit embarrassing. Between the prep and the procedure, you have to invest a bit of time. But at the end of the day, it is worth it. Detecting cancer early through colorectal cancer screenings can be a lifesaver, which is the best reason to get screened, especially since colorectal cancer is the second-leading cancer killer of men and women combined in the U.S. Screenings are essential to diagnosing colorectal cancer because
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(MT-sDNA) test every three years; flexible sigmoidoscopy every five years; double-contrast barium enema every five to 10 years; virtual colonoscopy every five years; or colonoscopy every 10 years. Those with increased risk factors should consult their physician whether to begin screenings earlier than age 45. Those with symptoms or a positive test from another type of test should have a colonoscopy. March is Colon Cancer Awareness Month. If you’re due for a colorectal cancer screening, stop putting it on your “to-do” list and move it to your “done” list. You won’t regret the decision. For more information, visit TexasOncology.com.
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Mental Health Recognizing Signs of Mental Health Issues and Eating Disorders In Children and Adolescents
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he COVID-19 pandemic has taken a major toll on the mental health of children and adolescents. The number of children and adolescents with eating disorders also has increased dramatically, according to Dr. Catherine Gordon, chair of pediatrics at Baylor College of Medicine and pediatrician-in-chief at Texas Children’s Hospital. That’s why it is important for parents, family members and teachers to be aware of signs of distress and know when to take action. Children are experiencing more stress at home, due to events such as a parent losing a job or a relative dying of COVID-19. In addition, quarantining and remote education have disrupted children’s routines, which has led to increased anxiety and depression, Gordon said. “In-person education is important for socialization as well as academic enrichment,” Gordon said. “We know that it’s hard for students to receive consistent education at home, and it hasn’t been the same for them as being in a classroom and interacting
with a teacher and peers. They have also missed out on extracurricular activities that are critical for their development.” Gordon offers these tips to parents concerned about anxiety and depression in their children: • Watch for signs of children tuning out or not wanting to engage in family activities. • Ask open-ended questions to engage your child in conversation such as “How are you doing?” • Address the behavior you see. For example: “You seem anxious to me. Did something upset you? Can you tell me about it?” • Contact your pediatrician or school counselor if you’re concerned. “I always tell parents to listen more than talk,” Gordon said. “Enable a child or teenager to share their feelings and let them know that it is okay to feel upset. Expressing feelings is a way to help them process something that may be troubling them and can ward off depression in the long-term.” Eating disorders also are being
diagnosed more frequently during the pandemic, often occurring as a manifestation of stress and anxiety. “An eating disorder can be a sign of an adolescent trying to regain control by restricting what they will and will not eat,” Gordon said. Signs of an eating disorder may include: • Skipping meals • Refusing to eat certain types of foods • New restrictions on specific foods
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Talking frequently about eating but only picking at a meal • Consuming caffeinated beverages to try to suppress appetite • Compulsive exercise, especially after meals “If your adolescent is not finishing his or her meals, gently ask about it,” Gordon said. “Monitor whether school lunches are being eaten from a lunch box and whether meals see Mental Health ...page 14
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March 2022
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Newer Generation Clot-Busting Medication Reduces Brain Bleeding by Half in Stroke Patients, Study Finds
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newer generation clot-busting medication called tenecteplase may dramatically reduce the risk of serious complications from bleeding into the brain after stroke treatment, according to preliminary research by Steven J. Warach, M.D., Ph.D., professor of neurology at Dell Medical School at The University of Texas at Austin. Warach will deliver his findings at the American Stroke Association’s International Stroke Conference next week in New Orleans. Nearly 800,000 people in the United States have a stroke every year. The vast majority of those strokes (87%) are ischemic strokes, which occur when a vessel supplying blood to the brain is obstructed. This can result in a corresponding loss of neurologic function. Tenecteplase is a newer generation medication administered by a single five-second intravenous injection. Researchers compared its performance with the standard drug for stroke, alteplase, which is injected over 60 minutes. Both tenecteplase and alteplase are federally-approved for use in dissolving clots in blocked
heart arteries, but the newer drug is already being used by clinicians to treat ischemic strokes. Warach’s study examined a data registry of tenecteplase use at hospitals in the U.S., Australia and New Zealand and included three years of data through June 2021. “Right now, tenecteplase is FDA-approved to treat heart attacks,” said Warach, who is also Stroke Director for Ascension Texas and Chair of Ascension’s national Stroke Affinity Group. “But the latest guidance from the American Heart Association, based on published clinical trials of tenecteplase for stroke, suggests physicians may consider the drug for ischemic stroke. Many stroke centers have been using tenecteplase in routine clinical practice over the last 3 years, so we wanted to find out if tenecteplase is at least as safe and effective as alteplase outside the controlled environment of clinical trials.” Warach’s team analyzed data on nearly 9,000 patients, all of whom were treated with thrombolytics, or clot-dissolving medications. This allowed researchers to have a tenecteplase-treated group and an
alteplase-treated group for comparison. On average, patients in both groups had suffered moderate ischemic strokes. The patients who received tenecteplase were more likely to also undergo thrombectomy— a procedure to remove large clots in the brain. Researchers said this difference was expected because some stroke centers only gave tenecteplase to patients with larger clots after small clinical trials confirmed the newer drug was better than alteplase in those patients. “We were surprised to find that those treated with tenecteplase had roughly half the rate of symptomatic hemorrhage – that’s major bleeding in
the brain – than those treated with the standard drug, alteplase,” Warach said, noting that the published clinical trials had found that the rates of serious brain bleeding was the same for either drug. “We’ve shown that in routine clinical use for stroke tenecteplase appears to be safer. But there are other factors to consider in comparing the relative effects of tenecteplase versus alteplase, like functional outcomes for patients and recovery time. There are several large, randomized clinical trials underway right now to assess those
see Clot-Busting...page 13
St. David’s Healthcare Facilities Among Top Five Percent of U.S. Hospitals For Clinical Outcomes, According To Healthgrades St. David’s Medical Center, St. David’s South Austin Medical Center named to Healthgrades 2022 America’s 250 Best Hospitals
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t. David’s HealthCare announced today that two of its facilities—St. David’s Medical Center and St. David’s South Austin Medical Center— have received the Healthgrades 2022 America’s 250 Best Hospitals Award™. The distinction places these hospitals in the top five percent of nearly 4,500 U.S. hospitals evaluated for their superior clinical performance according to Healthgrades, the leading resource that connects consumers, physicians and health systems. “Providing safe, high-quality care to every patient every day has long
March 2022
been our mission,” David Huffstutler, president and chief executive officer of St. David’s HealthCare, said. “This recognition underscores our commitment to providing the highest level of patient safety and care.” From 2018 through 2020, patients treated in hospitals achieving this award had, on average, a 27.8% lower risk of dying than if they were treated in hospitals that did not receive the award, as measured across 17 rated conditions and procedures for which mortality is the outcome.* During the same period, if all
hospitals performed similarly to those achieving the Healthgrades America’s 250 Best Hospitals Award, 160,256 lives could potentially have been saved. For example, patients treated for heart failure in hospitals achieving the award have, on average, a 34.0% lower risk of dying than if they were treated in hospitals that did not receive the award.* Recipients of the Healthgrades America’s 250 Best Hospitals Award stand out among the rest for overall clinical excellence across a broad spectrum of care. During the 2022
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study period (Medicare Fiscal Years 2018-2020), these hospitals showed superior performance in clinical outcomes for patients in the Medicare population across at least 21 of 31 most common inpatient conditions and procedures as measured by objective performance data (risk-adjusted mortality and in-hospital complications). The 2022 study period did not include clinical outcomes for COVID-19 patients.
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High CAC, High Cholesterol Increase Heart Attack/Stroke Risk, UT Southwestern Cardiologists Find
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atients with both a high lipoprotein(a) and high coronary artery calcium score (CAC) face a more than 20% risk of heart attack or stroke over the following 10 years, according to findings from a multicenter study led by preventive cardiologists at UT Southwestern Medical Center. “We are hopeful that by making the connection between Lp(a) and CAC as dual risk drivers, we Parag Joshi, M.D., is a member of the Clinical Heart and can raise awareness in Cardiologist Vascular Center at UT Southwestern, which is ranked #11 in the nation the medical community and #1 in Texas for cardiology and heart surgery, according to U.S. News and improve earlier heart & World Report than with high LP(a) and high attack prevention for these CAC combined. patients,” said cardiologist Parag Joshi, The findings are online in the M.D., Associate Professor of Internal Journal of the American College of Medicine at UT Southwestern. “Our data may also expedite Cardiology (JACC) and will appear the development of treatments in the March print edition. Read more designed specifically for this high-risk at “What Can Lp(a) Add to CAC population,” said Dr. Joshi, a member for ASCVD Risk Prediction? New of the Clinical Heart and Vascular Insights” at TMTMD. “Establishing the connection Center at UT Southwestern, which is ranked #11 in the nation and #1 in between Lp(a) and CAC means we Texas for cardiology and heart surgery, can move to the important next phase according to U.S. News & World of research, which will be defining and personalizing early screening Report. Approximately one in six people protocols to identify patients at high in the U.S. have high Lp(a), a type of risk of heart attack,” said Dr. Joshi, bad cholesterol whose levels are driven whose research focuses on assessing largely by one’s genes. Coronary artery risk for heart attack and stroke, calcium, known as CAC, is a marker CAC, cholesterol, and coronary CT angiography. “With further research, of plaque deposits around the heart. The team of researchers, which this could mean selectively scanning included researchers from Emory patients with high Lp(a) for their University, found that participants CAC score, and studying therapies with combined high Lp(a) and high specifically designed to reduce Lp(a) CAC had a 22% 10-year risk of heart among patients with high CAC.” Cardiology researchers attack or stroke, compared with a 10-15% 10-year risk in patients who confirmed the Lp(a) and CAC connection by comparing data from had either risk factor alone. Investigators identified three two landmark cardiovascular trials: • The Dallas Heart Study, an distinct risk-related trends: ongoing comprehensive study of • High Lp(a), high CAC: These 6,000 diverse and heart-healthy individuals face the highest patients conducted by UT 10-year risk of heart attack or Southwestern from 2000 to stroke. present • High Lp(a), zero CAC: 10-year Study of heart attack and stroke risk is low • Multi-Ethnic Atherosclerosis (MESA): when there is no CAC, even if A 6,000-participant study Lp(a) is high. investigating early-stage • Low Lp(a), high CAC: 10-year atherosclerosis (hardening of the heart attack or stroke risk is higher than average but lower arteries). austinmedtimes.com
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Heavy Cannabis Use by Female Adults Associated with Lower Incidence Of Diabetes The Study Found No Association Between Diabetes and Cannabis Use For Female Adults Who Lightly Use Cannabis Nor For Male Adults With Any Level Or No Use By Rae Lynn Mitchell
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new study recently published in Cannabis and Cannabinoid Research found that women who heavily used cannabis had lower incidence of diabetes, a chronic condition that prevents the body from either making enough insulin (type 1) or being able to use insulin efficiently (type 2). Approximately one in 10 Americans has diabetes, and the condition accounted for 87,647 deaths in the United States in 2019, making it the seventh leading cause of death for that year. For the study, Texas A&M University School of Public Health graduate students Ayobami Ogunsola,
Samuel Smith, Udeh Mercy and Olatunji Eniola, along with a colleague from Hofstra University, analyzed data from the National Health and Nutrition Examination Survey (2013-2018). From approximately 15,000 participants. The majority of participants were female, white (non-Hispanic), over 40, and had at least a college-level education. Cannabis use was estimated on the basis of exposure and frequency of use with smoking cannabis fewer than four times per month deemed “light use,” and “heavy use” defined as four or more times per month. Diabetes status was determined by physician diagnosis or meeting criteria for plasma glucose, fasting blood glucose or hemoglobin A1C levels.
Female participants who used cannabis heavily were less likely to be diagnosed with diabetes than female participants who did not use cannabis. Light cannabis use by female participants had no association with diabetes diagnosis. Researchers found no association in male participants between diabetes and any level of cannabis use. Previous research has shown that the endocannabinoid system, a series of neurotransmitters and receptors in the nervous system involved in numerous biological processes, has different effects depending on sex.
Cannabidol and delta-9-tetrahydrocannabidol, two key compounds in cannabis, stimulate receptors in the endocannabinoid system that result in improved glucose disposal. The authors note that this is one possible explanation for the sex-based difference found during their study. Further research is needed to better understand the association observed in this study, especially to analyze the individual and contextual variables and mechanisms that may be responsible.
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In Caregiving for Elderly Adults, A Local Partnership Offers Help By Ascension Texas
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newccording The realities of aging and its impact on loved ones can be a tough realization. Witnessing a decline in the physical or mental abilities of parents or older relatives, many people may not know where to get help. Historically, women have assumed the role of caregiver. They take on physical, emotional and financial responsibilities, often at their own expense – a reality that will only expand as the population of older adults in Central Texas continues to grow. Confronted by new caregiving responsibilities, women’s own health and well-being can quickly become sidelined. But it’s critical for caregivers to prioritize their own mental health so that they, in turn,
can better care for those they love. Through a partnership between Ascension Texas and AGE of Central Texas, caregivers in Central Texas can access help. “AGE of Central Texas has been a lifeline for both patients and caregivers,” said Gayle Ayers, DO, geriatric psychiatrist at Austin Ascension Medical Group Seton Behavioral Health, specializing in dementia and cognitive issues evaluation. “At Austin Ascension Medical Group Seton Behavioral Health, we evaluate individuals experiencing mental decline and often refer families and patients to AGE for further resources. Partnerships like this are so important for providing caregivers and communities the resources and support they need,” said Dr. Ayers. As part of its commitment to
women’s health through all stages of life, Ascension Texas also supports AGE of Central Texas’s educational events, such as the annual She Thrives conference. This event connects women caregivers with support through a community of peers as well as practical tools and resources. “AGE of Central Texas recognizes how complex and challenging a caregiver’s role can be, and it’s our mission to provide care, resources and support for caregivers
and patients alike,” said Jayden Beatty, chief development officer for AGE of Central Texas. “Our goal is to equip women of all ages and backgrounds with resources, information and community to validate and support them as they navigate life’s aging and caregiving journeys.” Among AGE of Central Texas’s robust programs, the largest see Partnership...page 13
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Age Well, Live Well Healthy Eating for Healthy Aging
By Chelsea Couch Texercise Program Coordinator
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arch is National Nutrition Month, which is a great time to learn about older adults’ changing nutritional needs and the eating habits that are so important to healthy aging. The Texas Health and Human Services Texercise initiative has a variety of free resources that engage older Texans in healthy lifestyle behaviors, including physical activity and eating habits. Nutrients are compounds in food that are vital to living. They help the body heal, regulate chemical process and provide the body with energy. We lose the ability to absorb nutrients as we age because our metabolism slows. As a result, nutrient recommendations will change. Experts recommend that older adults get more calcium, potassium, vitamin D and vitamin B12. Eating a variety of fruits, vegetables and fortified foods can help you get the recommended amounts of these nutrients. If you have
trouble getting enough of these nutrients through the foods you eat, you can talk with your doctor about supplements. Healthy eating is not only about the foods you eat but also habits like controlling portions, reading nutrition labels, substituting for healthier options and other practices. The United States Department of Agriculture’s MyPlate provides nutrition information and recommendations for all ages. To learn more, myplate.gov. Texercise is proud to announce the launch of Texercise Nourish, a free 12-week nutrition education program for older Texans. Nourish educates on and engages older adults in healthy eating behaviors for healthy aging. To learn more about Texercise Nourish as well as other Texercise resources (fact sheets, daily food log, etc.), visit texercise.com. Other Texas HHS nutrition services and resources include: • The Supplemental Nutrition Assistance Program assists people with buying the food they need for good health. To learn more about SNAP, how to apply and
•
•
how to purchase food online, visit yourtexasbenefits.com. Area Agencies on Aging provide older adults, their families and caregivers with nutrition services, like home and congregate meals. To connect with the nearest AAA and learn about available nutrition services, call Texas HHS at 800-252-9240. Aging and Disability Resource
Centers are part of the No Wrong Door System and help streamline access to long-term services and support for the whole family. To learn more about the full range of available long-term supports, call Texas HHS at 855-937-2372.
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Partnership Continued from page 11 is licensed adult day health care, which provides patients with the opportunity to socialize while being medically supervised by nursing staff. “This program allows elder patients to ‘age in place’ for longer periods of time without moving to a new facility and offers caregivers with young kids a much-needed break,” added Beatty. In addition, AGE of Central Texas’s resource center serves as a “first stop” for caregivers to receive guidance on navigating their
loved one’s illness. The center also provides information about other AGE resources, including emotional support groups for children, spouses and caregivers, as well as educational materials on managing medication, preventing falls and managing financial planning. There’s even CaregiverU, a program with free, evidence-based caregiving courses for family caregivers. For those with an older loved one who may be in need of assistance, Dr. Ayers suggests paying
close attention to lesser-known signs of decline, including: • Frequently repeating statements or questions • Losing important, hard-to-replace items such as keys, wallet or purse • Missing medication doses – a stockpile of medications is a red flag • Difficulty driving, dings on the car, fender benders and trouble getting from “A to B” • Technological challenges
such as difficulty using a TV remote, increasingly forgetting passwords, becoming less and less able to use a smartphone (i.e., no longer using apps, camera or texting) During major life changes like this, caregivers don’t have to go it alone. Resources and helping hands can support them as they take on this important role.
Clot-Busting
Continued from page 8 factors.” Future studies may also determine whether there’s a cause-and-effect relationship between the type of
clot-buster used and the risk of intracranial hemorrhage. “Physicians may elect to wait until the results of these trials are
published before deciding whether to switching, the results from this registry use tenecteplase in routine clinical should be reassuring about the safety of practice,” Warach said, “But for those tenecteplase.” who have switched or are considering
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Austin Medical Times
Events
Continued from page 1 the disease prevalence in your county. When that number drifts below 100 cases (per 100,000 population per seven days), you are much less likely to bump into someone carrying coronavirus in the community. The lower this number goes, the safer you are from contracting coronavirus. When the numbers rise above 100, you are much more likely to encounter someone with active disease. If you have symptoms, don’t go You should not visit crowded places if you have COVID-19 symptoms.
You do not want to spread your illness to someone else. If event venues do not require testing, attendees do not need to get COVID-19 tests before or after the event unless they exhibit symptoms. When considering the best mask for protection, McDeavitt recommends an N95 or KN95, or a surgical mask. If you cannot access these, he suggests wearing a double-layer cloth mask. “Learning to live with the virus doesn’t mean we ignore it and pretend
it’s not there. It’s taking personal responsibility for using the tools available to be as safe as possible while going about our lives,” McDeavitt said. “We need to start opening up public events and let individuals make their own risk-benefit calculation of whether attendance is the right thing for them.”
The Strategic Plan notes that achieving the five objectives outlined above will require changes in stakeholder outreach, data transparency, and defining model success. CMMI plans to expand opportunities for stakeholder input from patients and patient advocates as part of its new strategy and to determine barriers to participation by nonparticipants. CMMI also recognizes the need for broader data sharing regarding its models and is piloting efforts through the Virtual Research Data Center so that researchers will be able to link model claims data with model participants for analysis. Finally, CMMI plans to assess model success by evaluating new endpoints that include: (a) beneficiary impacts, such as patient experience, population level metrics, quality of care transitions, access to care across various settings, coordination across
providers, and cost; (b) provider impacts, such as care transformation, impact on administrative burden, level of alignment on models across payers, sustainability of participation in models, and access to actionable data; and (c) market impacts, such as level of consolidation, new linkages or relationships between providers, spread of model elements to other payers, scalability of model to other regions or payors, and generalizability of impacts to other populations. These new assessment points will provide additional information to help craft new models and also assist other payors in moving to value-based care models.
fix” and typically requires months of multidisciplinary care. Eating disorders, especially anorexia nervosa, often are a disease of denial and can be difficult to diagnose in the early stages. “If a parent begins to worry, it is a good idea to run concerns by the child’s primary care provider for guidance,” Gordon said. “A delayed diagnosis can lead to a more severe presentation once uncovered and even the need for hospitalization. An early diagnosis can lead to the adolescent
being managed in the outpatient setting and more quickly getting on the road to recovery.”
Mental Health
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Senior Designer Jamie Farquhar-Rizzo
Distribution Brad Jander
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or snacks are being thrown away. It is important to approach the adolescent with concern rather than in a punitive way. An adolescent is more likely to open up when a parent is supportive.” The care of eating disorders requires a multidisciplinary approach, including a physician or nurse practitioner trained in eating disorders (often adolescent medicine), a dietician and a mental health professional. According to Gordon, the treatment of an eating disorder is not a “quick
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1. populations and safety net providers in new models. 2. Support Care Innovations. Support innovation by strengthening patient engagement and including patient experience measures and patient-reported outcome measures in performance measurement. 3. Improve Access by Addressing Affordability. Facilitate approaches to address price and affordability of care with the goal of reducing the number of individuals who forgo care due to cost by 2030. 4. Partner to Achieve System Transformation. Pursuing more collaborative and ongoing partnerships with a broader group of stakeholders to improve quality, achieve equitable outcomes and reduce health care costs, and, where possible, create multi-payer alignment in all new models available by 2030.
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