! "#$%&'#&(!)*+%!,!#-!,.!

Transcription

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

2

3

4 Checkups by phone Checkups by phone JANUARY 16, :00 AM FELICIA FONSECA ASSOCIATED PRESS Gisele Sorenson knew where each person with congestive heart failure lived. With a map in hand, she set out driving in northern Arizona -- across tribal land and to the Grand Canyon -- to find out whether the former Flagstaff Medical Center patients had wireless access. The answer was key to determining whether patients could be remotely monitored via Bluetooth technology to help reduce their chance of being readmitted to the hospital. What Sorenson found is that not everyone would be able to use a cellphone to immediately transmit medical data, but many were close enough to a hot spot to send the information within a few days. "Just having them come into the hospital isn't the answer anymore for a lot of reasons," said Sorenson, the hospital's telemedicine director. The hospital that draws patients from across northern Arizona, including the Navajo and Hopi reservations, is in the midst of a yearlong pilot project aimed at a population that often skips regular checkups or lacks the money or transportation needed to get prescription medication. It also is trying to limit readmissions because of an upcoming federal rule that financially penalizes hospitals if people are readmitted for certain conditions within 30 days. WIRELESS TECHNOLOGY The project uses wireless technology and health-monitoring devices to keep the hospital advised of the patients' conditions. Fifty people are being sent home with an Android phone and equipment to check their blood pressure, weight, heart activity and oxygen levels. For those who don't have electricity, they also get a solar charger. The devices send the readings straight to the phone, which sends them directly to Kelly DeGraff, a hospital nurse. She then can look at the data and determine whether a follow-up call or text is needed. One patient she's been in contact with is Joe Alini, who has been dealing with kidney failure and heart problems. 5:09:08 PM]

5 Checkups by phone Before Alini signed up for the project a month ago, his go-to people for medical questions were friends who are flight nurses. Aside from weighing in at the dialysis clinic and getting his blood pressure checked, he said he had no real sense of whether he was doing the things needed to fend off another hospital visit. Those visits that were happening three or more times a month weren't easy to make. He's no longer employed because his condition prevents him from working, which meant he also lost his residence and his vehicle. He relies on his daughter for transportation and grocery shopping, and he sometimes doesn't have money to fill prescriptions. This past week he saw a startling change in his weight -- a difference of more than 10 pounds overnight -- his blood pressure was up and his oxygen levels down. He was scheduled to go to dialysis but said the monitoring equipment helped detect the change that was due to a fluid buildup earlier in the day. He called DeGraff, and she advised him to go to the hospital, which he hadn't needed to do for nearly a month. "My education has become better," said Alini, of Flagstaff. "I'm not panicking now. I'm calling to say 'should I or shouldn't I,' instead of 'I'm going to the emergency department.'" LIMITING READMISSIONS The project is backed by the National Institutes of Health, Verizon, Qualcomm Incorporated and Zephyr Technology. It isn't specifically aimed at American Indians, but they will benefit. Nearly 30 percent of patients at the Flagstaff Medical Center are American Indian, the majority being Navajo. Seven percent of them have had congestive heart failure, compared with 4 percent of non-native patients. While the illness is no more prevalent in American Indians than others, some precursors to heart conditions include diabetes and obesity. About 12 percent of people with congestive heart failure are readmitted to the Flagstaff hospital within 30 days. They have symptoms ranging from shortness of breath to organ failure and fatigue, which can keep them hospitalized for more than a week and bump up costs to insurance providers. The national readmission rate for all types of heart failure is nearly 25 percent over three years, according to the U.S. Centers for Medicare and Medicaid Services. Beginning in October, CMS will begin cutting reimbursements to hospitals that have too many patients readmitted for congestive heart failure, pneumonia and heart attacks. CMS has said readmissions can cost billions a year. NOTHING SIMILAR Mark Carroll, director of telehealth for the Indian Health Service, said telehealth is most common in Indian Country with diabetic retinal screenings, dermatology, psychiatry and mental health, pathology and radiology. In Alaska Native villages, IHS has been using landline phones for at-home monitoring. The agency also is looking at how to best remotely track people with high blood pressure or diabetes, Carroll said. But he said nothing is similar to the pilot project in northern Arizona. He called the project revolutionary for the health care system, in that it uses leading technology from a regional hospital that gets referrals from a diversity of communities and cultural environments. "So many folks that I've chatted with in different Indian communities are supportive of this at the concept 5:09:08 PM]

6 Checkups by phone level," Carroll said. "It makes sense to them, but there are questions about 'how does it work, who can see my information, and who am I working with? Am I going to feel cared for in a good way, or am I going to feel this is a big efficiency thing?'" SOME PATIENTS BALK Some patients approached to participate in the pilot project balked at the idea, Sorenson said, citing intimidation of the technology. She said some prefer the traditional call on their landline phones for checkups. One of the hurdles for telehealth in Indian Country has been access to a wireless network, with penetration estimated at 10 percent, according to the Federal Communications Commission. The Navajo Nation is deploying 3G mobile and 4G broadband services through fiber-optic cables and microwave towers. The Hopi Tribe also has a broadband initiative. Sorenson said the hospital hopes to take advantage of the Navajo build-out, though it doesn't track currently with the pilot project. For those who aren't near a wireless hotspot, Sorenson is counting on family members to help with transportation. After a year, she said the hospital is hoping to have enough information from patients, their primary care providers and their families to know whether to sustain the program. 5:09:08 PM]

7

8

9

10 TELE-HOME HEALTH CARE: Care Beyond Walls and Wires Enhances Life for Patients with Congestive Heart Failure 20

11 More than 5 million people in the U.S. suffer from congestie heart failure (CHF), according to the Centers for Disease Control and Prevention (CDC). The annual cost is estimated at more than $32 billion in health care services, medications, and lost earnings, the CDC says. Northern Arizona Healthcare s Care Beyond Walls and Wires can improve CHF patients health and reduce health care costs. Woody Smith and his daughter, Rita Yazzie, used to drive as often as twice a month from their home on the Navajo Reservation to Flagstaff Medical Center, nearly two hours away. Mr. Smith is living with congestive heart failure, with symptoms so severe he required frequent hospitalizations. But Mr. Smith can now get along for several months without having to be admitted to the hospital. His remarkable turnaround has resulted from an innovative program called Care Beyond Walls and Wires, a telemedicine-enabled home-monitoring program that has shown it can significantly improve the health of most patients living with congestive heart failure. The program also is reducing emergency room visits and hospital admissions and readmissions, and decreasing the length of stay for those who still require hospital care. It s phenomenal, says Gigi Sorenson, a registered nurse and telehealth director for Flagstaff-based Northern Arizona Healthcare, which operates Care Beyond Walls and Wires in collaboration with Flagstaff Medical Center and Verde Valley Medical Center in Cottonwood. Ms. Yazzie says Care Beyond Walls and Wires is the best thing ever for me, and the best thing for my dad. He has required only two hospital readmissions since enrolling in the program more than a year ago. And at 90, Mr. Smith has been able to return to his favorite activity: riding his horse. Care Beyond Walls and Wires provides patients with a backpack containing the equipment they need to check their blood pressure, measure their oxygen level, and check their weight daily; the latter because patients with CHF can gain and drop weight suddenly. The data are automatically transferred to a smart phone that transmits the information to Northern Arizona Healthcare s care coordination office, which provides the smart phone, monitoring equipment and backpack to every patient enrolled in Care Beyond Walls and Wires. Some of the program s patients have no electricity at home, so they also are given solar chargers. We have found that, number one, the tools and the technology are considered really cool. Grandkids love all the equipment, and help their grandparents understand it, Ms. Sorenson says. But it s the relationships that we have been able to develop with these patients that matter most. Care Beyond Walls and Wires is the best thing ever for me, and the best thing for my dad. Rita Yazzie They know someone is watching out for them, and they will not even have to initiate a call if something needs attention. If a care coordinator sees a patient s weight go up three pounds overnight, they will call the patient and ask, How are you feeling today? From Flagstaff Medical Center s perspective, the idea for Care Beyond Walls and Wires originated with the National Institutes of Health Office of Public and Private Partnerships, which was looking for better ways to monitor patients with CHF who live in rural areas. The goal was to provide better care while keeping the patients out of the hospital, thus reducing health-care costs. The San Diego telecommunications company Qualcomm was chosen to lead the project, with Maryland-based Zephyr Technology and Verizon providing software, smart phones and remote-monitoring hardware. Northern Arizona Healthcare agreed to conduct a pilot project involving 50 patients. The 16-month project got under way in December You could take part in the study if you lived in Flagstaff but had no family support, Ms. Sorenson says. Or you could live in Supai (at the bottom of the Grand Canyon) or on a mesa on the reservation. Our patients were Native American, Hispanic, and white, ranging in age from 31 to early 90s. Qualcomm funded the Care Beyond Walls and Wires pilot study. When it ended on April 1, 2013, Northern Arizona Healthcare took on the costs of continuing the program. The monitoring kits cost around $650, including the backpack, Ms. Sorenson says, and there are monthly cell phone charges. But it s very much worth the investment, she says. Not only are patients benefiting, but a new Medicare rule penalizes hospitals if patients with certain conditions, including congestive heart failure, are readmitted within 30 days of being discharged. And we have tremendous patient satisfaction. Patients like the feeling that they have more control over their health, Ms. Sorenson says. We couldn t have asked for anything more. It s a global win. 21

12 Search Showing events after 6/19. Look for earlier events Photo by Linda Kor -- Winslow resident Garrickson Begay demonstrates how he uses the Care Beyond Walls and Wires program to help him cope with chronic disease.

13 Oil Exploration Underway Near Holbrook Hartman Is Hired As WJHS Principal