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A Motherâ&#x20AC;&#x2122;s Good Health

Improving maternal outcomes before, during and after giving birth

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CONTENTS »» MAY 2019

4 Diabetes: In the News

Updated recommendations from ADA

10 A Mother’s Good Health

Improving maternal outcomes before, during and after giving birth

22 Steady Progress

An industrywide consortium took a big step this winter in its quest to bring uniformity to the vendor credentialing process.

26 Health news and notes

The Journal of Healthcare Contracting is published bi-monthly by Share Moving Media 1735 N. Brown Rd. Ste. 140 Lawrenceville, GA 30043-8153 Phone: 770/263-5262 FAX: 770/236-8023 e-mail: info@jhconline.com www.jhconline.com

PUBLISHER John Pritchard

MANAGING EDITOR Graham Garrison

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EDITOR Mark Thill

ART DIRECTOR Brent Cashman

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The Journal of Healthcare Contracting (ISSN 1548-4165) is published bi-monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2019 by Share Moving Media All rights reserved. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

The Journal of Healthcare Contracting | May 2019

DIABETES

Look up Standards of Medical Care in Diabetes—2019, American Diabetes Association, at http://clinical.diabetesjournals.org/content/37/1/11?utm_ source=TrendMD&utm_medium=cpc&utm_ campaign=Clin_Diabetes_TrendMD_0

‘Midlevel’ providers not so ‘midlevel’ Patients with diabetes who received care from nurse practitioners and physician assistants working within the U.S. Veterans Affairs health system had outcomes equivalent to those of patients cared for by physicians in a primary care setting, according to a study published in the Nov. 20 issue of the Annals of Internal

Diabetes: In the News Updated recommendations from ADA

Medicine. Data was analyzed from 568 VA primary care centers, involving more than 350,000 adults with pharmaceutically treated diabetes. The upshot? By using a team approach, healthcare providers are fully capable of providing high-quality care to patients with chronic disease.

The American Diabetes Association’s (ADA’s) Standards

“Given the right system – with re-

of Medical Care in Diabetes is updated and published annually

sources to provide education and sup-

in a supplement to the January issue of Diabetes Care. Based on

port, along with referral to an endocri-

new data, ADA changed the criteria for the diagnosis of diabe-

nologist or a diabetes team if needed,

tes to include two abnormal test results from the same sample

and including more innovative pro-

(i.e., fasting plasma glucose and A1C from same sample). Ad-

grams, such as telehealth, online pro-

ditional conditions were identified that may affect A1C test ac-

grams, and device-based data transfer

curacy including the postpartum period.

and support – persons with diabetes

The ADA’s Professional Practice Committee, which includes

can achieve their goals,” writes Anne L.

physicians, diabetes educators, registered dietitians, and public

Peters, M.D., Keck School of Medicine of

health experts, develops the Standards. The Standards include

the University of Southern California, in

the most current evidence-based recommendations for diagnos-

an editorial. “Moreover, it is time to stop

ing and treating adults and children with all forms of diabetes.

calling NPs and PAs ‘midlevel’ providers, May 2019 | The Journal of Healthcare Contracting

TRENDS

as is common in certain systems. Nurse practitioners and PAs

• Among obese adults, Hispanics (14.8

are competent PCPs in their own right and should be fully ac-

percent) were less likely than blacks

cepted as such.”

(18.2 percent) or whites (17.4 per-

Racial, ethnic disparities Based on nationally representative data from 2015 and 2016,

cent) to be reported as having been told they are diabetic. • Regardless of race/ethnicity, in

the Agency for Healthcare Research and Quality in December

2015-16, only a small proportion

published a “Statistical Brief” regarding treatment and moni-

(2.3 percent) of adults age 18 and

toring of adults with diabetes age 18 and over. The report of-

older with diagnosed diabetes

fers estimates of the prevalence of reported diagnoses by race/

reported not having their condi-

ethnicity, and then focuses on differences among racial/ethnic

tion currently treated with insulin

groups in treatment and monitoring of the condition. Here are

injections, oral medication, and/or

a few findings.

diet modification.

• An average of 10 percent (about 24.8 million people)

• The percentage of people with

were ever told by a health professional they had diabetes.

diabetes using insulin injections

Overall, blacks (13 percent) were more likely to have been

was much lower for Asians (15.2

diagnosed with diabetes than Hispanics (10.3 percent),

percent) than for the other racial/

whites (9.4 percent), or Asians (8.9 percent).

ethnic groups (28.2 to 32.0 percent). Conversely, Asians were more likely

While nearly three-fourths of adults with diabetes (72.1 percent) reported having had the A1C test, over one-fifth (22.3 percent) did not know if they had that test during the year.

to report having their condition treated by both diet modification and oral medication (but no insulin injections) (57.0 percent) than those in other racial/ethnic categories (45.1 to 48.7 percent). Regarding diabetes-monitoring services: • Blacks (82.8 percent) and Hispanics (81.5 percent) were less likely than

• Obesity is highly associated with diabetes, and the likelihood of being obese varies by race/ethnicity. In 2015-16, on average, about one-third (31.6 percent) of U.S. civilian

their blood cholesterol checked. • H ispanics (62.2 percent) and

non-institutionalized adults age 18 and older were obese

Asians (61.4 percent) were less

(i.e., their body mass index – BMI – was 30 or higher).

likely than whites (71.6 percent)

Blacks (41.7 percent) were more likely to be obese than

and blacks (69.3 percent) to have

Hispanics (34.9 percent) and whites (30.7 percent), while

had their feet checked.

Asians (8.4 percent) were much less likely to be obese than those in other racial/ethnic categories. 6

whites (89.0 percent) to have had

• Hispanics (59.3 percent) and Asians (56.5 percent) were less likely than May 2019 | The Journal of Healthcare Contracting

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TRENDS

A heads-up on glucose events

whites (67.1 percent) to have had an eye examination. • While nearly three-fourths of adults with diabetes (72.1 percent) reported having had the A1C test, over one-fifth (22.3

A new app feature uses artificial tech-

percent) did not know if they had that test during the year.

nology to assess whether someone with diabetes has a low, medium, or high like-

• Whites (76.7 percent) were more likely than the other racial/ethnic groups (63.4-66.3 percent) to report having had

lihood of experiencing a low-glucose

the A1C test and were less likely to report not having had

event in the next one to four hours. The

the test (3.7 versus 7.4 to 9.0 percent). Moreover, whites

new feature – called IQcast™ – was devel-

were less likely to report not knowing whether they had

oped by Medtronic plc and IBM Watson

the test than the other race/ethnic groups (19.5 versus 25.5

Health, and is part of Medtronic’s Sugar.

to 29.2 percent).

IQ™ personal diabetes assistant app.

The size of a blueberry Researchers led by the Massachusetts of Technology have developed a drug capsule that could be used to deliver oral doses of insulin, potentially replacing the injections that people with type 1 diabetes give themselves every day, reported MIT in February. About the size of a blueberry, the capsule contains a small needle made of compressed insulin, which is injected af-

“ We are really hopeful that this new type of capsule could someday help diabetic patients and perhaps anyone who requires therapies that can now only be given by injection or infusion,” – Robert Langer, David H. Koch Institute Professor

ter the capsule reaches the stomach. In tests in animals, the researchers showed that they could deliver enough insulin to lower blood sugar

The Sugar.IQ app is available to users

to levels comparable to those produced by injections given

of the Medtronic’s continuous glucose

through skin. They also demonstrated that the device can be

monitoring system, the Guardian™. With

adapted to deliver other protein drugs.

predictive alerts up to 60 minutes before

“We are really hopeful that this new type of capsule could

a low or high event and within one to four

someday help diabetic patients and perhaps anyone who re-

hours of a low event, Guardian Connect

quires therapies that can now only be given by injection or infu-

and the Sugar.IQ app have been shown

sion,” said Robert Langer, the David H. Koch Institute Professor, a

to help people with diabetes achieve an

member of MIT’s Koch Institute for Integrative Cancer Research,

extra 36 minutes per day in a healthy glu-

and one of the senior authors of the study.

cose range of 70-180 mg/dL, including

The research team also included scientists from the pharmaceutical company Novo Nordisk.

30 minutes less time in hyperglycemia and 6 less minutes in hypoglycemia.

May 2019 | The Journal of Healthcare Contracting

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PATIENT CARE

ENVIRONMENT OF CARE

INTERVENTIONAL CARE

May 2019 | The Journal of Healthcare Contracting

A Mother’s Good Health Improving maternal outcomes before, during and after giving birth

Childbirth-related maternal health outcomes are getting worse in the United States. That’s true not only during the nine months of pregnancy, but also in the so-called “fourth trimester,” that is, those months (some say as many as 12) following birth. Reasons include rising rates of chronic illness, obesity, C-sections and the advanced age at which some women are having children. “Looking at the numbers, there has been a jump in maternal deaths,” says Ron Yee, MD, MBA, FAAFP, chief medical officer for the National Association of Community Health Centers. But there is a need for better data-gathering, he adds. Prior to taking his current position, Yee was a family physician for 20 years in rural central California, where he estimates he delivered hundreds of babies, primarily those of migrant farm workers.

Rates climbing After a dramatic reduction in maternal mortality over most of the 20th century, rates began to climb

Pregnancy can unveil and magnify health issues that were previously undetected.

in the late 1980s, reports the Agency for Healthcare Research and Quality (AHRQ). In fact, the United States now lags behind other industrialized countries in maternal mortality. The rate of severe maternal morbidity (e.g., massive blood transfusion, eclampsia, hysterectomy, heart failure) has also risen in recent decades. The number of reported pregnancy-related deaths in the United States steadily increased from 7.2 deaths per 100,000 live births in 1987 The Journal of Healthcare Contracting | May 2019

MATERNAL CARE

to 18.0 deaths per 100,000 live births in 2014, ac-

Some blips can be detected in the statistics. For

cording to the Centers for Disease Control and Pre-

example, higher pregnancy-related mortality ra-

vention. (CDC defines a pregnancy-related death as

tios during 2009–2011 have been attributed to an

the death of a woman while pregnant or within one

increase in infection and sepsis deaths, reports the

year of the end of a pregnancy – regardless of the

CDC. Many of these deaths occurred during the

outcome, duration or site of the pregnancy – from

2009–2010 influenza A (H1N1) pandemic. Influenza

any cause related to or aggravated by the pregnan-

deaths accounted for 12 percent of all pregnancy-

cy or its management.)

related deaths during a 15-month period.

The United States lags behind other industrialized countries in maternal mortality. The rate of severe maternal morbidity has also risen in recent decades.

Chronic illness Events such as H1N1 aside, many studies show that an increasing number of pregnant women in the United States have chronic health conditions such as hypertension, diabetes, and chronic heart disease. These conditions can put a pregnant woman at higher risk of pregnancy complications. Among causes of pregnancy-related deaths, the following groups contributed more than 10 percent: • Cardiovascular conditions (15.5 percent). • Other medical conditions reflecting pre-existing illnesses (14.5 percent). • Infection (12.7 percent).

In a study of pregnancy-related deaths from 2011–2013 in the United States, approximately 30

• Hemorrhage (11.4 percent). • Cardiomyopathy (11.0 percent).

percent occurred before birth, 17 percent during birth, 18 percent one to six days after birth, and 34 percent more than six days after birth.

Government researchers report that compared with reports before 2006-2010, the contribution

While controversy exists about the accuracy of

of hemorrhage, hypertensive disorders of preg-

measurement of maternal and pregnancy-related

nancy, and anesthesia complications declined,

mortality, analysis consistently demonstrates that

whereas that of cardiovascular and other medical

at least 50 percent of deaths are potentially pre-

conditions increased.

ventable, reports AHRQ. In addition, many more

Pregnancy can unveil and magnify health issues

women experience serious pregnancy-related

that were previously undetected, says Yee. For exam-

complications during and after childbirth. Such

ple, a prediabetic woman may develop gestational

complications are 50 times more common than

diabetes during pregnancy, which can lead to type

pregnancy-related mortality.

2 diabetes later in life. Similarly, mild hypertension May 2019 | The Journal of Healthcare Contracting

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MATERNAL CARE

prior to pregnancy can lead to preeclampsia, which

intended to help providers define and document

is characterized by high blood pressure and high

the increased complexity of their patients, trans-

levels of protein in the urine, and which can increase

form care with integrated services and community

the risk of kidney failure. And in general, the older a

partnerships, advocate for change in their commu-

woman is, the higher the risk for chronic disease.

nities, and demonstrate the value they bring to pa-

There’s one more factor at play, points out Yee. The

tients, communities, and payers.

United States has a higher incidence of C-sections than many other countries, and C-sections present

Postpartum issues

a higher risk of hemorrhage, bleeding, infection and

The weeks following birth are critical for a wom-

anesthesia-related complications.

an and her infant, setting the stage for long-term health and well-being, according to the Ameri-

The physician’s office and the home

can College of Obstetricians and Gynecologists

Given the role of chronic illness in maternal health, it’s no surprise that primary care doctors can play a big role in improving maternal outcomes before, during and after giving birth. “When I was in practice, I treated any woman of child-bearing age as if she might in the future become pregnant,” says Yee. That calls for sensitivity to conditions that can adversely affect the health of the patient as a mother, as well as her child. “We need to try to get things like hypertension, diabetes and weight under control,” he says. “It calls for a lot of discussion about overall health and well-being.” That includes psychosocial factors, such as depression. The social determinants of health – e.g., the patient’s socioeconomic status, housing status, ability and willingness to eat healthy foods, and the ability

Women with chronic medical conditions should be counseled regarding the importance of timely follow-up with their OB-GYNs or primary care providers for ongoing coordination of care.

to travel to and from a doctor’s office or hospital – must be considered as well, says Yee.

(ACOG). Postpartum care should become an on-

The National Association of Community Health

going process, rather than a single encounter,

Centers is engaged in a national effort to help

with services and support tailored to each wom-

health centers and other providers collect the data

an’s individual needs.

needed to better understand and act on their pa-

Women with chronic medical conditions such as

tients’ social determinants of health. The program

hypertensive disorders, obesity, diabetes, thyroid

– PRAPARE (Protocol for Responding to and As-

disorders, renal disease, and mood disorders, should

sessing Patients’ Assets, Risks, and Experiences) – is

be counseled regarding the importance of timely May 2019 | The Journal of Healthcare Contracting

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MATERNAL CARE

follow-up with their OB-GYNs or primary care pro-

in its ability to obtain at least one blood pressure

viders for ongoing coordination of care, says ACOG.

within 10 days of discharge in 92 percent of pa-

During the postpartum period, the woman and her

tients using text messaging, compared to 44 per-

OB-GYN or other obstetric care provider should

cent in usual care. HUP met ACOG guidelines in 80

identify the healthcare provider who will assume

percent of its patients, and readmissions dropped

primary responsibility for her ongoing care in her

to zero percent among remote monitored women

primary medical home.

in the trial.

Heart Safe Motherhood, a program created at the Hospital of the University of Pennsylvania, makes

Racial disparities

postpartum, at-home blood pressure monitoring

A woman’s race/ethnicity has a big impact on pregnancy-related mortality, according to government

As many as 40 percent of women skip their postpartum visits, according to ACOG, and the rate is higher among low-income women of color.

researchers. The burden of maternal morbidity and mortality is especially high in the African-American community, reports AHRQ. From 2011 to 2014, the pregnancy-related mortality ratio was more than three times higher among black women than white women (40.0 deaths per 100,000 births vs. 12.4 deaths per 100,000). The pregnancy-related mortality ratio was also higher for women of other races (17.8 per 100,000 live births). As many as 40 percent of women skip their postpartum visits, according to ACOG, and the rate is higher among low-income women of color. “Meanwhile, their blood pressure can be way out of control,” says Yee. Further, if a woman returns to work

easy, so that providers can catch rising blood pres-

too soon after delivery, missing their follow-up visit,

sure earlier and keep patients safe at home. HUP

“that’s a setup for a chronic disease to spin out of

created the program because hypertension was the

control,” he adds.

leading cause of seven-day readmissions for obstetrics patients there.

Implicit or unconscious bias on the part of individual clinicians or institutions can contribute to

Patients are discharged with digital blood pres-

morbidity or mortality, says Yee. An individual pro-

sure monitors and sent reminders via text mes-

vider’s attitudes can affect their understanding, ac-

sage to check their blood pressure twice daily. In

tions and decisions in an unconscious manner. Age,

2017, HUP completed a randomized controlled

race, ethnicity, disabilities, sexual orientation, per-

trial comparing Heart Safe Motherhood to the

sonal hygiene can all have an impact, not to men-

usual care of one-time, office-based blood pres-

tion insurance status. “This is something that has to

sure checks. The organization found an increase

be picked apart,” he says. May 2019 | The Journal of Healthcare Contracting

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MATERNAL CARE

Interpregnancy Care Interpregnancy care aims to maximize a woman’s level of wellness not just between pregnancies and during subsequent pregnancies, but also along her life course, says the American College of Obstetricians and Gynecologists in its “Obstetric Care Consensus” document, published online Dec. 20, 2018. (See https:// www.acog.org/Clinical-Guidance-and-Publications/ Obstetric-Care-Consensus-Series/Interpregnancy-Care). All women of reproductive age who have been pregnant – regardless of the outcome of their pregnancies – should receive interpregnancy care as a continuum from postpartum care, says ACOG. For women

with chronic medical conditions, interpregnancy care provides an opportunity to optimize health before a subsequent pregnancy. For women who will not have any future pregnancies, the period after pregnancy also affords an opportunity for secondary prevention and improvement of future health. The consensus statement was endorsed by the American College of Nurse-Midwives and the National Association of Nurse Practitioners in Women’s Health, and was developed by the American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine.

The statement contains a table on specific health conditions, including – but not limited to – the following: Condition Gestational diabetes

Diabetes

Counseling Women with gestational diabetes have a sevenfold increased risk of developing type 2 diabetes.

Test/screening 2-hour oral glucose tolerance test (OGTT) at 4-12 weeks postpartum. Screening every 1-3 years. Poorly controlled diabetes damages Patients should demonstrate good eyes, heart, blood vessels and kidcontrol of blood sugney. Poor control further increases ars with hemoglobin risk of birth defects in the next pregnancy. Diabetes is a risk factor A1c <7.0%. for future heart disease.

Management Women with impaired fasting glucose, impaired glucose tolerance or diabetes should be referred for preventive or medical therapy. Weight management. Testing for underlying vasculopathy; retinal examination; 24-hour urine protein testing; and electrocardiography. Thyroid screening.

Preeclampsia

Gestational hypertension

Women with a history of preeclampsia have an increased risk of recurrence in subsequent pregnancies, as well as a twofold increased risk of subsequent cardiovascular disease. Women with a history of gestational hypertension have an increased risk of developing chronic hypertension, as well as a twofold increased risk of subsequent cardiovascular disease.

Evaluate blood pressure for resolution of hypertension.

(Continued to page 20)

May 2019 | The Journal of Healthcare Contracting

MATERNAL CARE

Chronic hypertension

Hypertensive disease is a major cause of maternal morbidity and mortality. Uncontrolled hypertension leads to end organ damage, renal disease and cardiovascular disease, such as heart attacks and strokes. Cardiovascular Cardiovascular disease is the leading disease cause of maternal mortality.

Overweight and obesity

Evaluate blood pressure for resolution of hypertension.

Optimal contraception counseling.

Evaluation and management by a cardiac disease specialist. Obesity is associated with increased Measure BMI. risk of perinatal and maternal morPreventive screenbidity as well as infertility. Weight loss in between pregnancy reduces ing for diabetes and lipids. that risk.

Obesity increases the risk of type 2 diabetes, hypertension, certain types of cancer, arthritis and heart disease. Renal disease Pregnancy may be associated with irreversible worsening of renal function in women with moderate to severe renal disease. Thyroid Poorly controlled thyroid disease is disease associated with adverse pregnancy outcomes, such as spontaneous abortion, preterm delivery, low birth weight, preterm birth, impaired neuropsychological development of the offspring, and possibly miscarriage. Immunizations Immunization against vaccine-preventable diseases is crucial for longterm maternal and infant health.

Serum creatinine. Urine protein. Management by primary proThyrotropin (also vider to remain ehthyroid. known as thyroidstimulating hormone). Women with symptoms of hypothyroidism should unFree T4 dergo thyroid screening before attempting pregnancy. All women should be screened for relevant vaccination opportunities per CDC guidelines.

Other conditions covered in the document: Depression or mental health disorders, HIV, epilepsy, systemic lupus erythematosus (SLE) and autoimmune disease, sexually transmitted infections, tobacco cessation, thrombophilia, psychosocial risks, and antiphospholipid antibody syndrome. (See https://www.acog.org/Clinical-Guidance-andPublications/Obstetric-Care-Consensus-Series/Interpregnancy-Care). Source: Interpregnancy care. Obstetric Care Consensus No. 8. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e51-72. 20

May 2019 | The Journal of Healthcare Contracting

VENDOR CREDENTIALING

Steady Progress An industrywide consortium took a big step this winter in its quest to bring uniformity to the vendor credentialing process.

only certified by ANSI if very specific criteria and processes are followed in their creation,” he says. “As required by ANSI, the Consortium’s standards development process involved all stakeholder groups in an open and transparent discussion. Formal

In January, the Consortium for Universal Healthcare

votes were taken, and consensus was

Credentialing (C4UHC) successfully completed the process of

reached. In the case of ANSI/NEMA SC1

certification to develop ANSI (American National Standards In-

2019 Standards for Supplier Credential-

stitute) standards for healthcare supplier credentialing through

ing in Healthcare, over 45 different stake-

NEMA, an ANSI-standards-setting body.

holder entities were involved, including

ANSI is the U.S. leader for standards development, says Dennis Orthman, consulting director for C4UHC. “Standards are 22

healthcare providers, suppliers, distributors, and others. May 2019 | The Journal of Healthcare Contracting

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VENDOR CREDENTIALING

“The Consortium could not be happier with what has been accomplished, and the process used to get there.”

The adoption of ANSI standards require suppliers to work with their provid-

NEMA is the association of electrical equipment and medi-

ers of background checks and other in-

cal imaging manufacturers, and is one of numerous standard-

formation to ensure that they also meet

setting bodies that are part of ANSI. Its connection to vendor

the ANSI/NEMA SC1 2019 standard, ex-

credentialing is a natural one.

plains Orthman. Suppliers then can com-

“Many healthcare providers and suppliers already conform

municate that their employee has met

to ANSI/NEMA standards, so there should be some familiar-

the requirement to the ANSI/NEMA SC1

ity for credentialing,’ says Orthman. “Virtually every piece

standard with no need to send source

of medical equipment – and the hospital electrical systems

documentation, personal information, or

they are plugged in to – used in the delivery of care of the

sensitive health information, minimizing the exposure of personal information. “Adherence to the standard protects

“ We would like supplier credentialing to look more like standardized and interoperable electrical components versus [its current state].”

not only the individuals, but any entity that comes in contact with the information, thus reducing the risk of exposure or the inappropriate use of the information,” he says. “As with other standards, audits will be conducted to ensure that the organization is conforming to the standard, or they will no longer be allowed to state that they are compliant to ANSI standards. “The next steps are to include additional stakeholders in the continuum of

patient conforms to ANSI/NEMA standards. This enhances

supplier credentialing to show the true

the ease of use and promotes safety, among other things. If

value of standardized and interoperable

every piece of equipment had a different plug and did not

credentialing. Ultimately this will benefit

have to meet fire and electrical safety minimums, think what

us all, either in our professional roles, or

that would mean to everyone?

as patients.”

“We would like supplier credentialing to look more like stan-

The Consortium for Universal Health-

dardized and interoperable electrical components versus [its

care Credentialing is the successor orga-

current state].”

nization to the Coalition for Best Practices

Reps’ personal information protected

in Healthcare Industry Representatives, which, beginning in 2012, has worked

Adopting the ANSI standards will minimize the exposure of per-

to develop best practices for vendor cre-

sonal and sensitive information from suppliers’ employees, ac-

dentialing. For more information, go to

cording to the Consortium.

www.c4uhc.org. May 2019 | The Journal of Healthcare Contracting

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TREAT

the condition with a plan that avoids inappropriate and unnecessary antibiotics. Antimicrobial stewardship interventions— delivering the right antibiotic or antiviral, at the right dose, at the right time, and for the right duration—improve individual patient outcomes, reduce the overall burden of antibiotic resistance, and save health care dollars.5

DIAGNOSE

quickly and accurately to identify the source of the infection. An inaccurate, incomplete, or late diagnosis could lead to the prescription of unnecessary antibiotics, accelerating the rate at which bacteria become resistant and putting patients at risk for allergic reactions or Clostridium difficile.3 Rapid lab testing — especially at the molecular level—ensures confident results.4 Choose from a range of readers and molecular diagnostics that meet the FDA’s recent flu reclassification requirements.

1. https://Professional-Practice/Practice-Resources/Antimicrobial-Stewardship 2. https://www.cdc.gov/infectioncontrol/pdf/outpatient/guide.pdf 3. https://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html 4. https://www.cdc.gov/mmwr/volumes/65/rr/rr6506a1.htm 5. https://www.cdc.gov/getsmart/healthcare/evidence.html

Learn more at www.henryschein.com/asp

HEALTH NEWS

Obesity in the four-legged population Humans are not the only residents of the United States gaining weight. So are their dogs, according to Nationwide, a provider of pet health insurance, as reported by The New York Times. Obesity among dogs and cats has risen for eight years in a row, along with claims for ailments related to being overweight. In 2017, obesity-related insurance claims

Health news and notes Delay the inevitable

million, a 24 percent increase over the last eight years, Nationwide reported in January. With only 2 percent of pets covered by insurance, the costs to owners of

Here’s good news for those who can’t stand the thought of getting

overweight pets is likely to be in the bil-

– and using – a gym membership. Physical activity of any intensity

lions. A study of 50 obese dogs enrolled

– even if it means just walking around for a bit – provides health

in a weight-loss program at the Univer-

benefits. “If you have a job or lifestyle that involves a lot of sitting,

sity of Liverpool demonstrated the value

you can lower your risk of early death by moving more often, for

of losing excess body fat. The 30 animals

as long as you want and as your ability allows,” said Dr. Keith Diaz

in the study that reached their target

at Columbia University, referring to a study funded in part by NIH’s

weight had greater vitality, less pain and

National Institute of Neurological Disorders and Stroke. Research

fewer emotional issues than the animals

has shown that long periods of sitting increase the risk of heart dis-

that remained too fat. Pet owners: Learn

ease and death overall. But the amount of activity needed to coun-

to resist dogs that beg for more food

ter these dangers has been unclear. The Columbia study included

than they need, suggested John P. Lof-

almost 8,000 participants aged 45 and older. All participants wore

tus, veterinarian at the Cornell University

an activity monitor for a week between 2007 and 2013. The device

College of Veterinary Medicine. “If you’re

recorded how often they moved while awake and the intensity of

already meeting your pets’ nutritional

their activities. Deaths were tracked through April 2017. The re-

needs, they’re not hungry. What they’re

searchers then used this data to model how, when substituting for

really asking for is your attention. Better

sitting, various amounts and intensities of activity affected the risk

to distract them with an activity.”

of death from any cause. The team found that any amount of activ-

for veterinary expenses exceeded $69

ity was better than sitting. People who swap 30 minutes of sitting

Sleep tight

for 30 minutes of light-intensity activity per day would have a 17

Researchers say they are closer to solving

percent lower risk of death. Light-intensity activities include walk-

the mystery of how a good night’s sleep

ing and doing chores that require moving around.

protects against heart disease. In studies May 2019 | The Journal of Healthcare Contracting

Better, faster. It’s what we want for patients.

What about your clinicians?

Connecting vital signs monitors to the EMR has been shown to: Y

Reduce errors caused by manual processes1

Save clinicians time by removing manual documentation steps2

Increase clinical time spent on value-added care3

Reduction in minutes of vital signs data latency in the EMR after connecting vital signs4

Welch Allyn partners with leading EMRs to send data from the Connex® family of vital signs devices directly to the patient’s record. Our goal is simple: help your clinicians work better, faster so they can focus on getting patients better, faster.

Start today at www.welchallyn.com. 1 CIN: Computers, Informatics, Nursing: Eliminating Errors in Vital Signs Documentation, FIELER, VICKIE K. PhD, RN, AOCN; JAGLOWSKI, THOMAS BSN, RN; RICHARDS, KAREN DNP, RN, NE-BC, 2013. The paper vital signs recording had an error rate of 18.75%. 2 JHIM FALL 2010 Volume 24:Number 4, Vital Time Savings: Evaluating the Use of an Automated Vital Signs Documentation System on a Medical/Surgical Unit 3 Going One Step Further at Scott & White Medical Center—Temple: Eliminating manual vital signs documentation to prioritize value-added care. 2017 Welch Allyn. www.welchallyn.com 4 CareAware® VitalsLink: Eliminating Data Latency & Manual Documentation at Naples Hospital. Prepared by Cerner, 2013. © 2017 Welch Allyn

MC14605

HEALTH NEWS

between the brain, bone marrow, and blood vessels that appears

Need another reason to quit smoking?

to protect against the development of atherosclerosis, or harden-

African-Americans who smoke appear

ing of the arteries – but only when sleep is healthy and sound.

to be at greater risk for peripheral artery

“We’ve identified a mechanism by which a brain hormone con-

disease, or PAD, new research has found,

trols production of inflammatory cells in the bone marrow in a

reports the National Institutes of Health.

way that helps protect the blood vessels from damage,” explained

Additionally, the findings suggest that

Filip Swirski, Ph.D., the study’s lead author who also is an associ-

smoking intensity – how many cigarettes

ate professor at Harvard Medical School and Massachusetts Gen-

a day and for how many years – also af-

eral Hospital in Boston. “This

fects the likelihood of getting the dis-

using mice, they discovered a previously unknown mechanism

anti-inflammatory

mecha-

nism is regulated by sleep, and it breaks down when you frequently disrupt sleep or experience poor sleep quality. It’s a small piece of a larger puzzle.” The study was funded by the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health.

E-cigarette use increased from 11.7 percent to 20.8 percent among high school students and from 3.3 percent to 4.9 percent among middle school students from 2017 to 2018.

Tobacco use: Going up

ease. PAD affects 8 to 12 million people in the United States and 202 million worldwide, especially those age 50 and older. It develops when arteries in the legs become clogged with plaque, which are fatty deposits that limit blood flow to the legs. The impact of cigarette smoking on PAD has been understudied in African-Americans, even though PAD is nearly three times more prevalent in African-Americans than in whites. For the study, researchers divided the 5,258 participants into smokers, past smok-

Tobacco product use among U.S. youth is increasing, reports

ers and never smokers. They found that

the Centers for Disease Control and Prevention. More than one

those smoking more than a pack a day

in four high school students and about one in 14 middle school

had significantly higher risk than those

students in 2018 had used a tobacco product in the past 30 days.

smoking fewer than 19 cigarettes daily.

This was a considerable increase from 2017, and was driven by an

Similarly, those with a longer history of

increase in e-cigarette use. E-cigarette use increased from 11.7

smoking had an increased likelihood

percent to 20.8 percent among high school students and from

of the disease. Despite strong asso-

3.3 percent to 4.9 percent among middle school students from

ciations between smoking and PAD,

2017 to 2018. No change was found in the use of other tobacco

however, the findings do not establish

products, including cigarettes, during this time. Among youth:

a causal link, according to the study’s

1) e-cigarettes are still the most commonly used tobacco prod-

authors. Nor can they be generalized

uct, ahead of cigarettes, cigars, smokeless tobacco, hookah, and

to people of African descent from oth-

pipes; 2) e-cigarettes are the most commonly used product in

er regions or countries, since the study

combination with other tobacco products; and 3) e-cigarette use

was conducted in a single community

is highest among boys, whites, and high school students.

of African-Americans. May 2019 | The Journal of Healthcare Contracting

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