That could mean contacting the patient before arrival in cases of planned admissions, and following up on the phone after discharge. It could also mean ensuring that all hospital tests are performed and information is handed off seamlessly between shifts, she said. To provide patients more continuity, attending nurses would work eight-hour shifts over five days instead of 12-hour shifts over three days.
In Montgomery County, the pharmacy counseling began two years ago at a Gaithersburg clinic, one of 12 safety clinics that are part of the Primary Care Coalition. One-on-one counseling with pharmacists has helped patients take their medications correctly for chronic conditions such as diabetes, hypertension and high cholesterol, said Botchway, who heads the coalition’s Center for Medicine Access.
The plan is to expand the pharmacy counseling to a clinic in Wheaton, she said.
Bruce wants to develop tele-monitoring of Washington Hospital Center’s homebound seniors. At George Mason University, Nichols is developing business models that show physicians and hospitals how they can be successful under the health-care overhaul.
Reducing the obesity stigma
On Long Island, Diane Curley wants registered nurses to identify people who are at risk for unhealthy weight whenever they enter the health system of Catholic Health Services of Long Island. It includes six hospitals and three nursing homes. She hopes to start the pilot at St. Catherine of Siena Medical Center in Smithtown, where Curley is the performance improvement coordinator.
A person’s weight is almost always taken as part of any health assessment, whether he or she is having scheduled surgery, a routine screening or an emergency room visit, Curley said.
Curley’s idea is for registered nurses to talk to patients about their weight when that evaluation takes place. The nurse would inform patients if their weight is normal or unhealthy. If the person is obese, the nurses would explain how unhealthy weight affects other medical conditions, offer a list of questions that patients can ask their doctor, and direct them to online resources.
Patients are routinely asked whether they smoke and whether they feel safe in their homes, among other questions. By talking about weight as part of that evaluation, “it takes away the stigma from obesity,” Curley said. “It’s a health-care problem, just like any other health-care problem.”
Talking about weight may seem like a small step. “But it can have a big impact, because nobody does it now” in that context, she said.
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