Quality Measures Resource Guide: 2016 New Year’s Resolution: Taking Healthy Steps to Empower Patients

As we begin 2016, it’s a good time for all healthcare providers to remind ourselves that we need to take necessary approaches to helping our patients understand how and why they need to take appropriate steps to take control of their diabetes and nutritional management. As wound care specialists, we see patients at their worst — often years into mismanaged diabetes and nutrition. The tricky part in many situations is trying to help patients understand the benefits of the “paradigm shift” of being more engaged with one’s own medical care management. We all know there’s no magical dressing or pill; it’s a combination of taking and being committed to a multidisciplinary, patient-centered, team approach. When engagement with patients begins, they create their own personal “paradigm shift” and wounds begin to heal. Our role is to be the coordinators of care and medical resources to make this happen for those in our care. 

Medical Management: Patient-Centered Philosophy

We as wound care specialists typically don’t see our patients until after long-term chronic conditions/diseases have taken over and patients are at the point of hospitalizations due to infections or are at risk for potential amputation. In many situations, these patients have not seen their primary care physicians (PCPs) in years or may not have even mentioned that they’re living with a wound(s) because they’re convinced they can take care of it themselves. Our role is to empower these patients to take initiative and remain “informed” by asking questions, reading up on available medical resources, and following our recommendations to achieve better outcomes. It is not uncommon to hear patients say they “rely on the Internet, family, and friends for medical advice.” It’s up to us to ensure they rely on us.  With today’s overall focus (and mandates) on healthcare quality, we are beginning to see more PCP groups developing new ways to involve, engage, and empower their patients to be at the center of their care. PCPs are utilizing Physician Quality Reporting System (PQRS) standards of practice that reflect published evidence-based practice and patient satisfaction surveys. Several local PCP practices in my region have helped to create the paradigm shift of the “patient partnership” model. This process focuses on the highest quality outcomes to exceed clinical benchmarking and standards of care in prevention and disease management, including the input of registered dietitians who are helping to improve trends in this country related to metrics in A1c, obesity, blood pressure management, and patient satisfaction scores. One large PCP practice in particular offers “real time” interactive electronic medical records so they can address any concerns as they occur.

It is also our duty as wound care specialists to coordinate care with patients’ medical home providers. Therefore, if these patients do not have a dedicated medical home, we need to facilitate, empower, and engage patient change. As wound care specialists, we have the benefits of seeing our patients on a weekly basis and, if they are receiving adjunctive hyperbaric oxygen therapy (HBOT), we get more opportunities to interact with our patients through a team approach to enhance overall experiences and improve outcomes. Implementing evidenced-based patient education, lifestyle modifications, and prevention methods will create a new medical/business culture addressing the rising healthcare costs.

Taking The Initiative to Create Paradigm Shift

Maintaining glucose (glycohemoglobin A1c) and nutritional control is a key component to wound healing and optimal health. A five-pound variance in one’s weight can make a difference in a normal body mass index (BMI) and an overweight BMI.

One of the first steps to achieving healthy weight is being aware of one’s BMI goals (suggested between 18.5-25 and an A1c level of less than 7%). It’s essential for patients to become informed “healthcare consumers” who are empowered and engaged in order to give them added incentives to make healthy lifestyle changes.

It takes a “patient-centered team approach” to make this possible. First, helping our patients to understand the benefits of how keeping a journal to track management of things like glucose control, general nutrition, water intake, and exercise will actually make them feel better and not sluggish all day. If they can find a friend to do this with, even better. The power of motivation from friends can be amazing versus, “My doctor told me to do this.” Getting patients involved with best practices and standards of care can help keep them engaged with their plan of care — making that care truly about them.

BMI Calculator for Patients: Follow this link for a helpful patient resource: www.mayoclinic.org/bmi-calculator/ITT-20084938/?utm_source=newsletter&utm_medium=email&utm_campaign=housecall

A1c Tips to Help Make Diabetes More Manageable

We all know there are several programs out there focusing on diabetes and nutrition management; however, do we have steps in place to challenge our patients while encouraging them more than preaching to them? Consider the following approaches:

Water consumption: According to the Mayo Clinic, 9 cups (2.2 liters) are recommended per day for women and 13 cups (3 liters) for men. Patients who are feeling tired may actually be experiencing a slight level of dehydration. Water can actually boost your metabolism and improve digestive system performance (requires ½ of body weight in ounces of water).

Soothing activities/walking: The holidays contribute to the feeling of “cabin fever,” which tends to create the emotional need to snack. Encourage patients to substitute a busy activity, craft, or hobby over time at home. Making a list of things that one enjoys can distract us from the refrigerator. We all know the research behind the benefits of exercise and why it’s important that it be incorporated into daily routine. Are we taking the added step of encouraging our patients to do the same? Just 5-10 minutes of walking after a meal improves digestion and helps lower blood glucose levels. Burning calories improves the cardiovascular system and overall mental health.

Attitude of abundance: It is not uncommon in a busy life/schedule to skip the most important meal of the day. By eating a balanced breakfast we lessen the odds of feeling the need for a midmorning snack or “sugar fix.” The first step is actually making the choice to choose a plan that includes nutrient-rich foods, fruits, vegetables, whole grains, etc. A large, flavorful latte or hot cocoa on a cold winter day can be 350-450 calories. A 20-ounce bottle of soda is at least 280 calories and a holiday alcoholic beverage can consume one’s daily caloric intake with just a few servings. Smaller plates, avoiding “free refills,” and chewing more slowly can be positive pointers. Eliminating food intake within three hours of bedtime (water is ok because it can curb appetite) is advisable. Helping our patients to make improvements in their self-esteem, energy, digestion, mental acuity, and regulation of blood sugars will aid our wound healing.

Audrey Moyer-Harris is executive director and founder of LEAP Synergies Inc. She can be reached at audreymoyerharris@yahoo.com.

Reference

1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity among adults: United States, 2011-2012. NCHS Data Brief. 2013;(131):1-8.

Resources:

1. James G. 57 Small Changes You Can Easily Make to Improve Your Life. Accessed online: www.themuse.com

2. Fife CE. Selecting Measures. Accessed online: https://carolinefifemd.com/2015/12/22/selecting-measures

3. Marshall J. Avoiding Weight Gain and Excess Carbs This Holiday Season. Accessed online: www.informationaboutdiabetes.com/lifestyle/lifestyle/avoiding-weight-gain-and-excess-carbs-this-holiday-season

4. Lee P. Sugar Is Out, Red Meat Is Spared: New Gov’t Dietary Guidelines Released. Strategic Health   Care. Accessed online: www.linkedin.com/pulse/sugar-out-red-meat-spared-new-govt-dietary-guidelines-paul-lee

Additional Resources & Websites for Patients:

Share these tips and website links for healthy dinner recipes and great-tasting food:

• Pear & Almond Salad: (www.informationaboutdiabetes.com/recipes/vegetarian/pear-andalmond-salad)

• Spaghetti Squash Romanoff: www.informationaboutdiabetes.com/recipes/vegetarian/spaghetti-squash-romanoff

• Wine Substitute: Using a wine glass, fill it 2/3 with sparkling water, a splash of cranberry juice and a slice of lime.

• Banana Pudding Square and Health Desserts: www.kraftrecipes.com/recipes/healthyliving/healthy-lving-desserts.aspx