Issue No. 20
Healthier at HomeDate: April 19, 2013
Better care outside the hospital promotes and protects independent living
Imagine you are at home when the telephone rings. The voice on the other end asks with interest how you are doing. You mention your car needs repairs this week; can someone give you a ride to the pharmacy? Then you bring up the family barbecue at the end of the month. The other person on the phone suggests you avoid Aunt Sheila’s famous potato salad in favor of some fresh fruit …
Such an exchange might be expected with friends and family, but typically not with your doctor or nurse. But why not? Clearly, health care needs aren’t confined to hospitals, which is why Johns Hopkins health care providers are extending their reach into homes and even beyond—and serving as a model for the rest of the medical community and perhaps for the future of health care.
From Hospital to Home
The period after hospitalization is a time when medical assistance is often still needed, yet, traditionally, that’s when hands-on health care usually ends.
A woman on IV therapy may be well enough to get back to work but needs treatment in the middle of the day. Or a man with sleep apnea requires a breathing mask but isn’t quite sure how to operate it. Helping people acclimate to their lives after a hospital stay, and seeing to it that they’re able to maintain their independence, daily functioning and quality of life, is being viewed more as part of the natural recovery process. Johns Hopkins Home Care Group has been providing this kind of assistance for 30 years.
“Our job is to help people be more independent in their own care and know how and when to get help,” says Kimberly Carl, director of Johns Hopkins Home Health Services, a division of Johns Hopkins Home Care Group, which offers adult and pediatric home health care; wound treatment; help with managing chronic diseases, such as diabetes and congestive heart failure; infusion therapy, such as chemotherapy and IV medications; enteral care, such as feeding tubes; pharmacy services and home medical equipment; respiratory care; and much more.
But in the last few years the approach has become even more holistic, creating closer bonds with physicians and their patients.
Science Meets Service
In 2007, Johns Hopkins launched a study that set the stage for an innovative approach to health care delivery outside the hospital. Named for Greek philanthropist Aliki Perroti, the Aliki Initiative was designed for medical residents to get to know their patients better.
“And what we meant by that was, we wanted them to know all of the conventional medical information, but we also wanted our doctors to know their patients as people—their aspirations, their goals, the people who are important in their lives,” says David Hellmann, M.D., director of the Johns Hopkins Center for Innovative Medicine and director of the Department of Medicine at Johns Hopkins Bayview Medical Center. “Sir William Osler, who founded the Department of Medicine at Johns Hopkins 120 years ago, said, ‘It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.’”
As part of the Aliki Initiative, residents, interns and medical students were asked to engage in activities to enhance their relationships with their patients, such as spending more time sitting and speaking with them; calling them after discharge to discuss transition and troubleshoot problems; and, for a minority of patients, making in-person visits as needed. The result? Patient satisfaction skyrocketed and, for patients who had heart failure, hospital readmissions within 30 days of discharge were reduced.
It has been six years since the Aliki Initiative was introduced. Since then, the scientific study with the curious name has become the standard of care throughout the Department of Medicine at Johns Hopkins Bayview.
“It’s very interesting to watch how our entire program has changed because of this project,” says Colleen Christmas, M.D., director of Johns Hopkins Bayview’s internal medicine residency program. “We found that once residents have rotated through this service, they start calling patients after discharge, they’re more likely to make home visits, and they contact the patient’s primary care providers.”
Proving That Relationships Matter
Trends have emerged that suggest we all should consider how well our doctors know us and not just our symptoms. A better relationship with their providers gives individuals a better understanding of their treatment regimens, and thus they’ll adhere to them more closely. People take their medication as prescribed and therefore tend not to make repeat visits to the hospital. They are more apt to follow up for X-rays or appointments with specialists. When people are more educated about their care, they lead healthier lives. The cumulative effect of a close doctor-patient connection seems to be better health in general.
There is a lot of research to show that the transition from one care setting to another is a troublesome time, a time when mistakes can happen, particularly for older patients and for people who have complex diseases.
“Very commonly,” Christmas says, “medications are changed at discharge, and people go home and realize they have some of the same medications, or even different medications, and they’re not sure which ones to take.”
With relationship-focused care, Christmas says, problems are caught early. “There are many things that we ask patients about,” she says. “Do they understand what they need to do to keep themselves well? Do they understand the next steps in their plan of care? For example, if they have an abnormal chest X-ray and need a CT scan, are they aware of that? Do they make that appointment?”
Adds Hellmann, “You find out a number of important things when you know your patients better.” He recalls one man who struggled with taking medications as prescribed. When the man’s physicians learned that he was particularly concerned about the welfare of his dog, this became an opening to motivating better adherence: If he were to fall ill, who would help care for his pet?
“Sometimes a person will take medication to better care for their dog than they would to better care for themselves,” Hellmann says. “It was the perfect illustration of why it is important to know people.”
Is Home Health Care Right for You?
There are tens of thousands of home health agencies in the United States, and that number continues to rise. But it can be hard to decide when you need help—and for some people it can be even harder to ask for or accept it.
A person taking care of an elderly parent is a common dilemma, as is an older person doing his or her best to remain independent while in failing health. But even a short recovery period after surgery can necessitate in-home assistance.
Johns Hopkins Home Support, a division of Johns Hopkins Home Care Group, helps families who could use a range of personal care services, whether it’s cooking, companionship or medication compliance.
One woman was unable to bathe independently or remain steady on her feet. Her grown daughter worked during the day and was not comfortable leaving her mother alone at home. Concerned about falls and particularly safety in the kitchen during meal preparation, the daughter called Johns Hopkins Home Support and asked for help. Johns Hopkins sent a registered nurse to the mother’s home to assess her environment and gain an understanding of her needs and desires and then developed a collaborative plan of care.
“What’s so important about what we do is that not only do we provide equipment and infusion services, we provide experts,” says Mary Myers, vice president and chief operating officer for Johns Hopkins Home Care Group.
Johns Hopkins Home Care Group’s nurses; physical, occupational, speech and respiratory therapists; social workers; home health aides; clinical pharmacists; disease managers and other specialists are encouraged to look beyond the medical chart and learn who their patients and their families really are. They can also have a conversation to determine how much help is actually needed. Sometimes it’s just a part-time caretaker so a family member can return to work or just take a break.
Watch This Video
See how the Aliki Initiative is transforming patient care through personalized, individualized medicine at Johns Hopkins. Visit bit.ly/jhhealthvideos. For more information, appointments or consultations, call 877-546-1872.