Homecare workers drive millions of miles

Home care nurses and other such providers traveled to the moon and back more than 17,000 times a year, according to one new study.

Such workers, serving the elderly, disabled and chronically ill, drove some 7.88 billion millions and made more than 718 million home care visits in 2013, according to a study released this week by the National Association for Home Care and Hospice.

The report says that such travel by home care nurses has increased significantly over the past 10 years, because of increases in Medicaid home care, Medicare home health growth, and Medicare hospice utilization. With baby boomers aging at a rapid rate, the need for some home services is only going to grow, the report states.

At a press conference yesterday, those involved said they believe the findings underline the need for changes in federal policy. Possible policy improvements might include establishing unified federal telehomecare reimbursement, and supporting training and recruitment of home care nurses and personal care assistants.

“The sheer volume of miles driven by the employees of the nation’s home care and hospice agencies to reach patients with complex medical problems in their homes is astonishing,” Val Halamandaris, president of the association, said in a press release. “The angels of home care cross all types of terrain, from crowded metropolitan streets to the dirt roads of frontier America, in all types of weather to provide care for the patients who depend on them — many of whom suffer from one or more chronic conditions such as congestive heart failure, stroke, chronic obstructive pulmonary disease, diabetes, cancer, Alzheimer’s disease and other life-threatening conditions.”

Big bucks toward furthering OpenNotes

The movement to get more nurses’ notes out in the open and into patients’ hands is getting a big push, thanks to a cash infusion from several notable donors.

The OpenNotes national initiative announced Tuesday that it’s receiving $10 million in funding to help expand access to clinical notes to the public across the country. Those dollars, which come by way of the Robert Wood Johnson Foundation and Peterson Center on Healthcare, among other philanthropies, will allow the initiative to spread to some 50 million patients nationwide, according to a news release.

OpenNotes, which dates back to 2010 and is neither a software program nor a technology, has proven in the past that such access to clinical information helps increase patient engagement and improve medication adherence. Plus, it always helps to have a second set of eyes on the medical record to improve patient safety, those involved note.

“Opening the doctor’s black box breaks down traditional barriers and provides a foundation for all kinds of exciting innovations in health care, changes that in my view will benefit the vast majority of patients and their clinicians,” said Tom Delbanco, M.D., a cofounder of the initiative, and primary care doc with Beth Israel Deaconess Medical Center, which took part in the initial study of OpenNotes.

Those involved plan to use the funding over the next three years to help nurses and other providers with adoption, along with reaching health care consumers and evaluating the impact of sharing notes, according to the release. An OpenNotes advisory board will help to target health care organizations and consumer advocacy groups that it wants to involve in the effort.

Expanding access to anesthesia in underserved areas

There is a gap in access to the anesthesiologists, critical to everything from labor and delivery to pain management, in rural and underserved areas, but one group has a way to close it.

Often, these areas — populated by patients with lower median incomes, unemployment and high uninsured rates — do, however, have a surplus of certified registered nurse anesthesists, according to a study recently released by the American Association of Nurse Anesthetists. The group says with an influx of new low-income and Medicaid patients entering the system, it is critical to make full use of CRNAs to close the shortage of anesthesiologists and expand access for the underserved.

The study, “Geographical Imbalance of Anesthesia Providers and its Impact on the Uninsured and Vulnerable Populations,” recently published in Nursing Economic$, concludes that states must work to expand scope of practice for CRNAs to improve access. Without such steps, patients will be forced to either suffer higher indirect costs, taking time off work and traveling farther for care, or even forego care due those burdens.

“These findings point to the significance CRNAs have in providing access to anesthesia care to low-income and vulnerable populations,” said lead researcher Lorraine Jordan, senior director of research for the American Association of Nurse Anesthetists. “As the Affordable Care Act places increased demands on the health care system due to the newly insured or Medicaid-eligible, including demands for surgical and pain management services, the role of CRNAs will become even more critical in providing access to quality health care to these populations.”