Coordinated Care

Care coordination synchronizes the delivery of a patient’s health care from multiple providers and specialists. The goals of coordinated care are to improve health outcomes by ensuring that care from disparate providers is not delivered in silos, and to help reduce health care costs by eliminating redundant tests and procedures.

Benefits of Coordinated Care

Effective population health management benefits patients, physicians, health care organizations, the entire health care system, and the nation at large. Here’s how:

  • Patients receive better coordinated care – and enjoy better health – because they are reminded of procedures needed to manage their condition or disease.
  • Physicians are better informed and their patients are more engaged, resulting in better outcomes in care. Physicians also more easily satisfy quality measures that focus on engaging patients and providing timely, appropriate, coordinated care.
  • Health care organizations are more profitable – whatever their payment model – because gaps in care are filled, patient volume increases and the cost of delivering care can be more accurately quantified.
  • The nation benefits from reduced health care costs, better management of diseases, and a generally healthier population.

Examples Of Care Coordination

  1. Primary care coordination

To care for patients with chronic diseases and conditions such as diabetes and high cholesterol, some providers have adopted a “guided primary care” approach. The Guided Care model was developed by a team of researchers at Johns Hopkins University, to respond to the challenge of caring for a rapidly aging America. A specially educated, registered nurse (RN) is responsible for patients with multiple chronic conditions. The RN performs an initial assessment with the patient, works directly with the primary care providers to develop a care plan, and coordinates specialty care with other providers to ensure that nothing is missed and the plan is followed.

  1. Acute care coordination

Patients with acute health problems like a stroke or heart attack require a more complex level of care due to the critical nature of their condition. Because emergencies like strokes and heart attacks can happen anytime, patients may first receive care by emergency medical services and by hospitals outside of their regular network. The risk for communication breakdowns, redundancies, and medical errors can increase when providers are involved, making it even more important that health care be coordinated to achieve the best clinical results. Studies show that acute care coordination focusing on communication between provider-handoffs is an important factor for success.

  1. Post-acute/long-term care coordination

Patients who reside in rehabilitation, long-term care (LTC) or post-acute care (PAC) facilities may need to move between facilities — or to different care levels within facilities — as their health changes.A majority of patients admitted to PAC are later transferred to a second PAC setting. These predominantly senior-aged patients often have mental and memory disorders in addition to physical ones. They therefore require coordinated care to manage medications transfers and update care plans. The importance of this is increasing as studies show that hospital discharges to post-acute care (PAC) facilities have increased rapidly and hospital readmission from PAC facilities is common and associated with a high mortality rate. Readmission risk factors may signify inadequate transitional care processes or a mismatch between patient needs and PAC resources.

Successes and failures in care coordination will be perceived in different ways depending on the perspective: patient/family, health care professional(s), or system representative(s). Consideration of views from these three potentially different perspectives is likely to be important for measuring care coordination comprehensively.


Color of Pee

Urine color generally ranges from a pale-yellow color to deep amber. This coloring is primarily caused by the pigment urochrome. Whether your urine is diluted by water or more concentrated determines how the pigment will appear. The more water you drink, and the more hydrated you become, the lighter the pigment in your urine. The pigments and chemical compounds in the foods you eat and the medications you take can also alter the color of your urine. These changes are fairly standard and typically don’t last for long. Certain changes in color may be a sign of an underlying medical condition.

Normal urine color varies, depending on how much water you drink. Fluids dilute the yellow pigments in urine, so the more you drink, the clearer your urine looks. When you drink less, the color becomes more concentrated. Severe dehydration can produce urine the color of amber.But urine can turn colors far beyond what’s normal, including red, blue, green, dark brown and cloudy white.

When to see a doctor
Seek medical attention if you have:

Visible blood in your urine. Bloody urine is common in urinary tract infections and kidney stones. These problems usually cause pain.

Dark or orange urine. If your urine is dark or orange — particularly if you also have pale stools and yellow skin and eyes — your liver might be malfunctioning.

What your urine can tell you
Here’s a quick lowdown for you. A little uncomfortable, but very important information that you should know.

When your urine is clear, it can indicate:

You’re drinking too many liquids. Be careful not to over-hydrate. Shoot for drinking half your body weight in ounces of water each day.

When your urine is bright or neon yellow, it can indicate:

Vitamin supplements that are being taken in excess or not being absorbed by your body. Word to the wise: take whole food-based vitamin supplements for better absorption.

When your urine is dark yellow or gold, it usually indicates one thing:

Dehydration.Get your drink on. Shoot for drinking half your body weight in ounces (i.e. if you weigh 130 pounds, shoot for 65 ounces of water per day).

When your urine is pink or red, it is usually indicative of:

Blood in the urine from a kidney or bladder infection.You’ve eaten too many pink or red foods like beets or berries or foods that are artificially colored.A side effect of some laxatives.

When your urine is orange, it usually indicates:

A side effect of a medication you’re taking. Ask your doctor about this, and bring your medication with you to the doctor’s visit.You’ve eaten too many orange or red foods like beets and berries or foods that are artificially colored.Dehydration.

If your urine is ever blue or green, it can indicate:

A side effect of certain medications; see your doc.You’ve eaten too many green foods, especially asparagus or foods that are artificially colored blue or green.

When your urine is dark brown or tea colored, it can indicate:

A liver disorder, especially if accompanied by pale stools and a yellow, jaundiced complexion.A side effect of certain medications.

If your doctor discovers that your dark-yellow urine color is due to dehydration, they will recommend that you add more fluids to your diet. The color of your urine should return to its normal yellow color within days. If an underlying medical condition is found, your doctor will pursue treatment for that condition.

If your urine takes on a dark-yellow color, it may be your body’s way of telling you to drink more water. This change in color may be caused by dehydration, so make sure to drink up. Whether you’re sitting at the office, working out at the gym, or laying out at the beach, it’s important to stay hydrated. If you’re taking any medication that causes this discoloration, it’s likely harmless. You should continue taking the medication under the supervision of your doctor, unless you’re advisedotherwise.

Top Healthcare Risks

As the New Year begins, it is important to take some time to evaluate the most important challenges in health care and determine which will require proactive and different planning. The complexity of many of these risks requires a multi-faceted approach in order to develop a comprehensive solution. Collaboration has never been more important, both in gaining a full understanding of the risk and in designing the most proactive solution. Experts, brokers and insurance providers should be consulted to assure that you optimize both risk control and risk transfer strategies. The following issues are prominent areas of discussion for risk managers, health care professionals and clinicians. Here are some of the most important healthcare risks.

  1. Cyber Risk
    The healthcare industry’s move to electronic records has created new patient privacy exposures as records are more easily accessed by consultants, vendors and other third parties for efficient operation, and targeted by cyber criminals. Moreover, healthcare organizations face exposure to cyber risks that could have significant impacts on their operations, including shutting down critical, health-related systems.
  1. Physician Contracting
    Organizations continue to pursue physician integration, and physician arrangements are increasingly complex, bringing with them much greater risk. Hospitals often must move quickly on contracts with crucial physicians, but it is extremely important for all parties to review the contracts before they finalized. A committee or attorney should review every contract for appropriate compensation based on location, specialty, and market comparability as well as potential Stark Law violations.
  1. Healthcare Infections
    Healthcare-acquired infections (HAIs) cost the U.S. healthcare system billions of dollars each year and lead to the loss of many lives.  At any given time, about 1 in 25 hospital patients has at least one such infection. Healthcare-acquired infections also come with a financial price, costing up to $10 billion a year.
  1. Quality Process Improvement
    Healthcare reform has brought an increased focus on the quality of patient care, with quality measures having a bigger impact on reimbursement. To help improve outcomes and recover the highest reimbursement possible, hospitals need to implement evidenced-based practices and reinforce the reliability of their clinical processes. Proper monitoring is essential to identifying and accurately addressing breakdowns.
  1. Ransomware
    Cyber criminals don’t even have to steal data from the computers of hospitals to be able to make easy money. Ransomware is a new data security threat that has victimized a great deal of hospitals in recent years. It also pertains to a type of malware that cyber criminals infect on a healthcare organization’s IT system, preventing the company from accessing certain files or sectors. Usually, the infected components become encrypted and the authorized user is then unable to access them. The hackers will then deliver a message containing instructions for sending payment or ransom in exchange for restored access to the affected system. What makes ransomware even more complex is that cyber criminals demand that payment be made through bitcoins. Unlike credit cards, bitcoin payments are difficult to trace which helps hackers in eluding authorities.
  1. Violent Incidents in Hospitals
    Hospitals may be places of healing, but they also have become the scene of number of violent incidents. Such incidents not only put patients at risk but also medical professionals, who are often the targets of attacks, harassment, intimidation and other disruptive behavior.

The risks facing the healthcare industry are complex and constantly evolving. Organizations need to conduct formal risk assessments to identify new and changing risks, regularly monitor identified risks, uncover gaps, and take appropriate actions to mitigate risks to an acceptable level.

Seasonal Influenza

Influenza (flu) is a contagious respiratory illness mainly caused by influenza viruses. It can cause mild to severe illness, depending on the person. Serious outcomes of flu infection can result in hospitalization or even death. Some people, such as older people, young children, and people with certain health conditions, are at a higher risk of serious flu complications. The best way to prevent the flu is by getting vaccinated each year.

People who have the flu often feel some or all of these signs and symptoms that usually start suddenly:

  • Fever or feeling feverish/chills
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches
  • Headaches

The flu is caused by the influenza virus and is easily spread from person to person through respiratory droplets formed when coughing or sneezing. You can become infected if you breathe in these droplets through your nose or mouth or if the droplets come into contact with your eyes. The virus can also be spread through the sharing of food or drinks. You can also catch it by touching objects contaminated with the flu virus, then touching your mouth, eyes or nose.

Period of Contagiousness
You may be able to pass on the flu to someone else before you even know you are sick, as well as while you are sick. Although people with the flu are most contagious in the first 3-4 days after their illness begins,  people may be able to infect others beginning 1 day beforesymptoms develop and up to 5 to 7 days after becoming sick. Some people, especially young children and people with weakened immune systems, might be able to infect others with flu viruses for an even longer time.

Most simple seasonal influenza cases are managed symptomatically and are advised bedrest at home to minimize the risk for infecting others. Treatment focuses on reducing fever and relieving the symptoms. The diagnosis can be confirmed by taking specimens for laboratory analysis. It is important that patients monitor themselves to detect if their condition deteriorates and they require medical intervention.

Risk Factors
Anyone can get the flu and serious problems related to the flu can happen at any age, but some people are at high risk of developing serious flu-related complications if they get sick. This includes people 65 years and older, people of any age with certain chronic medical conditions such as asthma, diabetes, or heart disease, pregnant women, and young children.

The best way to protect yourself and your loved ones against the flu is through immunization. Many hospitals and institutions haveimmunization programs which provide free, publicly-funded vaccines to those who are eligible. There are many different strains of the flu virus. The vaccine cannot protect against all of them. Scientists monitor the global spread of flu and decide which three flu strains will likely cause the most illness during the upcoming flu season. Those three strains are put into the flu vaccine each year. So it is important to get immunized against the flu every year with no exceptions.Other precautions can be taken, including: practicing good hand hygiene, covering your nose and mouth when you cough and sneeze, and avoiding touching your eyes, nose or mouth.

The first and most important step in preventing flu is to get a flu vaccination each year. Everyday preventive actions like staying away from people who are sick, covering coughs and sneezes and frequent handwashing will help slow the spread of germs that cause respiratory illnesses, like flu.

Hearing Loss Facts

Hearing loss is a sudden or gradual decrease in how well you hear. It can be mild or severe, temporary or permanent. Congenital hearing loss means you are born without hearing. Gradual hearing loss happens over time and can affect people of all ages. If you have hearing loss, you may not be aware of it, especially if it has happened over time. Your family members or friends may notice that you’re having trouble understanding what others are saying. There are some ways you can deal with hearing loss. And hearing aids and other devices can help you hear.

Symptoms of hearing loss

The symptoms of hearing loss can vary depending on the type of hearing loss, the cause of hearing loss, and the degree of loss.In general, people who have hearing loss may experience any or all of the following:

  • Difficulty understanding everyday conversation
  • A feeling of being able to hear but not understand
  • Asking others to repeat often
  • Avoidance of social situations that were once enjoyable
  • Tinnitus, or ringing and/or buzzing sounds in the ears

Causes of hearing loss

Hearing loss can have many different causes. For example:

  • Sudden hearing loss in one ear may be due to earwax, an ear infection, a perforated (burst) eardrum or Ménière’s disease.
  • Sudden hearing loss in both ears may be due to damage from a very loud noise, or taking certain medicines that can affect hearing.
  • Gradual hearing loss in one ear may be due to something inside the ear, such as fluid (glue ear), a bony growth (otosclerosis) or a build-up of skin cells (cholesteatoma)
  • Gradual hearing loss in both ears is usually caused by ageing or exposure to loud noises over many years.

How hearing loss can occur

Causes of hearing loss include:

  • Damage to the inner ear. Aging and exposure to loud noise may cause wear and tear on the hairs or nerve cells in the cochlea that send sound signals to the brain. When these hairs or nerve cells are damaged or missing, electrical signals aren’t transmitted as efficiently, and hearing loss occurs.
  • It may become difficult for you to pick out words against background noise. Heredity may make you more prone to these changes. This type of hearing loss is known as sensorineural hearing loss, which is permanent.
  • A gradual buildup of earwax. Earwax can block the ear canal and prevent conduction of sound waves. This can be restored with earwax removal.
  • Ear infection and abnormal bone growths or tumors. In the outer or middle ear, any of these can cause hearing loss.

Hearing loss treatments

Hearing loss is a medical condition that has many tried-and-true treatment options. Finding the right treatment is a joint venture between you and your hearing care professional, and if done properly, takes into consideration the following factors:

  • Type of hearing loss
  • Severity of hearing loss
  • Cause, if known
  • Your lifestyle
  • Your budget

Some types of hearing loss, especially conductive types, can be medically or surgically corrected but others cannot. The most common treatment for sensorineural hearing loss is hearing aids. Hearing aids are widely available in a range of styles, colors, sizes, technology levels and price points.

Your doctor will do a physical exam and ask about your symptoms and past health. He or she also may look in your ears with a lighted device called an otoscope. If your doctor thinks that you have hearing loss, he or she will do hearing tests to check whether you have hearing loss and find out how severe it is. You may be referred to an audiologist to do the tests.

Commonly Asked Questions on Testicular Cancer

As you deal with cancer and the process of treatment, you need to have honest discussions with your cancer care team. Ask any question, no matter how small it might seem. Among the questions you might want to ask are:

Testicular Cancer

What is testicular cancer?
Testicular cancer is cancer that starts in the testicles. The testicles are two male reproductive organs that hang below the penis in a sac called the scrotum. The testicles make several hormones, mainly testosterone. They also make reproductive cells called sperm. There are different kinds of cells in each testicle, each of which can grow into one or more types of cancer. Overall, testicular cancer is not that common. However, it is the leading cause of cancer in men in their twenties and thirties.

What are the symptoms of testicular cancer?
The most common symptom of testicular cancer, and probably the most alarming, is a lump on a testicle. Since this is where the cancer starts, this would be the first place to check. If the cancer has spread outside of the testicles, symptoms may appear elsewhere. If you experience unusual pain or discomfort in your back or lower abdomen, the cancer may have spread to the lymph nodes in the back of your abdomen. A cough or shortness of breath may indicate the cancer has spread to the lymph nodes in your chest area. Lastly, if your nipples or breasts are tender, this can be caused by the hormones produced by the cancer.

What causes it?
Doctors are not really sure what causes testicular cancer. The rate of testicular cancer is slightly higher in white men, as well as in higher income groups. Doctors do not know if this is because a lifestyle factor plays a big part in who gets testicular cancer. Doctors do know, however, some risk factors for testicular cancer. For example, an undescended testicle, a testicle that does not move from the abdomen into the scrotum, increases a man’s risk for the disease. Also, a man who has had cancer in one testicle is more likely to get it in the other testicle. A man who has a family history is slightly more at risk for getting testicular cancer.

How is testicular cancer diagnosed?
If you or your doctor finds a lump, you should make an appointment with an urologist right away. The urologist will then perform a variety of tests including an ultrasound. The ultrasound is used to detect what is going on in the testicles. It can be used to detect whether the lumps are solid or filled with fluid, and whether they are inside or on the testicle. If your doctor has reason to believe that the lumps may be cancerous, he or she will do a blood test. Our blood naturally has what are called “tumor markers”. Tumor marker levels will be raised if a tumor is present, but this does not mean you have cancer – it just helps the urologist make a better diagnosis.

What are the treatments for testicular cancer?
Treatment for testicular cancer is either local or systemic. Local treatments remove, destroy, or control the cancer cells in one certain area. Surgery and radiation are local treatments. Systemic treatments are used to destroy or control cancer cells throughout the entire body. Chemotherapy is a systemic treatment. A man may have just one treatment or a combination of treatments.

Along with these sample questions, make sure to write down some of your own. For example, you might want to ask about clinical trials for which you may qualify. Keep in mind, too, that doctors are not the only ones who can give you information. Other health care professionals, such as nurses and social workers, may have the answers to your questions.

Work Related Mental Disorders

A person can experience high pressure and demands outside work just as much as they can at work. Stressors at home can affect those at work and vice versa. Sometimes, it is difficult to control outside stressors, but you need to take a holistic approach to employee well-being. To manage work-related stress effectively, you need to recognize the importance and interaction of work and home problems and find an appropriate balance.


How common mental health problems (CMHPs) and work-related stress correlate

Work-related stress and CMHPs often go together. The symptoms of stress and CMHPs are very similar. For example loss of appetite, fatigue and tearfulness can be symptoms of both.Work-related stress can aggravate an existing mental health problem, making it even more difficult to control. If work-related stress reaches a point where it has triggered an existing mental health problem, it becomes very hard to separate one from the other.Work-related stress may result in mental health problems when it is experienced over a longer time.

Often, CMHPs and stress can exist independently – people can experience work-related stress and physical changes such as high blood pressure, without having anxiety and depression. They can also have anxiety and depression without stress.The key differences between the two are their cause and the way they are treated.

Stress is a reaction to events or experiences in someone’s home life, work life or very often, a combination of both. CMHPs can have a single cause outside work, for example bereavement, divorce, postnatal depression, a medical condition or a family history of the problem. But people can have CMHPs with no obvious causes.

Here are the most common work related mental disorders:

  1. Anxiety

Having high levels of anxiety can have a major impact on your ability to work. Anxiety takes many forms – from general anxiety to anxiety triggered by a particular situation (a phobia).Those experiencing anxiety may seem unusually worried or fearful in most situations, making excuses not to socialize or attend meetings.

Other signs of anxiety include:

  • panic attacks;
  • restlessness and becoming increasingly irritable;
  • difficulty concentrating or meeting deadlines;
  • a sense of fear.

Facing up to anxiety, and how it makes you feel, can be the first step in breaking the cycle of fear and insecurity. Feeling relaxed and able to talk about your anxieties to friends, family and colleagues can help you to take back control and deal with your anxiety before it becomes much more serious.

  1. Depression

Feeling sad from time to time is normal, but if these feelings continue for more than a couple of weeks, or are so bad that they affect your everyday life, you may need help.Depression can develop slowly and is usually caused by more than one thing, with work being a contributing factor due to:

  • workload;
  • unsociable hours;
  • lack of job security;
  • problems with colleagues.

If you are depressed, you might:

  • feel irritable or overly emotional;
  • have low confidence and find it difficult to concentrate;
  • lose interest in your work;
  • get tired quickly and feel disengaged.
  1. Panic attacks

Panic attacks are a sign of anxiety and are common in the workplace, causing an overwhelming sense of fear and apprehension. Left unmanaged, panic attacks can become more frequent and severe leaving you unable to work.Panic attacks can be treated effectively through a combination of therapy and medication. There are also several self-help techniques you can use to treat the symptoms yourself.

If you feel under pressure, it’s hard to distinguish when that ‘stress’ turns into a ‘mental health problem’ and when an existing mental health problem becomes aggravated by stress at work. Many of the symptoms of stress and a mental health condition are similar. The key differences are in the severity and duration of the symptoms and the impact they have on your everyday life. The majority of people with mental health problems are diagnosed and treated by their doctor and most continue to work productively. In fact, evidence shows that staying in work can be of great benefit to those affected.