About Bernadette Keefe

Physician & Healthcare Conference Twitter Curator. Follow me @nxtstop1

Falls Prevention Day 2015: Will the real ______________, please stand up!

              National Falls Prevention Awareness Day ~ September 23, 2015

                                        “Take a Stand to Prevent Falls” 
fallPrevention

 Bernadette Keefe MD

 “One of every three older adults falls each year, but less than half talk to their healthcare providers about it.” – Lawrence Z. Rubenstein MD, MPH Chair Geriatrics – U. of Oklahoma Health Sciences Center

 Introduction

Tomorrow, September 23, 2015, the U.S. will celebrate the 8th Annual Falls Prevention Awareness Day. The announcement on the National Council for Aging (NCOA) Falls Prevention Day website reads:

“The 8th annual Falls Prevention Awareness Day (FPAD) will be observed on September 23, 2015 – the first day of fall. The event seeks to raise awareness about how to prevent fall – related injuries among older adults. The 2015 theme is Take A Stand to Prevent Falls and the official twitter hashtag for this year’s event is #FPAD15 Continue reading

Our (Cultural) Sugar High

Sugar-comparisons HIGH

Bernadette Keefe MD

‘We need to start talking about how our food supply is making many of us sick.”

 “Sugar high” is the term used to describe the cascade of responses after eating a sugar load. A high sugar load, especially a pure sugar load, triggers is a rapid release of insulin to counteract the high blood sugar. With that response, glucose is absorbed into cells and the blood sugar plummets. We feel hunger with the low blood sugar and if we consume a sugary snack or meal, the cycle restarts. The taste of sugar is also ‘addictive’ over time. At this time we have a cultural sugar high, a palate tuned to the taste of sugar, across our nation and indeed the world. It has led to unprecedented levels of Type 2 diabetes and obesity. Continue reading

The Radiologist – Clinician Relationship

 Fluoroscopy_procedure_1909Image: Thoracic Flouroscopy Using Handheld Screen ~ Circa 1909 via @Wikipedia

Bernadette Keefe MD

 

Classically, the radiologist was known as the doctor’s doctor, and many consultations were carried out in person. Radiology reading rooms of the past were vibrant hubs, where radiologists received in depth and nuanced patient histories from the clinicians, then reviewed /discussed the images and finally the two physicians would reach agreement about next treatment steps. Continue reading

Population Health: Our lives, Our data

Population Health Blog pic

By Bernadette Keefe MD

On July 16th 2015 I had the pleasure of being on a panel discussing Population Health Management with eloquent, smart colleagues: Dan Munro (@danmunro) Janice McCallum (@janicemccallum), Deryk Van Brunt (@HCI_Solutions) and Justin Lanning (@LanningHlthcare). It was a fascinating wide ranging discussion covering the definition of population health, the mechanisms and strategies of population health management (including the overriding importance of data collection/analysis and practicing medicine/providing healthcare in teams), the value of universal medical coverage (despite ACA still too many uncovered), issues around security and privacy of data and the lack of health information technology standards and EHR interoperability (need for a patient identifier), patient empowerment and access to records and relevant health data to enable better self care, issues regarding the social determinants of health and examples of strategy/success stories, incentives and tools for value based care and optimal outcomes, the challenges of behavioral/ lifestyle change, health literacy and patient engagement, the importance of context to better treat patients and obtain improved outcomes, the role of community in population health and the utterly unsustainable level of cost of healthcare in the U.S., among other topics.

 

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losing our marbles – the dementia epidemic

The marble saga continues! This shot was taken in our back yard. I must say the marble is a remarkably patient model...

I think my favorite part of this one is how the lines from the tall grass in the background seem to echo the swirls inside the marble.

By Bernadette Keefe MD

All of us have personally known or heard the familiar drill. Dad couldnʼt find his way home. Mom didnʼt recognize her best friend. More and more memory lapses are occurring. Thereʼs a kitchen mishap. Finally the trip to family doc with the dreaded questions: Is It Alzheimerʼs? Is It Dementia?

The answer is yes, and they have a lot of company.

4.5 Million in the US are currently living with Dementia. The estimated prevalence of dementia among persons older than 70 years in US was nearly 15% in 2010. It is estimated that by 2050 there will be 13 Million people in the US living with dementia. There was hope that the incidence might be tapering off and even declining (from data comparing 1993 to 2002), however with the recent sharp increases in prevalence of diabetes and obesity over the past decade, it is feared that the numbers may rise precipitously.

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Quadruple Aim: Care of the Physician

Quadruple Aim

By Bernadette Keefe MD and Matthew Katz MD

The classic ‘triple aim’ for healthcare is a framework developed by the Institute for Healthcare Improvement (IHI) that describes an approach to optimizing health system performance. IHI asserts that new designs must be developed to simultaneously pursue three dimensions which we call the ‘Triple Aim’:

  • Improving the patient experience of care (including quality and satisfaction)
  • Improving the health of populations, and
  • Reducing the per capita cost of health care

Numerous publications suggest that the list be expanded to a ‘Quadruple Aim’ to include: Improving the Care of and Experience of The Provider (ie MDs/other HCPs).

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The 100 Year Lifespan.

aging-fashion

The quality, not the longevity, of one’s life is what is important.

– Martin Luther King Jr.

100 Year Lifespan: The coming reality

The 100 Year lifespan is coming. As of 2014 there were 72,000 centenarians (U.S.) and projections of as many as 1 million by 2050. In the industrialized world, people over 90 years of age are the fastest growing segment of the population. By the end of this century the average life expectancy is expected to be 100 years. Notably, Japan’s centenarians, who number about 30,000, have quadrupled in the last 10 years.

Now there are 43 Million Americans over age 65 years age. By 2050 that number is expected to rise to 108 million. The number of those over 85 years could increase five-fold by that time.

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population health: that means us

crowds

Population Health: ACA and ACOs

Population health has become the lynchpin of healthcare delivery in the United States, especially since the passage of the Affordable Care Act (ACA) in March 2010. (This law was passed due to the unsustainable costs of US health care coupled with less than stellar population health outcomes in the US.) A key way the ACA proposes to reduce health care costs is through the formation of Accountable Care Organizations (ACO). These are networks of doctors, hospitals, and ancillary health care providers who form networks to coordinate patient care and share financial and medical responsibility for that care. Required by ACOs is coordination by primary care physician, care of Medicare patients, and answering to multiple measures of quality. Providers get paid more for keeping their patients (their local population) healthy and out of the hospital.

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joint clinician/patient EHR

doctor-patient smartphones

Question number 4 for our “20 Questions for Health IT” project. Please comment in the comments section or on twitter using the #20HIT tag. View the other questions and comments here 

Question from Bernadette Keefe, MD:

How can an electronic health record (EHR) combine the formal record from clinicians with the patient’s ongoing chronicling of their health status? Continue reading

unstructured data: the star waiting in the wings

implement-emr-1

Data-filled electronic health records hold the promise of predictive, personalized medicine and improved population health. Up until now, much of the data retrieved from records is structured data, information recorded in specific data fields. However, the total amount of structured data accounts for as little as 20% of the EHR with as much as 80% of EHR data unstructured. For example, all MD and other health care provider notes anhd all written reports accompanying examinations (e.g., radiologic data) is unstructured data. Continue reading