Arthur's Diabetes Patient Success Story
In the fall of 2007 Arthur Payne started noticing a decline in his vision. After a few failed attempts to use glasses to correct the problem, Payne visited an eye doctor — the outcome was a diagnosis of Type 2 diabetes.
"I was going to the bathroom more often, out of breath after short walks and thirsty all the time," said Payne. "I knew I needed to make a change, but I just didn't know where to start."
Sharp Rees-Stealy family medicine physician Dr. Theresa Currier put a plan of action together for Payne that included prescribed medication, exercise and a balanced diet — a combination that she said could eliminate his diabetes. Payne wasn't convinced, and although he was taking the medication prescribed to manage his diabetes, he continued to eat poorly.
"The medication helped a great deal," explained Payne. "My vision went back to normal and I wasn't as thirsty as before, but I could not walk very far without becoming short of breath."
"I was eating three hamburgers, instead of one and taking nine pills of medication a day," said Payne. "It wasn't until I took an opportunity to join a boot camp at work in July of 2010 led by Michelle Szames that I began to understand why Dr. Currier's recommendations were so important."
Payne started attending boot camp three days a week and working out at home two days a week. In just three months, he lost 12 pounds. As the weight continued to drop, his motivation increased. Payne changed his diet, eating oatmeal in the morning and more green vegetables throughout the day.
Dr. Currier was thrilled.
"A doctor can guide a patient to help them achieve their best health. Ultimately, the patient has to make a personal decision and commitment to change their lifestyle, and that is exactly what Arthur did," said Dr. Currier. "He lost weight the right way with better eating habits and physical exercise. I'm so proud of him."
As he lost more weight (a total of 43 pounds in 10 months), his health improved to the point that Dr. Currier was able to reduce and eventually eliminate all of his diabetic and hypertensive medication.
Today, Payne is diabetes-free. Each week he continues to go to boot camp three days and work out at home two days.
"I feel fantastic now; I take 2.6 mile walks on the weekends with no problem," said Payne.
In 2007, more than 20 million people were diagnosed with diabetes.
"I know there are a lot of people out there that are in the same position I was just a few years ago," said Payne. "I want them to know that it's not going to be easy, but it's important to exercise, eat a balanced diet and listen to your doctor. Find a partner, like I did with Dr. Currier at Sharp Rees-Stealy, to help you get started and hold you accountable."
Reprinted with permission by Sharp Reese-Stealy.
A Letter from a Grateful Patient
Kudos to Personal Health Guide, Nurse Navigator, & Extensivist Physician
I have been a patient of ARC's (Austin Regional Clinic) Advanced Care Coordination Clinic for only a few months and have had nothing but good experiences with it. I spent about an hour with the head of Internal Medicine, Dr. Daghestani and several of his team members going over my various health conditions, medications, specialists and treatment programs. Dr. Daghestani made several recommendations that streamlined my prescription medications and OTC drugs after explaining the pros, cons and purpose of each. He told me of numerous services that could be provided by ARC during already scheduled lab or medical appointments with the results sent to my various specialists if necessary. All of these actions have saved me time and money without compromising in any way the quality of the care I receive. As a matter of fact, I have even easier access to Dr. D or someone on his team than I did to any previous PCP or their nurse. I've been provided a direct line and even a pager number for what I would call the "triage" nurse who can take care of my situation or get me to the person who can.
Last but not least is my Personal Health Guide. She calls me after I have met with medical staff to see if I understood everything and to see if I have any questions. She wants to know if it was a good experience and what could make it even better. She also checks in with me every week or two just to see how things are going. Each time she's done this, I find I have something that I've been worrying with but haven't figured how to begin to do something about. On at least two occasions she has taken over the next steps which have usually involved making sure the right referrals are in place and lets me know what is required of me. She won't do what I am capable of doing for myself but helps me figure out what needs to happen, checks out the medical requirements, and points me in the right direction. If I get into trouble or run into a roadblock, she's there to run interference. Sometimes it just takes someone who can translate between a patient and medical or insurance professional! This is what my Personal Health Guide does so well for me (and I can't help but think the medical and insurance professionals appreciate her, too).
If you are offered an opportunity to participate in ARC's Advanced Care Coordination Program, I would strongly encourage you to take advantage of it. You get a Personal Health Guide and a team of medical professionals whose goal it is to make sure you get coordinated, efficient, cost-effective care, the right medications in the right amounts, and access to the system when you need it. – A Very Grateful Patient
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15 Minutes with My Doctor Changed My Everything. . .
Gena B. was not too concerned when she began gasping for breath after two minutes of walking on a treadmill in the spring of 2008. She was experiencing a recurrence of her asthma so she went to see her primary care physician at Austin Regional Clinic. Until that point, she was “very healthy” and only saw her doctor for annual check-ups and colds.
“I went in and I said ‘I just need an inhaler so I can work out,’” Gena recalls. But after her doctor examined Gena he told her that her breathing was normal. To Gena’s shock, he then referred her to a board-certified cardiologist for a stress test. In retrospect, Gena thinks her primary care doctor knew that something serious was going on. He joked about the stress test, “If anything happens you will be in the right place.”
Her doctor immediately telephoned the cardiologist to discuss Gena’s case. Gena noticed this was different. “Another doctor would just refer you to another doctor and you’re on your own,” Gena says.
The stress test “went poorly” and, after making an appointment for an angiogram for the following week, Gena went home feeling her worst. “I never recovered from the stress test.“ Gena recalls. “All weekend I was exhausted. By Sunday, I couldn’t even get up from the couch.”
On Monday, Gena called the cardiologist to report her exhaustion and was instructed to go to the heart hospital immediately. Gena’s angiogram showed a 95% blockage and she had a stint implanted in her heart.
“Fifteen minutes with my doctor changed my everything,” Gena says. She believes that a less thorough doctor may have sent her home because her case did not necessarily point to heart disease. She was only 46 years old and had no symptoms other than shortness of breath at the gym. “I owe him so much,” Gena says. “He took me very seriously. If he hadn’t, I probably would have had a heart attack. I don’t know what would have happened.”
Today, Gena feels great. Five times a week she enjoys hour-long visits to the gym where she works out on an elliptical machine and trains with weights. She feels blessed to have regular visits with her Austin Regional Clinic doctor who closely monitors her health.
Life Can Get Busy at Times . . .
And sometimes it’s easy for us to put off things like a doctor’s visit or preventive screening.
But patient Lurner Hunter learned that you shouldn’t postpone what’s important for your health. Hunter, 61, has come in every year for her mammogram—until last year, when she was dealing with a family illness. Her personal physician, Brian Bautista, MD, at Kaiser Permanente's San Bernardino Medical Offices, sent reminders, and medical assistant Monica Lopez called to set up appointments, but Hunter would postpone or cancel.
After four months, Hunter finally came in for a mammogram. The results were abnormal and a second mammogram confirmed that she had breast cancer. Breast cancer is the second most common cancer among women in the United States after skin cancer. It’s most treatable when detected early. Dr. Bautista says women might feel too busy or be afraid of getting a mammogram.
“At Kaiser Permanente, we believe in preventive care,” he says. “So it’s important to have these routine screening mammograms done. It can save people’s lives.” Hunter went through surgery and chemotherapy and says she feels great today.
She comes in for regular follow-up mammograms. “I’m not going to skip an appointment in the future,” she says.
Kaiser Permanente recommends mammograms at least every two years for women between 40 and 49. For women between 50 and 69, we strongly encourage getting a mammogram at least every two years.
Georgia Patient Fights Diabetes with Communication
In the summer of 2008, Cindy S. was diagnosed with type 2 diabetes. Her first reaction was fairly typical: a painful combination of denial and fear. But as we all know, nothing is ever gained by hiding from reality.
Fortunately, her primary care physician from Kaiser Permanente TownPark Medical Center in Kennesaw, Ga., had helped many patients through this transition before. With large doses of consideration and encouragement, he patiently explained the realities of her new situation.
First, he signed Cindy up for two of our diabetes classes, “Diabetes Basics” and “Beyond the Basics,” which were taught by a registered nurse and a dietician. Being skilled motivators, the class instructors gave her the tools she needed to better understand diabetes.
Constant contact was the next step. Cindy's doctor prescribed a glucose monitor and had Cindy e-mail him her morning counts for several months. Using kp.org, she e-mailed her doctor two to three times a week about her results, and he responded personally to every e-mail.
By using us as her support system, Cindy has lost 33 pounds, and her sugar levels have dropped from 142 to the high 90s. All these positive changes were made through diet and exercise alone. As Cindy says, “Some days my blood sugar hits higher numbers than I would like. The key is not to get discouraged. I look at how far I have come in a few short months, and am excited about what I can accomplish in the future.
“I have talked with other people who have been diagnosed with diabetes, and they were not given a fifth of the information that I was to help me lead a long and productive life. I really appreciate that the care teams at Kaiser Permanente are doing their best to help me control what I can at the onset of this disease, versus letting the symptoms get worse. Thank you, Kaiser Permanente.”
How Teamwork Triumphed and a Miracle Was Born
On a routine visit to her doctor, Jenny, a nurse and mom-to-be from Livingston learns she not only has placenta previa, a condition where the placenta partially or completely covers the cervix, but also placenta accreta, a condition where the placenta grows into the uterus. Her OB/GYN knows this is serious--so serious, it’s life threatening to mother and baby.
So the OB/GYN refers Jenny to the maternal-fetal medicine specialist at the Billings Clinic Family Birth Center. He assembles a team of specialists and together, they develop a carefully choreographed approach to protect Jenny and her baby.
After weeks of bed rest, it is time for baby Chloe’s debut. The interventional radiologist and anesthesiologist insert special catheters and balloons to control potential bleeding. The urologist then puts stents into the ureters to make sure the other doctors could easily see them during surgery. The maternal-fetal medicine specialist and gynecologic oncologist team up for the delicate caesarian section, which is performed higher on the uterus so not to disturb the placenta. The pediatrician and NICU nurse are on hand to care for the baby. Then the gynecologic oncologist and maternal-fetal medicine specialist team up again to perform a hysterectomy. Even Jenny’s OB/GYN is there to provide moral support. From start to finish the whole procedure took two and a half hours.
Thanks to months of planning and Billings Clinic’s team approach, the birth was a success and two lives were saved. Jenny and baby Chloe are well and happy at home with Dad and big sister, Tess. Just like they should be.
Teamwork Delivers Expertise and Support
Minkin, who resides in Marenisco, Michigan, retired as a school principal almost four years ago. “Fishing and hunting were top items on my to-do list,” he said. “Cancer was not.” Three years ago, Minkin was diagnosed with non-Hodgkin T-cell lymphoma, a rare cancer requiring a complicated course of treatment. Despite repeated chemotherapy treatments to stop its growth, the disease returned with renewed strength. In search of more aggressive treatment, Minkin was referred to Marshfield Clinic.
Minkin was his own donor for the stem cell transplant, a procedure in which high doses of chemotherapy are used, sometimes with radiation therapy. A patient’s stem cells are removed or harvested from the circulating blood prior to treatment. Afterward, the cells are infused back into the patient’s blood stream, where they will settle in the bone marrow and begin to make blood cells. The transplant involves coordinating both hospital care and outpatient care until the immune system recovers.
“Caring for Roy required a coordinated team effort,” said Dr. Richard Mercier, M.D., oncology/hematology specialist and chair of the Oncology Department at Marshfield Clinic. “He lives in a more isolated area, so we needed to be able to work with him over a distance. Our ability to keep providers and patients connected through the Clinic’s regional center system and electronic health record made the difference.”
Minkin’s case required a team of medical specialists. Besides the stem cell transplant, he needed chemotherapy and radiation oncology, a more localized cancer treatment. These treatments were provided even during hospitalization.
“I’m like a specialist who comes in for the team from off the bench,” said Warren Olds, M.D., Marshfield Clinic radiation oncologist. “Our capabilities allow us to mobilize and respond when patients need us most. Here, specialists assisted by dedicated Clinic and hospital support staff are available, and state-of-the-art technology is aggressively supported. Patients know we have the resources to get done what needs to be done and in one place.”
“My doctors were able to work together to help me,” Minkin said. “For that, I am grateful.”
Brad, a physically active man in his 50’s comes into Billings Clinic West SameDay Care with an unexplained fever he’s had for days. The physician assistant, Chris Smith, who examines Brad, recognizes that it’s serious because of Brad’s heart history and consults cardiologist Dr. Barbara Dudczak.
The next morning she runs a transesophogeal echocardiogram on Brad’s heart and admits him to the hospital. Because of his fever, she calls in Dr. David Graham, an infectious disease specialist. After blood tests Brad is diagnosed with both endocarditis, a bacterial infection of the heart valve, and mitral valve prolapse.
Dr. Dudczak says his heart valve is very diseased and heart surgery is inevitable. She believes Brad is a lucky man to have come to Billings Clinic at this stage. Dr. Graham orders four weeks of intravenous antibiotics for Brad before surgery.
Dr. Scott Millikan, assisted by Dr. Scott Needham, both cardiovascular surgeons, replaces his diseased valve with a new artificial tissue valve.
After cardiac rehab, Brad is taking care of himself, seeing his Billings Clinic primary care doctor, and working out regularly at his gym. He’s back to his job as a video producer and is even taking dancing lessons with his wife (one of those things he said he’d never do!). Brad is living life to the fullest.
“I was absolutely confident in the Billings Clinic team,” said Brad. “The doctors are lifesavers. But to me, the heroes are the nurses and staff that helped me through the recovery process. Knowing that this big team of people is at the Billings Clinic is pretty darn comforting.”
Online Patient Services Supports This Patient and His Doctor
Robert is a 79 year-old patient with diabetes and high blood pressure. He is also hard of hearing which makes it very difficult for him to communicate with his HealthPartners’ doctor. Given Robert’s age and conditions, his doctor needs to monitor Robert’s lab tests closely and check his blood pressure regularly, but getting to and from the clinic is difficult for the patient.
Robert’s doctor discovered that he likes to use his computer. The doctor suggested that Robert sign up for Online Patient Services. Robert now takes his blood pressure and measures his blood sugar at home and records the information in his online medical chart. Robert and his doctor now e-mail each other regularly. Both Robert and his doctor agree that Online Patient Services make care much easier. Robert’s doctor reviews his lab tests weekly and has been able to quickly adjust Robert’s medications when necessary. Robert has also used e-visits which he finds to be more convenient than traditional office visits.
Read more about Online Patient Services
Emily, three years old, was carried into Austin Regional Clinic's After Hours Clinic on a Friday evening by her mother. Hours earlier, when Emily's grandfather had attempted to lift Emily up using only her arms, she began to scream out in pain.
Emily was worked in to see me. I am an ARC physician and was working in After Hours that evening. Seeing that Emily was emotionally breaking down, I asked her how old she was to distract her and taught her how to breathe deeply, thinking about each and every breath. Emily began to calm down.
I explained to Emily's mother that Emily suffered from "radial head subluxation," or nursemaid's elbow. Her radial head had gotten separated from the socket, which caused a great deal of pain for Emily. It can be caused when a caregiver lifts a child by the forearm and is fixable with some simple maneuvers. I showed Emily's mother how to relieve the child's pain and rotated the wrist medially until the radial head went back into the socket. Within minutes, Emily was pain free.
That night, Emily's mother decided to have Emily help write a thank-you note to ARC for their help in what could have been a stressful night at the Emergency Room. That note from Emily is one of the most treasured notes I've received from a patient.
This is a common situation that occurs at ARC's After Hours Clinic. Patients come into our clinic wanting fast, efficient, and trustworthy solutions to their medical needs. They can be quickly worked in, seen by a competent team of medical professionals, and feel valued both as people and patients. That's the kind of care ARC provides, both in the daytime outpatient setting as well as our After Hours locations across the city. "After Hours services is one of the reasons that makes our clinic unique," said Norman Chenven, CEO and Founder. "The same excellent staff that we have working in our outpatient offices are the doctors who treat patients in the evening, which provides a constant level of quality for patients."
Accountable medical groups want to make sure that patients have easy access to care, day or night. I am proud to be an ARC doctor.
Saved by Same-Day Mammography
At age 57, Judy knew she should have had screening mammograms by her age. But it was easy to put it off because her family didn’t have a history of breast cancer, she was busy with a full time job at a daily newspaper, and she didn’t go to the doctor that often. At the urging of her husband, she finally scheduled an appointment for a checkup at her HealthPartners clinic. A nurse practitioner noticed in Judy’s electronic medical record that she was overdue for a mammogram. But again, daily demands including her husband’s health problems, pushed it to the back burner.
Several months later, an inflamed tendon in Judy’s right shoulder prompted her to go back to the clinic. The nurse practitioner again gently suggested she get a mammogram. This time, there was no excuse to delay the test. Her clinic offered her a same-day mammogram and the nurse was able to set up the appointment right way at the clinic. The test revealed a mass that could have only been detected by a mammogram. Three weeks later, Judy underwent a lumpectomy at and her chances for full recovery are excellent.
Judy admits that if the mammogram had not been offered at the same time as her shoulder appointment, she probably would have put it off again. “I would have gotten it eventually, but getting it when I did probably saved my life.”
Read more about Saved by Same-Day Mammography
The 5 Real Answers
These five principles are shared by Accountable Care providers who take responsibility for the cost and quality of the care they provide you.
The best way to control health care costs is to stay healthy. ACOs believe in wellness and preventive care. You get reminders for the tests, screenings, and immunizations you need, and health information, classes, and advice are easily available.
Care teams and care coordination are very important when you need to see more than one doctor, or you need to be hospitalized. Coordinating your care among all your care providers ensures that each knows what the other is doing for you.
Shared electronic medical records help both your primary care doctor and specialists know your entire health history, the drugs you have been prescribed, and your test results. This improves the cost, quality and safety of the care you receive.
Scientific advancements are so rapid that no single physician can stay on top of all the current and best treatment options. ACOs support their patients and doctors by providing information about up-to-date treatments based on research and evidence.
Day or Night Access
Providing the right care at the right time is the goal of ACOs. Patients of ACOs are able to get professional medical advice day or night, in offices, by phone, and even via e-mail. Quick treatment helps maintain health and reduces cost.
Find out if your doctor or medical group is striving to achieve accountable, coordinated care.