Planning for the end of life can be an uncomfortable and often times overwhelming tasks – for both patients and providers. 

“These are important yet hard things to talk about,” Dr. Matthew Gonzales, chief medical information officer at the Institute for Human Caring at Providence St. Joesph Health, said during a HIMSS20 Digital  event. “They aren’t entirely the easiest thing to dig into and process – and talk about in our society, and they are ultimately so important to the way that we are trying to make sure that we work with our patients and families to be able to achieve what matters to them.”

Gonzales brought up a statistic from the CA HealthCare Foundation, which found that 80% of people who are seriously ill want to talk to their doctor about end-of-life care but only 7% have actually discussed their options. 

There can be several barriers for folks to actually have those conversations. Research shows that one of the biggest determents to having those conversations is level of health literacy. 

“[It] has a lot to do with health literacy and trying to improve the educational content out there is really challenging,” he said. 

The Providence team took notice of a new effort by the Advanced Care Planning organization to provide a platform full of short videos, aimed at patient education, on a number of topics having to do with the end of life. Their subjects range from CPR to feeding tubes.

The ACP had studied their tool on a small community in Hawaii , with the goal of researching if end-of-life conversations increased when the tool was introduced.

“It was not targeted at people who were seriously ill, but as a population-based example, as a way to be able to understand that if we use this video decision-aid, which was four minutes in length, how did people respond to this?” Gonzales said. “What was their interest and what happened, long-term, to their care outcomes?"

Researchers found that before these videos only 3% of patients had conversations about advanced care planning. By the end of the trial, close to 40% had those conversations. 

Providence decided to team up with ACP to implement the tool into its system – starting with a pilot in a practice with five doctors. Originally, he said the doctors were excited about the tool and were reporting better conversations for patients. However, after the first few months, the adoption rate began to drop off. 

In order to get the tool working, a doctor or medical assistant would have to log into a different platform with a different password and then show the patient the video, a process that added an extra burden. 

“That is the hard thing about systematic-based change – when it is just a single intervention and you are relying on an individual medical assistant or an individual doctor to do the manual workflow around this.” 

Since Providence is a large health system with around 38,000 nurses and 25,000 doctors, getting every provider educated and on board with the tool would be tough. Gonzalez’s team looked to automation and teamed up with health tech Xealth. 

Xealth was responsible for automating the system. So, instead of it being another platform for doctors and nurses to show patients, it could be sent to patients seven days before the doctor’s appointment. The tech company was also able to weed out patients that were not the appropriate candidates for the tool. It focused on sending emails to patients with no advance directives who had never declined a conversation about end-of-life care, hadn’t see a video and were over the age of 65. 

In addition to the video-learning aids, the email also gave patients the paperwork to fill out to request certain end-of-life care. Xealth reported a 60% open rate of the emails, and 35% of those who opened pulled down the advanced directives and 6% brought the file into their provider. 

Today Xealth and Providence are looking at ways to improve the tech and expand into other areas. 

“Ultimately this technology, this partnership we have, means that demonstrating we can do this at scale that is possible to think about how we automate other types of decisions people may be facing and trying to think about. 

A new study published in US Endocrinology found Abbott’s continuous glucose monitoring system, the FreeStyle Libre, demonstrated significant cost savings for diabetic care compared to traditional fingerstick testing. 

Abbott’s system uses flash continuous glucose monitoring (CGM) through a sensor placed to the back of the upper arm, and lasts for up to 14 days. The device automatically collects data throughout the day and wirelessly transfers it to a handheld reader or smartphone. 

The study's two authors noted that the review was funded by Abbott, and that one author is an employee and shareholder of the company.

TOPLINE DATA

Researchers found that the cost of care for individuals with Type 1 and Type 2 diabetes who used the FreeStyle Libre 14-day system was 61% and 63% less than those who use the fingerstick method. 

The study, which used a base of eight tests per day, found the finger prick standard of care cost $4,380 per year. Whereas, for Type 1 and Type 2 patients who used the FreeStyle Libre 14-day system, it cost $1,712 and $1,603 respectively per year.

The FreeStyle Libre 14-day system is also estimated to save about 50% in average annual medical costs for people with severe hypoglycemia (low blood sugar), according to the study. For people with severe hypoglycemia, the study estimated an annual cost of $4,494 for those self-monitoring blood glucose (SMBG) and $2,317 for flash monitoring. 

This type of glucose monitoring results in overall positive health outcomes, according to the study. The researchers found a 90% decrease in the need for SMBG, as well as decreases in hospital visits and ambulance use. People who use this type of monitoring reported improved satisfaction with their treatment compared to those who use SMBG. 

HOW IT WAS DONE 

Based on the American Diabetes Association (ADA) Standards of Care , people with diabetes that use SMBG techniques should test six or more times a day. 

To determine diabetes management cost savings, researchers crunched the average cost of care numbers for a hypothetical cohort of 1,000 patients. Diabetes monitoring habits were based on the ADA standard and two other more lax practices that it reports are common in real life.

“The base case compared the annual cost per person for the flash monitoring system with the cost of routine SMBG at 8 tests/day, the mid-point of the range recommended by the ADA,” researchers for the report wrote. “Scenarios 1 and 2 use the same approach as the base case, except they use the lower and upper limits of the range in the ADA Standards of Care, [six] and 10 SMBG tests/day, respectively. Scenario 3 is based on the same approach as the base case, but with routine SMBG used at 3 tests/day.”

THE LARGER TREND

Roughly two in five Americans living with diabetes reported difficulties paying their medical bills, according to a recent study. These bills cost more than double what they would be in the absence of diabetes, according to the ADA. 

“These new cost data published today in US Endocrinology  reinforce how use of Abbott's FreeStyle Libre technology, which was designed with affordability in mind, can transform how both patients and health systems improve health outcomes more cost-effectively compared to fingerstick testing,” Dr. Mahmood Kazemi, divisional VP of global medical and scientific affairs and CMO at Abbott, said in a statement. 

A number of organizations have created devices and solutions in an attempt to make treating diabetes easier. Last year, Abbott teamed up with Omada  to integrate the data collected on the FreeStyle Libre 14-day system on its mobile platform. One study found that using AI for diabetic retinopathy screenings could save providers money. And WellDoc’s BlueStar continues to add diabetes-management tools to its platform.