Pennsylvania health-care innovation shows results

  1. Nice to see the prominent role NPs and nurses are playing:

    After a year, the first 32 medical practices to sign up for the Rendell administration's chronic-care initiative reported that their diabetic patients were doing better.

    Forty-four percent of the 15,000 diabetic patients in the program gained ideal control of their blood sugar, up from 33 percent a year ago.

    Participants say the program works because it gives incentives for caregivers to track patients better and to hire more staff. Over time, proponents hope to see broad health improvements and big savings from fewer hospitalizations and ER visits.

    "You can see the trend lines going the right way," said Ann S. Torregrossa, the director of the Governor's Office of Health Care Reform.

    The effort is one part of Gov. Rendell's so-called Prescription for Pennsylvania, the health effort he launched in January 2007 to reduce health-care costs and extend insurance coverage to the state's one million uninsured residents.

    While the insurance expansion has stalled in the state Senate, smaller pieces of Rendell's proposal, such as allowing parents to cover children under their insurance through age 29, are moving ahead in Harrisburg.
    And the chronic-care program will extend to all parts of the state next month with the addition of primary-care practices in Northeastern Pennsylvania
    .
    Once that happens, it will involve 400 primary-care providers covering 750,000 patients.

    "This has been an effort to revitalize primary care," Torregrossa said. "This will be an important legacy of 'Rx for Pa.' . . . It will have transformed how health care is provided and paid for at the primary-care level."
    Doctors and other clinicians at the 32 practices in Southeastern Pennsylvania got financial support to redesign their practices into a more team-oriented system aimed at changing patient behaviors, in part by providing basic education, tracking patients' progress by computer and calling people who miss appointments.

    Independence Blue Cross, Aetna, and four other insurers committed to pay the practices up to $13 million over three years as they meet certain goals.

    Practices make slots available so patients can get same-day appointments, and they added staff to help educate patients in self-management of chronic conditions.

    The practices also added patient registries to alert them to test results and needed treatments.

    "It has been fun to create a system where there is a real strong interdisciplinary approach to managing diabetes," said Donna L. Torrisi, executive director of the Family Practice and Counseling Network, which has three nurse-run health centers in the program here.

    "The outcomes have been tremendous," she said. "And patients like it."

    That is true for Elaine Coles, 65, who for nearly 20 years has lived with the ups and downs of diabetes. Now, the North Philadelphia woman is learning to manage her condition.

    "Things started getting out of control," Coles said. "I had to buckle down and be more serious and dedicated to my life."

    She is trying to do so with the aid of a team of nurse practitioners and other staff at the Abbottsford Falls Family Practice in the city's Tioga-Nicetown neighborhoods.

    Ellen Peluso, a diabetic educator at Abbottsford, said simple things, such as replacing hard-to-read syringes with "insulin pens," help patients - particularly older ones like Coles - take their correct doses.


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