HSS Case Study: 67-year-old Man with Heart Failure

00:01 I like to always share a patient case example so that we can really visualize the impact of health system science and these concepts in medicine.

00:13 Let's go through a patient case.

00:15 A 67 year old man is hospitalized for shortness of breath and lower extremity edema. He is diagnosed with congestive heart failure during his stay.

00:25 After he is medically stabilized and euvolemic, he is discharged home.

00:29 He has six new medications.

00:31 A home health nurse for three home visits and follow up appointments with his primary care physician, a cardiologist, and a nutritionist for dietary education.

00:42 In my experience, I'm, as an aside here, in my experience as a physician, this is a very typical experience for a patient with a new diagnosis.

00:52 So our patient returns to the hospital four days later with the same symptoms and is readmitted with a heart failure exacerbation.

00:59 He has not taken any of his new medications because the dosages and timings were confusing. The home health nurse was unable to coordinate a visit with him as his cell phone was not working.

01:12 I will pause for a moment for you to consider how this patient got readmitted and what factors contributed to that, and how we might have prevented a readmission for this patient. Here are some questions to consider.

01:35 What could the medical team have done to optimize this patient's discharge further? How could readmission to the hospital have been avoided? When I think of this patient, I really see some of the things that we could have done better or where the health system is not working in our favor.

01:57 And we can see here that it goes beyond the medical decisions that were made in the hospital for the care that the patient should receive, But really, the impact of all of these domains of health system science on the patient's care and the experience of care for both the physician and the patient.

02:15 Some ideas that I have are we could have made sure the patient had optimal education on the six new medications that he was provided.

02:27 We could provide something like a pill box to help him organize his medications.

02:31 And we could also understand that many new medications might be confusing or difficult to take. I know if I have one medication for a cold three times a day, sometimes I forget to take it.

02:43 So I can imagine that six new medications would be difficult for anyone to incorporate into their life. Is there a way I could streamline these medications for dosing, especially at the outset, to anticipate the difficulties that the patient might have? The patient missed his or was not able to have scheduled a home nurse visit because his cell phone wasn't working.

03:05 So could we make his first home nursing appointment prior to leaving the hospital? These are things that we could have potentially done in the hospital prior to the patient discharging. We could have discussed further considerations for the patient that we didn't even think about prior to his discharge, like, could he come back and forth for so many different appointments? Does he have the financial means to cover the costs associated with his health care? Does he have access to healthier recommended foods? What are his community supports and his health system supports? These are the domains of health system science, the context that the 21st century physician must appreciate beyond the traditional model of medicine and medical education is evolving to meet this challenge and the expectations of the future physician.

03:55 I look forward to diving into some of the health systems science topics with you in future talks. Thank you.