ECRI Blog

​​​​Policies for managing comorbidities, as well as multimorbidity and multiple chronic conditions, vary based on the medical conditions involved; therefore, developing a uniform policy is not necessarily feasible given the differences between conditions. Approaches to comorbidity management often overlap with typical care management strategies. However, the presence of comorbidities often requires treatment adjustments based on disease-specific considerations, making individualized treatment plans the most appropriate approach. Professional organizations have developed guiding pri​​​nciples that healthcare organizations can use to tailor comorbidity management best practices. For example, see the following guiding principles for managing comorbidities developed by a working group convened by the American Geriatrics Society:

September 18 -22, 2023, marks Falls Prevention Awareness Week in the United States. Despite widespread fall prevention programs, fall incidence rates are on the rise in the United States, with an average 1.5% annual growth rate from 2016 to 2019. Although information specific to assisted living (AL) is difficult to track given the varying degrees of reporting and oversight, an overview of claims data provides a snapshot of the current state of fall-related claims in AL. According to the 2022 CNA Aging Services Claim Report:

​Every care transition carries increased risk of adverse events, poor health outcomes, emotional instability, and high healthcare costs—and the risks are even more elevated for older adults, especially for those with multiple chronic conditions. 

Although research has mainly focused on transitions from hospital to home or skilled-nursing facility (SNF), a few studies have highlighted the need for increased attention on short-stay patients. A Department of Health and Human Services' Office of Inspector General report found that 22% of Medicare beneficiaries who had spent 35 days or less in a SNF for rehabilitation after hospital discharge experienced an adverse event. Fifty-nine percent of the adverse events were deemed preventable by physician reviewers and 79% resulted in prolonged SNF stay, transfer to a different SNF or postacute facility, or hospitalization. Problems related to medication and patient care accounted for most of these adverse events, followed by infection-related events. (OIG) Another study found that fewer than 53% of short-stay patients at SNFs have a successful—meaning no hospitalizations or deaths within 31 days—discharge home or to community-based services (Guzik and Kothari). 

​​​Reducing hospital readmissions has long been an area of focus as they are associated with a quadrupled mortality rate within 100 days (Burke et al "Hospital"). Although national initiatives such as the SNF Value-Based Purchasing program aim to incentivize facilities in improving postacute and transitional care services, monetary penalties or incentives only go so far without providing SNFs the tools and resources needed to make such improvements. In fact, the program did not offer a viable path for nearly all (99.3%) low-performing SNFs to avoid financial penalties through improved readmission rates (Burke et al. "Skilled"). These results suggest that postacute care providers need actionable improvement guidance that hinges on current best practices. 

​An ECRI member recently asked for information regarding support for healthcare providers navigating the death of a pediatric patient. In our response, we discuss strategies and provide relevant resources for healthcare staff confronted with the death of a child. 

Although patients and their families are obviously at the center of adverse patient safety events, a ripple effect often occurs, turning the involved healthcare providers into "second victims," who may require or benefit from organizational support. A survey of over 100 healthcare professionals regarding their grief after the death of a child found that the majority of second victims turned to others to talk about the child and their emotions (85%), used positive reframing (80%), sought emotional support (75%) or self-distraction (57%). Other strategies included seeking religious guidance (55%), meeting with the patient's parents (43%), and attending the patient's funeral (19%). More than half (53%) believed that turning to coworkers, friends, or family helped them the most to overcome their grief. The second most useful strategy was spending time alone (19%). However, 31% wished they had more emotional support from their colleagues, and while 8% received organized support from their workplace, 40% would have appreciated more "official" support. 

A member recently asked about liabilities associated with the utilization of data from nonprescription consumer wearable devices that track various health statuses (e.g., heart rate, blood pressure, activity levels, glucose levels). In our response we discuss the potential risks of utilizing such data and provide information and resources to consider.

The wearable medical device market is rapidly expanding—Deloitte Global predicts that nearly 440 million consumer health and wellness wearable devices will ship worldwide by 2024, and around one-third of individuals own one. However, laws and regulations regarding their use remain unclear. While some physicians support their use as a way to encourage patients to track lifestyle habits that contribute to overall healthcare, others are concerned about associated risks. Many nonprescription commercial wearable devices available to the public are not approved or regulated by the U.S. Food and Drug Administration (FDA), and all have varying degrees of accuracy, usability, privacy protections, and interoperability with existing healthcare technology (e.g., electronic health records, remote patient monitoring systems prescribed by providers). Research on the predictive quality of wearables for health outcomes is also lacking. A 2018 JAMIA literature review found only eight studies of at least moderate quality that supported a significant association between data from wearables and the tracked outcome.