JACK AND CONTINUITY OF CARE Jack was told that he had high blood pressure and hi
ID: 359672 • Letter: J
Question
JACK AND CONTINUITY OF CARE
Jack was told that he had high blood pressure and high cholesterol when he was in the army. Because the conditions did not bother him, Jack paid little attention to them. His job did not provide health insurance, so he decided to take his chances rather than spend his last dollar paying for insurance through an exchange. Anyway, he was strong and athletic. Over the years, Jack gained weight, exercised less, and developed a “touch of diabetes.”
When the diabetes produced symptoms, he went to the emergency room, where they did a good job of diagnosing his problem and sent him off with a prescription and a few pills to get started. The pills seemed to help, but Jack could not afford to fill the prescription or follow up with his “family doctor” because he did not have one. Jack did not understand all the terms the doctors and nurses used to describe his condition, but he knew it was serious and could get worse.
It was not long before he was sick again, so this time, he sought care at a community health center. He did not qualify for Medicaid, but the treatment was affordable. For a couple of months, he followed up and was feeling better, but on the next scheduled visit, they told him, “You need to be in the hospital—you are getting worse.” They got him to the hospital, where he was admitted to the university service and assigned to a young resident who had just graduated from a well-known medical school. The resident reviewed his condition, developed a treatment plan, and explained to Jack what needed to be done. He ordered a TB skin test and collected sputum to check for TB because of Jack’s chronic cough. Unfortunately, before the treatment could be implemented, the resident rotated to another service and Jack’s new resident did not seem to pay much attention to him.
Jack decided to leave the hospital against medical advice and left no forwarding address. His TB skin test was never read. When his positive sputum culture for TB came back, the laboratory alerted the local health department. Not knowing where Jack lived, the health department was not able to follow up.
Before he left, the hospital made sure that Jack had signed all the forms to receive Medicaid payments for the hospitalization. However, Jack did not complete the forms because he did not plan to get any more medical care. That changed one day when the pain was more than he could stand. He decided to try another emergency room. This time, the place was very crowded and he had to wait hours to be seen. Once he was examined, the physicians and nurses tried to get information from him on his condition and treatment, but Jack could not provide much useful information.
He was prescribed pain medicine and sent home. He was told to follow up with a doctor in the next few days. By then, it was too late. One morning as he was getting up, Jack’s left leg was weak and numb and he had lost his speech. He struggled to call 911. Despite the fact that he could not speak, the operator was able to send an ambulance by tracing his telephone location. The EMTs rushed to Jack’s home and got him to the nearest hospital. Once again, the emergency room clinicians evaluated him, but this time, it was too late to be of much help. Jack was admitted for a stroke.
He stayed in the hospital for a week and made some improvement, but he needed help with the activities of daily living and could only speak a few words. The hospital was able to place him in a rehabilitation center because Jack, now 65, qualified for skilled nursing care under Medicare. He was transferred to the facility and received intensive rehabilitation services for the next month, until he no longer improved. At that point, Jack was no longer eligible for skilled nursing care. He was transferred to a Medicaid nursing home closer to his only relatives. The new facility had a large number of patients needing “custodial care.” It provided all the services required by law, but Jack soon realized that he was just another stroke patient.
Discussion Questions
1. How does this case illustrate the lack of institutional continuity?
2. How does this case illustrate the lack of continuity between the healthcare and public health systems?
3. How does this case illustrate the lack of financial continuity?
4. What role does the lack of information play in this case? How can information technology serve to reduce or eliminate these lapses in continuity?
5. Which lapses in continuity require other types of interventions?
Explanation / Answer
1. How does this case illustrate the lack of institutional continuity?
This is a clear case of lack of institutional continuity. Jack kept changing hospitals and medical centers but due to the hospitals not connected or talking to each other, Jack always got a delay in prescription and the root cause of the symptoms. The resident doctor had given a test for TB, but the results never being tested because Jack did not want to stay any longer in the medical center.
If there was institutional continuity, Jack could have been saved and received a better medical care.
2. How does this case illustrate the lack of continuity between the healthcare and public health systems?
Healthcare and public health systems are not connected well and there are an absolute gap and void of sharing the critical information with each other. What it does is proves fatal to the patients and also costs them a lot of expenses, though they might have an option of insurance and Medicaid.
3. How does this case illustrate the lack of financial continuity?
Again, if the government department and institutions like hospitals and medical centers were well connected with the health insurers, Jack could have been given a financial help to quickly treat this problem without any burden on him. Jack also withdrew from hospitals because he knew he cannot afford the expenses.
4. What role does the lack of information play in this case? How can information technology serve to reduce or eliminate these lapses in continuity?
Information Technology can enable sharing of information among all the stakeholders involved in this case – government agencies, medical centers, hospitals, and insurers. IT can provide a single view of the customer so that all the related parties have all the required information all the time and they can make quick decisions.
5. Which lapses in continuity require other types of interventions?
There are government interventions required to make it mandatory to share such critical information with each other. The government can also fix responsibility so that the institutions are encouraged to follow the guidelines and do the maximum to take care of a patient.
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