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Population Health and the End of Life

“Health nuts are going to feel stupid someday, lying in hospitals dying of nothing.”
Red Foxx
 Dad and Fred
In population health we talk a lot about improving the health of those with chronic diseases, preventing other diseases and keeping the healthy people healthy, but what should population health’s role be at the end of life? In the end, even if we are wildly successful at maintaining, improving or preventing diseases and conditions, we will still face death.
If the Triple Aim is better outcomes, lower costs, and improved health of populations, how should that be applied at the end of life? I believe its role should be in ensuring dignity, education and appropriate personal decision-making.
Over three years ago my father, a physician passed away.  He had been living with Lewy Body Dementia, a form of Parkinson’s disease for almost two decades.  When first diagnosed, he made clear to us how his disease would progress and what he wanted to happen at the end.   No feeding tubes, no extraordinary measures, if he got pneumonia, he wanted no antibiotics. When his disease had really progressed and he was bed ridden in a memory care unit, post stroke and not always lucid, he did get that infection. The facility wanted him transferred to the hospital across the street where he would get treated for his pneumonia.  While they were  nervous about us not approving that based upon his Advanced Directives, they understood his wishes, worked with us and hospice and we made clear that we would not hold them in any way accountable.
The hospice service was fantastic as was the facility which allowed my mother and others to stay there with him.  During this three weeks, we would take him outside when he was able and we were there with him throughout.  It was a moving and gentle experience and I am happy to have spent that time with him, my family and some of his friends and colleagues. During this experience, not everyone in the immediate family was in agreement, or felt it was handled as they wanted, but they knew it was being done based on his clear wishes.
We all know the costs associated with healthcare at the end of life, but that is a secondary issue; it’s hard to say goodbye to someone you love. Knowing his disease and its course, we were able to prepare for a long time. Others have much less time to make decisions and say what they feel is an appropriate goodbye. This is why we should think of the how and what we want to happen for us early, and clearly discuss it with our loved ones.
Too often when the end of life is near, it’s not about the person reaching that end, but about those close to her or him, about their time with the person, perhaps their guilt, the belief that they need to do everything possible. While this may seem like the right thing to do, many times it just increases the pain and suffering of the person nearing the end of their life. In a number of instances, I have seen and discussed the guilt felt by those who had gone to great lengths to try to keep their loved one from death.  The hospitalizations, intubations, amputations, feeding tubes, more doses of chemo. Hindsight is 20/20 for better or worse.
In fact, one of the things that influenced my father and his decision, was the death of his father. He had really suffered during the last 6 months as the doctors did this and that to (for?) him in an effort to try to keep him alive.  My father had supported some of these efforts. They were not a good six months, certainly not six months worth living; in fact my grandfather on at least one occasion had stated that he was ready to die. But more was done. Back then there was little talk of options or hospice.  My father sometimes spoke of his father’s last 6 months, at times with a tinge of guilt.
With advanced directives, we have come a long way, but there is still more we need to do.
If population health is about the full continuum of care with the patient at the center, we have to ensure that end of life decisions becomes part of the discussion. That people and their loved ones are educated about their options, given an opportunity to prepare for the day, and given the support to make the decision’s as they see fit. For my Father and us, his decisions made a world of difference and the hospice and memory care unit did an incredible job taking us through this difficult time. He died and left us in peace with memories of a great man, who was loved deeply by his family and still is.
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PopHealth Week with Prashant Natarajan – Big Data, Machine Learning and AI

Prashant Natarajan, Director of Business Strategy, Oracle Corporation

Discussing Big Data, Machine Learning, AI and Healthcare

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Prashant Natarajan on PopHealth Week

Prashant Natarajan is Director of Product Strategy at Oracle, where he is responsible for business strategy, product management, and go-to market solutions for a portfolio of Prashantinformatics products & cloud services for  population health, precision medicine, interoperability, and integrated little + big data analytics. Prashant received his chemical engineering degree from Mangalore University (India) in 1998 and his master’s degree in technical and professional communications from Auburn University (USA) in 2005. He is a prior recipient of the SBC/Chancellor’s Endowed Fellowship for graduate research.

Prashant is a lead author or contributor to 4 books on analytics, machine learning & AI, and precision medicine. He serves on the Board of Advisors for Council for Affordable Health Coverage. He is also Industry Advisor for Data Science & AI at UCSF/CIAPM. Prashant currently serves as Chairperson of the HIMSS NorCal Chapter’s annual Innovation Conference & Showcase.

Follow Prashant’s work via Big Data CXO.

 

PopHealth Week is Produced by Health Innovation Media

 

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Clean Living through “Forest Bathing” – Reasons Why Americans Need to Embrace What The Japanese Have Known For Decades

I recently wrote a Guest Blog Post for Hiking Trails for America and the Friends of the Florida Trail.  I have been on the Board of Friends of the Florida Trail since its founding by Jim Kern.  Jim is the founder of the Florida Trail and a number of non-profit hiking organizations.  His mission now is to complete the 10 National Scenic Trails that still have gaps or unprotected sections.  You can help support our efforts by signing the petition. There are many health benefits to getting out into nature and this Guest Post documents a few.

Here’s a picture from my recent trip along the Suwannee River on the Florida National Scenic Trail. Click on it to read the Post and please sign the petition.  Thanks!!

 

 

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The Jefferson Population Health Colloquium – A Full Serving of Population Health

 

Population Health continues to be a major buzzword around the healthcare industry. At the recent HiMSS 17 conference in Orlando the talk of population health was everywhere from the vendor booths to the presentations, but where does one turn to get more than just the IT focus of population health? Where can one get a sense of the breadth and depth of population health from operations to policy, current status to future state,  provider implementations, data and analytics, patient engagement, in the weeds medication adherence and wearables to large community based initiatives? In other words where can one find a full serving of all that population health is?

That place is the Jefferson Population Health Colloquium, also in its 17th year.

This year’s event features keynotes ranging from the Future of Managed Care to Good Health is Good Business: The Results of an Innovative Alignment with Physicians and Communities.

Here are just a few of the many leaders providing keynotes this year include:

The balance of keynotes can be found on the program Agenda. The range and diversity topics covered is impressive.

Digging deeper into the Colloquium’s agenda we find ‘mini-summits‘ and ‘concurrent sessions’ on day two covering the following topics:

And concurrent sessions:

The most difficult part of this conference is deciding which sessions to attend. The complete agenda is available here, and a direct registration link for full details, here.

Also on Day two will be the awarding of the Hearst Health Prize For Excellence in Population Health now in its second year, this $100,000 prize goes to……..? Check out last year’s debrief of the winner ‘Community Care of North Carolina‘.

Tuesday evening closes with an optional dinner session, but one definitely worth attending to hear from Michael Dowling and Dr. Stephen Klasko on a panel moderated by David Nash MD, MBA.  This interesting and informative panel will discuss The Future of Clinically Integrated Networks a critically important component of creating a better health system and integrating population health.

I hope to see you there.

 

 

 

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Guest Column in Local Paper: A call to action to improve community’s health

The Florida Times Union published a Guest Commentary I wrote on Improving the Health in our community

Guest column: A call to action to improve community’s health

Humana recently launched its local Bold Goal initiative with a conference at UNF. There were excellent presentations and I was honored to participate with a distinguished group of panelists from the Duval County Health Department, hospitals, providers of care and the Duval County Medical Society. It was nice to be involved in the event and try to play a small part in improving the health in the community in which I live.

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I’ll be posting a longer version with all the citations here.

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