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Take sixty-seven year old Bill Schoens, from Colorado, who recently suffered a heart attack. Before he was releaser from the hospital, registered nurs Becky Cline was assigned as hisTransitionsd Coach. She made sure that Bill understood the medications that his doctorsw prescribed and everything else he needed to do to get Bill evenpointed out, “When you are in the emergency room, you are all drugge up and can barely remembeer what to do. Confusion starts to set in.” Beckyg went through each step Bill needed to follow when he left the Beckyevaluated Bill’s ability to follow doctor’sx orders in his environment and helped him maintain his own Personak Health Record.
With her help, when Bill visited the doctor, he didn’yt have to remember everything that happene since he left the hospital — it was all in the book. Bill said “Wheb people are in front of their their blood pressure goes sky high and they forgeft what they needto ask,” He said he foun d the help and guidance he received from his Transitionsz Coach “invaluable and We need patient-centered coordinated care — care that viewes nurses, doctors and family members not as isolated caregivers, but as partners on a team whosre ultimate goal is to make sure patientes get the guidance and care they Hospitals aren’t the problem, primary care physicians aren’r the problem, and nurses aren’t the problem.
Our fragmentedd delivery system of care isthe problem. This bill also makex sure that we are teaching patients to manag e their own conditionat home. Sixty-nine year old Frank Yannoi of Denver, Colorado had surgery for a stap h infection of thespinal cord. After leaving the he noticed that the pain he was experiencint weeks after surgery wasgetting worse. Havingh been “coached,” he identified the problem and knew to insisg on visiting his doctor A hospital test showedthat Mr. Yanni requirede a second surgery. His coacyh said that, “Had he let that go for even another week, he could have ended up in the Intensive Care septic andhorribly sick.
” Our Colorado transitionm of care model, reflected in our legislation, gives healtjh care systems the choice of whether to creatde this program. But it allows existing patient-centered transitional care programs like the one in Mesa Colorado tocontinue on. We want communitiea and providers to thino and work together to reducereadmission rates, reduce cost and provide better coordinatedx care to our patients.
Other systems should look at Coloradoo and the systemsin twenty-four othedr states that have already begun to follow this As we begin to emerge from the economic we must call upon existiny health care professionals from all walks of life —nurses, nurse practitioners, social workers, long-term care, and community health workeras — to serve as transitional coaches. Colorado nurses like Becku Cline have found that focusing on transitional care has leveragedtheire skills, empowering them to take a more actives role with patients. They are able to work with both patientss andfamily caregivers. For too long, famil y caregivers have been “silent partners.
” 50 millionm Americans provide care for achronicallh ill, disabled or aged loved one. This bill recognizew their importance, connecting them with a coach who can teach them how to properltcoordinate at-home care. This bill is only a small part of the solutio to the complex challenges of our fragmentedr healthcare system. The problems of risingt costs and limited access affect people from all walkaof life. Skip Guarini of Parker, is a self-employed privatd consultant andretired U.S. After years of regular doctors’ visits, Skip’a dentist discovered a lump on his thyroid during a routine exam that had gone undetected by his physiciann despite 10previous exams.
Skip underweny a CT/MRI scan, Ultrasound, and all of which were inconclusive. A second series of testw six months later revealed that the lump had and Skipunderwent surgery. During the surgery, doctorsd found cancer. Skip was then sent to an endocrinologis t who orderedmore tests. All tests came back A second full body scan revealed no sign of cancee anywherein Skip's body. All these examsx and screenings costSkip $122,000. Since then, Skip has maintainecd perfect health, but he cannot obtain privatr insurance because of thethyroid surgery. He now reliews on COBRA and is paying a monthlyu premiumof $1,300.
This coverage is set to expire in less than one at which point Skip will have no insuranceat all. Holliss Berendt is a small business ownerin Greeley, She is covered through her husband’s which is according to her, “a luxury many otheer small business owners don’t have.” After graduatingg from Colorado State Universituy in 2004, their daughter Abby found a job with a larger company in New York City. She was told she couldn’tr get health care coveragre until she had been working at the company for one At ten monthsof employment, she was diagnoses with an ovarian tumorf that would require surgery.
The expensexs were too much for Abby, so her parentsz had to take out a second mortgag to pay her medical Hollisshared that, “This experiencre brought to light, all too clearly, how closse we all are to losing everything due to a healthj issue.” The current system is hurtingv our small business people and their Take Bob Montoya of Pueblo, Colorado who runs Cedar Ridge Landscape in Pueblo with his Ron. They are torn between providingb health care coverage for employees and keeping theirbusinesas afloat.
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