Issue link: https://beckershealthcare.uberflip.com/i/644565
21 pressure? When it's high, when do you retake the blood pressure?' We created registries and alerts so providers know when someone's had a high blood pressure that they need to reach out to the patient again. We created standard processes for the treatment and refill of medication. When we began the project in 2013, we had about 60 percent of our patients with high blood pressure under control. By 2014 we were at 75 percent control, and at the end of this year we had 84 percent of our hypertension patients under control. We increased to an 84 per- cent control and, at the same time, uncovered the hidden population of patients with hypertension that no one had diagnosed." New York Fritz Francois, MD, CMO, Patient Safety Offi- cer, Associate Professor of Medicine, NYU Lan- gone Medical Center (New York City) "What we see right now as a major concern is the overuse of antibiotics. As a result, we have seen the incidence of multidrug-resis- tant organisms rising, and we've also lost tools traditionally used for these organisms. Our concern is that individuals might present with conditions associated with these resistant bacteria. We're also think- ing about the individuals who might harbor resistant organisms and have not yet shown any signs of disease. We're approaching it in several different ways under the umbrella of antibiotic stewardship — to better understand the pattern of use of antibiotics and educate our clinicians about what [medicine] would be most appropriate. We continue to study recommendations and guide- lines about how long individuals should be exposed to antibiotics, and ask ourselves if it is possible that we could safely reduce that exposure. On the hospital side, in our step-down unit, we are using molecular techniques to not only identify certain organisms but also the pattern of spread. We tie that with a specific processes to reduce the chance of trans- mission, and with that we have started to see some improvements. On the outpatient side, we're in the beginning phases of looking at the data to understand the use of antibiotics as well as the conse- quences [of using them] in various populations. We have done some very interesting research here at NYU Langone. We are interested in investigating the consequence of early antibiotic exposure on the lifecycle of an individual. We are asking questions around this is- sue knowing full well that we've seen a rise of a number of things, including allergies and obesity that may be associated with changes in the microbiome. e data might allow us to develop strategies to reduce the chance that these higher risk populations would develop significant health problems in the future." North Carolina John D. McConnell, MD, CEO, Wake Forest Baptist Medical Center (Winston-Salem) "e increasing burden of chronic disease is the biggest health concern. In many of our highest-risk patients, all of these things, [such as obesity, high blood pressure and heart dis- ease], come together on a single individual. We have programs on the adult side that focus on weight management, but what is really scary is what's happening with obesity among children. If le unchecked, that will have an even more major impact on the incidence of Type 2 diabetes in adults. So we have a very specific set of strategies for pediatric obesity that are codified in a program we have that has been federally funded, called Brenner FIT (Families in Training). Children with obesity are referred into our center, usually by pediatricians, but the 'patient' is really the family. So they go through an assessment of eating be- haviors, physical activity behaviors, even family dynamics. en a customized regime is developed for the family that involves cooking classes, instructions on physical activity, some behavioral modifi- cation approaches and then a longer term follow-up. We do that in partnership with the YMCA." North Dakota Kurt Schley, Market CEO, CHI St. Alexius Health (Bismarck) "e biggest pressing health concern is work- force and access to labor. We've had an in- credible growth in population. Even with the decrease in oil prices, which has led to a de- crease in oil production, unemployment in our Bismarck area is still very, very low. And there are opportunities. ere is competition for not only skilled healthcare jobs but also plant operations and dietary [positions]. We have to compete with local fast food restaurants and other employers. is has not impacted our hospital yet, but there are businesses that closed on Sundays and Mondays because they don't have staff. It's an incredibly tight labor market. First and foremost, you have to be competitive with your wages. ere are all kinds of opportunities where folks can work at any lev- el. I frequently say to our associates at orientation, 'ank you for choosing to work at CHI St. Alexius Health,' because there are oppor- tunities everywhere. We have to be just very aware of that and we're trying to involve them in how we do things so they feel engaged and this is a place they want to come to work." Ohio Brian G. Donley, MD, Chief of Staff and Chief of Clinical Enterprise, Cleveland Clinic "e rise in chronic disease remains the most pressing health concern locally and throughout the country. As a nation, this continues to chal- lenge us in our effort to deliver better health outcomes at a lower cost. It is important for people to become more engaged in their care. at engagement must focus on wellness, pre- ventive care and both inpatient and outpatient healthcare. We need to increase our focus on "health" care rather than "sick" care to re- duce this burden of chronic disease. We created a wellness institute with an emphasis on teaching our pa- tients and employees how to live healthier and giving them tools they need to be successful in controlling their chronic disease. We no lon- ger allow smoking at our facilities and we do not hire smokers. Most importantly, we provide the resources necessary to help people stop smoking. Our employee health plan is focused on wellness and re- wards healthy behavior with reduced insurance premiums if they meet their goals. If an employee or their spouse has a chronic disease, we