What a Difference a Year Makes
Focus on Frailty and Other Positive Changes
Early in the COVID-19 pandemic, something positive happened. The outbreak prompted the National Institute for Health and Care Excellence (NICE) to issue a set of urgent care guidelines recommending screening patients using the Clinical Frailty Scale, a validated frailty screening tool, useful for brief bedside assessment. The importance of understanding patient frailty received international attention that we at Patient Pattern have long advocated for.
In these guidelines, the degree of frailty usually experienced by the patient was to be considered as part of a comprehensive assessment to guide the approach to their care. The need for determining aggressive approaches to care versus less aggressive or palliative care based on physiological risk, clinical judgment, and resilience to recover was necessitated by the very number of patients infected by the virus and resources available.
Things to Celebrate
- Frailty, promoted to the world as a risk metric providing valuable insight for clinical care.
- The discussing end-of-life priorities and documenting wishes early has increased.
- Age-Friendly Health Systems, recognizing frailty-contributing factors, are increasing.
- COVID-19 Vaccinations have begun and will be the lynchpin of a return to new-normal.
Things to Ponder
While this focus on frailty, as well as increased use of telemedicine and attention to the importance of advance care planning, have been positive developments, still the world is far from effectively managing the pandemic. Those at the highest risk continue to be suffering from excessive disease burden and increased mortality. We have made many positive changes, but more need to come:
- Congregate living settings – nursing homes, prisons, homeless shelters, etc.—need to be redesigned to help prevent/minimize outbreaks and the spread of infection. For instance, staples such as sleeping rooms with 4 or more people, large dining halls, and serve-yourself eating pose risks and must be rethought/reimagined to promote balance safety and engagement.
- Social determinants of health – access, literacy, transport, poverty, insurance, etc. – need redress. These have a major impact on people’s health, well-being, and quality of life. They also contribute to wide health disparities and inequities; just promoting healthy choices won’t eliminate these and other health disparities.
- A higher risk and disease burden exist for Blacks, Asians, and other people of color. Racial disparities are already getting great attention, and this attention needs to evolve into solutions.
- Health caregivers in high-risk settings are often most affected by the same social determinants as patients, and this needs to be attended to as well. The National Association of Health Care Assistants (NAHCA) is addressing this with a virtual CNA March on Washington on April 7 to rally support for the heroes on the frontlines of COVID-19.
Change Still Needed – Where to Start
We have a great deal to hope for in 2021 and beyond, but we also have work to do. To the extent possible, as caregivers in the healthcare world of high-risk, vulnerable populations, and as a company with a mission to improve healthcare for those with chronic illnesses and frailty, we will continue our work of introducing frailty software as one tool needed to identify the most vulnerable and to use the information to target and inform our clinical care.
Our patientpattern.com mission aligns with the needs addressed here. We can help you take the next steps to identify, manage, and communicate risk and improve outcomes and maximize reimbursement. Let’s work together for the future.