This is a story of how a very simple case management intervention changed the quality of life for a teenage member, drastically reduced expenses for Hudson Health Plan, and made me very proud of my role as case manager.
“Tod” has a history of lupus, hypertension and nephritis with multiple admissions for renal hypertension (with Blood Pressure ranges from 164/111 to 207/141) and seizures that were diagnosed as hypertensive encephalopathy.
Prior to our case management intervention, he was admitted to a regional medical center with respiratory distress following an infusion of Rituxan. His admitting diagnosis was pulmonary edema. While there, a biopsy was done which was consistent with Class 4-5 lupus nephritis. He also had worsening renal failure and left ventricular hypertrophy. In the six months prior to this event, he had eight admissions with total hospital costs of about $100,000.
I called and spoke with his rheumatologist, Dr. “Han” who said that there was a history of non-compliance with his medication and diet regime, and she was continually treating his emergencies rather than being able to prevent them. He now had to be placed on emergency hemodialysis for his renal failure.
Although I left a message for the hospital case manager to call me to discuss discharge planning, Tod was sent home before she could call back. I was finally able to reach his mother by phone, after several wrong number attempts.
I discussed my recommendation for a homecare referral to assist her, her son, and his siblings in diet and medication management. She admitted feeling overwhelmed by his condition and thought that, at 13, her son should be responsible for refilling all of his prescriptions and following his diet. She was agreeable to having a homecare referral for education for Tod and his family. I requested an order from Dr. Han for the homecare agency to do a nursing evaluation, and explained that Hudson Health Plan would support and authorize the visits. Dr. Han was enthusiastic about this suggestion. She said both Tod and his mother were becoming depressed from his illness. Dr. Han said Tod experienced an almost fatal reaction from Rituxan, and his prognosis was very guarded if he continued to be non-compliant. She felt he was a pretty responsible youth, but he needed more understanding of the importance of a low sodium and low protein diet. She said that his siblings made it more difficult by sharing chips and snacks with him.
The homecare agency made several successful visits for the education of Tod and his family. There were no further hospital admissions! A year later, I received a call from Dr. Han who said she was thrilled with how well he is doing since the referral for homecare. She praised Hudson Health Plan for our interest in this member and for the outreach that was made to him.
The proudest and most gratifying moment for me came recently when I learned that after three years he is still compliant with his diet and medications. A long-term victory for case management!
The cost of his homecare intervention … $194! The improved quality of his life …Priceless!
