Is Reducing Serious Hypoglycemia one of your PIPs?

by Timothy Gieseke MD, CMD

This year, our state QIO, HSAG, has been sponsoring webinars that help our facilities reduce the risk for incurring a readmission payment penalty, when the financial penalties go live January 1, 2019.  I will be presenting the webinar on June 27th for reducing the risk of serious hypoglycemia. You can register at:

While there are many traditional things we can do to identify and manage this risk, our tool bag for safely lowering the risk has increased in recent years with the addition of SLG2’s and Incretin Receptor Agonists.  Both classes of medicines have a much lower risk of inducing serious hypoglycemia then oral sulfonylureas or insulin and both may help reduce weight and may reduce the risk of macro-vascular disease. Empagliflozin (Jardiance) and lirglutide (Victoza) now have an FDA indication for macrovascular risk reduction.  Empagliflozin is ineffective if EGFR is < 30, but liraglutide has no dose adjustment for renal or hepatic disease. The expense of both of these medicines is similar to the now high cost of our insulins.

What Consumers Say about Nursing Homes in Online Reviews
2018 Poster Session: 3rd Place Winner
Presented by: Yujun Zhu, M.S.G., [email protected]* - *Mr. Zhu is the team’s corresponding author. (See full list below.)
Background: Although patient-centered care is an expressed value of our healthcare system, no studies have examined what consumers say in online reviews about nursing homes (NHs). Insight into themes addressed in these reviews could inform improvement efforts that promote patient-centered NH care.

Methods: We analyzed NH Yelp reviews. From a list of all NHs in California, we drew a purposeful sample of 51 NHs, selecting facilities representing a range of geographical areas and occupancy rates. Two research teams analyzed the reviews using grounded theory to identify codes and tracked how frequently each code was mentioned.

Anticholinergic Burden Assessment and Future Diagnosis of Dementia

by Janice Hoffman Simen, PharmD, EdD, APP, BCGP, FASCP

Recently, an article published in the British Medical Journal, April 2018, looked at patients in the UK with a new dementia diagnosis and the use of prescription medications with anticholinergic adverse effects up to 20 years previously (Richardson, et al., 2018). In this study, the researchers found a link between a new dementia diagnosis and an increasing average Anticholinergic Burden score (ACB). According to the results of this study, the risk of dementia increases with an ACB greater than three, including exposure 15-20 years prior to diagnosis, with the following drug classes: antidepressants, urologic, and antiparkinson agents. The findings are interesting as a risk factor for the onset of dementia and encourages the assessment of anticholinergic burden in younger patients.

Win as Much as You Can

by Timothy Gieseke MD, CMD

As the recipient of the 2018 CALTCM Leadership Award at this month’s annual meeting, I have had time to reflect on my career in medicine and the events that shaped that career.  I recalled my wife’s decision to become a pediatric physical therapist, in large part related to volunteer work she had done in High School at “We Care for Children.” ( and how that led this “Lone Ranger” trained physician to highly value the work of the various disciplines in our specialty. 

State of the Organization - May 2018

by Michael Wasserman, MD, CMD

How many of us have cared for frail older adults who were failing at home, yet seen them thrive in a nursing home?  The structure and socialization that is provided in nursing homes is hard to duplicate in the home setting. The delivery of care in nursing homes is the true definition of teamwork, and at CALTCM we are trying to model this.  In addition to physicians, our members include nurse practitioners, physician assistants, pharmacists, social workers, psychologists, DON’s, and nursing home administrators. The field of geriatrics has always accepted and promoted teamwork.  One thing I have learned through efforts to reduce antipsychotic medications in nursing homes is that it takes a collaborative approach between facility staff and the clinicians caring for the residents. We have a responsibility to lead the way in modeling the most effective collaborative approaches to caring for some of the most vulnerable members of our society.  We also need to effectively message the value of the care that is provided along the long term care continuum. As I visit nursing homes I am often struck by the gratitude of the residents, and am profoundly humbled by the efforts of the front-line staff, many of whom find their work to be a calling. I believe that we can all join them in that regard.

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