美国国家公共电台 NPR Can Home Health Visits Help Keep People Out Of The ER?

 

RACHEL MARTIN, HOST:

When people with simple, non-urgent medical problems go to the emergency room for treatment, it creates all kinds of problems - ERs get overcrowded, treatment is expensive, it's often inefficient¹. This is a big issue here in Washington, D.C., which has the highest per capita 911 call volume in the country. The District government, insurers and health providers are all trying to figure out how to bring ER visits down. One proposal is to go to Medicaid patients' homes and use telemedicine for primary care. Selena Simmons-Duffin from member station WAMU explains.

SELENA SIMMONS-DUFFIN, BYLINE²: When Dennis Lebron Dolman went to a health screening fair over the summer, he found out he had crazy high blood pressure - 180 over 100 - stroke-level high. He's 41 years old and hated doctor's offices, didn't want to go. Three months later...

GRACE KELLY: So what I want you to do is listen to this while I take your blood pressure...

DENNIS LEBRON DOLMAN: OK.

KELLY: ...Because I do not want it to be high.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED WOMAN: As you breathe in, be aware of breathing in.

SIMMONS-DUFFIN: Dolman's on a cushy brown couch³ getting his blood pressure taken by medical assistant Grace Kelly. She's part of a new telemedicine program at Mary's Center, a community health center in D.C. They've had several of these appointments. Today, the blood pressure reading is OK.

KELLY: It's a lot better than before, but it's still high. You might have to actually take something. Hi.

GITA AGARWAL: Hi.

SIMMONS-DUFFIN: That's Dr. Gita Agarwal video calling in from across town.

AGARWAL: Hi. How are you, sir?

DOLMAN: I'm fine, and yourself? How are you today?

SIMMONS-DUFFIN: Dr. Agarwal checks out Dolman's vitals that Kelly has entered into her system - temperature, blood pressure and weight.

AGARWAL: Great. Let's see how your weight is. Oh, what happened with the weight?

DOLMAN: I haven't made it to the gym yet. That's the problem.

SIMMONS-DUFFIN: He weighs 210 pounds, which isn't too bad for his height, but he lost weight with diet and exercise to get his blood pressure down. And now it's crept back up.

AGARWAL: What should we do? What do you think? Do you want to see a nutritionist?

DOLMAN: I mean, that would be - that would be fine.

AGARWAL: And how about an exercise program?

DOLMAN: Yes.

SIMMONS-DUFFIN: This exchange, connecting patients with different health care providers and services that can help them, is the real promise of telemedicine in D.C. according to Erin Holve. She's the director of health care reform and innovation⁴ at the D.C. Department of Health Care Finance⁵.

ERIN HOLVE: It's still early days for telemedicine, but there are lots of reasons to believe that establishing the kind of relationship between a patient and provider and having that continuity⁶ of care will ultimately⁷ reduce some of the non-emergent visits to the ER and result in better outcomes⁸ for the long run.

SIMMONS-DUFFIN: The patients being targeted by this program otherwise wouldn't go to a regular doctor visit, meaning they'd miss out on preventive care. Some patients like Dennis Lebron Dolman just really don't want to go to the doctors. Others can't get there because of mobility⁹ or child care issues or because they can't get time off work. In the immediate¹⁰ sense, this program might have prevented an ER visit. If Dolman's blood pressure had gone unchecked, he could have had a stroke. But it's also connected him to a provider he can go to in the future for any issue with his health that might come up.

AGARWAL: Do you want a flu shot?

DOLMAN: I usually do fine without a flu shot.

AGARWAL: But how do you know you'll be fine this year?

SIMMONS-DUFFIN: Dr. Gita Agarwal talks Dolman into it. Medical assistant Kelly has a flu shot with her, and he gets it on the spot there in his mom's living room.

DOLMAN: Dr. Gita's good. I like her.

SIMMONS-DUFFIN: Dolman walks Kelly out at the end of the visit. He's now linked with a provider he trusts who comes to him.

DOLMAN: Because it's convenient and like just good company and all of the above.

SIMMONS-DUFFIN: He likes feeling like someone is keeping track of him so he doesn't slack¹¹ off, someone who'll check to see if he's gone to the gym, improved his eating habits and ultimately gotten that blood pressure down. For NPR News, I'm Selena Simmons-Duffin in Washington.

(SOUNDBITE OF MARCUS D'S "ALL AROUND THE WORLD")

1 inefficient   

adj.效率低的，无效的

参考例句：

• The inefficient operation cost the firm a lot of money.低效率的运作使该公司损失了许多钱。
• Their communication systems are inefficient in the extreme.他们的通讯系统效率非常差。

2 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

3 couch   

n.睡椅，长沙发椅；vt.表达，隐含

参考例句：

• Lie down on the couch if you're feeling ill.如果你感觉不舒服就躺到沙发上去。
• The rabbIt'sprang from its grassy couch.兔子从草丛中跳出。

4 innovation   

n.改革，革新，新观念，新方法，新发明

参考例句：

• There are all sorts of possibilities for technical innovation.技术革新的门道很多。
• An enterprise should encourage innovation.企业应鼓励创新。

5 finance   

n.财务管理，财政，金融，财源，资金

参考例句：

• She is an expert in finance.她是一名财政专家。
• A finance house made a bid to buy up the entire company.一家信贷公司出价买下了整个公司。

6 continuity   

n.连贯性，连续性，持续性

参考例句：

• There is no continuity between the three parts of the book.这本书的三个部分之间没有连贯性。
• Unfortunately,no questions from the audience broke the continuity of his harangue.令人遗憾的是，没有听众提出问题来打断他的高谈阔论。

7 ultimately   

adv.最后地，最终地，首要地，基本地

参考例句：

• It was a demeaning and ultimately frustrating experience.那是一次有失颜面并且令人沮丧至极的经历。
• Vitamin C deficiency can ultimately lead to scurvy.缺乏维生素C最终能道致坏血病。

8 outcomes   

结果( outcome的名词复数 )

参考例句：

• The two scenarios provide illustrations of consistent set of outcomes for range of possible policies. 这两个方案说明某一套可能采取的政策将会产生的一系列后果。
• We analyzed all the possible outcomes of your mission, Commander. 我们分析过所有可能的结果，指挥官。

9 mobility   

n.可动性，变动性，情感不定

参考例句：

• The difference in regional house prices acts as an obstacle to mobility of labour.不同地区房价的差异阻碍了劳动力的流动。
• Mobility is very important in guerrilla warfare.机动性在游击战中至关重要。

10 immediate   

adj.立即的；直接的，最接近的；紧靠的

参考例句：

• His immediate neighbours felt it their duty to call.他的近邻认为他们有责任去拜访。
• We declared ourselves for the immediate convocation of the meeting.我们主张立即召开这个会议。

11 slack   

adj.松弛的，萧条的，懈怠的；vt.使松弛

参考例句：

• Slack off those ropes there,there's a storm coming!把那里的绳索放松，暴风雨就要来了！
• Some are hard at work and some are slack in work.有的勤奋工作，有的则消极怠工。