Demystifying Value-Based Care: Ensuring Success-Minerva Case Study

Minerva Case Study
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Minerva, an 86-year-old female, is seen for the first time post-discharge from Memorial Hospital after a hospitalization for congestive heart failure (CHF) exacerbation compounded by bilateral leg edema and cellulitis. Minerva has experienced multiple hospital admissions over the past year due to leg edema and cellulitis related to CHF, as well as an episode of urinary tract infection (UTI) with mental status changes.<br /><br />Her medical history is complex, including a diagnosis of moderate Alzheimer's disease with behavioral disturbances, coronary artery disease, chronic kidney disease (stage 3), macular degeneration, generalized osteoarthritis, hypothyroidism, gastroesophageal reflux disease (GERD), breast cancer (status post-mastectomy), and recurrent UTIs. Minerva's dementia, diagnosed six years ago, has recently worsened, manifesting as increased forgetfulness, agitation during personal care, and bouts of verbal and physical aggression.<br /><br />Minerva lives with her daughter, the primary caregiver, while her son holds her health power of attorney (HPOA). The family has noted significant caregiver burden, with her daughter's burden score indicating high stress levels. <br /><br />Upon examination, Minerva presented various health issues, including mild flexor contracture in the knees, a sacral-coccygeal stage 4 pressure ulcer, and chronic venous changes in her swollen legs. She showed signs of irritability but could be redirected, though her cooperation during the exam was inconsistent.<br /><br />Minerva's medical regimen includes Donepezil, Memantine, Isosorbide, Furosemide, KCL, MgCl, Metoprolol, Hydrocodone/APAP (occasionally), APAP, Levothyroxine, Omeprazole, Ocuvite, and a multivitamin. <br /><br />The family seeks strategies to manage her heart failure and leg swelling to avoid further hospitalizations, enhance her mobility to reduce caregiving burden, improve her mood and behavior, and minimize UTI occurrences. <br /><br />Key areas of concern include her mood/mentation, mobility, medication complexity, and the multicomplexity of her health status. Potential adjustments to her treatment will focus on achieving these care goals and improving overall patient and family well-being.
Keywords
congestive heart failure
leg edema
cellulitis
Alzheimer's disease
caregiver burden
pressure ulcer
medication regimen
mobility
UTI
behavioral disturbances