Demystifying Value-Based Care: Getting Started-Minerva Case Study

Minerva Case Study

Pdf Summary

Minerva, an 86-year-old woman, was recently discharged from Memorial Hospital following an exacerbation of congestive heart failure (CHF) complicated by bilateral leg edema and cellulitis. She has a history of moderate Alzheimer’s disease, diagnosed six years ago, with a recent increase in behavioral disturbances. Over the past 6-9 months, her symptoms have worsened, including increased forgetfulness, agitation during personal care, and episodes of verbal and physical aggression.<br /><br />Her medical history reveals multiple hospitalizations this past year for leg edema and cellulitis related to her CHF and a prior admission for a urinary tract infection (UTI) with mental status changes. Minerva also has a complex medical background that includes systolic heart failure with reduced ejection fraction (EF 35%), coronary artery disease (CAD), hypertension (HTN), chronic kidney disease (CKD) stage 3, macular degeneration, generalized osteoarthritis, hypothyroidism, gastroesophageal reflux disease (GERD), and a past mastectomy for breast cancer.<br /><br />Minerva currently lives with her daughter, who is her primary caregiver, while her son holds the healthcare power of attorney and assists with groceries and medications. Minerva demonstrates significant cognitive decline, with a Mini-Cog score of 0 and a PHQ-9 score of 14, indicating moderate depression. Physical examination reveals 1+ edema in her legs and a stage 4 pressure ulcer in the sacral area, among other findings.<br /><br />The family has expressed the need for managing her CHF and leg swelling to avoid hospitalizations, improving her mobility and strength, addressing her behavioral issues, and reducing the frequency of UTIs. The care plan includes addressing her complex medical and behavioral symptoms, ensuring her safety and mobility, and providing support to her caregivers to manage her extensive medication regimen and healthcare needs effectively.

Keywords

congestive heart failure

Alzheimer's disease

leg edema

cellulitis

behavioral disturbances

caregiver support

chronic kidney disease

pressure ulcer

medication management

mobility improvement