Innovations and Efficiencies in Home-Based Care: HCCI Solutions Suite for NPHI Members-Ralph Case

Ralph Case
Pdf Summary
Ralph is a 77-year-old African-American man with a complex medical history including oxygen-dependent COPD, pulmonary hypertension, and heart failure with reduced ejection fraction (HFrEF). He has a history of frequent hospitalizations due to severe shortness of breath, but after working with his healthcare provider and nephew, Reggie, his hospital visits had reduced until a recent escalation in symptoms led to another hospital stay.<br /><br />Ralph's past medical history includes stage 4 COPD, coronary artery disease (CAD) with a remote coronary artery bypass graft (CABG), atrial fibrillation, hypertension, benign prostatic hyperplasia, chronic kidney disease stage 3, and anemia among others. He currently uses several medications including carvedilol, amiodarone, and Isosorbide mononitrate ER for heart conditions, as well as furosemide and hydralazine for blood pressure control.<br /><br />His social history reveals he is a widower living alone in a neighborhood with gang activity. He has family support from Reggie, who checks on him daily, and his sister Jessica, who helps with groceries. Ralph lives on social security payments, and cost issues often cause Reggie to miss picking up medications from the pharmacy.<br /><br />Clinically, Ralph presents with poorly controlled systolic hypertension, and his recent vitals show persistent high blood pressure. He experiences significant mobility issues, uses a cane for stability, and exhibits symptoms of shortness of breath, fatigue, and notable bilateral leg edema. His COPD and heart failure severely affect his functional status, contributing to his overall complexity as a patient.<br /><br />Recent assessments indicate a PHQ-9 score of 13 suggesting depression, and environmental factors such as a cluttered home with extension cords pose added risks. Despite the use of multiple medications and devices including an oxygen concentrator and nebulizer, Ralph continues to struggle with daily activities and symptom management.<br /><br />To address Ralph’s situation, some key areas of focus include enhancing medication adherence possibly by reducing complexity and cost, improving home safety to prevent falls, and considering interventions for mental health and sustained support to maintain his independence.
Keywords
COPD
heart failure
hypertension
medication adherence
depression
mobility issues
home safety
family support
social security
oxygen therapy