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2020 Heart of Case Management Awards

Winners of preeminent case management award show resilience during an unprecedented year

In a year when pandemic restrictions put the world on pause, Genex Services’ case managers kept going, determined to help injured employees regain function and return to work in a timely manner. Such successful acts of perseverance resonated in each nomination received for the 5th annual Heart of Case Management Awards and the four winning cases selected for this year’s honors reflect the best of these individual acts of excellence.

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Held this year in conjunction with National Case Management Week (Oct. 11-17), the Genex Heart of Case Management Award recognizes four case managers who have made the greatest impact on the injured employees they served. Now in its fifth year, the Heart of Case Management Awards is a national program recognizing Genex case managers who are highly regarded for transcending beyond their traditional job duties to improve the lives of thousands of injured employees each year. The four winners were nominated from a field of more than 1,600 Genex case managers across the country and judged on the following criteria: specialist, excellence, adaptability, trust, influential communication and outcomes.

Among this year’s winners is a case manager who worked tirelessly to keep a homeless injured employee off the streets so she could recover and avoid contracting COVID, another who advocated for an amputee to receive a highly functional hand prosthetic to return to full duty and a bilingual case manager who broke down cultural barriers to help four employees who sustained serious burns get the care they needed to heal and get back to their jobs.

Watch this video to see how case managers moved claims forward during COVID-19.

The following are synopses of the winning entries.

Catastrophic Case Management
Kayla Payne, RN, BSN, CCM
Memphis, TN
A 45-year old man working on a conveyer accidentally had his hand get stuck in an augur. The immense trauma he experienced was intensified by the tenuous process of safely releasing his hand from the machine — a 30-minute ordeal. Finally freed, the man was rushed to the local emergency department (ED) where he was diagnosed with a crush injury. Payne was assigned to the case and met the injured employee at the hospital. A hand surgeon was called in and it was determined the man would require below-elbow amputation of his left arm. Prior to becoming a case manager, Payne had worked as an ED nurse at the same hospital where the man was being treated. Her experience and relationships with medical staff allowed her to quickly report the necessary information to the adjuster to begin the treatment plan. After extensive surgery, Payne developed a return-to-work plan, communicating realistic outcomes to the adjuster and the employer. When the specialist recommended the injured employee be fitted with an electrical hand and a gripper prosthesis, Payne became educated on the prosthesis, so she could address the injured employee’s questions and concerns. Through

HFpEF Management: 5 Things to Know

4. Physicians need to be mindful to protect the right ventricle of patients with HFpEF.

Both pulmonary hypertension and RV dysfunction are highly prevalent in HFpEF. RV dysfunction probably results from a combination of impaired RV contractile function and elevated RV afterload. Longitudinal HFpEF studies have shown that RV structure and function worsen over time; this deterioration has been associated with atrial fibrillation, coronary artery disease, obesity, and increased left heart and pulmonary venous pressures.

As left heart filling pressures rise, the pulmonary vasculature becomes less compliant, increasing RV afterload. In addition, remodeling of the pulmonary vasculature, including intimal thickening in the veins and intimal and medial thickening in the arteries, may occur. Therefore, tailored diuretic therapy to normalize left heart filling pressures and prevent pulmonary congestion is a mainstay of treatment for patients with HFpEF. Discharge diuretics were recently associated with both a reduction in 30-day HF rehospitalizations and mortality in patients with HF, independent of ejection fraction. In the setting of diuretic resistance, transitioning patients from furosemide to a loop diuretic with more consistent bioavailability (eg, bumetanide, torsemide) may also be helpful. Although thiazide diuretics may be used on an as-needed basis to facilitate diuresis, their daily use in conjunction with a loop diuretic should be limited in the outpatient setting owing to the risk for kidney injury and electrolyte abnormalities. Finally, implantable pulmonary artery pressure monitoring devices may be particularly useful in the HFpEF population to maintain and achieve euvolemia, proving effective in guiding diuretic therapy in order to reduce hospitalizations.

Although physiologically tempting, pulmonary vasodilator therapy is currently contraindicated in this population and may only be given to patients in a clinical trial setting. Two such studies, one testing whether sildenafil improves outcomes in patients with persistent pulmonary hypertension and the other evaluating the effects of macitentan on pulmonary hypertension with LV dysfunction, have suggested worse outcomes with these therapies.

5. Patients with refractory HFpEF should consider enrolling in clinical trials.

The lack of effective medical therapies for HFpEF has led researchers to reassess clinical trial designs for HFpEF. In particular, the delineation of specific clinical (eg, HFpEF with right heart failure), hemodynamic (eg, marked rise in left-sided filling pressures with exertion), and genetic (eg, amyloid) phenotypes is now shaping trial enrollment in an attempt to better match drug and device mechanisms to pathophysiologic mechanisms. (HFpEF with concomitant right ventricular failure, HFpEF with predominant exercise intolerance, and HFpEF due to amyloidosis are just some examples of phenotypic variants.) One example includes interatrial shunt devices that produce left-to-right shunts, lowering left atrial pressures (particularly during exertion). Initial studies on such devices have enrolled carefully selected patients with HFpEF whose hemodynamic profiles favor left-to-right shunting. Early results from ongoing major outcome trials, such as REDUCE LAP-HF I, have shown promise.

Physicians caring for patients with refractory HFpEF are strongly encouraged to refer them to a specialized center participating in clinical trials. Such participation may benefit not only these patients but others like them who are seriously in need