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Purpose: An ICD-10 code for Familial Hyperchole sterolemia (FH), E78.01, became effective October 2016 following a proposal in 2013 to the ICD-10 Coordination and Maintenance Committee by the Family Heart Foundation. The code differentiated FH from other forms of elevated cholesterol, signaling the need for differential diagnosis of a condition in which management in the first two decades of life can substantially reduce the burden of aggressive atherosclerosis. This study aims to characterize the % of FH patients diagnosed with E78.01 in an expansive, real-world US dataset. Method(s): The Family Heart DatabaseTM includes diagnostic/ procedural/prescription data from claims and/or laboratory data for >300 million individuals from the US who were screened or treated for any form of cardiovascular risk. This analysis dataset includes 197 million people, including 22 million children, with diagnostic data from October 2016 through June 2020. The number of total (diagnosed + undiagnosed) FH patients within the dataset was estimated assuming an occurrence of 1:250 individuals. Patients with FH (E78.01) were counted if the diagnostic code was applied for a single in-patient claim or at least twice, >7 days apart, for an out-patient claim. Result(s): The number of patients diagnosed with FH using E78.01 has increased substantially since 2016. During 2017 and 2018, use of the code was brisk and likely included previously and newly diagnosed individuals. Diagnosis was reduced dramatically with the onset of the COVID-19 pandemic corresponding with the marked reduction of in-person clinic visits and near halting of preventive care. By June 2020, 246,689 patients were diagnosed with FH representing 31.3% of the estimated total (diagnosed + undiagnosed) FH population of 787,886 within the dataset. Compared with all individuals in the analysis dataset, those diagnosed with FH were substantially more likely to have atherosclerotic cardiovascular disease (40% versus 8%). Conclusion(s): Prior to 2016, an estimated <1% of patients with FH in the US were diagnosed, but without an ICD code it was impossible to track. The number of patients diagnosed with FH (E78.01) has increased substantially since 2016. Within this large, real-world dataset of Americans, 31.3% of the estimated FH population had been diagnosed as of June 2020. However, despite clear screening guidelines, effective therapies, and classification of FH as a public health threat by the World Health Organization, most of the FH population remains undiagnosed, leaving these genetically vulnerable individuals at high risk for premature cardiovascular disease.
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Research methodology: The case was developed by interviewing Rizwan Koita, CitiusTech chief operating officer (CEO) and cofounder. Case overview/Synopsis: CitiusTech, Inc. was a privately held health-care technology and consulting services provider with over 6,000 employees worldwide, with the majority in India. Since 2015, CitiusTech has been certified as one of India's best workplaces by the Great Place to Work Institute®.The case is set in 2020 when CitiusTech's business operations were severely disrupted as its customers suspended work on health-care technology projects to focus on responding to the COVID-19 pandemic. As a result, Rizwan Koita, CitiusTech's CEO and cofounder, suddenly found himself with a considerably large, highly qualified, underused talent pool and a significant loss in revenue. Instead of laying off highly skilled and trained employees, CitiusTech took a long-term view of the situation, believing that business would pick up in the third or fourth quarters and there would be a need to scale up teams. However, as 2020 was closing, Koita wondered if he had done enough to enhance employee engagement amid the disruption caused by COVID-19. Complexity academic level: This case is intended for use in undergraduate courses focusing on leadership, industrial and organizational psychology or human resources management. This case may be positioned after students have been familiarized with the fundamental concept of employee engagement. © 2022, Emerald Publishing Limited.
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Methods: Semi-structured interviews were conducted with 51 providers and 30 Veterans across 12 VHA Medical Centers (VAMCs). Interviewees included staff delivering and patients participating in tele WH coaching, tele WH educational classes, and tele-complementary and integrative therapies (e.g., acupuncture, chiropractic, yoga, Tai Chi, mindfulness or meditation). Interviews were transcribed and a content analysis was performed using a rapid approach. Results: Participants described a broad range of benefits associated with Veteran participation in teleWH services. These included: 1) Improved access to services that previously were not widely offered in-person;2) Increased comfort engaging in services, especially for specific Veteran populations (e.g., Veterans with PTSD, LGBTQ, women, and younger Veterans);3) Greater convenience, including less stress related to travel, length of time required to use services, and integration with workday;and 4) Increased engagement in self-care outside of classes or services. Disadvantages included: 1) Decreased socialization and opportunities for group interaction;2) Decreased access to touch-based services (e.g., acupuncture);3) Technological challenges with approved virtual platforms. Facilitator skill and tele health etiquette mattered greatly for satisfaction with tele WH. Background: The Veterans Health Administration (VHA) quickly responded to the COVID-19 pandemic by providing access to care via tele health. This rapid pivot occurred simultaneously with VHA's Whole Health transformation, which includes the integration of complementary and integrative health services, education, and coaching to develop self-care skills. This qualitative study explored providers' and patients' perspectives on the implementation and advantages/ disadvantages of tele-Whole Health services (tele WH). Conclusion: Tele WH is perceived to be a strong complement to in-person services and poses many physical and mental health benefits for patients. Attention to facilitator skills training and ease of virtual platform use is needed to increase engagement and make tele WH a viable patient centered option for care.