We’re always looking for how we can incorporate technology, how we can be innovative to meet the changing needs of our patients. You know, I think we’re seeing patients with more complex care needs at home and we need to find ways to incorporate advancements such as molecular testing into our care. I believe, as all of us in home health believe and the patients we serve, that receiving care in the home is the patient’s top choice for where they want to be and where they want to heal. So this cross-collaboration and healthcare advancements will really help to ensure that home health care will be available for the foreseeable future.
Erin Vailler:
Welcome to another episode of the Home Health 360 podcast, where we speak to home-based care professionals from around the globe. I’m your host, erin Valliere, and today I’m joined by Barbara Andazola, home Health VP of Clinical Practice Strategy and Programs at Amedisys. Barbara oversees the creation and execution of clinical practice standards, programs and processes. Her work is pretty pivotal in optimizing strategic initiatives to enhance clinical care and patient outcomes. With a rich career spanning 27 years as a registered nurse, barbara has dedicated 22 of those years to home health and a variety of leadership roles, and has been a member of a Medisys for the last four years.
Erin Vailler:
Welcome to the show, barbara. Thank you Glad to be here. I am so excited to talk to you today. You have this really interesting program that you’ve recently launched at Amedisys. That caught our eye and I feel like we need to talk all about it, because it seems like it might revolutionize some things in home care, including delivery, diagnosis and treatment to keep people safe in the home, and it’s molecular testing. Can you tell me a little bit about that? What is molecular testing?
Barbara Andazola :
We’re pretty excited here at Emeticis as well about molecular testing. Molecular testing, it’s also known as real-time PCR or polymerase chain reaction testing. The test works by applying polymerase, which is an enzyme, to a sample of blood, urine, saliva, mucus, etc. After the enzyme is applied to the specimen, it is inserted into a machine, and if the sample contains infection-causing pathogens, the enzyme will cause the DNA of that pathogen to replicate, and so in a short amount of time, or an hour or so I’m not the lab expert, but as I understand it, an hour or so millions or actually billions of copies are made and the specific pathogen responsible for the infection is identified.
Erin Vailler:
Well, that’s pretty cool. So, if folks are familiar with COVID, if you remember that there was a PCR test that you had to go and take before you got on a plane, this is what you’re doing to diagnose different things in the home. Is that correct? Exactly, very cool. So what inspired Amedisys to invest in providing this testing to clients? I’m sure there’s a good origin story here.
Barbara Andazola :
Absolutely. I started talking with a couple of folks over at Patient Choice Laboratories. I didn’t know at the time when we were doing COVID testing that this same technology was used to help identify other infections UTIs, urinary tract infections, other respiratory infections could also help us identify infections and wounds, and when you look at our elderly population, there is a pretty significant number of urinary tract infections and UTIs are actually one of the leading causes of hospitalizations with our patients, and so that’s what really piqued my interest and we started talking with them and we felt that through use of molecular testing, we could really make an impact by identifying the infections early and help prevent hospitalizations.
Erin Vailler:
Wow, I also didn’t know that a PCR was good for other things than COVID. It’s really very cool that you’re using it for UTIs. It can cause death. Yes, absolutely, and a lot of cases. I have a personal experience with my own grandmother, who didn’t catch that UTI quite in time.
Barbara Andazola :
I’m sorry to hear that we have that in common, unfortunately.
Erin Vailler:
I can tell that this is probably why you’re a little passionate about this project, because we can implement this technology and prevent some of those things from happening, which is amazing. How does molecular testing improve the speed and accuracy of infection diagnosis in home health care?
Barbara Andazola :
Yes, great question. As I just said, we can. Through molecular testing. The specific pathogen can be identified within an hour or so.
Barbara Andazola :
Traditional methods of testing. Let’s take UTIs. Usually we contact the provider, the physician provider, and that provider usually orders a urinalysis with a culture and sensitivity if indicated. So the first part of that test is that urinalysis and really what that urinalysis shows is if there are any red blood cells, white blood cells or bacteria in the urine. That is the first result that we get and that takes a day to get those results. What does the physician do?
Barbara Andazola :
Of course, if that test shows that there might be potential infection, the physician makes a decision and that decision is usually to prescribe a broad spectrum antibiotic. So it’s an antibiotic that may cover more than one type of bacteria, right? That may cover more than one type of bacteria, right? Not until we get the culture do we know that specific type of bacteria or virus, right? That’s causing infection, that pathogen. So when we get the information about the specific pathogen, unfortunately and often the physician provider needs to prescribe a different antibiotic, one that is specific to treating the pathogen. So you can see the time delay again 24 hours for your analysis. I think I failed to mention that a culture and sensitivity piece of the test can take anywhere from two to five days or more. That culture process there are solutions applied to the specimen sample. Then that sample gets put into an incubator and, depending on the specific pathogen causing the infection, it can take two to five days or longer, as some of these pathogens have different incubation periods.
Erin Vailler:
Wow, that’s too long. Yeah, we don’t recognize the symptoms in the elderly until they’re pretty far advanced, especially if a client has dementia, because they don’t necessarily understand pain anymore. Some of that’s numbed out and, wow, you really do need a much faster way to diagnose things. And this is exciting, what you’re telling me now about molecular testing.
Barbara Andazola :
Yeah, we’re super excited.
Erin Vailler:
Thank you. What impact has the introduction of molecular testing had on patient outcomes so far?
Barbara Andazola :
We’re still rather early into the adoption of molecular testing. I can share and really happy to report that overall in our care centers that are higher utilizers of molecular testing we are seeing an overall decrease in hospitalizations. One of the other things that molecular testing does, like you say, it’s rapid identification of the pathogen. But also with those results that we receive from the laboratory there’s also recommendations specific to that patient for how the bacteria should be treated. So this helps us get the patient on the right antibiotic the first time and help to keep them out of the hospital.
Erin Vailler:
I love that. It’s going to make a real huge impact the more and more you guys continue to use this solution. How have you been able to ensure the integration of advanced molecular testing into your centers nationwide?
Barbara Andazola :
Yeah, great question and also just to clarify and this is really a licensing issue we have and we can do molecular testing nationwide. We work with patient choice laboratories and they are able to do the molecular testing for all of our care centers with the exception of those in New York. However, if our care centers or providers work with a lab in New York City or New York State, we can do the testing in New York as well. So as far as how we integrate advanced molecular testing into our care centers, what we have done is we have updated our clinical pathways in our EMR system and this really helps to guide the patient as to when they should use molecular testing. We also have established protocols and we work really hard to get physician approval to incorporate these protocols into our plan of care upon admission of the patient to services so that at first signs and symptoms of an infection, whether it be a respiratory wound or urinary, we can get a specimen collected, get it sent to the lab and get that patient on the right treatment.
Erin Vailler:
It does sound like a really nice integration of technology and collaboration with the doctor. Is what’s happening here? You’ve mentioned your partner a couple of times Patient Choice Laboratories.
Barbara Andazola :
Can you explain the significance of that partnership? Yeah, absolutely. At Amatis we recognize that strategic partnerships such as the one we have with Patient Choice Laboratories play a pivotal role in reinforcing our commitment to quality home-based care, and our collaboration with Patient Choice Laboratories really exemplifies this commitment by leveraging the latest in diagnostic technology. It also reflects our commitment to evidence-based practices which empower us to really tailor treatment plans to the specific needs of our patients.
Erin Vailler:
Yeah, sounds like you found yourself a really good partner, and that’s amazing. We’ve talked a little bit about UTIs and we’ve talked about COVID, but I’m curious if there’s other types of infections that you can use molecular testing to identify and inform treatment decisions.
Barbara Andazola :
Yeah, absolutely. We also use this to help us identify if we have an infection in a wound that may be slow to heal or just not responding to treatment. It can also be used to identify gastrointestinal infections of various sorts as well and, as we mentioned, covid, influenza A, b, other respiratory infections.
Erin Vailler:
Wow GI infections even that’s fascinating. Yeah, it’s a very robust testing mechanism. I’m thoroughly impressed. What challenges have you faced implementing this testing and how did you guys manage to overcome those?
Barbara Andazola :
Yeah, as you can imagine, with anything new or different, there is going to be some hesitancy, and we found this to be true with providers and even our clinicians.
Barbara Andazola :
However, once we were able to educate on the benefits, which of course, are precise and timely identification of pathogens, and then also when we shared with those who are maybe hesitant that this is the same testing that we used with COVID right, with rapid COVID testing then they were more open to learning and adopting molecular testing into their care.
Barbara Andazola :
And I’ll say, for our clinicians, we all are operating during staffing shortages. As a clinician in myself, I think, oh goodness, is this more? Is this going to add more to my day Is just how different is this? But once they found that collecting the specimen was no different and in fact sometimes easier than a traditional specimen, and then the fact that they can collect a specimen, drop it in, of course, package it up, seal it up, package it nicely into a FedEx envelope or UPS envelope and drop it at the nearest drop-off, versus having to drive out of their way to go to a lab or rearrange how they visit their patients that day just to make sure that they’re close by to a lab, this was also a benefit that our clinicians saw. It made it much easier to collect the specimen and get it to the right place so we could get that processed.
Erin Vailler:
That’s great. It sounds like it was just a little bit of a change management situation for you guys, having to educate the clients just to make sure they were comfortable with this new and scary thing and make sure that it was really convenient for your clinicians to do, because, lord knows, their job is hard enough as it is. We don’t need to add any extra layers of administrative burden or time on the road right, exactly, exactly. In what ways, I’m curious, does molecular testing contribute to antibiotic stewardship and the prevention of antibiotic resistance? I read a little bit about that.
Barbara Andazola :
I think we hear more and more about and what some will say are super bugs right these infections or bacteria that are resistant to multiple drugs. So by using PCR testing or molecular testing, because of that rapid detection of the specific pathogen, physician providers are able to prescribe the precise antibiotic to treat that pathogen much more quickly than by using traditional methods and this really helps to minimize or reduce the increase of these drug-resistant bacterias.
Erin Vailler:
That’s important. That’s very important, as the bugs seem to be morphing I don’t know if that’s the right scientific word A little bit faster these days.
Barbara Andazola :
Yeah, and not so much scientific word, but right, I think they’re becoming resistant to the antibiotics prescribed. They’re becoming powerful, right, yeah.
Erin Vailler:
Do you have a success story that you can share with us where you use molecular testing and it significantly impacted the patient’s care?
Barbara Andazola :
I’ve heard from not maybe not one specific, if you will, but just overall and, like I said, with our care centers that are using molecular testing more so than others just a lot of good feedback from the nurses and the providers on, just again, the ease of use and how just getting the patient on the antibiotic, the right antibiotic the first time, how they’re able to see that patient overcome the infection so that they can engage in their plan of care and help to achieve the outcomes a lot quicker than versus having to send the patient to an ER or urgent care on the weekend because we’re still pending culture results and the current antibiotic isn’t working, but so we have been able to keep patients out of the ERs and hospitals.
Erin Vailler:
That’s wonderful, not just because it’s more convenient for the client and they get the care they need a lot faster, but it also helps reduce health care costs Absolutely. So this is great. You’ve mentioned your EMR and you’ve mentioned a couple other technology pieces, so I’m curious if you could expand on that a little bit and tell me what role does technology play in your strategy to enhance those outcomes?
Barbara Andazola :
Yeah, absolutely. We’re always looking for how we can incorporate technology, how we can be innovative to meet the changing needs of our patients. You know, I think we’re seeing patients with more complex care needs at home and we need to find ways to incorporate advancements such as molecular testing into our care. I believe, as all of us in home health believe and the patients we serve, that receiving care in the home is the patient’s top choice for where they want to be and where they want to heal top choice for where they want to be and where they want to heal. So this cross-collaboration and healthcare advancements will really help to ensure that home health care will be available for the foreseeable future.
Erin Vailler:
That’s awesome. You mentioned some innovation and I want to know if you have any future plans. How are you going to further innovate in the field of home health care diagnostics? Do you have any projects or anything you’re exploring?
Barbara Andazola :
You know in general and how we care for our patients. I think a medicine like many other providers, you know, we’re looking at ways that maybe we can use technology to improve patient engagement. We’re also looking at how we can optimize our support teams. We’re all in a staffing shortage, so how best can we support our clinicians? With tools that include technology education, emr, but definitely focus on the patient and always open to hearing new ideas or new technologies and what that can do to the care delivery.
Erin Vailler:
Are you dabbling with AI at all?
Barbara Andazola :
Yeah, some. We are trying to see where that fits in. Is it in the back office, in the front end? But yeah, just vetting through some options there.
Erin Vailler:
Yeah, I’ve seen some exciting solutions with AI to help predict adverse events and also enhance the back office, so I’ll keep my eye on you guys and see how you continue to develop in that area. Yeah, I have one final question for you as we approach our time here, and this one is in honor of Jeff Howell. He was one of the creators of this podcast and he was the one who teed this conversation up for us today, so I feel like it’s only fitting that I steal his question that he always asks his guest. So, barbara, can you give us a reason to be excited about the care provided in the place that our patients call home?
Barbara Andazola :
I think home is where we all want to be, but a reason to be excited about it. I work among so many dedicated caregivers. In a medicine, everyone is a caregiver. You don’t have to be a clinician, you don’t have to be a nurse, a speech therapist, occupational therapist we are all caregivers and we truly believe in what we do, and that is providing the best care in the home for our patients, and so that excites me every day. It motivates me to get up and do my best, and so, for everyone out there, you have a team of caregivers at Ametasys that are really challenging each other every day to provide the best quality care out there.
Erin Vailler:
Sounds like a great place to be if you’re working and it sounds like a great place to partner with if you need the care and the place that we call home. I appreciate your time, barbara. It’s been a lovely conversation and I’ve learned a lot about molecular testing, and I’m sure that you have piqued the interest of our listeners as well. So thank you.
Erin Vailler:
Yeah thank you, Erin. Homehelp 360 is presented by AlayaCare and hosted by Erin Vailler. First, we want to thank our amazing guests and listeners. Second, new episodes air every month, so be sure to subscribe today so you don’t miss an episode. And, last but not least, if you like this episode and want to learn more about all things home-based care, you can explore all of our episodes at alayacare. com / homehealth360 or visit us on your favorite podcast platform.
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Episode Description
In this episode, Barbara Andazola, VP of Clinical Practice, Strategy, and Programs at Amedisys, discusses the groundbreaking role of molecular testing in home health care. As an RN with over 27 years of nursing experience, Barbara shares how Amedisys is leveraging PCR (Polymerase Chain Reaction) testing to diagnose infections like UTIs, respiratory conditions, and even COVID-19 faster and more accurately at home. By identifying pathogens within hours, this technology not only improves patient outcomes but also helps prevent hospitalizations and antibiotic resistance. Barbara explores the challenges and rewards of integrating this advanced technology into home care, its impact on reducing healthcare costs, and the future possibilities for further innovation in diagnostics. Listen to this episode to learn how molecular testing is not only improving care but also driving efficiency, reducing healthcare costs, and shaping the future of home-based care—proving that innovation in home health care can lead to faster, smarter, and more precise treatment at home.