A cardiac psychologist
Kristina J. McGuire prevents unnecessary
re-hospitalizations through intensive case management.
Preventing cardiac patients from boomeranging back into the hospital was one reason the North Shore-Long Island Jewish Health System hired psychologist Kristina
J. McGuire, PsyD, to launch its behavioral cardiology service
in 2011. Hospitals now face hefty fines from the Centers for
Medicare and Medicaid Services if they have above-average 30-
day re-admission rates for heart failure and acute myocardial
infarction patients, says McGuire, who is based in the system’s
Zucker Hillside Hospital in Glen Oak, N. Y.
Of course, says McGuire, helping cardiac patients avoid rehospitalization isn’t just a matter of finances. It’s also about
improving their health. Before the North Shore-Long Island
Jewish Health System created its behavioral cardiology service,
“there really was no system in place for cardiac patients to have
their complex psychosocial needs met,” says McGuire, who
worked on her own until the system hired another psychologist
at a different site last year. (A psychiatrist who devotes half her
time to behavioral cardiology provides psychiatric evaluations
and medication management.) Yet those needs were often what
contributed significantly to patients — especially heart failure
patients — ending up back in the hospital.
Heart failure can be an especially challenging disease for
patients to manage, says McGuire. Patients must monitor their
salt intake and diet carefully to reduce fluid buildup in the lungs
and the rest of the body, for example. They’re often on a lot
of medications. And they can be depressed or anxious about
their diagnosis, something that makes juggling those kinds of
practical matters even more difficult.
“Often patients don’t know where else but the hospital to
turn in order to get their needs met,” says McGuire.
hospitalizations through intensive case management: helping
with discharge planning, identifying support services and
following up to make sure patients adhere to treatment
regimens and get to appointments. For some patients, case
management may make up 50 percent of her work, she says.
In one case, that meant providing a suitable scale for a
patient with heart failure to take home from the hospital.
“Buying a scale sounds very minor, but weighing yourself can
mean the difference between re-admission to the hospital or not
for some patients,” says McGuire.
What she does is above and beyond normal psychotherapy,
says McGuire, who also screens patients for depression,
anxiety and other problems and provides brief psychotherapy
interventions to those who need help. “It requires targeting the
highest-risk patients and using an individualized 360-degree
approach,” she says, explaining that she assesses patients’
perceptions and management of their disease, support system,
logistics and any psychological problems that may be interfering
with their medical treatment. Interventions may include
coordination with treatment providers, telephone support,
individual or group therapy, referrals to community resources
and caregiver support.
Given the nation’s aging population, McGuire believes such
work will become increasingly common. She’s not the only one.
“Kristina McGuire is the wave of the future,” says
psychologist Robert Allan, PhD, co-editor of APA’s “Heart and
Mind: The Practice of Cardiac Psychology.” “The Medicare fines
represent a watershed opportunity for psychologists to go to
the nearest hospital and see if they can sign on in some way to
reduce hospital readmissions.”