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"Health care system" redesign

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https://www.readbyqxmd.com/read/28598747/overarching-challenges-to-the-implementation-of-competency-based-medical-education
#1
Kelly J Caverzagie, Markku T Nousiainen, Peter C Ferguson, Olle Ten Cate, Shelley Ross, Kenneth A Harris, Jamiu Busari, M Dylan Bould, Jacques Bouchard, William F Iobst, Carol Carraccio, Jason R Frank
Medical education is under increasing pressure to more effectively prepare physicians to meet the needs of patients and populations. With its emphasis on individual, programmatic, and institutional outcomes, competency-based medical education (CBME) has the potential to realign medical education with this societal expectation. Implementing CBME, however, comes with significant challenges. This manuscript describes four overarching challenges that must be confronted by medical educators worldwide in the implementation of CBME: (1) the need to align all regulatory stakeholders in order to facilitate the optimization of training programs and learning environments so that they support competency-based progression; (2) the purposeful integration of efforts to redesign both medical education and the delivery of clinical care; (3) the need to establish expected outcomes for individuals, programs, training institutions, and health care systems so that performance can be measured; and (4) the need to establish a culture of mutual accountability for the achievement of these defined outcomes...
June 2017: Medical Teacher
https://www.readbyqxmd.com/read/28544493/-it-s-a-fight-to-get-anything-you-need-accessing-care-in-the-community-from-the-perspectives-of-people-with-multimorbidity
#2
Julia W Ho, Kerry Kuluski, Jennifer Im
BACKGROUND: There is a growing interest in redesigning health-care systems to better manage the increasing numbers of people with multimorbidity. Knowing how patients experience health-care delivery and what they need from the health-care system are critical pieces of evidence that can be used to guide health system reforms. OBJECTIVE: The purpose of this study was to understand the challenges patients with multimorbidity face in accessing care in the community, and the implications for patients and their families...
May 24, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28488991/geriatric-hip-fracture-care-fixing-a-fragmented-system
#3
Mary E Anderson, Kelly Mcdevitt, Ethan Cumbler, Heather Bennett, Zachary Robison, Bryan Gomez, Jason W Stoneback
CONTEXT: Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28250024/care-system-redesign-for-preterm-children-after-discharge-from-the-nicu
#4
Dennis Z Kuo, Robert E Lyle, Patrick H Casey, Christopher J Stille
Approximately 1 in 8 children in the United States are born preterm. Existing guidelines and research examine the cost of prematurity from the NICU stay and developmental surveillance and outcomes after discharge from the NICU. Preterm children are at greater risk for excess hospitalizations, outpatient visits, and societal costs after NICU discharge. Improved delivery of care and health promotion from the community setting, particularly from the patient-centered medical home, may result in improved growth, health, and development, with accompanying reduction of post-NICU discharge costs and encounters...
April 2017: Pediatrics
https://www.readbyqxmd.com/read/28132168/delivery-and-payment-redesign-to-reduce-disparities-in-high-risk-postpartum-care
#5
Elizabeth A Howell, Norma A Padrón, Susan J Beane, Joanne Stone, Virginia Walther, Amy Balbierz, Rashi Kumar, José A Pagán
Purpose This paper describes the implementation of an innovative program that aims to improve postpartum care through a set of coordinated delivery and payment system changes designed to use postpartum care as an opportunity to impact the current and future health of vulnerable women and reduce disparities in health outcomes among minority women. Description A large health care system, a Medicaid managed care organization, and a multidisciplinary team of experts in obstetrics, health economics, and health disparities designed an intervention to improve postpartum care for women identified as high-risk...
March 2017: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/28093379/the-epital-care-model-a-new-person-centered-model-of-technology-enabled-integrated-care-for-people-with-long-term-conditions
#6
Klaus Phanareth, Søren Vingtoft, Anders Skovbo Christensen, Jakob Sylvest Nielsen, Jørgen Svenstrup, Gro Karine Rosvold Berntsen, Stanton Peter Newman, Lars Kayser
BACKGROUND: There is worldwide recognition that the future provision of health care requires a reorganization of provision of care, with increased empowerment and engagement of patients, along with skilled health professionals delivering services that are coordinated across sectors and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs)...
January 16, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28062813/the-transition-of-primary-care-group-practices-to-next-generation-models-satisfaction-of-staff-clinicians-and-patients
#7
Therese Zink, John Kralewski, Bryan Dowd
INTRODUCTION: Restructuring primary care is essential to achieve the triple aim. This case study examines the human factors of extensive redesign on 2 midsized primary care clinics (clinics A and B) in the Midwest United States that are owned by a large health care system. The transition occurred when while the principles for patient-centered medical home were being rolled out nationally, and before the Affordable Care Act. METHODS: After the transition, interviews and discussions were conducted with 5 stakeholder groups: health system leaders, clinic managers, clinicians, nurses, and reception staff...
January 2017: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/27729027/what-is-the-impact-of-systems-of-care-for-heart-failure-on-patients-diagnosed-with-heart-failure-a-systematic-review
#8
REVIEW
Andrea Driscoll, Sharon Meagher, Rhoda Kennedy, Melanie Hay, Jayant Banerji, Donald Campbell, Nicholas Cox, Debra Gascard, David Hare, Karen Page, Voltaire Nadurata, Rhonda Sanders, Harry Patsamanis
BACKGROUND: Hospital admissions for heart failure are predicted to rise substantially over the next decade placing increasing pressure on the health care system. There is an urgent need to redesign systems of care for heart failure to improve evidence-based practice and create seamless transitions through the continuum of care. The aim of the review was to examine systems of care for heart failure that reduce hospital readmissions and/or mortality. METHOD: Electronic databases searched were: Ovid MEDLINE, EMBASE, CINAHL, grey literature, reviewed bibliographies and Cochrane Central Register of Controlled Trials for randomised controlled trials, non-randomised trials and cohort studies from 1(st) January 2008 to 4(th) August 2015...
October 11, 2016: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/27637827/across-the-divide-primary-care-departments-working-together-to-redesign-care-to-achieve-the-triple-aim
#9
Steven Koslov, Elizabeth Trowbridge, Sandra Kamnetz, Sally Kraft, Jeffrey Grossman, Nancy Pandhi
BACKGROUND: Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim. METHODS: As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care...
September 2016: Healthcare
https://www.readbyqxmd.com/read/27586403/modeling-and-designing-health-care-payment-innovations-for-medical-imaging
#10
Hui Zhang, Christian Wernz, Danny R Hughes
Payment innovations that better align incentives in health care are a promising approach to reduce health care costs and improve quality of care. Designing effective payment systems, however, is challenging due to the complexity of the health care system with its many stakeholders and their often conflicting objectives. There is a lack of mathematical models that can comprehensively capture and efficiently analyze the complex, multi-level interactions and thereby predict the effect of new payment systems on stakeholder decisions and system-wide outcomes...
September 1, 2016: Health Care Management Science
https://www.readbyqxmd.com/read/27568505/organizing-publicly-funded-substance-use-disorder-treatment-in-the-united-states-moving-toward-a-service-system-approach
#11
Howard Padwa, Darren Urada, Patrick Gauthier, Traci Rieckmann, Brian Hurley, Desirée Crèvecouer-MacPhail, Richard A Rawson
Historically, publicly funded substance use disorder (SUD) treatment services in the United States have been disorganized and inefficient. By reconfiguring and linking services to create systems of care-services, structures, and processes that are purposively interconnected to treat SUD systematically-health systems can transform discrete service components into cohesive service systems that comprehensively and efficiently treat SUDs. In this article we: (1) articulate the potential benefits of organizing publicly funded SUD services into systems of care; (2) review basic principles underlying theories of SUD system organization; (3) describe the mix and configuration of services needed to create comprehensive, integrated systems of publicly funded SUD care; (4) elucidate how patients can flow through systems of SUD services in a clinically sound and cost-efficient manner, and; (5) propose eight steps that can be taken to create systems of care by identifying and leveraging the strengths, assets, and capacities of SUD service providers already operating within their health care systems...
October 2016: Journal of Substance Abuse Treatment
https://www.readbyqxmd.com/read/27396533/six-health-care-trends-that-will-reshape-the-patient-provider-dynamic
#12
Joshua M Liao, Ezekiel J Emanuel, Amol S Navathe
Six trends - movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse - are driving the US health care system towards a future defined by quality- and patient-centric care. Health care organizations are responding to these changes by implementing provider and workforce changes, pursuing stronger payer-provider integration, and accelerating the use of digital technology and data...
September 2016: Healthcare
https://www.readbyqxmd.com/read/27332212/preparing-the-next-generation-of-advanced-practice-nurses-for-connected-care
#13
Diane J Skiba, Amy J Barton, Krista Estes, Eric Gilliam, Sarah Knapfel, Chanmi Lee, Gina Moore, Katy Trinkley
The health care delivery system in the United States is transforming at a rapid pace. Several trends, including the emergence of a Connected Health care system, will require advanced nurse practitioners to have new knowledge, skills and competencies to practice in the future. This paper describes the redesign of coursework and the development of a Connected Care Framework to guide the learning needs of nurse practitioners. A Connected Care Quotient consisting of ten relevant questions and learning activities will serve as a guide for the future development of competencies for advanced practice nurses...
2016: Studies in Health Technology and Informatics
https://www.readbyqxmd.com/read/27164866/assessing-fidelity-of-cognitive-behavioral-therapy-in-rural-va-clinics-design-of-a-randomized-implementation-effectiveness-hybrid-type-iii-trial
#14
RANDOMIZED CONTROLLED TRIAL
Michael A Cucciare, Geoffrey M Curran, Michelle G Craske, Traci Abraham, Michael B McCarthur, Kathy Marchant-Miros, Jan A Lindsay, Michael R Kauth, Sara J Landes, Greer Sullivan
BACKGROUND: Broadly disseminating and implementing evidence-based psychotherapies with high fidelity, particularly cognitive behavioral therapy (CBT), has proved challenging for many health-care systems, including the Department of Veterans Affairs, especially in primary care settings such as small or remote clinics. A computer-based tool (based on the coordinated anxiety learning and management (CALM) program) was designed to support primary care-based mental health providers in delivering CBT...
May 10, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27111748/a-narrative-review-of-patient-and-family-engagement-the-foundation-of-the-medical-home
#15
REVIEW
Crystal W Cené, Beverley H Johnson, Nora Wells, Beverly Baker, Renee Davis, Renee Turchi
BACKGROUND: Patient and family engagement (PFE) is vital to the spirit of the medical home. This article reflects the efforts of an expert consensus panel, the Patient and Family Engagement Workgroup, as part of the Society of General Internal Medicine's 2013 Research Conference. OBJECTIVE: To review extant literature on PFE in pediatric and adult medicine and quality improvement, highlight emerging best practices and models, suggest questions for future research, and provide references to tools and resources to facilitate implementation of PFE strategies...
July 2016: Medical Care
https://www.readbyqxmd.com/read/27016948/rapid-process-optimization
#16
Jennifer L Wiler, Kelly Bookman, Derek B Birznieks, Robert Leeret, April Koehler, Shauna Planck, Richard Zane
Health care systems have utilized various process redesign methodologies to improve care delivery. This article describes the creation of a novel process improvement methodology, Rapid Process Optimization (RPO). This system was used to redesign emergency care delivery within a large academic health care system, which resulted in a decrease: (1) door-to-physician time (Department A: 54 minutes pre vs 12 minutes 1 year post; Department B: 20 minutes pre vs 8 minutes 3 months post), (2) overall length of stay (Department A: 228 vs 184; Department B: 202 vs 192), (3) discharge length of stay (Department A: 216 vs 140; Department B: 179 vs 169), and (4) left without being seen rates (Department A: 5...
March 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/27008357/creating-the-medical-schools-of-the-future
#17
Susan E Skochelak, Steven J Stack
Despite wide consensus on needed changes in medical education, experts agree that the gap continues to widen between how physicians are trained and the future needs of our health care system. A new model for medical education is needed to create the medical school of the future. The American Medical Association (AMA) is working to support innovative models through partnerships with medical schools, educators, professional organizations, and accreditors. In 2013, the AMA designed an initiative to support rapid innovation among medical schools and disseminate the ideas being tested to additional medical schools...
January 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/26929234/collaborating-in-an-evolving-health-care-system-opportunities-for-redesigning-health-care-delivery
#18
REVIEW
Susie Adams
No abstract text is available yet for this article.
January 2016: Journal of the American Psychiatric Nurses Association
https://www.readbyqxmd.com/read/26871644/availability-of-care-concordant-with-patient-centered-medical-home-principles-among-those-with-chronic-conditions-measuring-care-outcomes
#19
Nadereh Pourat, Shana A Charles, Sophie Snyder
BACKGROUND: Care delivery redesign in the form of patient-centered medical home (PCMH) is considered as a potential solution to improve patient outcomes and reduce costs, particularly for patients with chronic conditions. But studies of prevalence or impact at the population level are rare. OBJECTIVES: We aimed to assess whether desired outcomes indicating better care delivery and patient-centeredness were associated with receipt of care according to 3 important PCMH principles...
March 2016: Medical Care
https://www.readbyqxmd.com/read/26855635/episode-of-care-payments-in-total-joint-arthroplasty-and-cost-minimization-strategies
#20
REVIEW
Benedict U Nwachukwu, Evan O'Donnell, Alexander S McLawhorn, Michael B Cross
Total joint arthroplasty (TJA) is receiving significant attention in the US health care system for cost containment strategies. Specifically, payer organizations have embraced and are implementing bundled payment schemes in TJA. Consequently, hospitals and providers involved in the TJA care cycle have sought to adapt to the new financial pressures imposed by episode of care payment models by analyzing what components of the total "event" of a TJA are most essential to achieve a good outcome after TJA. As part of this review, we analyze and discuss a health economic study by Snow et al...
February 2016: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
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