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"Health care system" redesign

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https://www.readbyqxmd.com/read/29471480/family-medicine-clinic-a-case-study-of-a-hospital-family-medicine-practice-redesign-to-improve-chronic-disease-care-in-the-community-in-singapore
#1
Yee Wei Lim, Joanna Ling, Zoe Lim, Audrey Chia
Background: Singapore's health care system is strained by the health care needs of a rapidly aging population. The unprecedented collaboration between a public hospital and a private family practice to set up the Family Medicine Clinic (FMC) to co-manage patients with chronic disease is an example of efforts to shift care to the community. Objective: To explore patients' initial experience of shared chronic disease care in a private family practice setting. Methods: In this exploratory case study, we surveyed 330 patients with stable chronic diseases and interviewed 10 complex care patients and their caregivers...
February 17, 2018: Family Practice
https://www.readbyqxmd.com/read/29439895/adding-value-to-total-joint-arthroplasty-care-in-an-academic-environment-the-utah-experience
#2
Christopher E Pelt, Mike B Anderson, Jill A Erickson, Jeremy M Gililland, Christopher L Peters
BACKGROUND: Adding value in a university-based academic health care system provides unique challenges when compared to other health care delivery models. Herein, we describe our experience in adding value to joint arthroplasty care at the University of Utah, where the concept of value-based health care reform has become an embraced and driving force. METHODS: To improve the value, new resources were needed for care redesign, physician leadership, and engagement in alternative payment models...
February 10, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29409641/health-care-clinicians-engagement-in-organizational-redesign-of-care-processes-the-importance-of-work-and-organizational-conditions
#3
L Dellve, M Strömgren, A Williamsson, R J Holden, A Eriksson
The Swedish health care system is reorienting towards horizontal organization for care processes. A main challenge is to engage health care clinicians in the process. The aim of this study was to assess engagement (i.e. attitudes and beliefs, the cognitive state and clinical engagement behaviour) among health care clinicians, and to investigate how engagement was related to work resources and demands during organizational redesign. A cohort study was conducted, using a questionnaire distributed to clinicians at five hospitals working with care process improvement approaches, two of them having implemented Lean production...
April 2018: Applied Ergonomics
https://www.readbyqxmd.com/read/29389335/need-for-diagnostic-centric-care-in-dentistry-a-case-study-from-the-marshfield-clinic-health-system
#4
Neel Shimpi, Zhan Ye, Rajesh Koralkar, Ingrid Glurich, Amit Acharya
BACKGROUND: The study objective was to evaluate the workflow of dental providers who use the existing electronic dental record (EDR) system at a large regional health care system to establish a diagnostic-centric culture as part of their dental practice. A further goal focused on identifying when improvements to the workflow and design of the EDR may be indicated. METHODS: Dental procedures performed on patients and corresponding International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses were retrospectively mined from Marshfield Clinic's enterprise data warehouse...
February 2018: Journal of the American Dental Association
https://www.readbyqxmd.com/read/29188455/the-role-of-cardiologists-in-the-management-of-patients-with-heart-failure
#5
Vera Maria Avaldi, Jacopo Lenzi
Heart failure is a complex clinical syndrome with a remarkable impact on health care systems in terms of patients' morbidity and mortality, as well as direct and indirect costs. It is essential to redesign models of care for patients with heart failure that are tailored on personalized health care needs and carried out in the most appropriate setting. There is some debate about the role of cardiologists in the management of patients with heart failure. Indeed, results regarding the inclination of cardiologists' patients to achieve better outcomes are controversial, given the heterogeneity of studies in terms of study design, population, setting and variables considered...
November 30, 2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29078948/quality-improvement-and-patient-safety-on-labor-and-delivery
#6
REVIEW
Bethany Sabol, Aaron B Caughey
There has been an emphasis on redesigning our health care system to eliminate medical errors and create a culture of safety. The American College of Obstetrics and Gynecologists defines a culture of safety as an environment in which all care providers are empowered to identify errors, near misses, risky behaviors and broader systems issues while engaging in active collaboration to improve and resolve processes and system failures. This article reviews key components that promote a culture of safety and help to implement safer, more effective, evidence-based quality care on labor and delivery units...
December 2017: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/29076957/reducing-and-sustaining-duplicate-medical-record-creation-by-usability-testing-and-system-redesign
#7
Adjhaporn Khunlertkit, Leonard Dorissaint, Allen Chen, Lori Paine, Peter J Pronovost
OBJECTIVES: Duplicate medical record creation is a common and consequential health care systems error often caused by poor search system usability and inappropriate user training. METHODS: We conducted two phases of scenario-based usability testing with patient registrars working in areas at risk of generating duplicate medical records. Phase 1 evaluated the existing search system, which led to system redesigns. Phase 2 tested the redesigned system to mitigate potential errors before health system-wide implementation...
October 25, 2017: Journal of Patient Safety
https://www.readbyqxmd.com/read/29056181/a-scalable-program-for-customized-patient-education-videos
#8
Ishani Ganguli, Chrisanne Sikora, Briana Nestor, Rachel Clark Sisodia, Adam Licurse, Timothy G Ferris, Sandhya Rao
PROBLEM DEFINITION: Patients must make sense of increasingly complex information to navigate their health and the health care system, with limited opportunity to do so in clinical settings. Patient education videos may help to communicate key information, but they are often impersonal and cumbersome to produce or update with new evidence. To address these limitations, a program was developed to facilitate local video creation to deliver targeted information to patients. APPROACH: The Patient Education Video Program was created at a large urban academic medical center...
November 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28975221/association-of-an-asthma-improvement-collaborative-with-health-care-utilization-in-medicaid-insured-pediatric-patients-in-an-urban-community
#9
Carolyn M Kercsmar, Andrew F Beck, Hadley Sauers-Ford, Jeffrey Simmons, Brandy Wiener, Lisa Crosby, Susan Wade-Murphy, Pamela J Schoettker, Pavan K Chundi, Zeina Samaan, Mona Mansour
Importance: Asthma is the most common chronic condition of childhood. Hospitalizations and emergency department (ED) visits for asthma are more frequently experienced by minority children and adolescents and those with low socioeconomic status. Objective: To reduce asthma-related hospitalizations and ED visits for Medicaid-insured pediatric patients residing in Hamilton County, Ohio. Design, Setting, and Participants: From January 1, 2010, through December 31, 2015, a multidisciplinary team used quality-improvement methods and the chronic care model to conduct interventions in inpatient, outpatient, and community settings in a large, urban academic pediatric hospital in Hamilton County, Ohio...
November 1, 2017: JAMA Pediatrics
https://www.readbyqxmd.com/read/28958418/planning-for-the-future-emergency-department-presentation-patterns-in-tasmania-australia
#10
Claire Morley, Jim Stankovich, Gregory Peterson, Leigh Kinsman
BACKGROUND: Emergency department crowding and associated adverse outcomes are major issues in health care systems worldwide. The Australian government has highlighted the need to analyse emergency presentations to inform system redesign. OBJECTIVE: To describe the profile of emergency department presentations by Tasmanian residents to emergency departments over four years, and examine regional variations. METHOD: A retrospective analysis of emergency department data for Tasmania's public hospitals over four financial years, 2010-11 to 2013-14, was undertaken...
September 22, 2017: International Emergency Nursing
https://www.readbyqxmd.com/read/28691677/feasibility-of-a-lifestyle-redesign-%C3%A2-inspired-intervention-for-well-older-adults
#11
Theresa B Cassidy, Lorie Gage Richards, Aaron M Eakman
OBJECTIVE: We examined the feasibility of Aging Well by Design, a Lifestyle Redesign(®)-inspired intervention for community-dwelling older adults. The original Lifestyle Redesign program was shortened to 3 mo and implemented as a community outreach program of a major health care system. METHOD: Community-dwelling older adults participated in the 12-wk program, which emphasized an occupational approach to healthy aging. Outcomes evaluated were recruitment, attendance, resource use, participant satisfaction, and subjective benefit to participants...
July 2017: American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association
https://www.readbyqxmd.com/read/28669568/modeling-the-potential-economic-impact-of-the-medicare-comprehensive-care-for-joint-replacement-episode-based-payment-model
#12
Omar Z Maniya, Richard C Mather, David E Attarian, Bipin Mistry, Aneesh Chopra, Matt Strickland, Kevin A Schulman
BACKGROUND: The Medicare program has initiated Comprehensive Care for Joint Replacement (CJR), a bundled payment mandate for lower extremity joint replacements. We sought to determine the degree to which hospitals will invest in care redesign in response to CJR, and to project its economic impacts. METHODS: We defined 4 potential hospital management strategies to address CJR: no action, light care management, heavy care management, and heavy care management with contracting...
November 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28598747/overarching-challenges-to-the-implementation-of-competency-based-medical-education
#13
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
#14
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...
December 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
#15
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
#16
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
#17
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
#18
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
#19
COMPARATIVE STUDY
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
#20
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 1st January 2008 to 4th August 2015...
October 11, 2016: BMC Cardiovascular Disorders
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