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Health care redesign

João Manuel Graveto, Cristina Santos, Paulo Santos Costa, Elisabete Fernandes, Susana Alarico, Nádia Osório, Helena Albano, Vânia Oliveira
OBJECTIVE: To describe the determining factors in hand hygiene management among nurses and identify associated collective health challenges. METHOD: Cross-sectional descriptive study. Data were collected using a questionnaire that was applied in four internal medicine units of a hospital of reference in Portugal. RESULTS: The sample was composed of 50 nurses aged 26 to 55 years (mean age of 34.88 years); 80% were women, 58% had a Bachelor's degree, and had 5-30 years of nursing practice (X̄ =11...
2018: Revista Brasileira de Enfermagem
Adrienne W Henize, Andrew F Beck, Melissa D Klein, John Morehous, Robert S Kahn
Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center...
March 10, 2018: Maternal and Child Health Journal
Nicole VanHeerwaarden, Genevieve Ferguson, Alexxa Abi-Jaoude, Andrew Johnson, Elisa Hollenberg, Gloria Chaim, Kristin Cleverley, Gunther Eysenbach, Joanna Henderson, Andrea Levinson, Janine Robb, Sarah Sharpe, Aristotle Voineskos, David Wiljer
BACKGROUND: Seventy percent of lifetime cases of mental illness emerge before the age of 24 years, but many youth are unable to access the support and services they require in a timely and appropriate way. With most youth using the internet, electronic health (eHealth) interventions are promising tools for reaching this population. Through participatory design research (PDR) engagement methods, Thought Spot, a Web- and mobile-based platform, was redeveloped to facilitate access to mental health services by transition-aged youth (aged 16-29 years) in postsecondary settings...
March 6, 2018: Journal of Medical Internet Research
M Fung-Kee-Fung, D E Maziak, J R Pantarotto, J Smylie, L Taylor, T Timlin, T Cacciotti, P J Villeneuve, C Dennie, C Bornais, S Madore, J Aquino, P Wheatley-Price, R S Ozer, D J Stewart
Background: The Ottawa Hospital (toh) defined delay to timely lung cancer care as a system design problem. Recognizing the patient need for an integrated journey and the need for dynamic alignment of providers, toh used a learning health system (lhs) vision to redesign regional diagnostic processes. A lhs is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions...
February 2018: Current Oncology
C Daniel Mullins, La'Marcus T Wingate, Hillary A Edwards, Toyin Tofade, Anthony Wutoh
The learning healthcare system (LHS) model framework has three core, foundational components. These include an infrastructure for health-related data capture, care improvement targets and a supportive policy environment. Despite progress in advancing and implementing LHS approaches, low levels of participation from patients and the public have hampered the transformational potential of the LHS model. An enhanced vision of a community-engaged LHS redesign would focus on the provision of health care from the patient and community perspective to complement the healthcare system as the entity that provides the environment for care...
February 26, 2018: Journal of Comparative Effectiveness Research
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
Liza Bonin
Quality Improvement (QI) is a health care interprofessional team activity wherein psychology as a field and individual psychologists in health care settings can and should adopt a more robust presence. The current article makes the argument for why psychology's participation in QI is good for health care, is good for our profession, and is the right thing to do for the patients and families we serve. It reviews the varied ways individual psychologists and our profession can integrate quality processes and improve health care through: (1) our approach to our daily work; (2) our roles on health care teams and involvement in organizational initiatives; (3) opportunities for teaching and scholarship; and (4) system redesign and advocacy within our health care organizations and health care environment...
February 21, 2018: Journal of Clinical Psychology in Medical Settings
Helen Lloyd, Hannah Wheat, Jane Horrell, Thavapriya Sugavanam, Benjamin Fosh, Jose M Valderas, James Close
BACKGROUND: Patient-reported measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a range of constructs including quality of life and experiences of care. Current health and social care policy increasingly advocates their use for embedding the patient voice into service redesign through new models of care such as person-centered coordinated care (P3C). If chosen carefully and used efficiently, these tools can help improve care delivery through a variety of novel ways, including system-level feedback for health care management and commissioning...
February 14, 2018: Journal of Medical Internet Research
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
Richard J Aspinall
Recurrent admissions to hospital are a major issue for people living with decompensated cirrhosis, particularly those who develop chronic hepatic encephalopathy, a condition that leads to significantly impaired quality of life for patients and their family caregivers. Such patients have high health-care use costs but recent data have shown how the appropriate use of effective medical therapy can significantly reduce hospital admissions, length of stay and unplanned readmissions. Redesigning clinical services to optimize access to specialist care and improving the education and support of patients and their carers can further help to reduce the burden of this disease...
February 2, 2018: British Journal of Hospital Medicine
Lisa Penrose, Yvette Roe, Natalie A Johnson, Erica L James
The Institute for Urban Indigenous Health (IUIH) aimed to improve access to cataract surgery in urban South East Queensland (SEQ) for Indigenous Australians, without compromising clinical visual outcomes. The Penchansky and Levesque concept of access as the 'fit' between the patient's needs and the ability of the system to meet those needs was used to inform the redesign of the mainstream cataract surgical pathway. The IUIH staff and community stakeholders mapped the traditional external cataract surgical pathway and then innovatively redesigned it to reduce the number of patients being removed by the system at key transition points...
February 9, 2018: Australian Journal of Primary Health
Karen MacKinnon, Diane L Butcher, Anne Bruce
Work relationships between registered nurses (RNs) and practical nurses (LPNs) are changing as new models of nursing care delivery are introduced to create more flexibility for employers. In Canada, a team-based, hospital nursing care delivery model, known as Care Delivery Model Redesign (CDMR), redesigned a predominantly RN-based staffing model to a functional team consisting of fewer RNs and more LPNs. The scope of practice for LPNs was expanded, and unregulated health care assistants introduced. This study began from the standpoint of RNs and LPNs to understand their experiences working on redesigned teams by focusing on discourses activated in social settings...
January 2018: Global Qualitative Nursing Research
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
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
Holly Miller, Lucy Johns
The document "Feature and Function Recommendations To Optimize Clinician Usability of Direct Interoperability To Enhance Patient Care" offers recommendations from the clinician point of view. Widespread adoption of even a few of these recommendations by designers and vendors would greatly enhance care.
January 2018: Managed Care
Melissa L Danielson, Rebecca H Bitsko, Reem M Ghandour, Joseph R Holbrook, Michael D Kogan, Stephen J Blumberg
The purpose of this study is to estimate the national prevalence of parent-reported attention deficit/hyperactivity disorder (ADHD) diagnosis and treatment among U.S. children 2-17 years of age using the 2016 National Survey of Children's Health (NSCH). The NSCH is a nationally representative, cross-sectional survey of parents regarding their children's health that underwent a redesign before the 2016 data collection. It included indicators of lifetime receipt of an ADHD diagnosis by a health care provider, whether the child currently had ADHD, and receipt of medication and behavioral treatment for ADHD...
January 24, 2018: Journal of Clinical Child and Adolescent Psychology
Christopher McKevitt, Angus I G Ramsay, Catherine Perry, Simon J Turner, Ruth Boaden, Charles D A Wolfe, Naomi J Fulop
BACKGROUND: Patient and public involvement is required where changes to care provided by the UK National Health Service are proposed. Yet involvement is characterized by ambiguity about its rationales, methods and impact. AIMS: To understand how patients and carers were involved in major system changes (MSCs) to the delivery of acute stroke care in 2 English cities, and what kinds of effects involvement was thought to produce. METHODS: Analysis of documents from both MSC projects, and retrospective in-depth interviews with 45 purposively selected individuals (providers, commissioners, third-sector employees) involved in the MSC...
January 18, 2018: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
Sue Lacey Bryant, Helen Bingham, Ruth Carlyle, Alison Day, Linda Ferguson, David Stewart
This article is the fourth in a series on New Directions. The National Health Service is under pressure, challenged to meet the needs of an ageing population, whilst striving to improve standards and ensure decision making is underpinned by evidence. Health Education England is steering a new course for NHS library and knowledge services in England to ensure access to knowledge and evidence for all decision makers. Knowledge for Healthcare calls for service transformation, role redesign, greater coordination and collaboration...
January 10, 2018: Health Information and Libraries Journal
Hui P Liew
OBJECTIVE: This study seeks to examine how older adults rate and identify the importance of attributes associated with healthcare seeking and utilization (eg, affordability, type of facility, and accessibility) in the United States. METHODS: The empirical work of this cross-sectional study is based on the 2014 Health and Retirement Study. Conjoint analysis and cluster analysis are used to assess the objective. RESULTS: There is a pressing need for sound policies that seek to reduce the cost of treatment and consultation and to improve the accessibility of care facility for older adults even though satisfaction pertaining to these attributes (ie, affordability, type of facility, and accessibility) differs across clusters...
January 1, 2018: American Journal of Health Behavior
Esther Bay, Andrea Sherzer, Emily Darnbrook
In response to regulators of nursing education and the Institute of Medicine, an academic-service partnership was formed between a research-intensive school of nursing and a tertiary health care facility. In that partnership, clinical experiences occurred mostly within 1 organization. This case report showcases the development, implementation, and revisions within our capstone immersion course, designed to ease the new graduates' transition into practice, including transitions to critical care nursing. Herein, we highlight our successes and challenges of implementing the clinical component within 2 critical care units focused on trauma and neurosurgical care of complex patients...
January 2018: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
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