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Health care redesign

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https://www.readbyqxmd.com/read/28729232/development-feasibility-and-small-scale-implementation-of-a-web-based-prognostic-tool-surveillance-epidemiology-and-end-results-cancer-survival-calculator
#1
Michelle Henton, Bridget Gaglio, Laurie Cynkin, Eric J Feuer, Borsika A Rabin
BACKGROUND: Population datasets and the Internet are playing an ever-growing role in the way cancer information is made available to providers, patients, and their caregivers. The Surveillance, Epidemiology, and End Results Cancer Survival Calculator (SEER*CSC) is a Web-based cancer prognostic tool that uses SEER data, a large population dataset, to provide physicians with highly valid, evidence-based prognostic estimates for increasing shared decision-making and improving patient-provider communication of complex health information...
July 20, 2017: JMIR Cancer
https://www.readbyqxmd.com/read/28723845/lean-six-sigma-techniques-to-improve-ophthalmology-clinic-efficiency
#2
Thomas A Ciulla, Mohan V Tatikonda, Yehya A ElMaraghi, Rehan M Hussain, Amanda L Hill, Julie M Clary, Eyas Hattab
PURPOSE: Ophthalmologists serve an increasing volume of a growing elderly population undergoing increasingly complex outpatient medical care, including extensive diagnostic testing and treatment. The resulting prolonged patient visit times ("patient flow times") limit quality, patient and employee satisfaction, and represent waste. Lean Six Sigma process improvement was used in a vitreoretinal practice to decrease patient flow time, demonstrating that this approach can yield significant improvement in health care...
July 18, 2017: Retina
https://www.readbyqxmd.com/read/28702863/walking-together-towards-a-collaborative-model-for-maternal-health-care-in-pastoralist-communities-of-laikipia-and-samburu-kenya
#3
Michelle Kermode, Alison Morgan, Josephat Nyagero, Florence Nderitu, Tanya Caulfield, Matthew Reeve, John Nduba
Purpose In 2009 the Kenyan Government introduced health system reforms to address persistently high maternal and newborn mortality including deployment of skilled birth attendants (SBAs) to health facilities in remote areas, and proscription of births attended by traditional birth attendants (TBAs). Despite these initiatives, uptake of SBA services remains low and inequitably distributed. This paper describes the development of an SBA/TBA collaborative model of maternal health care for pastoralist communities in Laikipia and Samburu...
July 12, 2017: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/28700194/california-public-hospitals-improved-quality-of-care-under-medicaid-waiver-program
#4
Nederah Pourat
California has 12 county-owned and operated hospital systems and 5 University of California hospitals designated as public hospitals. These organizations deliver the majority of inpatient care and a significant amount of outpatient care to Medicaid patients in the state. In 2010, California was the first state in the nation to implement a five-year Delivery System Reform Incentive Payment (DSRIP) program under the Section §1115 Medicaid "Bridge to Reform" waiver to improve the capacity of these hospitals to deliver high quality and more efficient care...
June 2017: Policy Brief
https://www.readbyqxmd.com/read/28693330/reducing-unnecessary-blood-chemistry-testing-in-the-emergency-department-implementation-of-choosing-wisely
#5
Arjun K Venkatesh, David Hajdasz, Craig Rothenberg, Meir Dashevsky, Vivek Parwani, Mark Sevilla, Marc Shapiro, Ian Schwartz
Point of care (POC) laboratory testing is used to improve emergency department (ED) throughput but often overuses resources by duplicating formal laboratory testing. This study sought to evaluate the effect of a multimodal intervention on duplicate chemistry testing. This pre-post analysis included all visits to 2 urban EDs between June 2014 and June 2016. The multimodal intervention including provider education, signage, electronic health record redesign, and audit and feedback focused on reducing duplicate chemistry testing...
February 1, 2017: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
https://www.readbyqxmd.com/read/28692138/the-2025-big-g-geriatrician-defining-job-roles-to-guide-fellowship-training
#6
Deborah Simpson, Rosanne M Leipzig, Karen Sauvigné
Changes in health care that are already in progress, including value- and population-based care, use of new technologies for care, big data and machine learning, and the patient as consumer and decision maker, will determine the job description for geriatricians practicing in 2025. Informed by these future certainties, 115 geriatrics educators attending the 2016 Donald W. Reynolds Foundation Annual meeting identified five 2025 geriatrician job roles: complexivist; consultant; health system leader and innovator; functional preventionist; and educator for big "G" and little "g" providers...
July 10, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28691677/feasibility-of-a-lifestyle-redesign-%C3%A2-inspired-intervention-for-well-older-adults
#7
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/28691498/delivering-end-of-life-cancer-care-perspectives-of-providers
#8
Manali I Patel, Vyjeyanthi S Periyakoil, David Moore, Andrea Nevedal, Tumaini R Coker
OBJECTIVES: Persistent gaps in end-of-life cancer care delivery and growing associated expenditures remain imminent US public health issues. The objective of this study was to understand clinical providers' experiences delivering cancer care for patients at the end of life and their perspectives on potential solutions to improve quality of care. METHODS: Semistructured interviews were conducted with 75 cancer care providers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28690707/understanding-how-to-support-family-caregivers-of-seniors-with-complex-needs
#9
Lesley Charles, Suzette Brémault-Phillips, Jasneet Parmar, Melissa Johnson, Lori-Ann Sacrey
PURPOSE OF THE STUDY: The purpose of this study was to describe the experiences and challenges of supporting family caregivers of seniors with complex needs and to outline support strategies and research priorities aimed at supporting them. DESIGN AND METHODS: A CIHR-funded, two-day conference entitled "Supporting Family Caregivers of Seniors: Improving Care and Caregiver Outcomes" was held. An integrated knowledge translation approach guided this planning conference...
June 2017: Canadian Geriatrics Journal: CGJ
https://www.readbyqxmd.com/read/28671543/quality-and-innovation-redesigning-a-coordinated-and-connected-health-system
#10
Peter W Vaughan
Nova Scotia's consolidated health system was launched on April 1, 2015. This new approach to organizing health administration and services in the province arose out of necessity. When planning began, Nova Scotia was spending 41% of its annual budget on health services. In comparison to other provinces and territories, our per capita health-related spending was among the highest in the country, we had one of Canada's oldest populations and we had some of the worst health outcomes. Clearly, we could not continue to do the same things and expect different results...
2017: HealthcarePapers
https://www.readbyqxmd.com/read/28669568/modeling-the-potential-economic-impact-of-the-medicare-comprehensive-care-for-joint-replacement-episode-based-payment-model
#11
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...
June 8, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28661798/getting-the-incentives-right-improving-oral-health-equity-with-universal-school-based-caries-prevention
#12
Richard Niederman, Shulamite S Huang, Anna-Lena Trescher, Stefan Listl
Despite significant financial, training, and program investments, US children's caries experience and inequities continued to increase over the last 20 years. We posit that (1) dental insurance payment systems are not aligned with the current best evidence, exacerbating inequities, and (2) system redesign could meet health care's triple aim and reduce children's caries by 80%. On the basis of 2013 to 2016 Medicaid and private payment rates and the caries prevention literature, we find that effective preventive interventions are either (1) consistently compensated less than ineffective interventions or (2) not compensated at all...
May 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/28661383/lifestyle-redesign-%C3%A2-for-chronic-pain-management-a-retrospective-clinical-efficacy-study
#13
Ashley Uyeshiro Simon, Chantelle E R Collins
OBJECTIVE: Our objective was to determine the efficacy of a Lifestyle Redesign(®) intervention for people living with chronic pain on quality of life (QOL), function, self-efficacy, and pain levels. METHOD: Clinical outcomes were collected from 45 patients who completed an individual outpatient Lifestyle Redesign occupational therapy program for chronic pain as part of their usual plan of medical care. Outcome measures included the Canadian Occupational Performance Measure, the 36-Item Short-Form Survey, the Brief Pain Inventory, and the Pain Self-Efficacy Questionnaire...
July 2017: American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association
https://www.readbyqxmd.com/read/28648221/designing-and-implementing-an-electronic-patient-registry-to-improve-warfarin-monitoring-in-the-ambulatory-setting
#14
Shin-Yu Lee, Roy Cherian, Irene Ly, Claire Horton, Alaya Levi Salley, Urmimala Sarkar
BACKGROUND: Warfarin requires individualized dosing and monitoring in the ambulatory setting for protection against thromboembolic disease. Yet in multiple settings, patients spend upwards of 30% of time outside the therapeutic range, subjecting them to an increased risk of adverse events. At an urban, publicly funded clinic, the electronic health record (EHR) would not support integration with extant warfarin management software, which led to the creation and implementation of an electronic patient registry and a complementary team-based work flow to provide real-time health-system-level data for warfarin patients...
July 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28639548/a-leadership-perspective-on-a-shared-vision-for-healthcare
#15
Tracy Kitch
Our country's recent negotiations for a new Health Accord have shone light on the importance of more accessible and better home care. The direction being taken on health funding investments has sent a strong message about healthcare system redesign. It is time to design a healthcare system that moves us away from a hospital-focused model to one that is more effective, integrated and sustainable and one that places a greater emphasis on primary care, community care and home care. The authors of the lead paper (Sharkey and Lefebre 2017) provide their vision for people-powered care and explore the opportunity for nursing leaders to draw upon the unique expertise and insights of home care nursing as a strategic lever to bring about real health system transformation across all settings...
2017: Nursing Leadership
https://www.readbyqxmd.com/read/28637744/group-clinics-for-young-adults-with-diabetes-in-an-ethnically-diverse-socioeconomically-deprived-setting-together-study-protocol-for-a-realist-review-co-design-and-mixed-methods-participatory-evaluation-of-a-new-care-model
#16
Chrysanthi Papoutsi, Dougal Hargreaves, Grainne Colligan, Ann Hagell, Anita Patel, Desirée Campbell-Richards, Russell M Viner, Shanti Vijayaraghavan, Martin Marshall, Trisha Greenhalgh, Sarah Finer
INTRODUCTION: Young adults with diabetes often report dissatisfaction with care and have poor diabetes-related health outcomes. As diabetes prevalence continues to rise, group-based care could provide a sustainable alternative to traditional one-to-one consultations, by engaging young people through life stage-, context- and culturally-sensitive approaches. In this study, we will co-design and evaluate a group-based care model for young adults with diabetes and complex health and social needs in socioeconomically deprived areas...
June 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28609248/using-statewide-data-on-health-care-quality-to-assess-the-effect-of-a-patient-centered-medical-home-initiative-on-quality-of-care
#17
Nathan D Shippee, Michael Finch, Douglas Wholey
Patient-centered medical homes comprise a large portion of modern health care redesign. However, most efforts have reflected rigid, limited models of transformation. In addition, evaluations of their impact on quality of care have relied on data designed for other purposes. Minnesota's Health Care Home (HCH) initiative is a statewide medical home model relying on state-run, adaptive certification and supportive data infrastructure. This longitudinal study leverages a unique statewide system of clinic-reported, patient-level quality data (2010-2013) to assess the effect of being in a HCH clinic on health care quality...
June 13, 2017: Population Health Management
https://www.readbyqxmd.com/read/28604260/developing-high-functioning-teams-factors-associated-with-operating-as-a-real-team-and-implications-for-patient-centered-medical-home-development
#18
Somava Stout, Leah Zallman, Lisa Arsenault, Assaad Sayah, Karen Hacker
Team-based care is a foundation of health care redesign models like the patient-centered medical home (PCMH). Yet few practices rigorously examine how the implementation of PCMH relates to teamwork. We identified factors associated with the perception of a practice operating as a real team. An online workforce survey was conducted with all staff of 12 primary care sites of Cambridge Health Alliance at different stages of PCMH transformation. Bivariate and multivariate analyses of factors associated with teamwork perceptions were conducted...
January 1, 2017: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://www.readbyqxmd.com/read/28598747/overarching-challenges-to-the-implementation-of-competency-based-medical-education
#19
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/28596445/development-of-a-new-care-model-for-hospitalized-children-with-medical-complexity
#20
Christine M White, Joanna E Thomson, Angela M Statile, Katherine A Auger, Ndidi Unaka, Matthew Carroll, Karen Tucker, Derek Fletcher, David E Hall, Jeffrey M Simmons, Patrick W Brady
Children with medical complexity are a rapidly growing inpatient population with frequent, lengthy, and costly hospitalizations. During hospitalization, these patients require care coordination among multiple subspecialties and their outpatient medical homes. At a large freestanding children's hospital, a new inpatient model of care was developed in an effort to consistently provide coordinated, family-centered, and efficient care. In addition to expanding the multidisciplinary team to include a pharmacist, dietician, and social worker, the team redesign included: (1) medication reconciliation rounds, (2) care coordination rounds, and (3) multidisciplinary weekly handoff with outpatient providers...
June 8, 2017: Hospital Pediatrics
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