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Health care redesign

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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
#1
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
#2
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
#3
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
#4
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
https://www.readbyqxmd.com/read/28582249/design-and-development-of-a-telerehabilitation-platform-for-patients-with-phantom-limb-pain-a-user-centered-approach
#5
Andreas Rothgangel, Susy Braun, Rob Smeets, Anna Beurskens
BACKGROUND: Phantom limb pain is a frequent and persistent problem following amputation. Achieving sustainable favorable effects on phantom limb pain requires therapeutic interventions such as mirror therapy that target maladaptive neuroplastic changes in the central nervous system. Unfortunately, patients' adherence to unsupervised exercises is generally poor and there is a need for effective strategies such as telerehabilitation to support long-term self-management of patients with phantom limb pain...
February 15, 2017: JMIR Rehabil Assist Technol
https://www.readbyqxmd.com/read/28568245/quality-metrics-and-systems-transformation-are-we-advancing-alcohol-and-drug-screening-in-primary-care
#6
Traci Rieckmann, Stephanie Renfro, Dennis McCarty, Robin Baker, K John McConnell
OBJECTIVE: To examine the influence of Oregon's coordinated care organizations (CCOs) and pay-for-performance incentive model on completion of screening and brief intervention (SBI) and utilization of substance use disorder (SUD) treatment services. DATA SOURCES/STUDY SETTING: Secondary analysis of Medicaid encounter data from 2012 to 2015 and semiannual qualitative interviews with stakeholders in CCOs. STUDY DESIGN: Longitudinal mixed-methods design with simultaneous data collection with equal importance...
May 31, 2017: Health Services Research
https://www.readbyqxmd.com/read/28562309/value-based-insurance-design-pharmacy-benefits-for-children-and-youth-with-special-health-care-needs-principles-and-opportunities
#7
Mark E Helm
Value-based insurance design (VBID) represents an innovative approach to health insurance coverage. In the context of pharmacy benefits, the goal of VBID is to minimize access barriers to the most effective and appropriate treatments for specific medical conditions. Both private and public insurance programs have explored VBID pharmacy projects primarily for medical conditions affecting adults. To date, evidence for VBID pharmacy programs for children and youth with special health care needs (CYSHCN) appears lacking...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28561660/the-oncology-care-model-perspectives-from-the-centers-for-medicare-amp-medicaid-services-and-participating-oncology-practices-in-academia-and-the-community
#8
Ron Kline, Kerin Adelson, Jeffrey J Kirshner, Larissa M Strawbridge, Marsha Devita, Naralys Sinanis, Patrick H Conway, Ethan Basch
Cancer care delivery in the United States is often fragmented and inefficient, imposing substantial burdens on patients. Costs of cancer care are rising more rapidly than other specialties, with substantial regional differences in quality and cost. The Centers for Medicare & Medicaid Services (CMS) Innovation Center (CMMIS) recently launched the Oncology Care Model (OCM), which uses payment incentives and practice redesign requirements toward the goal of improving quality while controlling costs. As of March 2017, 190 practices were participating, with approximately 3,200 oncologists providing care for approximately 150,000 unique beneficiaries per year (approximately 20% of the Medicare Fee-for-Service population receiving chemotherapy for cancer)...
2017: American Society of Clinical Oncology Educational Book
https://www.readbyqxmd.com/read/28553806/perspectives-of-patients-clinicians-and-health-system-leaders-on-changes-needed-to-improve-the-health-care-and-outcomes-of-older-adults-with-multiple-chronic-conditions
#9
Rosie Ferris, Caroline Blaum, Eliza Kiwak, Janet Austin, Jessica Esterson, Gene Harkless, Gary Oftedahl, Michael Parchman, Peter H Van Ness, Mary E Tinetti
OBJECTIVE: To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. METHOD: Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. RESULTS: Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians...
February 1, 2017: Journal of Aging and Health
https://www.readbyqxmd.com/read/28550698/boomr-better-coordinated-cross-sectoral-medication-reconciliation-for%C3%A2-residential-care
#10
Vincent Vuong, Denis O'Donnell, Hrishikesh Navare, Debra Merrill, Michal Racki, Sheila Burton, Lori Anderson, Carla Beaton
There is evidence that medication errors often arise during the transition of residents from acute care to long-term care (LTC) homes due to lapses in communication and documentation. Better Coordinated Cross-Sectoral Medication Reconciliation (BOOMR) is an integrated practice change improving medication safety during patient transitions through the health system. Our Medication Reconciliation (MedRec) redesign improved patient engagement using "the patient's story," increased quality of information, workflow efficiency and reduced unnecessary medications...
2017: Healthcare Quarterly
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
#11
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/28538054/achieving-high-reliability-with-people-processes-and-technology
#12
Candice L Saunders, John A Brennan
High reliability as a corporate value in healthcare can be achieved by meeting the "Quadruple Aim" of improving population health, reducing per capita costs, enhancing the patient experience, and improving provider wellness. This drive starts with the board of trustees, CEO, and other senior leaders who ingrain high reliability throughout the organization. At WellStar Health System, the board developed an ambitious goal to become a top-decile health system in safety and quality metrics. To achieve this goal, WellStar has embarked on a journey toward high reliability and has committed to Lean management practices consistent with the Institute for Healthcare Improvement's definition of a high-reliability organization (HRO): one that is committed to the prevention of failure, early identification and mitigation of failure, and redesign of processes based on identifiable failures...
July 2017: Frontiers of Health Services Management
https://www.readbyqxmd.com/read/28535380/development-of-an-international-comorbidity-education-framework
#13
C Lawson, S Pati, J Green, G Messina, A Strömberg, N Nante, D Golinelli, A Verzuri, S White, T Jaarsma, P Walsh, P Lonsdale, U T Kadam
CONTEXT: The increasing number of people living with multiple chronic conditions in addition to an index condition has become an international healthcare priority. Health education curricula have been developed alongside single condition frameworks in health service policy and practice and need redesigning to incorporate optimal management of multiple conditions. AIM: Our aims were to evaluate current teaching and learning about comorbidity care amongst the global population of healthcare students from different disciplines and to develop an International Comorbidity Education Framework (ICEF) for incorporating comorbidity concepts into health education...
May 17, 2017: Nurse Education Today
https://www.readbyqxmd.com/read/28528621/using-lean-to-rapidly-and-sustainably-transform-a-behavioral-health-crisis-program-impact-on-throughput-and-safety
#14
Margaret E Balfour, Kathleen Tanner, Paul J Jurica, Dawn Llewellyn, Robert G Williamson, Chris A Carson
BACKGROUND: Lean has been increasingly applied in health care to reduce waste and improve quality, particularly in fast-paced and high-acuity clinical settings such as emergency departments. In addition, Lean's focus on engagement of frontline staff in problem solving can be a catalyst for organizational change. In this study, ConnectionsAZ demonstrates how they applied Lean principles to rapidly and sustainably transform clinical operations in a behavioral health crisis facility. METHODS: A multidisciplinary team of management and frontline staff defined values-based outcome measures, mapped the current and ideal processes, and developed new processes to achieve the ideal...
June 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28527501/clinical-decision-support-and-the-electronic-health-record-applications-for-physiatry
#15
REVIEW
Joel S Shoolin
Clinical decision support (CDS) is a process that provides information to assist the user in decision making for evaluation and treatment. Although many think only of rules and alerts, CDS is much more than that. Order sets, clinical documents, information fields, and medication sentences are just a few other CDS tools to be considered. CDS has been shown to improve care. Forming the third point of the triangle, CDS, along with process redesign and workflow considerations, improves care and helps create successful outcomes...
May 2017: PM & R: the Journal of Injury, Function, and Rehabilitation
https://www.readbyqxmd.com/read/28501117/institutional-variation-in-surgical-care-for-early-stage-breast-cancer-at-community-hospitals
#16
Christopher M Dodgion, Stuart R Lipsitz, Marquita R Decker, Yue-Yung Hu, Sudha R Pavuluri Quamme, Anita Karcz, Leonard D'Avolio, Caprice C Greenberg
BACKGROUND: There is significant institutional variation in the surgical care of breast cancer, and this may reflect access to services and resultant physician practice patterns. In previous studies, specialty care has been associated with variation in the operative treatment of breast cancer but has not been evaluated in a community setting. This study investigates these issues in a cohort of 59 community hospitals in the United States. MATERIALS AND METHODS: Data on patients receiving an operation for breast cancer (2006-2009) in a large, geographically diverse cohort of hospitals were obtained...
May 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28488991/geriatric-hip-fracture-care-fixing-a-fragmented-system
#17
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/28487459/patient-flow-within-uk-emergency-departments-a-systematic-review-of-the-use-of-computer-simulation-modelling-methods
#18
Syed Mohiuddin, John Busby, Jelena Savović, Alison Richards, Kate Northstone, William Hollingworth, Jenny L Donovan, Christos Vasilakis
OBJECTIVES: Overcrowding in the emergency department (ED) is common in the UK as in other countries worldwide. Computer simulation is one approach used for understanding the causes of ED overcrowding and assessing the likely impact of changes to the delivery of emergency care. However, little is known about the usefulness of computer simulation for analysis of ED patient flow. We undertook a systematic review to investigate the different computer simulation methods and their contribution for analysis of patient flow within EDs in the UK...
May 9, 2017: BMJ Open
https://www.readbyqxmd.com/read/28476159/sustainability-in-health-care-by-allocating-resources-effectively-share-2-identifying-opportunities-for-disinvestment-in-a-local-healthcare-setting
#19
Claire Harris, Kelly Allen, Richard King, Wayne Ramsey, Cate Kelly, Malar Thiagarajan
BACKGROUND: This is the second in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Rising healthcare costs, continuing advances in health technologies and recognition of ineffective practices and systematic waste are driving disinvestment of health technologies and clinical practices that offer little or no benefit in order to maximise outcomes from existing resources. However there is little information to guide regional health services or individual facilities in how they might approach disinvestment locally...
May 5, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28470833/redistribution-and-redesign-in-health-care-an-ebbing-tide-in-england-versus-growing-concerns-in-the-united-states
#20
EDITORIAL
Alan Maynard, Stuart H Altman, Sally C Stearns
No abstract text is available yet for this article.
June 2017: Health Economics
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