How to Initiate and Sustain Operational Excellence in Healthcare Delivery: Evidence from Multiple Field Experiments
|
|
- Gyles Douglas
- 6 years ago
- Views:
Transcription
1 How to Initiate and Sustain Operational Excellence in Healthcare Delivery: Evidence from Multiple Field Experiments Aravind Chandrasekaran PhD Peter Ward PhD Fisher College of Business Ohio State University June 2017 Institute of Medicine (IOM) Report 1999 Almost 20 years later.. People die from the care they receive more often than the illness that brought them to the hospital in the first place Makary et al BMJ Examples of Preventable Medical Errors (IOM) Wrong site procedures Incorrect prescriptions Healthcare Associated Infections Central Line Infections Handoffs 2 1
2 Why does this happen? Consider simple handoffs and discharge instructions delivered 3 Discharge process (say after a surgical procedure) HOSPITAL STAY OUTPATIENT CARE Teaching related to discharge begins at various points during stay One directional conversation rushed due to topical coverage Outpatient staff may use different terms and vary instructions Care for life Patient Arrives for Surgery (T = 0) Surgery (T=2 days) Multiple RNs, PAs, Doctors, Residents/ Fellows, Social Workers, Psychologists emphasize different aspects of discharge Multiple teaching/ technology aids (with errors) Discharge from Hospital (T=7days) Lack of Handoff between inpatient and outpatient teams regarding the patient Labs and Other wellness Appointments (T= 9 days) [48 hrs. after discharge] 30-days after discharge 1 in 3 patients get readmitted back to the hospital Several forms of variation introduced by the care provider 4 2
3 Patient demographics Variations can also come from the patients Education level Language/ Culture Learning styles (e.g. visual vs. narrative) Support structure (e.g. family members) Technology readiness (e.g. use of internet, online systems) 5 Other Healthcare Delivery Challenges Hierarchy Process is too complex to standardize Limited empowerment Initiatives fail to sustain 6 3
4 What is the solution? Developing Patient Centric Healthcare Delivery systems that are highly standardized yet have in built processes to allow customization for each patient 7 Evidence from Two Experiments Site The Ohio State Wexner Mayo Clinic Medical Center Context Kidney Transplant Outpatient Setting Discharge Process Years ongoing Intervention Standardized Discharge Daily Huddles Process Type of Experiment Quasi Experiment Randomized Control Trial Results 8% reduction in 30 day readmission and 6% increase in HCAHPS scores Preliminary results better access and improved screening outcomes 8 4
5 Experiment 1 Research Question What is the effect of caregiver designed and implemented Patient Centric Standardized Discharge Work (PSDW *) with patient input on care delivery outcomes? PSDW set of activities standardized in terms of content, sequence, timing, and outcome but flexible enough to allow patient specific customization Other Collaborators: Susan Moffatt Bruce MD, Todd Pesavento MD, Mary Lou Hauenstien RN, Gopesh Anand PhD 9 Study Design 3 year grounded work at OSUWMC Field work: 40 caregivers, 102 transplant patients T 1 = 6 months Phase 1: Pre Study Work (Q Q2 2014) T 2 = 9 months Phase 2: Intervention (Q Q1 2015) T 2 = 12 months Phase 3: Post Implementation (Q Q1 2016) 1. Pre Study Work Map Current Discharge process Collect Patient Data (100+ patients) Collect Nurses/Coordinator data Observe Discharge Process Shadow Nurses and Talk to Patients 3. Patient Input for SDW Collect patient input on the newly developed SDW 2. SDW Workshop Develop SDW by the team Synchronize all teaching kits and discharge planning with the standards) 4. Implement SDW Train all the nurses CI of SDW 5. Post SDW (Q ) Collect patient and caregiver data Observe the effectiveness of CI
6 Phase 1: Pre Implementation Shadowing caregivers and observations on the discharge process Instructions on water intake Evidenced Based Standards Transplant recipients must drink at least 3 liters of water every day. Failure to adhere to this standard can result in increased creatine levels. More creatine levels results in increased blood pressure resulting in readmission. Scenario 1: Drink a lot of water Scenario 2: Drink 2 liters of water Scenario 3: Drink a lot of fluids Scenario 4: Drink six 16.9 ounce bottled water 11 Pre Study* Surveyed 87 kidney transplant recipients and matched them with their medical records Conducted focus groups with kidney transplant recipients and families to understand the current state of the discharge process Results Risks of getting readmitted is 102% higher for a one unit increase in anxiety levels one week following discharge * Journal of Surgical Research (October 2016) Lack of standardized discharge work and lower levels of empathetic care delivery increases patient anxiety upon discharge (explains 27% of variation in anxiety) 12 6
7 Phase 2: Implementation Caregivers developed PSDW through six (3 hour) workshops Content, Sequence, Timing and Outcome Components Content Instructions prior to discharge based on evidenced based standards (Before our study: 90+, Now = 20+) Sequence Sequence of instructions (Before our study: Varied, Now = one standard sequence agreed upon) Timing How long and when to start instructions (Before our study: Anytime, Now = 24 hrs, RASS =0, First meal) Output Assessing patient compliance (Before our study: Varied, Now = Smart phrases and Teach back)
8 Major Topics Pre PSDW Major Topics Post PSDW Infection Prevention * Symptoms of Rejection * Labs * Dental Care Eye Care Vaccinations * Sports and Recreation Activities Lifestyle changes Going back to Work * Treatment of Complications * When to Call Medications Vital Signs * Gardening OTC Meds * Follow up Appointments * Fluid Intake * Activity Progressions * (e.g. Pregnancy, Sexual Activity, Special Activity) Pet Care Holiday Schedules for Labs Wound Care * Going out to Public Places Lifting Instructions * Emergency Contact (e.g. 911, primary care) * Smoking and Drinking Use of EMR/Patient Portal * Multiple topics Part I (During Hospital Stay) by Inpatient Nurses Starts when the follow: 24 hrs. post transplant and no later than 32 hours, RASS Score = 0, family present and patient tolerate first meal Infection Prevention * Vital Signs and Symptoms * Labs * When to Call Medications Vital Signs * Fluid Intake * Emergency Contact (e.g. 911, primary care) * Part II (After Discharge) by Outpatient Nurses Starts within 48 hours after discharge and continues for about 3 months (face to face as well as over the phone) Medications Follow up Appointments Activities (e.g. pregnancy, sexual, social, gardening) Vaccinations Eye and Dental Care Lifestyle Change Treatment of Complications Post op care (Wound Care) * Emergency Contact (e.g. 911, primary care) * OTC Meds Going back to work, Public Places Pet Care Exercising & Sports Activities * 15 Phase 3: Post Implementation Hospital Stay Outpatient Clinic Patient Arrives for Surgery (T = 0) Transplant Surgery (T = 2 days) Teaching begins 24 hours after surgery (Patient must tolerate meal to demonstrate attentiveness) Teach-back (Conversational) using multiple aids to reinforces learning Patient discharged from hospital (T = 6) Outpatient nurse calls patents (T = 8) 48 hrs. after discharge First lab appointments (T = 14 days) 7 days after discharge 30-days after Discharge 50% Reduction in topics (Most important for immediate well being are taught) Handoff between inpatient and outpatient teams (Outpatient nurse sees patient before discharge) Everything done in outpatient unit is standardized and communicated with inpatient unit Instruction standardized and consistent across teaching aids (cheat sheets, flip charts etc) Bi weekly Problem solving huddles Weekly Problem solving huddles Weekly huddles between inpatient and outpatient managers with nursing director 16 8
9 Phase 3: Inpatient/Outpatient huddles Bi weekly Huddles (Inpatient) Weekly Huddles (Outpatient) 17 Empirical Validation (Post Implementation) Difference in Difference Methodology Readmission Control Treatment Effect of Intervention Pre During Post Control Group Heart and Liver Transplant process Same hospital unit, share technologies Discharge process were streamlined with kidney transplant prior to study Influenced by any changes at OSUWMC Patients face similar issues post discharge Units are spatially separated to avoid any spillovers 18 9
10 Empirical Validation (May 2015 April 2016) Treatment Group Kidney Transplants Heart Transplants Control Group Liver Transplants Volume Age years years years Length of Stay 7.84 days days days 30 day 36.60% % Readmissions 30 day Mortality 0.7% % Gender 40% Female Female 30% Female Readmissions and other demographics are comparable to national average Minimal nursing and physician turnovers during the study period 19 Benefits Probability of Readmission Likelihood of readmission postimplementation is 0.32 times lower than control group and pre and during implementations Pre-Implementation Control Group Time Period Treatment Group Post-Implementation Cost Benefits Data on direct (room and board, pharmacy, drugs etc) and indirect costs (salaries & benefits, building, labs) Total cost / Readmission = $14, readmissions avoided (Savings) = $
11 HCAHPS Quality Ratings VBP Weight FY 2016 Outcome 40% Process 10% Efficiency VBP Weight FY 2017 Efficiency and Cost Reduction, HCAHPS PROPOPSED VBP Weight FY 2018 Efficiency and Cost Reduction, HCAHPS HCAHPS Safety, 20% Clinical Care Process, 5% Clinical Care Outcomes, Safety, Clinical Care Outcomes, HCAHPS Scores are a part of reimbursements for Medicare and Medicaid Patients, Source: CMS.gov Access to HCAHPS unit level data for treatment (Unit A) and control (Unit B) groups 21 HCAHPS Post Implementation Overall Patient Satisfaction (%) Pre-Implementation Control Group Time Period Treatment Group Post-Implementation HCAHPS scores increased by 6% for treatment group while it is decreased by 7% for control group 22 11
12 Key Takeaways Showing that the problem exists is a good approach to drive change People doing the work must develop their work standards Sustaining requires middle managers to initiate and sustain huddles Requires Cultural Transformation (Not just tools!) 23 Experiment 2 Research Question How does physician engagement in daily huddles improve team effectiveness and outpatient performance? Other Collaborators: Dave Rushlow MD, Marc Tummerman MD, Brad Staats PhD and Nilay Shah PhD 24 12
13 Background Mayo Model of Outpatient Care (MMOC) deployed in 2014 with mixed results Element of MMOC Team Based Care Lack of proper buy in among physicians (Not studied in literature) Poor team effectiveness and mixed effects on screening performance 25 Study Design Pre Work Observations (April 2016 Aug 2016) Study Design and Recruiting Teams (Sep 2016 April 2017) Study Workshop with treatment group (April 2017) Post observations (May 2017 Oct 2017) 26 13
14 Pre Work Observations Visited multiple outpatient sites and semi structured interviews with care team Mixed huddle participation and compliance Correlated with team climate and screening outcomes 27 Correlational Observations Pod 3 huddled most frequently with physician mostly present while Pod 2 huddled very ad hoc 28 14
15 Study Design and Recruiting Multiple sites from WI and MN regions to participate Each team physician, nursing and admin 30 teams expressed interest divided into treatment and control arms 29 April Workshop for Treatment arm Each team with an assigned coach Training on content and process of huddling 30 15
16 Huddle Workshop Communicate and Assign Accountabilities 1. Status and Flow Match resources to patients Create plan and schedule 2. Occurrence Tracking Compare the plan to actual Identify and capture issues 3. Problem Solving Show scientific thinking Experiment using PDSA Status & Flow Occurrence Tracking Problem Solving Huddle Managing Daily Improvement System Match resources to patients Create plan and schedule Compare the plan to actual Identify and capture issues Scientific thinking Experiment using PDSA Communicate Assign accountabilities 31 Post Observations Bi weekly coaching by the assigned coaches Onsite visits 30 day & 100 day follow up by coaches Pre survey on team climate, psychological safety and trust for all 30 teams (response rate 70% no sig. difference across the arms) Track outcomes after 6 months for both the arms 32 16
17 Post Observations Results pending on the overall effectiveness (Nov 2017) Preliminary qualitative insights are positive Nice process story by tracking progress over time 33 Questions Thank you!
Design and Implementation of Standard Work on Care Delivery Performance: A Quasi-Experimental Investigation
Design and Implementation of Standard Work on Care Delivery Performance: A Quasi-Experimental Investigation Aravind Chandrasekaran Fisher College of Business The Ohio State University Gopesh Anand University
More informationIntroduction. Singapore. Singapore and its Quality and Patient Safety Position 11/9/2012. National Healthcare Group, SIN
Introduction Singapore and its Quality and Patient Safety Position Singapore 1 Singapore 2004: Top 5 Key Risk Factors High Body Mass (11.1%; 45,000) Physical Inactivity (3.8%; 15,000) Cigarette Smoking
More informationPartner with Health Services Advisory Group
Partner with Health Services Advisory Group Bonnie Hollopeter, LPN, CPHQ, CPEHR Health Services Advisory Group (HSAG) Quality Improvement Lead Rosalie McGinnis, MS, RN HSAG Quality Improvement Lead November
More informationQuality and Health Care Reform: How Do We Proceed?
Quality and Health Care Reform: How Do We Proceed? Susan D. Moffatt-Bruce, MD, PhD Chief Quality and Patient Safety Officer Associate Dean of Clinical Affairs Quality and Patient Safety Associate Professor
More informationAdvancing Accountability for Improving HCAHPS at Ingalls
iround for Patient Experience Advancing Accountability for Improving HCAHPS at Ingalls A Case Study Webconference 2 Managing your audio Use Telephone If you select the use telephone option please dial
More informationMedido, a smart medication dispensing solution, shows high rates of medication adherence and potential to reduce cost of care.
White Paper Medido, a smart medication dispensing solution, shows high rates of medication adherence and potential to reduce cost of care. A Philips Lifeline White Paper Tine Smits, Research Scientist,
More informationPENN Medicine. National Health Policy Forum. The Cost of Hospital Care. Keith A. Kasper
PENN Medicine National Health Policy Forum The Cost of Hospital Care Keith A. Kasper SVP & Chief Financial Officer University of Pennsylvania Health System October 8, 2010 0 PENN Medicine Organizational
More informationFinancing and Sustainability Strategies for Behavioral Health Integration Anna Ratzliff, MD, PhD Associate Director for Education AIMS Center
Financing and Sustainability Strategies for Behavioral Health Integration Anna Ratzliff, MD, PhD Associate Director for Education AIMS Center Advancing Integrated Mental Health Solutions The Healthier
More informationPay-for-Performance. GNYHA Engineering Quality Improvement
Pay-for-Performance GNYHA Engineering Quality Improvement The Writing Is On The Wall IOM Report - Rewarding Provider Performance: Aligning Incentives In Medicare 9/21/06 Medicare P4P and quality improvement
More informationsnapshot Improving Experience of Care Scores Alone is NOT the Answer: Hospitals Need a Patient-Centric Foundation
SATISFACTION snapshot news, views & ideas from the leader in healthcare satisfaction measurement The Satisfaction Snapshot is a monthly electronic bulletin freely available to all those involved or interested
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services
More informationDefinitions/Glossary of Terms
Definitions/Glossary of Terms Submitted by: Evelyn Gallego, MBA EgH Consulting Owner, Health IT Consultant Bethesda, MD Date Posted: 8/30/2010 The following glossary is based on the Health Care Quality
More informationElectronic Surgical Scheduling Improves Patient Safety and Productivity
Electronic Surgical Scheduling Improves Patient Safety and Productivity Katrina Spears, MA, Manager Business & Informatics Surgical Services Lina Munoz, BSN, RN, CPAN Manger Presurgical Testing, PACU,
More informationUnderstanding Patient Choice Insights Patient Choice Insights Network
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Understanding Patient Choice Insights Patient Choice Insights Network SM www.aetna.com Helping consumers gain
More informationDischarge checklist and follow-up phone calls: the foundation to an effective discharge process
Discharge checklist and follow-up phone calls: the foundation to an effective discharge process Shari Aman, BSN, RN, MBA, CPHQ Denise Andrews, MBA Stephanie Storie, BSN, RN, CMSRN Deb Nation, RN, CMSRN
More informationThe 5 W s of the CMS Core Quality Process and Outcome Measures
The 5 W s of the CMS Core Quality Process and Outcome Measures Understanding the process and the expectations Developed by Kathy Wonderly RN,BSPA, CPHQ Performance Improvement Coordinator Developed : September
More informationEvaluation of a High Risk Case Management Pilot Program for Medicare Beneficiaries with Medigap Coverage
Evaluation of a High Risk Case Management Pilot Program for Medicare Beneficiaries with Medigap Coverage American Public Health Association Monday, October 29, 2012: 10:30 AM-12:00 PM Kevin Hawkins, PhD
More informationPRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management
PRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management Mission: To improve the health of the people of Connecticut through safe and effective medication
More informationAGENDA. Introduction and Executive Leadership Year in Review Environment of Care Report and Policy Approvals
AGENDA Introduction and Executive Leadership Year in Review Environment of Care Report and Policy Approvals San Francisco General Hospital and Trauma Center Executive Leadership Roland Pickens, Interim
More informationBrittany Turner, 2015 PharmD Candidate 1 Justin Campbell, PharmD 2 Katie McKinney, PharmD, MS, BCPS 2
Discharge Medication Concierge Program: A pilot project in heart failure to reduce readmission rates, improve patient satisfaction, and increase pharmacy business metrics Brittany Turner, 2015 PharmD Candidate
More informationHCAHPS and Readmissions: Making the Connection Wednesday, September 18, :00 a.m. 10:00 a.m.
HCAHPS and Readmissions: Making the Connection Wednesday, September 18, 2013 9:00 a.m. 10:00 a.m. Facilitated by: Katie McCullough, VHHA and Carla Thomas, VHQC Session Objectives: Understand the published
More informationExpansion of Pharmacy Services within Patient Centered Medical Homes. Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice
Expansion of Pharmacy Services within Patient Centered Medical Homes Jeremy Thomas, PharmD Associate Professor Department Pharmacy Practice What is a Patient Centered Medical Home (PCMH)? "an approach
More information7/7/17. Value and Quality in Health Care. Kevin Shah, MD MBA. Overview of Quality. Define. Measure. Improve
Value and Quality in Health Care Kevin Shah, MD MBA 1 Overview of Quality Define Measure 2 1 Define Health care reform is transitioning financing from volume to value based reimbursement Today Fee for
More informationHCAHPS: Background and Significance Evidenced Based Recommendations
HCAHPS: Background and Significance Evidenced Based Recommendations Susan T. Bionat, APRN, CNS, ACNP-BC, CCRN Education Leader, Nurse Practitioner Program Objectives Discuss the background of HCAHPS. Discuss
More informationREDUCING READMISSIONS through TRANSITIONS IN CARE
REDUCING READMISSIONS through TRANSITIONS IN CARE Christina R. Whitehouse, PhD, CRNP, CDE Postdoctoral Research Fellow NewCourtland Center for Transitions and Health University of Pennsylvania School of
More informationMedicare P4P -- Medicare Quality Reporting, Incentive and Penalty Programs
Medicare P4P -- Medicare Quality Reporting, Incentive and Penalty Programs Presenter: Daniel J. Hettich King & Spalding; Washington, DC dhettich@kslaw.com 1 I. Introduction Evolution of Medicare as a Purchaser
More informationDecision Support Project Team. Fall 2010
Decision Support Project Team Engineering the System of Healthcare Delivery ESD 69 HST 926j HC 750 MIT Seminar on Health Care Systems Innovation ESD.69, HST.926j, HC.750 MIT Seminar on Health Care Systems
More informationHospital Compare Quality Measures: 2008 National and Florida Results for Critical Access Hospitals
Hospital Compare Quality Measures: National and Results for Critical Access Hospitals Michelle Casey, MS, Michele Burlew, MS, Ira Moscovice, PhD University of Minnesota Rural Health Research Center Introduction
More informationUTILIZATION MANAGEMENT AND CARE COORDINATION Section 8
Overview The focus of WellCare s Utilization Management (UM) Program is to provide members access to quality care and to monitor the appropriate utilization of services. WellCare s UM Program has five
More informationThrough Use of Teach-back. Kimberly Cahill RN, BSN ICPC Project Coordinator
Enhancing Patient Empowerment Through Use of Teach-back Kimberly Cahill RN, BSN ICPC Project Coordinator Quality Insights of Pennsylvania Program Objectives Define the Teach Back method of patient education
More informationHCAHPS. Presented by: Bill Sexton. Proudly recognized as one of the Nation s Top 100 Critical Access Hospitals - ivantage Health Analytics
HCAHPS Presented by: Bill Sexton HCAHPS results will impact your organization's reimbursement in the era of health care reform HCAPHS results are a quality metric, not just a patient satisfaction metric
More informationUPMC Passavant Goals and Objectives for Fiscal Year 2016
1 UPMC Passavant s and Objectives for Fiscal Year 2016 UPMC Passavant Summary of Significant FY16 s Strive to create a safe, fair culture, focusing on elimination of preventable harm and death. Enhance
More informationCardiovascular Disease Prevention and Control: Interventions Engaging Community Health Workers
Cardiovascular Disease Prevention and Control: Interventions Engaging Community Health Workers Community Preventive Services Task Force Finding and Rationale Statement Ratified March 2015 Table of Contents
More informationImproving Nurse-patient Communication about New Medicines
The University of San Francisco USF Scholarship: a digital repository @ Gleeson Library Geschke Center Master's Projects and Capstones Theses, Dissertations, Capstones and Projects Summer 8-17-2015 Improving
More informationA Journal of Rhetoric in Society. Interview: Transplant Deliberations and Patient Advocacy. Staff
Present Tense A Journal of Rhetoric in Society Interview: Transplant Deliberations and Patient Advocacy Staff Present Tense, Vol. 2, Issue 2, 2012. www.presenttensejournal.org editors@presenttensejournal.org
More informationEHR Enablement for Data Capture
EHR Enablement for Data Capture Baylor Scott & White (15 min) Bonnie Hodges, RN University of Chicago Medicine(15 min) Susan M. Sullivan, RHIA, CPHQ Kaiser Permanente (15 min) Molly P. Clopp, RN Tammy
More informationHealth Care Systems - A National Perspective Erica Preston-Roedder, MSPH PhD
Health Care Systems - A National Perspective Erica Preston-Roedder, MSPH PhD Outline Quality Overview Overview and discussion of CMS programs Increasing transparency Move from P4R to P4P Expanding beyond
More informationNational Readmissions Summit Safe and Reliable Transitions: An Integrated Approach Reducing Heart Failure Readmissions
National Readmissions Summit Safe and Reliable Transitions: An Integrated Approach Reducing Heart Failure Readmissions Michael Kanter, MD, Medical Director Quality and Clinical Analysis Patti Harvey, RN,
More informationEVOLENT HEALTH, LLC Diabetes Program Description 2018
EVOLENT HEALTH, LLC Diabetes Program Description 2018 1 Evolent Health Diabetes Program Description 2018 Table of Contents Section Page Number I. Introduction... 3 II. Program Scope... 3 III. Program Goals...
More informationReducing Infections and Improving Engagement St. Luke's Nephrology Associates. Contact Information: Robert Gayner, M.D., FASN
BEST PRACTICES Vascular Access and CLABSI Reduction Reducing Infections and Improving Engagement St. Luke's Nephrology Associates Contact Information: Robert Gayner, M.D., FASN St. Luke's Nephrology Associates
More informationIHI Expedition. Improving Patient Experience and Making It Stick Session 5. Expedition Coordinator
Wednesday, August 21, 2013 These presenters have nothing to disclose IHI Expedition Improving Patient Experience and Making It Stick Session 5 Barbara Balik, RN, EDd Kelly McCutcheon Adams, LICSW Expedition
More informationNursing skill mix and staffing levels for safe patient care
EVIDENCE SERVICE Providing the best available knowledge about effective care Nursing skill mix and staffing levels for safe patient care RAPID APPRAISAL OF EVIDENCE, 19 March 2015 (Style 2, v1.0) Contents
More informationOxford Condition Management Programs:
Oxford Condition Management Programs: Helping your employees learn, be encouraged and get support. Committed to helping improve the health and well-being of those we serve and improve the health care
More informationChapter 7 Inpatient and Outpatient Hospital Care
7 Inpatient & Outpatient Hospital Care ACUTE INPATIENT ADMISSIONS All elective and emergent admissions require prior authorization and/or notification for all Health Choice Generations Member admissions.
More informationFrom Implementation to Optimization: Moving Beyond Operations
From Implementation to Optimization: Moving Beyond Operations Session 260, March 8, 2018 Scott Aikey, Sr. Director, Core Clinical Applications Children s Hospital of Philadelphia 1 Conflict of Interest
More informationMerced College Registered Nursing 34: Advanced Medical/Surgical Nursing and Pediatric Nursing
Merced College Registered Nursing 34: Advanced Medical/Surgical Nursing and Pediatric Nursing Course Description, Student Learning Outcomes and Competencies, Clinical Evaluation Tool, and Clinical Activities
More informationFY 13 Pillar Goal Update and FY 14 Pillar Goals
FY 13 Pillar Goal Update and FY 14 Pillar Goals Summer Leadership Assembly C. Wright Pinson, MD, MBA Deputy Vice Chancellor, Health Affairs CEO, Vanderbilt Health System June 19, 2013 Staying Focused on
More informationImproving Hospital Performance Through Clinical Integration
white paper Improving Hospital Performance Through Clinical Integration Rohit Uppal, MD President of Acute Hospital Medicine, TeamHealth In the typical hospital, most clinical service lines operate as
More informationOutline 11/17/2014. Overview of the Issue Program Overview Program Components Program Implementation
Physical Health Integration in a Behavioral Health Setting Robin Reed, MD, MPH Rupal Yu, MD, MPH Acknowledgements The Duke Endowment Piedmont Health Services Carolina Advanced Health Community Care of
More informationThe Power of Clinical Callbacks: Preventing Early Readmissions with Clinical Callbacks. Cheryl Crumpton, BSN, RN, CEN
The Power of Clinical Callbacks: Preventing Early Readmissions with Clinical Callbacks Cheryl Crumpton, BSN, RN, CEN Making the Patient Call Manager (PCM) Connection Quality Initiative Improve Clinical
More informationLeveraging the Accountable Care Unit Model to create a culture of Shared Accountability
Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and Quality Outcomes at Northwest Hospital Our Journey to Shared Accountability Implementation
More informationLeadership: Simple Strategies to Engage and Sustain
Leadership: Simple Strategies to Engage and Sustain Susan Moffatt-Bruce, MD, PhD, FACS Chief Quality and Patient Safety Officer Associate Dean of Clinical Affairs, Quality and Patient Safety Associate
More informationImproving the Patient Experience through Key Nursing Practices and Authentic Patient Connections
Improving the Patient Experience through Key Nursing Practices and Authentic Patient Connections Mary Del Guidice, MSN, BS, RN, CENP Chief Nursing Officer Penn Medicine, Pennsylvania Hospital Assistant
More informationServices Covered by Molina Healthcare
Services Covered by Molina Healthcare As a Molina Healthcare member, you will continue to receive all medically-necessary Medicaid-covered services at no cost to you. The following list of covered services
More informationThe Patient Protection and Affordable Care Act of 2010
INVITED COMMENTARY Laying a Foundation for Success in the Medicare Hospital Value-Based Purchasing Program Steve Lawler, Brian Floyd The Centers for Medicare & Medicaid Services (CMS) is seeking to transform
More informationHealth Home Flow Hypothetical Patient Scenario
Health Home Flow Hypothetical Patient Scenario Client Background: Soozie SoonerCare Soozie is a single female, age 42, 5'6" tall 215 pounds. She smokes 2 packs of cigarettes a day. At age 24, Soozie was
More informationValue-Based Purchasing & Payment Reform How Will It Affect You?
Value-Based Purchasing & Payment Reform How Will It Affect You? HFAP Webinar September 21, 2012 Nell Buhlman, MBA VP, Product Strategy Click to view recording. Agenda Payment Reform Landscape Current &
More informationReducing Hospital Readmissions: Home Care as the Solution
Reducing Hospital Readmissions: Home Care as the Solution Kathy Duckett RN, BSN Sutter Center for Integrated Care ducketk@sutterhealth.org www.suttercenterforintegratedcare.org Learning Objectives 1 Review
More informationEffective Care Transitions to Reduce Hospital Readmissions
Effective Care Transitions to Reduce Hospital Readmissions November 8, 2017 Anchorage, Alaska The vicious cycle of readmissions What is Care Transitions? The movement of patients across settings, referred
More informationSENTARA HEALTHCARE. Norfolk, VA
SENTARA HEALTHCARE Norfolk, VA 1 Sentara Healthcare Overview 11 Acute Care Hospitals in Virginia with a total of 2572 licensed beds 1E Extended dstay hospital 9 Ambulatory Care Campuses; 5 with freestanding
More informationDELTA CARE CHANGING LIVES. A CARE TRANSITION PROGRAM of EPHRAIM MCDOWELL HEALTH DR. JOAN HALTOM, PHARM.D, FKSHP GAIL SHEARER, BSN, MBA,CCM
DELTA CARE CHANGING LIVES A CARE TRANSITION PROGRAM of EPHRAIM MCDOWELL HEALTH DR. JOAN HALTOM, PHARM.D, FKSHP GAIL SHEARER, BSN, MBA,CCM DELTA CARE Delta Care is an Innovative approach to transitioning
More informationL19: Improving Transitions from the Hospital to Post Acute Care Settings
This presenter has nothing to disclose L19: Improving Transitions from the Hospital to Post Acute Care Settings Gail A. Nielsen December 8, 2013 25th Annual National Forum on Quality Improvement in Health
More informationAccountability Agreement Tool Kit
0 Organization-Wide Leadership Accountability Agreement Effective I. HCAHPS Goals (Provider of Choice) # 12 Mos High 12 Mos Low 1 1. Communication with nurses 2. Communication with doctors. Responsiveness
More informationHome Health Value-Based Purchasing Series: HHVBP Model 101. Wednesday, February 3, 2016
Home Health Value-Based Purchasing Series: HHVBP Model 101 Wednesday, February 3, 2016 About the Alliance 501(c)(3) non-profit research foundation Mission: To support research and education on the value
More informationSTATE OF KANSAS DEPARTMENT FOR AGING AND DISABILITY SERVICES OSAWATOMIE STATE HOSPITAL OPERATIONS ASSESSMENT EXECUTIVE SUMMARY
STATE OF KANSAS DEPARTMENT FOR AGING AND DISABILITY SERVICES OSAWATOMIE STATE HOSPITAL OPERATIONS ASSESSMENT Prepared by: THE BUCKLEY GROUP, L.L.C. OVERVIEW The Osawatomie State Hospital (OSH) in Osawatomie
More informationSuccessfully Using Six Sigma. (6σ) to Improve Nursing Quality. Indictors. Objectives. 1. Describe how Six Sigma can be used to
Successfully Using Six Sigma (6σ) to Improve Nursing Quality Indictors Joann Hatton, RN MS, 6σ Black Belt Director of Nursing Professional Practice Heritage Valley Health System Beaver, PA Objectives 1.
More informationCAMDEN CLARK MEDICAL CENTER:
INSIGHT DRIVEN HEALTH CAMDEN CLARK MEDICAL CENTER: CARE MANAGEMENT TRANSFORMATION GENERATES SAVINGS AND ENHANCES CARE OVERVIEW Accenture helped Camden Clark Medical Center, (CCMC), a West Virginia-based
More informationQuest for Excellence. Award Application. Bergan Mercy Medical Center Mercy Road. Omaha, Nebraska Contact:
Quest for Excellence Award Application Bergan Mercy Medical Center 7500 Mercy Road Omaha, Nebraska 68124 Contact: Gail Brondum, Operations Director Quality Management Services gail.brondum@alegent.org
More informationCHF Education March Courtney Reaves, BSN, RN-BC Amy Taylor, BSN, RN Corey Paris, BSN, RN, CCRN
CHF Education March 2015 Courtney Reaves, BSN, RN-BC Amy Taylor, BSN, RN Corey Paris, BSN, RN, CCRN Objectives To improve patient outcomes Decrease CHF readmissions Improve patient and family compliance
More informationAdministrative Update: How to Implement Discharge Pharmacy Services (DPS) Objectives
Administrative Update: How to Implement Discharge Pharmacy Services (DPS) Morgan Pendleton, PharmD, BCOP Hematology/Oncology Clinical Pharmacist Wake Forest Baptist Health Objectives Evaluate the need
More informationCultivating Empathy. iround for Patient Experience. Why Empathy Is Important and How to Build an Empathetic Culture. 1 advisory.
iround for Patient Experience Cultivating Empathy Why Empathy Is Important and How to Build an Empathetic Culture 2016 The Advisory Board Company advisory.com 1 advisory.com Cultivating Empathy Executive
More information"Working Smartly: Better Communication and Reduced Error through Improved Clinical Informatics"
"Working Smartly: Better Communication and Reduced Error through Improved Clinical Informatics" Healthcare Transformation Services Lisa Pahl, MSN, Principal, Practice Lead Alarm Management May, 2017 Data,
More informationSchool of Nursing Applying Evidence to Improve Quality
Applying Evidence to Improve Quality Linda A Dudjak PhD RN Associate Professor University of Pittsburgh School of Nursing Compare Two Alternatives Implement a Test of Change (Experiment) to Fix a Broken
More informationWakeMed Rehab Hospital Stroke Rehabilitation Scope of Service
WakeMed Rehab Hospital Stroke Rehabilitation Scope of Service WakeMed Rehab Hospital provides an integrated, comprehensive delivery of rehabilitation services utilizing evidenced-based practice directed
More informationValue Based Purchasing
Value Based Purchasing Baylor Health Care System Leadership Summit October 26, 2011 Sheri Winsper, RN, MSN, MSHA Vice President for Performance Measurement & Reporting Institute for Health Care Research
More informationIntroduction. Singapore and its Quality and Patient Safety Position. Singapore 2004: Top 5 Key Risk Factors. High Body Mass
Introduction Singapore and its Quality and Patient Safety Position Singapore 2004: Top 5 Key Risk Factors High Body Mass (11.1%; 45,000) Physical Inactivity (3.8%; 15,000) Cigarette Smoking (7.4%; 28,000)
More informationWPCC Workgroup. 2/20/2018 Meeting
WPCC Workgroup 2/20/2018 Meeting Today s Agenda 1. Introductions 2. Medicaid Transformation Overview 3. WPCC in the Transformation 4. Change Plan Overview 5. Review of Supporting Data 6. Change Plan Deep
More informationFee: The fee for the 12-month renewal is $10,000.
CHILDHOOD CANCER AND BLOOD DISORDERS NETWORK 2017 RENEWAL TOOLS HOW TO Renew To renew, simply submit a completed Childhood Cancer & Blood Disorders Network Renewal Form to Gena Paulk via email at gena.paulk@childrenshospitals.org.
More informationCAH PREPARATION ON-SITE VISIT
CAH PREPARATION ON-SITE VISIT Illinois Department of Public Health, Center for Rural Health This day is yours and can be flexible to the timetable of hospital staff. An additional visit can also be arranged
More informationServices Covered by Molina Healthcare
Services Covered by Molina Healthcare Because you are covered by Medicaid, you pay nothing for covered services. As a Molina Healthcare member, you will continue to receive all medically necessary Medicaid-covered
More informationUNDERSTANDING SHARED MEDICAL APPOINTMENTS AN INTRODUCTION TO GROUP VISITS
TO GROUP VISITS OVERVIEW The complex needs of today's patients present a challenge to medical group physicians who try to meet patients' needs within the constraints of the traditional office visit. Studies
More informationMicrosoft Dynamics 365 Foundational Platform for Next Generation Patient Experience Management
Microsoft Dynamics 365 Foundational Platform for Next Generation Patient Experience Management Tracy Picon Director Healthcare, Dynamics Microsoft Grayson Shroyer Digital Health Architect Avanade (Microsoft
More informationCME Disclosure. HCAHPS- Hardwiring Your Hospital for Pay-for-Performance Success. Accreditation Statement. Designation of Credit.
CME Disclosure Accreditation Statement Studer Group is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Designation
More informationOh No! I need to write an abstract! How do I start?
Oh No! I need to write an abstract! How do I start? Why is it hard to write an abstract? Fear / anxiety about the writing process others reading what you wrote Takes time / feel overwhelmed Commits you
More informationTransitioning Adolescents to Adult Care. Beverly Kosmach-Park DNP Clinical Nurse Specialist Children s Hospital of Pittsburgh Pittsburgh, PA USA
Transitioning Adolescents to Adult Care Beverly Kosmach-Park DNP Clinical Nurse Specialist Children s Hospital of Pittsburgh Pittsburgh, PA USA Graft Survival Following Deceased Kidney Transplantation
More informationImproving Pain Center Processes utilizing a Lean Team Approach
Improving Pain Center Processes utilizing a Lean Team Approach Organization Name: St. Joseph Medical Center Type: Acute Care Hospital Contact Person: Sue Mitchell Title: Nurse Mgr Pain Mgmt Center E-Mail:
More informationTHE ALPHABET SOUP OF MEDICAL PAYMENTS: WHAT IS MACRA, VBP AND MORE! Lisa Scheppers MD FACP Margo Ferguson MT MSOM
THE ALPHABET SOUP OF MEDICAL PAYMENTS: WHAT IS MACRA, VBP AND MORE! Lisa Scheppers MD FACP Margo Ferguson MT MSOM THE REASON FOR CHANGE VOLUME TO VALUE Fee-for-service PAYMENT Bundled, Shared Patient FOCUS
More informationCatherine Porto, MPA, RHIA, CHP Executive Director HIM. Madelyn Horn Noble 3M HIM Data Analyst
1 Catherine Porto, MPA, RHIA, CHP Executive Director HIM Madelyn Horn Noble 3M HIM Data Analyst University of New Mexico Hospitals» The state s only academic medical center» The primary teaching hospital
More informationo Recipients must coordinate these testing services with other HIV prevention and testing programs to avoid duplication of efforts.
E. GENERAL SERVICE DEFINITIONS & SERVICE DELIVERY The following section provides specific service definitions, service delivery and any special reporting requirements for each of the services funded in
More informationSFGH. Management System. Components. SFGH Management System. Improvement. Time. Strategic Planning True North. Value Streams: Rapid Improvement Events
SFGH Management System 1 SFGH Management System Components Strategic Planning True North Improvement Management System Value Streams: Rapid Improvement Events Time 2 1 Refining our Strategic Planning PATIENT
More informationResults from Contra Costa Regional Medical Center
Results from Contra Costa Regional Medical Center Karin Stryker, MBA DSRIP Manager, Health Services Administrator Chris Farnitano, MD Medical Director, Ambulatory Care High Impact Interventions Sepsis
More informationPopulation Centric Intelligence: Using Data Segmentation and Community Health Assessments for Better Patient Insights
Population Centric Intelligence: Using Data Segmentation and Community Health Assessments for Better Patient Insights Charles Boicey, MS, RN-BC, CPHIMS President American Nursing Informatics Association
More informationU.S. Healthcare Problem
U.S. Healthcare Problem U.S. Federal Spending GDP (%) Source: Congressional Budget Office This graph shows that government has to spend a lot of more money in healthcare in the future and it is growing
More informationTransitions of Care Innovations in the Medical Practice Setting
Transitions of Care Innovations in the Medical Practice Setting Linda Wendt, System Director of Quality- UnityPoint Clinic Sheila Tumilty, Senior Project Manager- UnityPoint Clinic Session Objectives After
More informationSAN FRANCISCO GENERAL HOSPITAL and TRAUMA CENTER
SAN FRANCISCO GENERAL HOSPITAL and TRAUMA CENTER 1 WHY IS SAN FRANCISCO GENERAL HOSPITAL IMPORTANT? and Trauma Center (SFGH) is a licensed general acute care hospital which is owned and operated by the
More informationTransitions in Care. Why They Are Important and How to Improve Them. U. Ohuabunwa MD
Transitions in Care Why They Are Important and How to Improve Them U. Ohuabunwa MD Learning Objectives Define transitions in care and the roles patients and providers play in safe transitions Describe
More informationHardwiring Processes to Improve Patient Outcomes
Hardwiring Processes to Improve Patient Outcomes Barbara Adcock Mohr, Administrative Director, Rehabilitation Services Mark Prochazka, Assistant Director, Rehabilitation Services UNC Hospitals FIM, UDSMR,
More informationBrent Treichler, M.D., FACEP Assistant Professor, UT Southwestern Department of Surgery, Division of Emergency Medicine Chief of Emergency Services,
Brent Treichler, M.D., FACEP Assistant Professor, UT Southwestern Department of Surgery, Division of Emergency Medicine Chief of Emergency Services, Parkland Health and Hospital System September 13, 2010
More informationM7: Improving Transitions and Reducing Avoidable Rehospitalizations. St. Luke s Hospital Member, Iowa Health System
M7: Improving Transitions and Reducing Avoidable Rehospitalizations Peg M. Bradke, RN, MA St. Luke s Hospital, Cedar Rapids, Iowa This presenter has nothing to disclose. St. Luke s Hospital Member, Iowa
More information