This document summarizes a mixed methods analysis of practice transformation at the University of Utah Community Clinics from 2003-2009. Key elements of the transformation included implementing care teams with expanded medical assistant roles, standardized schedules, and pre-visit planning. Both qualitative and quantitative data were collected through surveys, interviews, observations and clinical/operational data. Preliminary results found improved quality measures, patient satisfaction, and access associated with higher levels of transformation implementation. Future analysis will link data on implementation, clinical outcomes, operations and costs to assess total impact on care delivery and costs. Challenges included coordinating multi-method research and navigating approvals for clinical and claims data.
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
Advanced Laboratory Analytics — A Disruptive Solution for Health SystemsViewics
As US healthcare systems grapple with the recent upheavals in care payment and delivery, they are turning to advanced analytics as their “central nervous systems” for driving care and financial performance.
Laboratory information — spanning chemistry, pathology, microbiology and molecular testing, for example — is among the best sources of data for these advanced analytics, including clinician decision support, predictive analytics, population health management, and personalized medicine. When strategically harnessed and integrated to create a patient-centric lab data lake, laboratory information can form an affordable yet competitively powerful advanced analytics solution well suited for many health systems — i.e., a disruptive option.
L. Eleanor J. Herriman, MD, MBA, Chief Medical Informatics Officer of Viewics, explains why laboratory data should be a core strategic component for achieving success in value-based healthcare.
Best Practices for a Data-driven Approach to Test UtilizationViewics
Would you like to learn how data-driven interventions can improve laboratory test utilization in your organization? Would you like to hear about the impact that leading hospitals/health systems and managed care organizations have made through these interventions?
If so, you might be interested in this presentation by utilization management expert Dr. Michael Astion, Medical Director at the Department of Laboratories at Seattle Children’s Hospital and Clinical Professor of Laboratory Medicine at the University of Washington.
In this presentation, Dr. Astion discusses the current state of the misuse of laboratory testing in the United States and some of the interventions that are being implemented to improve it. He covers a number of common areas of unnecessary testing — from pure abuse to tests that could be useful but are ordered inappropriately.
You'll learn about:
• Two areas of laboratory testing where misordering of tests occur frequently
• Three interventions to improve the value of testing for patients
• The role of genetic counselors and other laboratory professionals in improving lab test ordering
• The national endeavor known as PLUGS, the Pediatric Laboratory Utilization Guidance Service
Revolutionizing Renal Care With Predictive Analytics for CKDViewics
Chronic Kidney Disease (CKD) is a common and growing condition, affecting about half of the Medicare population and of diabetics. In the United States, the lifetime risk of CKD for 30-year-olds is now greater than half, and the prevalence of CKD is projected to rise significantly over the next 15 years.
Current methods of predicting which CKD patients will progress to renal failure and require dialysis or transplant have low accuracy rates, causing great anxiety and suboptimal care. Without accurate risk prediction, many patients are over-treated, effectively wasting limited resources and negatively impacting outcomes. Conversely, other patients may receive inadequate treatment, restricting options to only the most costly and least desirable interventions.
Watch this on-demand webinar with Dr. Navdeep Tangri, developer of the Kidney Failure Risk Equation, which revolutionizes the way CKD patients are managed by leveraging laboratory data to accurately predict the risk of kidney failure in patients with CKD.
You’ll learn:
• How CKD is burdening our healthcare system, and the need for better care management tools
• How the Kidney Failure Risk Equation was researched, developed, and validated
• How Viewics is implementing CKD predictive analytics to automatically deliver risk information to clinicians and issue customized, educational reports to patients and clinicians
Patient Blood Management: Impact of Quality Data on Patient OutcomesViewics
Patient blood management (PBM) has been proven to improve patient outcomes and save hospitals millions of dollars. Ensuring the quality of your data is central to decision making and critical to having a strong PBM program.
Would you like to learn how your organization can improve patient outcomes by implementing a PBM program based on accurate data?
If so, view this presentation by blood management expert Lance Trewhella. Lance presents how to develop a successful, evidence-based, multidisciplinary PBM program aimed at optimizing the care of patients who might need transfusion.
You’ll learn:
• Current recommendations for blood transfusion utilization
• The impact of quality data on PBM programs
• Best data practices in PBM
Sills MR. Overview of the SAFTINet Program. Presented to the Emergency Department Research Committee, Department of Pediatrics, University of Colorado School of Medicine. 6 January 2015.
Advanced Laboratory Analytics — A Disruptive Solution for Health SystemsViewics
As US healthcare systems grapple with the recent upheavals in care payment and delivery, they are turning to advanced analytics as their “central nervous systems” for driving care and financial performance.
Laboratory information — spanning chemistry, pathology, microbiology and molecular testing, for example — is among the best sources of data for these advanced analytics, including clinician decision support, predictive analytics, population health management, and personalized medicine. When strategically harnessed and integrated to create a patient-centric lab data lake, laboratory information can form an affordable yet competitively powerful advanced analytics solution well suited for many health systems — i.e., a disruptive option.
L. Eleanor J. Herriman, MD, MBA, Chief Medical Informatics Officer of Viewics, explains why laboratory data should be a core strategic component for achieving success in value-based healthcare.
Best Practices for a Data-driven Approach to Test UtilizationViewics
Would you like to learn how data-driven interventions can improve laboratory test utilization in your organization? Would you like to hear about the impact that leading hospitals/health systems and managed care organizations have made through these interventions?
If so, you might be interested in this presentation by utilization management expert Dr. Michael Astion, Medical Director at the Department of Laboratories at Seattle Children’s Hospital and Clinical Professor of Laboratory Medicine at the University of Washington.
In this presentation, Dr. Astion discusses the current state of the misuse of laboratory testing in the United States and some of the interventions that are being implemented to improve it. He covers a number of common areas of unnecessary testing — from pure abuse to tests that could be useful but are ordered inappropriately.
You'll learn about:
• Two areas of laboratory testing where misordering of tests occur frequently
• Three interventions to improve the value of testing for patients
• The role of genetic counselors and other laboratory professionals in improving lab test ordering
• The national endeavor known as PLUGS, the Pediatric Laboratory Utilization Guidance Service
Revolutionizing Renal Care With Predictive Analytics for CKDViewics
Chronic Kidney Disease (CKD) is a common and growing condition, affecting about half of the Medicare population and of diabetics. In the United States, the lifetime risk of CKD for 30-year-olds is now greater than half, and the prevalence of CKD is projected to rise significantly over the next 15 years.
Current methods of predicting which CKD patients will progress to renal failure and require dialysis or transplant have low accuracy rates, causing great anxiety and suboptimal care. Without accurate risk prediction, many patients are over-treated, effectively wasting limited resources and negatively impacting outcomes. Conversely, other patients may receive inadequate treatment, restricting options to only the most costly and least desirable interventions.
Watch this on-demand webinar with Dr. Navdeep Tangri, developer of the Kidney Failure Risk Equation, which revolutionizes the way CKD patients are managed by leveraging laboratory data to accurately predict the risk of kidney failure in patients with CKD.
You’ll learn:
• How CKD is burdening our healthcare system, and the need for better care management tools
• How the Kidney Failure Risk Equation was researched, developed, and validated
• How Viewics is implementing CKD predictive analytics to automatically deliver risk information to clinicians and issue customized, educational reports to patients and clinicians
Patient Blood Management: Impact of Quality Data on Patient OutcomesViewics
Patient blood management (PBM) has been proven to improve patient outcomes and save hospitals millions of dollars. Ensuring the quality of your data is central to decision making and critical to having a strong PBM program.
Would you like to learn how your organization can improve patient outcomes by implementing a PBM program based on accurate data?
If so, view this presentation by blood management expert Lance Trewhella. Lance presents how to develop a successful, evidence-based, multidisciplinary PBM program aimed at optimizing the care of patients who might need transfusion.
You’ll learn:
• Current recommendations for blood transfusion utilization
• The impact of quality data on PBM programs
• Best data practices in PBM
Tackling the U.S. Healthcare System’s Infectious Disease Management ProblemViewics
The United States healthcare system has a serious infectious disease management problem. The antibiotic resistance crisis is widespread, serious, costly, and deadly. Delays in pathogen identification lead to poor clinical outcomes, including increased mortality risk. And, optimally managing outbreaks is critical to health systems whose reimbursement is tied to the health of a population, such as ACOs.
Eleanor Herriman, MD, MBA, Chief Medical Informatics Officer at Viewics led an informative panel discussion with industry leaders on the issues surrounding the infectious disease management crisis. Margret Oethinger, MD, Ph.D., Medical Director of Providence Health & Services, and Susan E. Sharp, Ph.D., DABMM, FAAM, Regional Director of Microbiology and the Molecular Infectious Disease Laboratories, Department of Pathology, Kaiser Permanente and President-Elect, American Society for Microbiology cover the current state of infectious disease management in the U.S., and what can be done to improve it.
You’ll learn about:
• The magnitude of the U.S. health system’s infectious disease management problem
• The most serious concerns and trends for healthcare institutions and communities across the nation
• The most promising solutions to health systems’ most urgent infectious disease management challenges
Advanced Lab Analytics for Patient Blood Management ProgramsViewics
Reports indicate that 30 – 70% of blood transfusions are inappropriate. Inappropriate blood transfusions put patients at increased risk of post-surgical infections, multi-system organ failure, longer hospital stays, and higher mortality rates. The transfusion guidelines most clinicians learned in their training are now outdated. As such, blood transfusion practices vary widely, and overutilization remains a major quality and cost problem.
Patient Blood Management (PBM) programs are designed to optimize the use of transfusions through a team-based approach, evidence-based guidelines, and algorithms that together guide decisions regarding specifically which patients and clinical procedures warrant blood products, and how much to transfuse. PBM programs have been quite successful in improving patient morbidity and mortality outcomes and generating millions of dollars in savings for hospitals.
Laboratory analytics can be an effective means of instituting restrictive transfusion programs, and advanced lab analytics can be critical in implementing PBM programs, as lab testing and tracking blood usage is central to decision making, changing behavior, and improving performance.
Watch a presentation by Dr. Eleanor Herriman, Chief Medical Informatics Officer at Viewics. She unveils a new suite of advanced analytics tools that support PBS and other restrictive blood management programs, enabling health systems to better leverage their valuable lab medicine assets and fully integrate this key service line into these programs.
You’ll learn:
• How inappropriate blood transfusions are burdening our healthcare system, and the need for better utilization management tools
• New guidelines restricting red blood cell transfusions
• The role of advanced lab analytics in PBM programs
• How Viewics is leveraging advanced lab analytics to help health systems more easily and cost-effectively implement PBM programs
Health care reforms in England during the last decade have been influenced by the idea that encouraging competition between hospitals, with nationally fixed prices, will increase the quality of care for patients. Some research has found a positive connection between competition and outcomes. A principal criticism of such studies has been the measures of quality of care that were used. This analysis uses NHS PROMs data, collected both before and after treatment, indicating the extent to which the surgery produces improvement in patients’ self-reported health status.
Following an approach common in the literature on competition, hospital market concentration is used as an indicator of competition. Data were collected for 2011–12 for all English NHS hospitals and all elective primary hip replacements.
This presentation explains methods and presents results.
ISCaHN Treatment Dashboard: Providing clinician decision support with data ge...Cancer Institute NSW
Illawarra Shoalhaven Cancer and Haematology Network (ISCaHN) has been using an oncology information system (OIS) as a complete electronic record for over 4 years. There has been both considerable and valuable treatment data generated at the point of care. Are we able to rapidly assess the outcomes of our own treatment data, and use this outcome data to help inform the delivery of care to our patients?
Four strategies to upgrade clinical trial quality in this computerized world ...Pubrica
• Biostatistics Services is important for collecting, reviewing, presenting, and interpreting data in clinical research.
• Applications of clinical biostatistics services are in different areas, such as epidemiology, clinical trials, population genetics, the biology of structures, and more.
Reference : https://pubrica.com/services/research-services/biostatistics-and-statistical-programming-services/
Continue Reading: http://bit.ly/36nwtcs
Why Pubrica?
When you order our services, Plagiarism free|onTime|outstanding customer support|Unlimited Revisions support|High-quality Subject Matter Experts.
Contact us :
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44- 74248 10299
Effective integration of specialty practices into medical neighborhoods is likely to require several important environmental precursors. First, a sound infrastructure
design can connect PCMHs to the spectrum of surrounding
specialty practices. An aligned information architecture
will be vital to adequate patient access, care coordination, and communication. Second, a patient centered
neighborhood will rely on an organizational culture that
supports shared learning and transparency of performance and cost data among participating practices. Third, payment incentives will have to be aligned around shared accountability for outcome and cost. Responsibility
for outcomes and total cost of care will have to rest not only with primary care clinicians, but also with specialists who perform(often expensive) procedures and specialty services.The launch of the NCQA’s PCSP recognition program is a sign of a new phase of delivery system reform
Tackling the U.S. Healthcare System’s Infectious Disease Management ProblemViewics
The United States healthcare system has a serious infectious disease management problem. The antibiotic resistance crisis is widespread, serious, costly, and deadly. Delays in pathogen identification lead to poor clinical outcomes, including increased mortality risk. And, optimally managing outbreaks is critical to health systems whose reimbursement is tied to the health of a population, such as ACOs.
Eleanor Herriman, MD, MBA, Chief Medical Informatics Officer at Viewics led an informative panel discussion with industry leaders on the issues surrounding the infectious disease management crisis. Margret Oethinger, MD, Ph.D., Medical Director of Providence Health & Services, and Susan E. Sharp, Ph.D., DABMM, FAAM, Regional Director of Microbiology and the Molecular Infectious Disease Laboratories, Department of Pathology, Kaiser Permanente and President-Elect, American Society for Microbiology cover the current state of infectious disease management in the U.S., and what can be done to improve it.
You’ll learn about:
• The magnitude of the U.S. health system’s infectious disease management problem
• The most serious concerns and trends for healthcare institutions and communities across the nation
• The most promising solutions to health systems’ most urgent infectious disease management challenges
Advanced Lab Analytics for Patient Blood Management ProgramsViewics
Reports indicate that 30 – 70% of blood transfusions are inappropriate. Inappropriate blood transfusions put patients at increased risk of post-surgical infections, multi-system organ failure, longer hospital stays, and higher mortality rates. The transfusion guidelines most clinicians learned in their training are now outdated. As such, blood transfusion practices vary widely, and overutilization remains a major quality and cost problem.
Patient Blood Management (PBM) programs are designed to optimize the use of transfusions through a team-based approach, evidence-based guidelines, and algorithms that together guide decisions regarding specifically which patients and clinical procedures warrant blood products, and how much to transfuse. PBM programs have been quite successful in improving patient morbidity and mortality outcomes and generating millions of dollars in savings for hospitals.
Laboratory analytics can be an effective means of instituting restrictive transfusion programs, and advanced lab analytics can be critical in implementing PBM programs, as lab testing and tracking blood usage is central to decision making, changing behavior, and improving performance.
Watch a presentation by Dr. Eleanor Herriman, Chief Medical Informatics Officer at Viewics. She unveils a new suite of advanced analytics tools that support PBS and other restrictive blood management programs, enabling health systems to better leverage their valuable lab medicine assets and fully integrate this key service line into these programs.
You’ll learn:
• How inappropriate blood transfusions are burdening our healthcare system, and the need for better utilization management tools
• New guidelines restricting red blood cell transfusions
• The role of advanced lab analytics in PBM programs
• How Viewics is leveraging advanced lab analytics to help health systems more easily and cost-effectively implement PBM programs
Health care reforms in England during the last decade have been influenced by the idea that encouraging competition between hospitals, with nationally fixed prices, will increase the quality of care for patients. Some research has found a positive connection between competition and outcomes. A principal criticism of such studies has been the measures of quality of care that were used. This analysis uses NHS PROMs data, collected both before and after treatment, indicating the extent to which the surgery produces improvement in patients’ self-reported health status.
Following an approach common in the literature on competition, hospital market concentration is used as an indicator of competition. Data were collected for 2011–12 for all English NHS hospitals and all elective primary hip replacements.
This presentation explains methods and presents results.
ISCaHN Treatment Dashboard: Providing clinician decision support with data ge...Cancer Institute NSW
Illawarra Shoalhaven Cancer and Haematology Network (ISCaHN) has been using an oncology information system (OIS) as a complete electronic record for over 4 years. There has been both considerable and valuable treatment data generated at the point of care. Are we able to rapidly assess the outcomes of our own treatment data, and use this outcome data to help inform the delivery of care to our patients?
Four strategies to upgrade clinical trial quality in this computerized world ...Pubrica
• Biostatistics Services is important for collecting, reviewing, presenting, and interpreting data in clinical research.
• Applications of clinical biostatistics services are in different areas, such as epidemiology, clinical trials, population genetics, the biology of structures, and more.
Reference : https://pubrica.com/services/research-services/biostatistics-and-statistical-programming-services/
Continue Reading: http://bit.ly/36nwtcs
Why Pubrica?
When you order our services, Plagiarism free|onTime|outstanding customer support|Unlimited Revisions support|High-quality Subject Matter Experts.
Contact us :
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44- 74248 10299
Effective integration of specialty practices into medical neighborhoods is likely to require several important environmental precursors. First, a sound infrastructure
design can connect PCMHs to the spectrum of surrounding
specialty practices. An aligned information architecture
will be vital to adequate patient access, care coordination, and communication. Second, a patient centered
neighborhood will rely on an organizational culture that
supports shared learning and transparency of performance and cost data among participating practices. Third, payment incentives will have to be aligned around shared accountability for outcome and cost. Responsibility
for outcomes and total cost of care will have to rest not only with primary care clinicians, but also with specialists who perform(often expensive) procedures and specialty services.The launch of the NCQA’s PCSP recognition program is a sign of a new phase of delivery system reform
South central foundation Alaska
If you are in a mechanical manufacturing environment then hitting a target is a matter much like the throwing of a rock – figuring out speed trajectory
If you are in a messy, human, complex, adaptive environment it is like throwing a
bird at a target – it is all about the ‘attractor’
Healthcare mostly throws birds at targets and only thinks about the throwing part than wonders why the Human fails to hit the target
Data for Impact hosted a one-hour webinar sharing guidance for using routine data in evaluations. More: https://www.data4impactproject.org/resources/webinars/routine-data-use-in-evaluation-practical-guidance/
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21Health Catalyst
Population Health Management is in its early stages of maturity, suffering from inconsistent definitions and understanding, and is overhyped by vendors and ill-defined by the industry. And yet, many systems are moving forward in innovative pioneering ways to address this growing trend. In this session, you will hear from two very different, successful health systems: a physician-led group and a large integrated delivery system. They will share their best practices, learnings, and different approaches to population health management.
Pharmacy's Emerging Role in Accountable Care Organizations (ACO)Parata Systems
Your pharmacy is an excellent partner for accountable care organizations. ACOs are formed by doctors, hospitals and other healthcare providers to improve health outcomes and lower overall medical expenses for a targeted patient population. Reimbursements are tied to patient outcomes.
ACOs’ highest-risk and highest-cost patients are those managing chronic illnesses and taking multiple medications a day. When your pharmacy can improve and track adherence – a key driver of readmission prevention and overall health – you are a valuable partner to help ACOs prevent unnecessary medical care.
Jamie Hale serves as the Chief Pharmacy Officer for Cornerstone Health Care where he is responsible for the development and integration of pharmaceutical care services in the Accountable Care Organization. He transitioned to Cornerstone in December 2012 after a 15 year career at Wake Forest Baptist Health, where he last served as Director of Pharmacy.
Download the full audio webinar at http://bit.ly/pharmacyACO.
Two of the New York metro area’s largest provider organizations will share their experiences leveraging HIE as one of many tools to decrease fragmentation of care and improve patients’ experiences across acute and post-acute care settings for patients undergoing elective surgeries. Representatives from NYULMC and VNSNY will summarize their efforts to redesign more personalized specific care pathways and the central role played by the implementation of real-time data exchange to provide a seamless transfer of clinical data between providers caring for the patient at the time of discharge and throughout the post-acute period.
• Kathleen Mullaly - Senior Director for Clinical Operations, Department of Network Integration, NYU Langone Medical Center
• Amy Weiss - Director for Strategic Account Development, Integrated Delivery Systems, Visiting Nurse Service of New York (VNSNY)
New York eHealth Collaborative Digital Health Conference
November 18, 2014
The CMS Innovation Center held the second in a series of webinars for potential applicants to Health Care Innovation Awards Round Two. The webinar held Wednesday, June 12, 2013 1:30pm – 3:00pm EDT, focused specifically on the first two of the four innovation categories.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Health IT Summit Denver 2014 - "Anatomy of a Health System"
This unique discussion series explores behind-the-scenes looks at the most progressive and high performing health systems in the country. Panelists will discuss critical areas such as go-live strategy, vendor management, patient engagement, IT governance and more. Attendees will walk away with a better understanding of how departments can effectively work together, tangible strategies for delivering high quality care while maintaining an efficient and secure health information system.
Moderator: Cynthia Burghard, Research Director, IDC Health Insights
Marc Lassaux, CTO, Technical Director Beacon Project, Quality Health Network
Justin Aubert, Chief Financial Officer, Quality Health Network
Kevin Fitzgerald, MD, CMO, Rocky Mountain Health
The Near Future of Healthcare Delivery - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Dissertation presentation: Study of the Process of Hospital Accreditation and Its Impact on Healthcare Facilities.
Presented By: Yasser Alsharif, Muwafag Kamash, Nasrat Esmat, Amer Tayeb
Supervised By: Dr. Mohammad Kamal Hussain
The healthcare transformation from fee for service to fee for outcomes just got an adrenaline shot in the arm April 27th when the Department of Health and Human Services surprised many in the market by announcing a Quality Payment Program, a proposed set of new rules to take effect in 2019 based on key provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Conocé los casos de éxito de Qonnections 2017: Johns HopkinsData IQ Argentina
La misión de Johns Hopkins Medicine es mejorar la salud de la comunidad y el mundo estableciendo el estándar de excelencia en la educación médica, la investigación y la atención clínica.
Our presentation at AMIA about our regional MRSA collaborative and use of health information technology to share MRSA colonization and infection data electronically.
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
PCMH implementation, highly associated with important outcomes for both patients and providers. The rate of emergency department visits was significantly
lower in sites with more PCMH effective implementation. Efficient PCMH implementation favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services.
A systematic review of the challenges to implementation of the patient-centre...Paul Grundy
review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable
evidence for Australian clinicians, policymakers, and
organisations approaching adoption of PCMH elements
within reform initiatives in Australia.
"'I am proud that MaineCare has been working in partnership with other payers to advance payment reform through greater investment in primary care to both improve outcomes for patients and reduce preventable high cost spending in emergency departments and avoidable inpatient admissions.
– Mary C. Mayhew, Commissioner, Maine Department of Health & Human Services
Summary -- Patient Centered Medical Home the Necessary Foundation for Accountable Care and Population Management.
In the next 10 years, we will be living in 1) mobile world 2) in the middle of an aging and chronic disease epidemic and 3) data. But , we will also have the ability to analyze data in a cognitive way this will do for doctors’ minds what X-ray and medical imaging have done for their vision. How? By turning data into actionable information. Take, for instance, IBM’s intelligent supercomputer, Watson. Watson can analyze the meaning and con-text of human language and quickly process vast amounts of information. With this in-formation, it can suggest options targeted to a patient’s specific circumstances.
We need the basic foundation to support this transformation a system integrator where data at the level of a patients flows and is held accountable and that model is the Patient Centered Medical Home. (PCMH) starts to happen when clinicians/ healers step up to comprehensive relationship based care empowered by tools to manage the data and communicate effectively. This move to PCMH level care requires the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system and all of that is power by data made into meaningful information.
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
The Patient-Centered Medical Home (PCMH) lies at the center of the effort to get at population health, integrated and coordinated care. PCMH is where the Primary care healer leads an organization that delivers clinician-led primary care, with comprehensive, accessible, holistic, coordinated, evidence-based coordination and management. In the USA this is now the standard in the US Veterans Administration and the US Military and under the ACA.
OVERVIEW -- Care by Design - Putting Care back into healthcare the University of Utah experience in building PCMH level care over the decade of 2001 to . 2011
Care by design magill lloyd successful turnaroundPaul Grundy
The University of Utah purchased a 100-clinician, 9-practice multispecialty primary care network in 1998. The university projected the network to earn a profit the first year of its ownership in a market with growing capitation; however, capitation declined and the network incurred up to a $21 million operating loss per year. This case study describes the financial turnaround of the network.
Care by design 2 bodenheimer teams 2 utah chapterPaul Grundy
Putting Care back into healthcare the University of Utah experience in building PCMH level care. this talks about the team base experice as written up in 2007 by Tom Bodenheimer.
New zealand cantabury timmins-ham-sept13Paul Grundy
This is a great example of a community in New Zealand of the interrogation of social services and healthcare. They are changing the demand curve and getting away from “we need more and more resources to see more patients”. The language we use, very deliberately, is “right care, right place, right time”. Once you start getting the whole
system to work as one system, it starts flushing out unnecessary expenditure. So you can do more and/or do it better.’ worth a read.
I did a visit to new zealand in 2003 and did a number of talks from 2003 to 2005 on the transformation taking place in new zealand. back in NZ in 2014 so looked at those early slide so impressed with the leadership and the robust primary care
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
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The Importance of Community Nursing Care.pdfAD Healthcare
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
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Care by design magill retrospective mixed methods analysis sep 21 2011
1. Retrospective
Mixed Methods Analysis of
Practice Transformation
Michael K Magill, MD
Professor and Chairman
Department of Family and Preventive Medicine
University of Utah School of Medicine and Community Clinics
AHRQ Grants #
HS019136-01 (TPC)
HS20106-01 (ARRA-SSCM)
2. Interdisciplinary Team
Julie Day, MD
University of Utah Community Clinics
JaeWhan Kim, PhD
School of Medicine, Dept of Family & Preventive Medicine
Annie Sheets Mervis, MSW
University of Utah Community Clinics
Debra L. Scammon, PhD
David Eccles School of Business, Dept of Marketing
Andrada Tomoaia-Cotisel, MPH, MHA
School of Medicine, Dept of Family & Preventive Medicine
Norman J Waitzman, PhD
College of Social and Behavioral Science, Dept of Economics
4. University of Utah Community Clinics
Clinic Year Opened
Total
Providers
Primary Care
Providers
Visits Per
Year (FY09)
Madsen 1975 6 5 18,970
Greenwood 1976 17 10 54,475
Redwood 1985 20 10 93,110
Westridge 1988 7 6 29,208
Parkway 1989 6 5 19,488
Sugar House 1996 10 9 20,344
Stansbury 1999 7 6 24,145
Redstone 2001 7 5 26,309
South Jordan 2003 3 2 11,359
Centerville 2007 4 4 8,044
5. Care by DesignTM
• Appropriate Access – 2003
• Balance supply and demand of visits
• Standardized schedules
• Care Team – 2004
• Expanded MA role
• Providers and MAs working in teams
• EMR tools
• Planned Care – 2006
• Pre-visit planning
• Registries
• Labs prior to visit
6. Retrospective Analysis:
Qualitative Aims
AHRQ Grant # 1R18 HS019136-01 Transforming Primary Care
Aim Method
Document and measure the
transformation
• Archival Search
Determine impact on the
experiences and satisfaction
of providers, staff and
patients
• Provider and Staff Surveys
• Provider and Staff Interviews
• Patient Satisfaction Survey
• Patient Focus Groups
Explore organizational &
contextual factors
• Clinic Environmental Audit
• In-Clinic Observations
Assess in depth how the
transformation was
implemented
• Archival Search
• Leadership Interviews
• Provider and Staff Interviews
7. Care by DesignTM
• Appropriate Access – 2003
• Balance supply and demand of visits
• Standardized schedules
• Care Team – 2004
• Expanded MA role
• Providers and MAs working in teams
• EMR tools
• Planned Care – 2006
• Pre-visit planning
• Registries
• Labs prior to visit
8. Qualitative Data: Care Teams
8
Component Type of Information Gathered
Archival search • when/how the care team was rolled out
Clinic
Environmental Audit
• size of clinic, team composition, patient volume,
presence of specialists
In-clinic observations • feeling in the clinic, background info
Employee Interviews • personal experience with implementing care
team + experimenting with local adaptations:
how + why
Leadership interviews • personal experience with leading the care team
roll out + managing the evolution: what + why
Provider & Staff
Survey
• trends in team development, employee burn out,
organizational culture
Patient Sat. Surveys • patients’ satisfaction with visits
Patient Focus Groups • changes noticed and patient perspective
9. Care Team Structure
& MA Role CBD Care
Team
Model
Variations
Traditional
Model
Team
Members:
• Providers
• MAs
10. “Care
Team”
• 5 MAs: 2 Providers
• Working together
• Doing it all!
MA
specialists
• (V1): 1 MA phlebotomist does all
draws
• Others are 5 MAs :2 Providers
• (V2): 1 MA rooms patients + 1 MA
scribes in the room : 1 Provider
Clinic-
wide team
• All of the MAs are in one pool
• Room patients in a rotation
• Outside visit work done in between
Hybrid
Traditional
Model
• 1 MA : 1 Provider
• Variation – 2 MAs : 1 Provider
Team
Members:
• Providers
• MAs
Care Team Structure
& MA Role
• (V1): 5 MAs : 2 Providers for patient visits, but
• 2 MAs: 1 Provider for outside visit work
• (V2): 5 MAs : 2 Providers, but
• 1 “primary” MA : 1 Provider
11. Example of Insights from
Quantitative Research
Clinic Culture
An illustration of possible
explanations for the observed
differences in implementation
of Care Teams
18. Aim Method
Document and measure the
transformation and impact on
the quality of patient care
delivery
• Clinical Data
• CBD Implementation
Determine impact of the
transformation on cost to the
clinics
• Operational Data
Determine impact of
transformation on overall costs
of healthcare services,
including direct costs to
patients
• Centers for Medicare &
Medicaid Services Data
• Utah All Payer Claims
Database
Retrospective Analysis:
Quantitative Aims
AHRQ Grant # 1R18 HS019136-01 Transforming Primary Care
19. Quantitative Data
Component Type of Information Gathered
CBD Implementation • Use of EMR tools
• Appointment availability
• Continuity with PCP
• Use of pre-visit planning tools and processes
• Flow and processes of Care Team
• Efficiency of visit/wait times
Impact on Operations • Provider productivity
• Financial performance
• Patient population characterization
Clinical Outcomes • Quality performance (chronic & preventive)
• Patient, Provider, Staff satisfaction
Cost of Care • Utilization and cost of care
• CMS
• Utah Population Data Base (UPDB)
• Utah All Payer Claims Database (APCD)
Gray = data analysis pending
20. 10%
20%
30%
40%
50%
60%
70%
80%
2003 2004 2006 2008 2009
Quality Measures
Percent of Patients Receiving Recommended Care
CAD* Preventive Care* Diabetes* Heart Failure*
Note: Sample size=14 providers who had all measures in FY 2003, 2004, 2006, 2008, and 2009; *p≤0.05
21. 20%
30%
40%
50%
60%
70%
80%
90%
100%
2003 2004 2006 2008 2009
Patient Satisfaction
Percent of Patients Reporting "Very Satisfied"
Recommend provider* Explanation of what was done*
Visit overall* Time spent with physician*
Length of time waiting at office*
Note: Sample size=16 providers who had all measures in FY 2003, 2004, 2006, 2008, and 2009; *p≤0.05
22. Overview of Quantitative Design:
Link data from multiple sources to assess
impact of transformation to CBD
Cost &
Utilization
CBD
Implementation
Clinical
Data
Operations
Data
23. Level of CBD Implementation:
2008
1.00
1.20
1.40
1.60
1.80
2.00
2.20
All elements
24. Examples of Correlation between
CBD Implementation and Patient Satisfaction
Patient Satisfaction
CBD Implementation Measure
2008
Same Day Appointments Efficient Visit
Length of time waiting at the office 0.61** 0.33*
Time spent with the physician/health
care professional you saw
0.20 -0.21
Explanation of what was done for you 0.14 -0.13
The visit overall 0.50** 0.20
Would you recommend the
physician/health care professional to
your friends and family?
0.34* -0.17
N=16 providers *p≤0.1, **p≤0.05
25. Correlation between CBD
Implementation and Quality Measures
CBD Implementation
Measure 2008
Quality Measures
Diabetes
Coronary Artery
Disease
Preventive Care
Seen by PCP last visit 0.60* 0.61* 0.57*
Use of X-files by MA 0.33* 0.18 0.18
Best Practice Alerts 0.34* 0.26 0.29
After-Visit summary 0.23 0.18 0.11
Labs done prior to
visit
0.54** 0.47* 0.36*
N=14 providers with data across five years *p≤0.1, **p≤0.05
26. Impact of practice redesign
• Quality improves
• Continuity matters
• Pre-visit planning and EMR reminders help
• Patients notice
• Access improves patient satisfaction
• Level of implementation varies across
clinics
• Clinic culture impacts implementation
• Culture is a critical factor in translational
research
27. Future analysis:
impact of redesign on…
• Internal cost and
productivity of clinics
• Overall utilization
• Total cost of care
28. Future: Internal Performance Analyses
Cost &
Utilization
CBD
Implementa-
tion
Clinical
Data
Operations Data
• Provider productivity
• Financial performance
• Patient population
characterization
29. Future: Cost and Utilization
Cost & Utilization
CMS, APCD
CBD
Implementa-
tion
Clinical
Data
Operations
Data
CMS Data
• All Medicare Claims
at individual level for
Utah (2007+)
• For the following:
• Outpatient
• Inpatient
• Home Health
• Nursing Home
• Prescription
Drug (Part D)
•Linked to State Vital
Statistics and facility
data (Utah Population
Database )
All Payer Claims
Database (APCD)
• Data elements:
• Charges
• Reimbursements
• Utilization
• For the following:
• Outpatient,
Inpatient,
Rehabilitation
• Prescription Rx
• Linked to State
Vital Statistics and
facility data
30. Challenges in Assembling
Cost, Utilization and Demographic Data
• Gaining access
• Navigating layers of documentation,
requests, approvals (CMS)
• Obtaining IRB and other database
approvals
• Building APCD platform as 1st user
• Translating utility into usable research database
• Creating files linkable at individual level
• Linking data – hospital, ED, vital statistics
31. Challenges of Retrospective
Mixed Methods Research
• Timing of all the components
• Recall isn’t perfect – current events color
memory
• Data used for operations differ from data
required for research
• IRB & HIPAA rules for linking PHI to
operations and external data
32. Benefits of
Mixed Method Research
• Multiple components inform each other
throughout data collection
• Participant selection
• Instrument development
• Sequencing
• Multiple components inform each other
throughout data analysis
• Convergent/consensual validation
• Multiple components facilitate integration of
different perspectives