The document discusses UnitedHealthcare's Evercare clinical model and telemedicine initiatives. The Evercare model provides individualized care plans and addresses systems of care through increased assessments, treatment of changes in condition, and enhanced communication. A proposed telemedicine pilot would use existing equipment with Evercare nurse practitioners to improve communication, enhance treatment in place, and reduce transfers from nursing homes to hospitals. The document also discusses UnitedHealthcare's broader telehealth activities aimed at expanding access to care in rural areas.
A Home Care Practice That Works (For Syllabus)BCAGCP
This document outlines two models of home care practices for frail elderly patients. It describes the Home ViVE Program in Vancouver which provides comprehensive home care through a team of physicians, nurses, and other specialists. The program aims to keep patients out of the hospital and in their homes as long as possible. It highlights the benefits of home-based care for conducting thorough assessments, improving access to care, and achieving better outcomes for patients' quality of life, function, and caregiver strain while reducing health system costs.
outcomes for inpatient or residential OCD_Systematic reviewLucinda Gledhill
The document presents a systematic review and meta-analysis of 19 studies on inpatient and residential treatment outcomes for obsessive-compulsive disorder (OCD). It finds that intensive residential or inpatient cognitive behavioral therapy (CBT) can significantly reduce OCD symptoms compared to admission, with an average reduction of 10.7 points on the Yale-Brown Obsessive Compulsive Scale and an effect size of 1.87. However, the review notes that little is known about the long-term benefits or cost-effectiveness of these intensive treatments compared to alternatives.
Advanced Practice Structure within the children\'s hospital in conjunction with capturing the billing and measuring the cost savings is crucial to optimization the Pediatric Nurse Practitioner role. Please contact us, Jill Gilliland Melnic Cosulting Group (800) 886-7906, with questions
EmCare was hired to optimize operations at the emergency department of Community Hospital South in Indianapolis. They implemented a top-down approach, focusing on strong physician leadership, instituting a culture of excellence, and data-driven decision making. Key changes included bedside registration, team nursing, and optimized staffing models. Metrics improved significantly within 6 months, with left without being seen rates dropping from 3.8% to 0.24% and average length of stay decreasing from 351 to 281 minutes. Continued focus on recruitment, staff satisfaction, documentation, and aligning with hospital goals helped sustain these operational improvements.
This document provides information about discussing goals of care with family members of patients with dementia. It begins with an introduction and outlines the session goals. It then discusses the natural history and progression of Alzheimer's disease using the FAST scale. Data on the clinical course of advanced dementia is presented showing high rates of infections, eating problems, and burdensome interventions in the last months of life. Evidence is discussed regarding treating or not treating pneumonia and tube feeding. The role play provides an example case of a patient with advanced dementia to discuss goals of care.
Primary care teams led by physicians and including nurses and other professionals can improve patient outcomes and reduce costs. This model, called the Patient-Centered Medical Home (PCMH), provides comprehensive and coordinated care centered around the patient. However, the U.S. faces shortages of both primary care physicians and nurses that threaten the viability of the PCMH. To address this, we must fix workforce issues, train more primary care doctors, and have physicians and nurses work together effectively in teams.
This document provides a summary of a presentation about palliative care efforts in Delaware. It discusses the difference between palliative care and hospice, current palliative care programs available in Delaware, and opportunities for expansion. Key points include:
- Palliative care aims to improve quality of life by relieving symptoms for patients with serious illnesses, while hospice focuses on the last 6 months of life after curative treatments stop.
- Delaware has several palliative care programs in hospitals, home care, and long-term care settings, but access could be expanded by having palliative specialists in all hospitals and outside of hospitals.
- Opportunities remain to improve palliative care in Delaware through increasing the number of board
This document outlines a presentation about optimizing stays at skilled nursing facilities (SNFs). It begins with introducing the speaker and their background in geriatrics. It then defines what a SNF is and who pays for SNF care. The presentation discusses factors to consider for SNF placement like a patient's functional status and goals of care. It also addresses challenges families and facilities face including lack of training, high patient loads, and navigating the healthcare system. The presentation aims to help attendees better understand SNFs and provide strategies to humanize care and plan for the well-being of patients and their loved ones.
A Home Care Practice That Works (For Syllabus)BCAGCP
This document outlines two models of home care practices for frail elderly patients. It describes the Home ViVE Program in Vancouver which provides comprehensive home care through a team of physicians, nurses, and other specialists. The program aims to keep patients out of the hospital and in their homes as long as possible. It highlights the benefits of home-based care for conducting thorough assessments, improving access to care, and achieving better outcomes for patients' quality of life, function, and caregiver strain while reducing health system costs.
outcomes for inpatient or residential OCD_Systematic reviewLucinda Gledhill
The document presents a systematic review and meta-analysis of 19 studies on inpatient and residential treatment outcomes for obsessive-compulsive disorder (OCD). It finds that intensive residential or inpatient cognitive behavioral therapy (CBT) can significantly reduce OCD symptoms compared to admission, with an average reduction of 10.7 points on the Yale-Brown Obsessive Compulsive Scale and an effect size of 1.87. However, the review notes that little is known about the long-term benefits or cost-effectiveness of these intensive treatments compared to alternatives.
Advanced Practice Structure within the children\'s hospital in conjunction with capturing the billing and measuring the cost savings is crucial to optimization the Pediatric Nurse Practitioner role. Please contact us, Jill Gilliland Melnic Cosulting Group (800) 886-7906, with questions
EmCare was hired to optimize operations at the emergency department of Community Hospital South in Indianapolis. They implemented a top-down approach, focusing on strong physician leadership, instituting a culture of excellence, and data-driven decision making. Key changes included bedside registration, team nursing, and optimized staffing models. Metrics improved significantly within 6 months, with left without being seen rates dropping from 3.8% to 0.24% and average length of stay decreasing from 351 to 281 minutes. Continued focus on recruitment, staff satisfaction, documentation, and aligning with hospital goals helped sustain these operational improvements.
This document provides information about discussing goals of care with family members of patients with dementia. It begins with an introduction and outlines the session goals. It then discusses the natural history and progression of Alzheimer's disease using the FAST scale. Data on the clinical course of advanced dementia is presented showing high rates of infections, eating problems, and burdensome interventions in the last months of life. Evidence is discussed regarding treating or not treating pneumonia and tube feeding. The role play provides an example case of a patient with advanced dementia to discuss goals of care.
Primary care teams led by physicians and including nurses and other professionals can improve patient outcomes and reduce costs. This model, called the Patient-Centered Medical Home (PCMH), provides comprehensive and coordinated care centered around the patient. However, the U.S. faces shortages of both primary care physicians and nurses that threaten the viability of the PCMH. To address this, we must fix workforce issues, train more primary care doctors, and have physicians and nurses work together effectively in teams.
This document provides a summary of a presentation about palliative care efforts in Delaware. It discusses the difference between palliative care and hospice, current palliative care programs available in Delaware, and opportunities for expansion. Key points include:
- Palliative care aims to improve quality of life by relieving symptoms for patients with serious illnesses, while hospice focuses on the last 6 months of life after curative treatments stop.
- Delaware has several palliative care programs in hospitals, home care, and long-term care settings, but access could be expanded by having palliative specialists in all hospitals and outside of hospitals.
- Opportunities remain to improve palliative care in Delaware through increasing the number of board
This document outlines a presentation about optimizing stays at skilled nursing facilities (SNFs). It begins with introducing the speaker and their background in geriatrics. It then defines what a SNF is and who pays for SNF care. The presentation discusses factors to consider for SNF placement like a patient's functional status and goals of care. It also addresses challenges families and facilities face including lack of training, high patient loads, and navigating the healthcare system. The presentation aims to help attendees better understand SNFs and provide strategies to humanize care and plan for the well-being of patients and their loved ones.
Iom birth settings_provider_perspectives_b_potter_final Brynne Potter
This document summarizes the perspectives of midwives on home birth in the United States. It discusses why women choose home birth, the safety of planned home birth compared to hospital birth based on observational studies, and suggestions to make home birth as safe as possible including risk assessment, access to qualified providers, and standards for transfers of care. It also discusses factors that can disturb the normal physiologic process of birth.
Improving Patient Flow conference will explore strategies to manage capacity and demand across the healthcare system. Over two days, the conference will present case studies and lessons learned from facilities that have implemented initiatives to improve patient flow. Attendees will learn practical solutions for change management, strategies to balance quality and efficiency, and methods for using performance indicators to enhance patient care. Pre-conference and post-conference workshops will provide an in-depth look at understanding and controlling patient flow, and embedding key performance indicators at the frontlines.
Mrs. M had chronic headaches and visited 3 emergency rooms over one month but still had no diagnosis or treatment plan. She underwent various medical tests but her condition did not improve. After her third emergency room visit, a clinic screened her for housing risks and discovered she lived in a damp, moldy home. The doctor then correctly diagnosed her in 12 minutes with a housing-related illness. With medication and assistance to improve her home's conditions, Mrs. M's health improved. The document argues that healthcare needs to address social determinants of health like housing conditions to provide more effective and satisfying care. It introduces a startup that provides expertise and technology to help healthcare professionals improve patient health by tackling social and environmental factors.
Kathrin Boerner-Direct Care Worker's Experiences with Patient Death: Training...jewishhome
This study examined the experiences of direct care workers (CNAs and HHAs) with patient death, including their grief symptoms and needs for training and support. Key findings include:
1) Both CNAs and HHAs reported grief symptoms similar to family caregivers after a patient's death, though some symptoms were less common in staff.
2) Most staff felt unprepared, both emotionally and informationally, for patient death due to little training.
3) Greater emotional preparedness and closer relationships with patients predicted more intense grief.
4) More intense grief was also related to more negative employment outcomes like increased emotional exhaustion.
5) Staff desired more training, preparation, rituals to acknowledge
This document summarizes a presentation on optimizing health outcomes in the workplace. It discusses:
1) Different types of healthcare like primary care, specialty care, and occupational health care and when each is appropriate.
2) Signs that warrant emergency care vs when self-care or seeing a primary care provider is sufficient.
3) Ways employers can positively impact healthcare like wellness programs, health plan design, and creating a culture that supports healthy behaviors.
4) How better health consumerism can control costs, increase productivity and improve outcomes.
Comparison Of The Physical Assessment Of Children By A Pediatric NurseJack Frost
This study compared the physical examination findings of 182 children by pediatric nurse practitioners and pediatricians. The nurse practitioners and pediatricians agreed in their assessments for 239 of the 278 total findings. The assessments differed for 39 findings, but the difference was considered insignificant in 37 cases. There was only a significant difference in assessment for 2 of the 278 total findings (0.7%). This demonstrates that pediatric nurse practitioners can perform accurate and comprehensive physical examinations comparable to pediatricians.
Avado CEO Dave Chase's presentation to the Collaborative Health Consortium's weekly Pilots and Collaborations Webinar. Dave is doing some leading edge thinking on collaborative care.
This document discusses a proposed randomized controlled trial to evaluate the impact of family presence during resuscitation (FPDR) on the psychological health of family members. The trial would divide families into two groups: one that can witness resuscitation and one that cannot. At eight months post-resuscitation, both groups will complete the Impact of Event Scale-Revised (IES-R) questionnaire by phone. The hypothesis is that families who witnessed resuscitation will report significantly lower IES-R scores, indicating better psychological health. Previous studies provide evidence that FPDR does not affect resuscitation outcomes but may improve family member mental health outcomes.
This document discusses pediatric palliative care and why internists need experience treating pediatric patients. It notes that pediatric palliative care aims to improve quality of life for children with life-limiting illnesses and their families through pain and symptom management as well as psychosocial support, often provided in conjunction with curative treatment. Rates of pediatric deaths at home have increased in recent decades due to improved palliative care. The document outlines considerations for discussing prognosis with pediatric patients of different ages and provides an overview of key recommendations and resources for pediatric palliative care.
The document discusses the nursing process, which is a systematic method for providing goal-oriented, humanistic care effectively and efficiently. It involves assessment, nursing diagnosis, planning, implementation, and evaluation (ADPIE). Assessment involves comprehensive data collection to determine a client's health status. Nursing diagnoses are clinical judgments about a client's response to health problems. Planning establishes goals and outcomes and determines interventions. Implementation involves performing interventions and evaluation compares a client's status to goals. The primary purpose of the nursing process is to help nurses manage patient care scientifically, holistically, and creatively.
This case study describes the end-of-life care of Lorna, a 77-year old woman with metastatic renal cell carcinoma. Lorna originally presented with flank and abdominal pain and was diagnosed with advanced renal cell carcinoma in 2011. In 2014, the cancer recurred and metastasized to her spine, causing cauda equina syndrome with lower limb weakness and urinary/fecal incontinence. She was admitted to palliative care for pain and symptom management, where she received psychological support, medication via syringe pump, and focus on comfort. The document discusses renal cell carcinoma, cauda equina syndrome, medications, nursing interventions and compassionate end-of-life care.
Caswell Center in North Carolina utilizes occupational therapists and other professionals to enhance the quality of life for
individuals with developmental disabilities. Occupational therapists help individuals develop skills for daily living through
adaptive equipment, specialized activities like Snoezelen therapy, and research using biofeedback. This helps individuals
gain independence and experience happiness through meaningful activities. Community partners and funding support
allow Caswell Center to provide innovative programs to individuals.
Scoring Suffering to Address Patient Needs in Palliative Care: The "Maslow Sc...Mike Aref
Introduction
Palliative care patients have been scored by their symptom burden and performance but there is little standardization of their multidimensional suffering, needs, and wants. Maslow’s Hierarchy of Needs is a model for describing these needs as physiological, safety, love/ belonging, esteem, and self-actualization. The functional pain score is a validated method of scoring pain based on patient report and provider assessment. Using these two frameworks, the “Maslow Score” seeks to use Maslow’s Hierarchy to score the current patient situation based on symptom burden, plan, network, and meaning.
Methods
The scores are four-digit codes describing the patient situation at a given time base on team consensus. Each digit is a score from most secure, 0, to most vulnerable, 5. Both written examples and an algorithmic approach have been provided to obtain each score.
Results
Morning huddle has been expedited by utilizing scores recorded the previous day. Also if sudden changes have been reported they can be compared rapidly against a team standard. This triaging helps direct team resources as to whether patients should be reassessed by the entire team or specific members. The discussion has improved assessment of patients from an interdisciplinary perspective. In general, patients cannot improve their network and meaning scores until symptom and planning scores have been optimized.
Discussion
The “Maslow Score” appears to have improved the quality of care that our service delivers by improving efficiency. Further development and study is needed to standardize and validate our method.
Much has been written in the business literature about managing the waiting experience. Federal Express has noted that “waiting is frustrating, demoralizing, agonizing, aggravating, annoying, time consuming, and incredibly expensive.” We intuitively know this from our own experience as well as from our patients. In this #ACEP13 presentation, Dr. Jensen gives practical tips to improve your patients' ED experience.
The document discusses strategies for improving patient-centered care. It focuses on ensuring patients feel oriented, informed, and involved in their care. This includes introducing all medical staff, explaining plans in plain language, checking for understanding, keeping patients updated on delays, allowing them to explain concerns, and setting clear expectations for next steps. The goal is for patients to understand their care and feel their needs, preferences, and questions are being addressed.
This document discusses interprofessional rounding teams and strategies to improve teamwork and communication. It provides background on how interprofessional healthcare teams can improve patient outcomes. Checklists, care pathways, and interprofessional education are presented as potential solutions. Checklists have been shown to reduce medical errors and mortality. Care pathways, while challenging to implement, can standardize care and reduce prescribing errors. Brief interprofessional education sessions have been found to improve collaboration attitudes and skills among professionals. Overall, the document advocates for interprofessional rounding teams and strategies to enhance communication and teamwork across disciplines.
The document discusses intensive/critical care nursing. It describes intensive care as providing immediate care to patients with life-threatening health issues. Over 5 million patients are admitted annually to intensive care units in the US for issues like brain injuries, heart/lung problems, childbirth complications, infections, and surgery. The aging population is leading to more chronic illnesses and greater need for critical care. Critical care nursing requires specialized skills and knowledge to holistically care for critically ill patients and their families during crisis situations.
This homecare agency provides a wide range of in-home medical, rehabilitation, and support services to help clients remain in their homes. They have a doctor-owned, nurse-managed model with strict safety standards. Services include skilled nursing, physical/occupational/speech therapy, medical social work, and 24/7 nurse support. They aim to improve outcomes through coordinated, compassionate long-term care that improves quality of life.
Whsrma 2013 grundy singapore april 2013Paul Grundy
The document discusses the patient centered medical home (PCMH) model which aims to transform healthcare delivery from episodic care to population health management. It provides an overview of the key components of the PCMH model including acting as a system integrator across providers, driving primary care redesign, and offering utilities for population health and financial management. Studies show PCMHs can lead to reductions in hospital and ER use as well as lower overall costs. The PCMH framework focuses on features like patient-centeredness, comprehensive and coordinated care, improved access, and a commitment to quality and safety.
Iom birth settings_provider_perspectives_b_potter_final Brynne Potter
This document summarizes the perspectives of midwives on home birth in the United States. It discusses why women choose home birth, the safety of planned home birth compared to hospital birth based on observational studies, and suggestions to make home birth as safe as possible including risk assessment, access to qualified providers, and standards for transfers of care. It also discusses factors that can disturb the normal physiologic process of birth.
Improving Patient Flow conference will explore strategies to manage capacity and demand across the healthcare system. Over two days, the conference will present case studies and lessons learned from facilities that have implemented initiatives to improve patient flow. Attendees will learn practical solutions for change management, strategies to balance quality and efficiency, and methods for using performance indicators to enhance patient care. Pre-conference and post-conference workshops will provide an in-depth look at understanding and controlling patient flow, and embedding key performance indicators at the frontlines.
Mrs. M had chronic headaches and visited 3 emergency rooms over one month but still had no diagnosis or treatment plan. She underwent various medical tests but her condition did not improve. After her third emergency room visit, a clinic screened her for housing risks and discovered she lived in a damp, moldy home. The doctor then correctly diagnosed her in 12 minutes with a housing-related illness. With medication and assistance to improve her home's conditions, Mrs. M's health improved. The document argues that healthcare needs to address social determinants of health like housing conditions to provide more effective and satisfying care. It introduces a startup that provides expertise and technology to help healthcare professionals improve patient health by tackling social and environmental factors.
Kathrin Boerner-Direct Care Worker's Experiences with Patient Death: Training...jewishhome
This study examined the experiences of direct care workers (CNAs and HHAs) with patient death, including their grief symptoms and needs for training and support. Key findings include:
1) Both CNAs and HHAs reported grief symptoms similar to family caregivers after a patient's death, though some symptoms were less common in staff.
2) Most staff felt unprepared, both emotionally and informationally, for patient death due to little training.
3) Greater emotional preparedness and closer relationships with patients predicted more intense grief.
4) More intense grief was also related to more negative employment outcomes like increased emotional exhaustion.
5) Staff desired more training, preparation, rituals to acknowledge
This document summarizes a presentation on optimizing health outcomes in the workplace. It discusses:
1) Different types of healthcare like primary care, specialty care, and occupational health care and when each is appropriate.
2) Signs that warrant emergency care vs when self-care or seeing a primary care provider is sufficient.
3) Ways employers can positively impact healthcare like wellness programs, health plan design, and creating a culture that supports healthy behaviors.
4) How better health consumerism can control costs, increase productivity and improve outcomes.
Comparison Of The Physical Assessment Of Children By A Pediatric NurseJack Frost
This study compared the physical examination findings of 182 children by pediatric nurse practitioners and pediatricians. The nurse practitioners and pediatricians agreed in their assessments for 239 of the 278 total findings. The assessments differed for 39 findings, but the difference was considered insignificant in 37 cases. There was only a significant difference in assessment for 2 of the 278 total findings (0.7%). This demonstrates that pediatric nurse practitioners can perform accurate and comprehensive physical examinations comparable to pediatricians.
Avado CEO Dave Chase's presentation to the Collaborative Health Consortium's weekly Pilots and Collaborations Webinar. Dave is doing some leading edge thinking on collaborative care.
This document discusses a proposed randomized controlled trial to evaluate the impact of family presence during resuscitation (FPDR) on the psychological health of family members. The trial would divide families into two groups: one that can witness resuscitation and one that cannot. At eight months post-resuscitation, both groups will complete the Impact of Event Scale-Revised (IES-R) questionnaire by phone. The hypothesis is that families who witnessed resuscitation will report significantly lower IES-R scores, indicating better psychological health. Previous studies provide evidence that FPDR does not affect resuscitation outcomes but may improve family member mental health outcomes.
This document discusses pediatric palliative care and why internists need experience treating pediatric patients. It notes that pediatric palliative care aims to improve quality of life for children with life-limiting illnesses and their families through pain and symptom management as well as psychosocial support, often provided in conjunction with curative treatment. Rates of pediatric deaths at home have increased in recent decades due to improved palliative care. The document outlines considerations for discussing prognosis with pediatric patients of different ages and provides an overview of key recommendations and resources for pediatric palliative care.
The document discusses the nursing process, which is a systematic method for providing goal-oriented, humanistic care effectively and efficiently. It involves assessment, nursing diagnosis, planning, implementation, and evaluation (ADPIE). Assessment involves comprehensive data collection to determine a client's health status. Nursing diagnoses are clinical judgments about a client's response to health problems. Planning establishes goals and outcomes and determines interventions. Implementation involves performing interventions and evaluation compares a client's status to goals. The primary purpose of the nursing process is to help nurses manage patient care scientifically, holistically, and creatively.
This case study describes the end-of-life care of Lorna, a 77-year old woman with metastatic renal cell carcinoma. Lorna originally presented with flank and abdominal pain and was diagnosed with advanced renal cell carcinoma in 2011. In 2014, the cancer recurred and metastasized to her spine, causing cauda equina syndrome with lower limb weakness and urinary/fecal incontinence. She was admitted to palliative care for pain and symptom management, where she received psychological support, medication via syringe pump, and focus on comfort. The document discusses renal cell carcinoma, cauda equina syndrome, medications, nursing interventions and compassionate end-of-life care.
Caswell Center in North Carolina utilizes occupational therapists and other professionals to enhance the quality of life for
individuals with developmental disabilities. Occupational therapists help individuals develop skills for daily living through
adaptive equipment, specialized activities like Snoezelen therapy, and research using biofeedback. This helps individuals
gain independence and experience happiness through meaningful activities. Community partners and funding support
allow Caswell Center to provide innovative programs to individuals.
Scoring Suffering to Address Patient Needs in Palliative Care: The "Maslow Sc...Mike Aref
Introduction
Palliative care patients have been scored by their symptom burden and performance but there is little standardization of their multidimensional suffering, needs, and wants. Maslow’s Hierarchy of Needs is a model for describing these needs as physiological, safety, love/ belonging, esteem, and self-actualization. The functional pain score is a validated method of scoring pain based on patient report and provider assessment. Using these two frameworks, the “Maslow Score” seeks to use Maslow’s Hierarchy to score the current patient situation based on symptom burden, plan, network, and meaning.
Methods
The scores are four-digit codes describing the patient situation at a given time base on team consensus. Each digit is a score from most secure, 0, to most vulnerable, 5. Both written examples and an algorithmic approach have been provided to obtain each score.
Results
Morning huddle has been expedited by utilizing scores recorded the previous day. Also if sudden changes have been reported they can be compared rapidly against a team standard. This triaging helps direct team resources as to whether patients should be reassessed by the entire team or specific members. The discussion has improved assessment of patients from an interdisciplinary perspective. In general, patients cannot improve their network and meaning scores until symptom and planning scores have been optimized.
Discussion
The “Maslow Score” appears to have improved the quality of care that our service delivers by improving efficiency. Further development and study is needed to standardize and validate our method.
Much has been written in the business literature about managing the waiting experience. Federal Express has noted that “waiting is frustrating, demoralizing, agonizing, aggravating, annoying, time consuming, and incredibly expensive.” We intuitively know this from our own experience as well as from our patients. In this #ACEP13 presentation, Dr. Jensen gives practical tips to improve your patients' ED experience.
The document discusses strategies for improving patient-centered care. It focuses on ensuring patients feel oriented, informed, and involved in their care. This includes introducing all medical staff, explaining plans in plain language, checking for understanding, keeping patients updated on delays, allowing them to explain concerns, and setting clear expectations for next steps. The goal is for patients to understand their care and feel their needs, preferences, and questions are being addressed.
This document discusses interprofessional rounding teams and strategies to improve teamwork and communication. It provides background on how interprofessional healthcare teams can improve patient outcomes. Checklists, care pathways, and interprofessional education are presented as potential solutions. Checklists have been shown to reduce medical errors and mortality. Care pathways, while challenging to implement, can standardize care and reduce prescribing errors. Brief interprofessional education sessions have been found to improve collaboration attitudes and skills among professionals. Overall, the document advocates for interprofessional rounding teams and strategies to enhance communication and teamwork across disciplines.
The document discusses intensive/critical care nursing. It describes intensive care as providing immediate care to patients with life-threatening health issues. Over 5 million patients are admitted annually to intensive care units in the US for issues like brain injuries, heart/lung problems, childbirth complications, infections, and surgery. The aging population is leading to more chronic illnesses and greater need for critical care. Critical care nursing requires specialized skills and knowledge to holistically care for critically ill patients and their families during crisis situations.
This homecare agency provides a wide range of in-home medical, rehabilitation, and support services to help clients remain in their homes. They have a doctor-owned, nurse-managed model with strict safety standards. Services include skilled nursing, physical/occupational/speech therapy, medical social work, and 24/7 nurse support. They aim to improve outcomes through coordinated, compassionate long-term care that improves quality of life.
Whsrma 2013 grundy singapore april 2013Paul Grundy
The document discusses the patient centered medical home (PCMH) model which aims to transform healthcare delivery from episodic care to population health management. It provides an overview of the key components of the PCMH model including acting as a system integrator across providers, driving primary care redesign, and offering utilities for population health and financial management. Studies show PCMHs can lead to reductions in hospital and ER use as well as lower overall costs. The PCMH framework focuses on features like patient-centeredness, comprehensive and coordinated care, improved access, and a commitment to quality and safety.
10 Unexpected Pitfalls of Telehealth Home Care for SeniorsVSee
While the acceptance of technology by seniors has been the biggest concern of those who want to do telehealth with them, the truth is many elderly love their iPhones and are comfortable with doing FaceTime with their grandchildren. So what are the real barriers?
For more information of the webinar such as recording and transcript, please visit:
https://goo.gl/IIAyNw
For other webinars:
https://vsee.com/webinars/
Or join our Linkedin Group: https://www.linkedin.com/groups/Telehealth-Failures-Secrets-Success-13500037/about
Or Join our Facebook Group:
https://www.facebook.com/groups/tfssgroup/?ref=group_cover
The document defines nursing as involving diagnosis and treatment of actual or potential health problems through a problem-solving process. It outlines the nursing process as assessment, diagnosis, planning, implementation, and evaluation. The nursing process is used for critical thinking, communication, and developing an individualized care plan. Physical assessment involves gathering data through interviews, observations, examinations, and medical record review. The data is analyzed to identify problems and clinical judgments, which are then expressed as nursing diagnoses. Goals are set to direct interventions and evaluate their effectiveness in addressing the abnormal signs and symptoms identified in the nursing diagnoses.
1. Nursing diagnosis is a clinical judgment about a patient's response to actual or potential health problems. It focuses on issues a nurse can treat, unlike a medical diagnosis which identifies disease.
2. The nursing diagnostic process involves collecting data, analyzing it for deviations from norms, clustering related cues, and formulating a diagnosis statement describing the patient's problem, likely cause, and defining characteristics.
3. Nursing diagnoses can be one-part, two-part, or three-part statements specifying the problem, related factors or etiology, and defining signs/symptoms. Variations include unknown or complex etiologies, possible diagnoses, and specifying secondary causes.
Dementia patients are liable for hospitalization. Most of the physicians are concerned with the acute condition. Upon improvement, another problem emerges. Safe discharge of dementia patient.
This document discusses the importance of nursing documentation and how a nurse's license may depend on thorough and accurate documentation. It notes that poor documentation can lead to malpractice lawsuits and loss of a nursing license. The document provides examples of legal cases where nurses faced consequences due to deficiencies in their documentation. It emphasizes that if an action is not documented, it is considered as if it was not performed.
Clarity Health Journal submission for the NYeC Patient Portal Challenge. An overview of the capabilities of Clarity Health Journal a consumer health application design for families to take charge of their health.
The document summarizes findings from regional consultations with seniors and caregivers about navigating Ontario's healthcare system. Key themes emerged around primary care being disorganized and unconnected; difficulty connecting services; variable communication; disregard for family members' roles; and lack of support for those without family. The document also describes a patient experience survey in Northumberland County that found transitions between care settings often lacked coordination, communication, and inclusion of patients and caregivers in decision-making. Overall, the information suggests opportunities to improve navigation, coordination, communication and inclusion across healthcare settings from the perspectives of patients and caregivers.
Chantay Brown is an experienced LPN seeking a nursing position. She has over 16 years of experience in various nursing specialties including pediatrics, geriatrics, surgery, and internal medicine. She has worked in clinical, hospital, and military settings. Her background demonstrates strong clinical skills as well as the ability to educate patients, document care, and ensure quality of care.
This document discusses various ethical issues that arise in neonatal intensive care units. It begins by stating that the goal of NICU care should be survival with an acceptable quality of life, not just survival alone. It then discusses challenges around determining when not to initiate or continue intensive care for extremely premature newborns or those with severe conditions. The document also addresses ensuring parental autonomy while balancing medical facts, distributing limited resources fairly, and minimizing patient pain and suffering. Throughout, it emphasizes the importance of open communication with parents and shared decision-making.
This document discusses age-specific competencies in caring for patients of different ages. It covers growth and development from infancy through adolescence, highlighting physical, mental, communication and safety needs specific to each age group. The document is intended as training material for medical staff, emphasizing the importance of understanding age-appropriate needs and behaviors in providing quality patient care.
What can a Clinical Nurse Leader do for your critical care nursing unit? Plenty! Consider this new nursing role as one that can improve patient outcomes and increase satisfaction for both clients and staff. Successful microsystems begin with empowering patients, families and front line nurses.
The document summarizes the Special Care Center, a service created by AtlantiCare to provide coordinated care for patients with chronic conditions. The Special Care Center aims to (1) manage chronic conditions effectively through a patient-centered medical home model, (2) reduce healthcare costs by focusing on preventative care and avoiding unnecessary emergency visits and hospitalizations, and (3) improve patient outcomes by providing integrated care, health coaching, open access to providers and services, and an emphasis on the patient experience. Since opening in 2007, the Special Care Center has expanded its services and grown to over 2,600 enrolled patients.
There is a need to form a perinatal palliative care team consisting of physicians, certified nurse midwives, and nurses trained in palliative care to provide specialized support. This team would arrange meetings, manage referrals, and provide continuity of care for grieving families and clinicians. Peer support groups and continued education on coping with loss can help clinicians process their experiences. The hospital environment may need a separate unit detached from the labor and delivery ward to allow families privacy to grieve.
From Burnout to Engagement: Strategies to Promote Physician Wellness and Work...Modern Healthcare
Slides from a Modern Healthcare presentation.
http://www.modernhealthcare.com/article/20150225/INFO/302259999/webinar-from-burnout-to-engagement-strategies-to-promote-physician
Faced with long hours, unrelenting administrative burdens and the pressure to treat patients quickly, a growing number of physicians are experiencing burnout, a condition characterized by loss of empathy, exhaustion, and a low sense of accomplishment. According to a Mayo Clinic survey from 2012, nearly one in two U.S physicians reported at least one symptom of burnout, up from 22% in 2001. For hospitals with stressed caregivers, the stakes are high. Burned out, dissatisfied physicians are far more likely to make medical errors and are less able to communicate effectively with patients and co-workers. They're also at a higher risk for substance abuse and are more likely to leave clinical practice altogether.
Similar to UnitedHealthcare Nursing Home PlanEvercare Clinical ModelTelemedicine Initiatives (20)
Abraham Baldwin Agricultural College is located in Tifton, Georgia. Tammy Carter and Troy Spicer are registered nurses who work at the college. Both Carter and Spicer have master's degrees in nursing and Spicer is also a family nurse practitioner.
This document summarizes Georgia's telehealth initiative. It discusses plans to expand access to care through telehealth while not replacing the medical home. Telehealth is currently used across Georgia to deliver services like WIC and increase access to specialty care. The document outlines various telehealth projects across different departments, including high risk OB care, children's services, infectious disease care, and dentistry. It discusses partners, funding sources, goals of increasing access and capacity, and next steps like securing more funding and expanding available services.
The Hancock Healthcare Access Initiative aims to improve access to emergency and primary care in Hancock County through a partnership model. Hancock County ranks poorly in health factors, social economic factors, and physical environment. Approximately 68% of emergency room visits were for non-emergent issues and there is limited primary care access. The initiative would use emergency medical technicians trained in telemedicine to conduct in-home exams and diagnostics to treat non-emergency issues. This would decrease emergency room overuse and transportation costs while strengthening primary care. The goals are to enhance emergency care, decrease non-emergency transportation and emergency room use, provide 24/7 minor illness access, and ultimately decrease hospital readmissions by improving care transitions and prevention.
Telemedicine provides benefits to both physicians and patients. It allows physicians to expand their reach to serve more rural or underserved areas while improving patients' access to care and quality of life. However, telemedicine must be practiced according to the rules of state medical boards to ensure quality, safety, and compliance. The document outlines Georgia's rules for physicians, which require the establishment of a patient relationship, maintenance of proper records, credentialing of physician extenders, emergency contact information, and annual in-person examinations to practice telemedicine according to the highest standard of care.
The document discusses predictions for the future growth of telehealth. Sensors will continuously monitor vital signs and activities. Annual growth in telehealth is predicted to be 18.5% worldwide through 2018 and 56% annually in the US, reaching $1.9 billion by 2018. Consumer demand and government support will drive telehealth to become mainstream healthcare. Telehealth also enables greater international collaboration in business and healthcare missions.
The 2015 GPT Spring Conference focused on telehealth and the Southeastern TeleHealth Resource Center (SETRC) which provides technical assistance to advance telehealth in several southeastern states. SETRC's education arm, the National School of Applied TeleHealth (NSAT), offers online telehealth certification courses and has collaborated with various organizations across the U.S. and internationally to provide telehealth training. NSAT graduates come from 42 U.S. states and 16 foreign countries.
This document discusses how telehealth can help control healthcare costs, improve outcomes, avoid readmissions, and modify patient behavior. It provides examples of how telehealth is being used at UMMC and Mississippi to expand access to specialty care, support chronic disease management, improve care coordination, and enhance population health through tools like remote patient monitoring and data analytics. The goal is to improve quality, efficiency and safety through telehealth while empowering patients and preventing unnecessary hospitalizations and ER visits.
Mario gutierrez georgia trc 2015 mario finalSamantha Haas
The 6th Annual Georgia Partnership for TeleHealth Spring Conference will take place from March 25-27 in Savannah, Georgia. Telehealth uses digital technologies to enhance healthcare delivery and support. It can help redistribute healthcare expertise to where it is needed and create greater value. Common telehealth modalities include live video, store-and-forward, remote patient monitoring, and mobile health. Both federal and state policies will need to evolve to support greater use of telehealth as the healthcare system shifts from volume-based to value-based care.
We have a global presence to serve customers worldwide. With offices in North America, Europe, and Asia, we support over a million users across 150 countries. Our international teams help ensure customers have a consistent experience regardless of location.
The document discusses Berrien School-Based TeleCare Clinics. It appears to be written by Kayla Money, who is identified as the RN and nurse at Berrien Middle School. The document likely provides information about telehealth clinics operating within the Berrien school system.
This document summarizes the business case for remote patient monitoring. It outlines how remote monitoring has progressed from initial technologies to integrated virtual care solutions. It shows how new care delivery models incentivize providers to adopt remote monitoring to reduce costs and improve outcomes. Studies show remote monitoring can significantly reduce hospitalizations, ER visits, and costs for patients with chronic conditions. The document concludes by describing opportunities for hospitals, physicians, and post-acute providers to leverage remote monitoring.
This document discusses building a successful telehealth program. It begins by outlining the key components needed: a clinical business model that identifies needs and services, appropriate technology, and consideration of legal and reimbursement factors. The author describes three domains of telehealth - hospital/specialty care, integrated primary care, and transitions/monitoring. Different value propositions apply to each. Business models discussed include fee-for-service payments, travel reduction, remote hiring/retention, and remote monitoring. The document stresses adopting approaches aligned with the "Triple Aim" of improving patient experience, population health and reducing costs. It emphasizes having a team of champions, partners, and support from Telehealth Resource Centers.
This document provides information about Memorial University Medical Center (MUMC) and its telestroke program. MUMC is a 654-bed tertiary care hospital and regional referral center located in Georgia and South Carolina. It serves as the region's only level 1 trauma center and children's hospital. MUMC has been recognized as a primary stroke center and for its treatment of stroke patients according to national guidelines. The document outlines statistics on MUMC's stroke patients and telestroke program which allows neurologists to evaluate and treat acute stroke patients at regional spoke sites via telemedicine. The telestroke program has increased the number of patients receiving tPA and improved outcomes since its launch in 2011.
The document discusses the challenges facing healthcare systems due to an aging population and rising costs. It argues that new models of care delivery enabled by connected technologies can help address these issues. Specifically, it envisions a future where remote patient monitoring, clinical decision support, and analytics help manage chronic conditions and shift care settings to be more efficient and preventative. Realizing this vision will require overcoming historical barriers through incremental innovation and the development of an interoperable technology-enabled care ecosystem.
With A Successful Telehealth Program Comes An Unbeatable ROI
This document discusses the telehealth program and connections of Tift Regional Medical Center (TRMC) in Tifton, Georgia. It provides a list of the current telehealth connections TRMC has established, including with primary care physicians, neurology, nephrology, wound care, infectious disease, sleep lab follow-ups and more. It also lists potential future opportunities for telehealth connections including with dialysis, neurology, diabetic education, and continuing education. In summary, the document outlines the existing telehealth program partnerships and services of TRMC and possibilities to expand the program in the future.
The document lists different levels of exhibitors at an event, including Platinum Plus exhibitors at the top, followed by multiple Gold exhibitors, and then several Silver exhibitors listed afterwards in descending order.
Ellen bolch & max stachura advanced telehomecareSamantha Haas
RightHealth provides remote patient monitoring and chronic disease management using technologies like remote monitoring devices, video visits, electronic health records, and clinical decision support. Their population health model focuses on chronic disease management through risk stratification, physician-led care teams, and care coordination across settings. Studies show their program reduces hospital readmissions and Medicare charges. They propose a bundled payment program to further monitor and prevent rehospitalizations for certain conditions over 90 days post-discharge. Background literature supports telehealth tools for caregiver support, independent living for elders, and positive quality perceptions of telehomecare. Video conferencing can allow inspection for signs like edema or depression and detect changes from a baseline. Some patients feel video is better for openness while
This document summarizes Joseph Zanga's efforts to simplify the credentialing process for telemedicine physicians to provide specialty services at Midtown Medical Center in Columbus, Georgia. It outlines the challenges of the previous lengthy 47-page credentialing packet and 24 required documents. It then describes the process developed to allow credentialing by proxy based on the distant site's credentialing, in accordance with Joint Commission requirements. This new streamlined process involving verification of key documents has enabled Midtown to credential 15 telemedicine physician consultants to expand specialty services.
Dr. winston price decatur co telehealth march 26Samantha Haas
The document discusses the implementation of a telehealth program in Decatur County schools. The program establishes telehealth clinics in school nurses' offices to provide virtual visits with physicians for minor health needs of students. This allows students to be treated without missing school. The program launched at two schools in 2015 and has since expanded access to healthcare in rural areas while reducing barriers to care. Metrics show it has saved time in treating conditions like ear infections and behavioral health issues. Partnerships within the community will help ensure the long-term sustainability of telehealth in Decatur County.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
Home
Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Public Health Lecture 4 Social Sciences and Public Health
UnitedHealthcare Nursing Home PlanEvercare Clinical ModelTelemedicine Initiatives
1. UnitedHealthcare Nursing Home Plan
Evercare Clinical Model
Telemedicine Initiatives
Cathy Lipton, MD
Senior Medical Director
03/15/2012
2. The Evercare Model offers individualized solutions
Currently:
• Complex problems require individual solutions; not just disease –specific
programs
• Typical Disease Management programs have not demonstrated desired
outcomes
• Poor communication between providers of care and the delivery system;
doctors and nurses don’t get to do what they do best
With Evercare:
• Evercare programs offer individualized and comprehensive care plans
• Evercare program results address the systems of care with better quality
outcomes and improved satisfaction
Evercare Nurse Practitioners / Clinical Support accomplish 3 main
objectives:
• Increased assessments and proactive medicine to prevent ailments from
becoming acute
• Facilitate treatment of changes in condition immediately in place
• Enhance communication for entire care-plan, disease trajectory, ACP 2
Propriety and Confidential. Do not distribute.
3. UnitedHealthcare Nursing Home Plan Clinical Features & Benefits
Nurse Practitioners as a central part of providing more intensive primary
care working in collaboration with nursing home staff and primary
care physicians.
Physicians who are encouraged to increase their involvement with
families and nursing home residents.
PCP continued participation rating of 91%
Decreased hospital admissions by 50%
Year over year family/responsible party satisfaction ratings of greater
than 95%.
Clinical staff provides both formal and informal education for nursing
home staff.
Early identification and change in condition programs and tools to
promote early clinical intervention and improve outcomes.
Annual Clinical Indicator Studies that drive clinical practice guideline
development that promotes quality of care.
3
Propriety and Confidential. Do not distribute.
4. UnitedHealthcare Nursing Home Plan
Waiver of 3-day Qualifying Stay
– Stable Census
– Reduced Bed-Hold Days
– Immediate Part A Reimbursement
– Skilled Days Outside of Medicare
On-site clinician (NP/PA) at no additional cost
Focus on ongoing Advance Care Planning with families and staff
Enhanced Medical Records (EMR, documentation)
Additional Covered Items
– Therapy Screenings
– Dental and Eyewear Benefits
– Blood Glucose Monitoring
– Skilled Days Outside of 3-day Qualifying Stay
Afterhours support
Enhance overall clinical quality
4
Propriety and Confidential. Do not distribute.
5. Evercare works in partnership with nursing home staff to execute
these components:
Intensive Delivery of Primary Care – by our clinical team, which includes nurse
practitioners collaborating with physicians
Onsite Nurse Practitioner – at no cost to the facility or resident, results in:
• Increased visits for residents
• Emphasis on proactive care
• Early identification of change of condition
• Increased communication with residents, families, staff, and physicians
• Formal and informal education to nursing staff
Treat in Place Model
• Frequent visits by Nurse Practitioner
• Intensive Collaboration with primary care physician
• Ability to initiate skilled benefit without 3-day hospitalization
5
Propriety and Confidential. Do not distribute.
6. UnitedHealthcare Nursing Home Plan Population Profile
Custodial, permanent stay, frail elderly, no active discharge plan
Average age 81+ years old
80% female
85% Moderate To Severe Dementia
75% require assistance with 4+ ADLs
Must be long-term resident of SNF, have Medicare A & B, and not
enrolled in ESRD program
Primary diagnosis
• Dementia
• Hypertension
• Anxiety and Depression
• Vision Impairment
• Arthritis
< .5% discharged to home
6
Propriety and Confidential. Do not distribute.
7. The Evercare Clinical Model: How does it work?
Apply an individualized, whole-person approach to care of frail,
institutionalized elders
• Focus on promoting maximum function, comfort, and quality of life
Preventive Care and Early Recognition of Change in Condition
• Evidence-based medical care
• Frequent monitoring and communication with nursing staff
• Rapid response to changes – rapid initiation of treatment
Provide care in a safe but least invasive manner, in the least invasive
setting
• Provide as much care as possible in the nursing home setting
• “Treat in place” philosophy – avoiding complications and trauma of unnecessary
hospitalizations
Provide care through a primary care team – partnership of nursing home
staff, primary care physician, and nurse practitioner
• Clinical support for facility
• Access to skilled benefits without hospitalization
• Enhanced reimbursement for physician services
7
Propriety and Confidential. Do not distribute.
8. Why do patients transfer out of Skilled Facilities?
Fundamental system issues related to transitions in care
Physician/NP/PA presence in SNFs and coverage issues
SNF technical capabilities
ACP/Family dynamics
Staffing
Education/training in SNFs
Regulatory environment
Patient mix
Fragmentation in system/information systems
Over 50% of admitting diagnoses for avoidable hospitalizations:
• Cardiovascular (CHF and chest pain)
• Respiratory (pneumonia and bronchitis)
• Mental Status Change/Neurological
8
Propriety and Confidential. Do not distribute.
9. Focused Expert Reviews of Transfers out of Nursing Centers
show….
Key facility factors identified when defining “avoidable” hospitalizations:
The same benefits could have been achieved at a lower level of care
The SNF should have been able to provide the care
Availability of on-site physician/NP/PA evaluation
Better quality of care in assessing the resident’s change in status
Better advance care planning
The resident’s overall condition limited his ability to benefit from the
hospitalization
Key facility resources helpful in preventing hospitalizations:
Examination by a physician, NP or PA within 24 hours
Physician or physician extender present in the SNF at least 3 days per week
Care by a registered nurse (vs LPN/CNA)
Availability of lab tests within 3 hours
Ability of the SNF to initiate and maintain intravenous therapy
9
Propriety and Confidential. Do not distribute.
10. What can happen as a result of hospitalization?
New physical or Conflicting
Outpatient (clinic)
chemical information
visits get scheduled
Altered functional restraint given to family
Increased when not necessary
status/weakness or appropriate
confusion-‘out of
sorts’
Pressure Sores
Psychiatric Lost teeth,
Over sedation/lethargy exacerbation hearing aids
Eccymosis from IV/lab and glasses
sticks
Decline in
Relocation Physically unkempt
ADL’s
Trauma
Incontinence
UTI’s secondary to catheter
MRSA and or VRE
Relocation Fecal Impaction
Weight loss/ Loss of Broken bones from
Trauma
appetite falls in hospital
Initial problem not fully
investigated/resolved
Advance Directives NOT followed
Increased anxiety/agitation
Lost equipment: Confusion from the
Decreased
(splints/braces)
Activity Phlebitis hospitalization that can take a
long time to clear
Bad memories/waiting in ER
for up to 18 hours
Resident not a
Lack of discharge summary and
priority to acute 10
info related to hospitalization Heel ulcers
care staff Death or poor quality death
Propriety and Confidential. Do not distribute.
11. Reduction In Unnecessary Hospitalizations
The University of Minnesota School of Public Health found that the incidence of hospitalizations among nursing home
populations was twice as high in control residents as in Evercare residents. Members in the control group were also twice
as likely to go to the Emergency Room than Evercare members. Evercare had ½ the hospitalizations compared to fee-for-
service Medicare (Control 1 & 2).
Effect of Evercare on Hospital Use
80
70
60
Admits per 50
1000
Enrollees 40
30
20
10
0
Evercare Control 1 Control 2 Evercare Control 1 Control 2
Hospital Emergency Room
Admissions Visits
Source: Dr. Robert Kane et al, University of Minnesota, 2003 11
Propriety and Confidential. Do not distribute.
12. It’s not just good geriatric care…
One in 4 Medicare patients admitted to skilled nursing facilities from
hospitals is readmitted to the hospital within 30 days
Up to 2/3 of hospital transfers are rated as potentially avoidable by
expert long-term care health professionals
Health Care Reform requirement: “Hospital Readmissions Reduction
Program” becomes fully effective October 1, 2012
Medicare is putting in place financial incentives to reduce potentially
avoidable hospital transfers through pay-for-performance, bundled
payments, and other strategies
First phase: Heart Attack, Heart Failure, Pneumonia
Second phase: COPD, CABG, PTCA, Other vascular conditions
The OIG considers unnecessary hospitalizations during a nursing home
stay a compliance priority in its 2011 and 2012 work plans
Budget plans for similar reductions in skilled nursing facility
reimbursement as of 2015 for high rates of preventable hospital
admissions
12
Propriety and Confidential. Do not distribute.
13. Proposed Telemedicine Pilot
Work in Ethica Health centers in conjunction with Georgia Partnership for
Telehealth
Target buildings that have the Evercare model in place and still have
continued high rates of transfers
Use existing telemedicine equipment with the Evercare NPs and PAs as
“end users”
Overlay Evercare’s existing 24-7 on call system
One year pilot proposed
Goals:
• Improve “face-to-face” communication with staff and families
• Enhance treatment in place
• Reduce transfer rates
Replicate across our shared nursing centers and expand beyond to
underserved and geographically remote centers
13
Propriety and Confidential. Do not distribute.
14. UnitedHealthcare Telemedicine/Telehealth Activities
Goal to enhance use of telehealth in rural areas:
1. Expand broadband connectivity to enable growth of telemedicine adoption.
2. Improve and align reimbursement approaches across payers to encourage
greater
use of telemedicine across rural settings.
3. Encourage physicians to incorporate telemedicine into their practice.
4. Use telemedicine to build primary care capacity in rural areas.
5. Increase access choices for rural beneficiaries.
6. Raise patient comfort levels with telemedicine technology and encourage
its use
in rural care models.
7. Update regulations associated with technologies and professionals.
8. Improve care coordination and patient safety in rural areas.
14
Propriety and Confidential. Do not distribute.
15. Bringing Primary Care and Specialty Services to the Navajo Nation
UnitedHealthcare serves 24,000 special needs children in the
Arizona Medicaid program. Obtaining pediatric specialty services in
rural parts of the state is a significant challenge for many children.
In 2010, UnitedHealthcare generated a Title V grant for the
expansion of telemedicine into Tuba City on the Navajo Nation in
Northeastern Arizona. Access to specialty medical care on the Navajo
Nation is extremely limited. Children and their families typically must
travel 200 miles to Phoenix, the closest urban center, to see a
specialist.
The Navajo telemedicine program utilizes high-definition
technology through an established T1 network that provides hub site
services (at regional clinics) to patients presenting from remote
locations on the Navajo Nation.
Financial support for travel and individual service plans are
helping underserved tribal members gain access to needed primary
care and specialty services in the most remote areas of Northeastern
Arizona.
15
Propriety and Confidential. Do not distribute.
16. OptumHealth’s Connected Care Delivery of Telehealth Technology
and Services
Connected Care delivers telehealth services in low-access rural
and urban areas using a combination of advanced
telecommunications technologies, health care delivery expertise and
scalable operations.
Through the provision of telemedicine equipment and
operational assistance, Connected Care enables communication
among existing medical communities, providing the technology and
professional support necessary to implement telemedicine. This
includes everything from equipment, software and support services,
to coordinating scheduling systems, training, facility design and
reimbursement analysis. All equipment — video gear, stethoscopes,
etc. — is telemetry-enabled.
Connected Care improves access to care by reducing travel time
to see specialty providers and making it easier to provide follow-up
care in a local setting. It serves rural populations in collaboration with
local providers and remote specialists, including Critical Access
Hospitals, Rural Health Clinics and larger hospital systems.
16
Propriety and Confidential. Do not distribute.
17. Thank You!
17
Propriety and Confidential. Do not distribute.