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Comprehensive Program Proposal Presentation.pptx
- 1. Comprehensive Program Proposal Presentation JOSEPHROMERO SOUTHERN NEW HAMPSHIRE UNIVERSITY IHP 670 DR. SUZANNE PAONE
- 2. OVERVIEW Introduction Assessments Logic Model Outcomes Financial Aspects Evaluation Strategy Conclusion
- 3. INTRODUCTION West Texas Telehealthwill provide tele monitoring and potential future telehealth services to the aging retirement community and patients located within the city and county limits in and around Abilene Texas. With roughly 13% of the population being at or above the retirement age of 65 and the ratio of clinician to patient in Taylor county being 1 to 68 for primary care, a service such as this may help to ease the burden of patient load that requires monitoring services such as blood pressure, blood glucose, weight, etc.
- 4. ASSESSMENTS ORGANIZATIONAL DESIGN Currentcommunity need for telehealth/telemonitoring services are not being met Diabetes prevalence of 10% with associated complications Obesity prevalence of 31% with associated complications Long waits at physician offices for routine monitoring services of diabetes and obesity conditions Telemonitoring service used to monitor and control glucose levels without multiple visits
- 5. ASSESSMENTS DISPARITIES AND CULTURALCOMPETENCE Disparities Insurance providers may not support telehealth/telemonitoring Medicaid & Medicare may not pay costs Insurance may not recognize patient’s home as originating site Federal Grant Program Cultural Competence Multilingual support Monitoring services commensurate with religious beliefs
- 6. ASSESSMENTS STRATEGIES AND ETHICALGUIDELINES Strategies and Ethical Guidelines Utilize current Health Information Technology (HIT) already in place Up to date software and hardware ISO/TS Health Informatics, Telehealth Services Quality Planning Guidelines 24 hours a day, 7 days a week monitoring services Ethical guidelines will be set by utilizing NAHQ Code of Ethics and Standards of Practice
- 7. Logic Model Program: WestTexas Telehealth Logic Model Situation: Validity of Providing Telehealth Services to Local Area Investment Capital Staffing Equipment Materials Technology Knowledge Community Partners Patients Telehealth monitoring services Monitor certain health informatics at home using wireless tools Local community Rural families Facilitate access to care and improve overall health Local physicians Hospitals Clinics Emergency Rooms Awareness Access Inputs Outputs Activities Participation Outcomes Short Medium Long Log results quickly and accurately to patient EHRs Intervene with emergency response if results warrant it Expanded patient base possible Reduction in cancellations Less time taken for routine monitoring Better coverage overall Participation Changed Behavior Improved access to patient information Assumptions Minimal setup costs due to in-place technology at all local facilities. Meaningful participation by the target demographic of retired persons needing monitoring services. Willingness of local physicians, hospitals, and clinics to participate in data sharing External Factors Wireless service capability in the rural outlying areas. Ability to reach all target demographics. Possible rejection of services due to non-familiarity or unwillingness of older patients to use newer technology. Less time spent in the physician’s office for biometrics Improved medication compliance Improved patient health and safety Shorter wait times for more pressing medical appointments Reduced healthcare costs overall
- 8. OUTCOMES ANTICIPATED RESULTS ShortTerm Awareness Access Shortened wait time Medium Term Improved Compliance Expanded patient base Reduction in cancellations Long Term Improved patient health and safety Shorter wait times for more pressing medical appointments Reduced healthcare costs overall
- 9. OUTCOMES EXPECTED IMPACT -COMMUNITY Raise health awareness Improve patient health and safety Provide a necessary service to the area Generate revenue sources Improving patient, physician, and hospital communications
- 10. OUTCOMES EXPECTED IMPACT –CULTURAL COMPLIANCE Multilingual support added Improving community diversity efforts and cultural compliance Improving health services in compliance with various religious beliefs Data collection to update services
- 11. FINANCIAL ASPECTS RESOURCES ExistingHIT resources (EHRs utilized by physician and local hospitals) Compatible software Wireless technology and equipment Cell tower capability No hard line phones or internet connection necessary
- 12. FINANCIAL ASPECTS BUDGET ANDSUSTAINABILITY Lack of community funds available Federal Grant money available Telehealth Resource Center Grant Pro Program provides new sources of revenue Job positions Generate local tax monies Possible service fee reduction from local Telecom companies
- 13. EVALUATION STRATEGY BENCHMARKS Costsand/or benefits gained or lost Continual validation of service needs Constant status of network monitored to identify possible bottlenecks Inclement weather impact on the system
- 14. EVALUATION STRATEGY TOOLS USEDTO EVALUATE Recommendations of tools from the Institute of Medicine Race/Ethnicity/Language (R/E/L) Data Data shows efficacy of program at reducing disparities Stratified data shows root causes of leading disparities within demographics Consumer Assessment of Healthcare Providers and Systems (CAHPS) program Quality and Safety Review System (QSRS)
- 15. CONCLUSION With proper planning,this system should fit seamlessly into the local healthcare community. The expected outcome would be to lower the burden of patient load on the physicians by removing and replacing the simple monitoring tasks with that of the telehealth systems. The program will help to ensure healthcare equity within the system by addressing the needs of the diverse population of the local community and providing the necessary care and services needed to all participating.
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- 17. REFERENCES Agency forHealthcare Research and Quality. (2016). Quality Measure Tools & Resources. Retrieved from https://www.ahrq.gov/professionals/quality-patient-safety/quality- resources/index.html Data USA. (2016). Taylor County Texas. Retrieved from https://datausa.io/profile/geo/taylor- county- tx/#health Eldercare Workforce Alliance. (2015). Caring for older adults. Retrieved from https://eldercareworkforce.org/files/State_Issue_Briefs_2014/TX_State_Issue_Brief_-_2.14.pdf Harrington, H. J. (2009). The Organization’s Stakeholders: Resource or Obligation? Retrieved from http:// www.qualitydigest.com/magazine/2009/may/column/organization-s-stakeholders-resource-or- obligation.html International Organization for Standardization. (2016, March 22). Health informatics -- Telehealth services -- Quality planning guidelines. Retrieved from http://www.iso.org/iso/catalogue_detail? csnumber=53052 Longest Jr., B. B. (2015). Health program management: From development through evaluation (2nd ed.). San Francisco, CA: Jossey-Bass.
- 18. REFERENCES continued NationalAssociation for Healthcare Quality. (2016). NAHQ Code of Ethics and Standards of Practice. Retrieved from http://www.nahq.org/Quality- Community/content/codeethicspractice.html National Telehealth Policy Resource Center. (2016). National Telehealth Policy Resource Center. Retrieved from http://www.cchpca.org/national-telehealth-policy-resource-center Robert Wood Johnson Foundation. (2014, April). Using Data to Reduce Disparities and Improve Quality: A Guide for Health Care Organizations. Retrieved from http://www.solvingdisparities.org/sites/default/files/data%20issue%20brief.pdf U.S. Department of Health & Human Services. (2016). Telehealth Resource Center Grant Program. Retrieved from https://www.hrsa.gov/ruralhealth/programopportunities/fundingopportunities/? id=bd201808- a31c-4266-b52e-50278bd612f9 Vanderwerf, M. (2016). 10 Critical Steps for a Successful Telemedicine Program. Retrieved from http://www.amdtelemedicine.com/downloads/10_steps.pdf
Editor's Notes
- #1 Comprehensive Program Proposal Presentation Joseph Romero Southern New Hampshire University IHP 670 Dr. Suzanne Paone
- #2 During this presentation we will be discussing the following: Introduction Assessments – We will cover organizational design for program development, healthcare disparities, cultural competence, programmatic strategies and how they align with ethical guidelines. Logic Model - Will identify the stakeholders and their relationship with the programs as well as resources, activities, inputs and outputs expected for the program. Outcomes- All anticipated outcomes Financial Aspects – This will cover specific resources necessary as well as budget expectations and ideas to ensure the program remains sustainable financially. Evaluation Strategy – Evaluation methods will be discussed such as the measure methodology as well as what will be measured and what tools will be used to show incident reduction and program success. Conclusion
- #3 The agency chosen, West Texas Telehealth, will be able to provide certain telehealth services to the residents of the Abilene Texas community as well as many of the smaller surrounding outlying communities. The focus of this agency will be to cover or close the gap that exists between the number of elderly retired patients requiring some level of daily or weekly scheduled monitoring and the physicians in the area. This gap is predicted to widen by 100% in the next few years as more and more people reach the age and health level that requires more attention from physicians (Eldercare Workforce Alliance, 2015). With roughly 13% of the population being at or above the retirement age of 65 and the ratio of clinician to patient in Taylor county being 1 to 68 for primary care (Data USA, 2016), a service such as this may help to ease the burden of patient load that requires monitoring services such as blood pressure, blood glucose, weight, etc.
- #4 The servicing area, Abilene Texas and the surrounding rural areas currently have no telehealth/telemonitoring service availability unless their care is associated with the Veterans Health administration (VHA). The focus of this agency will be to cover or close the gap that exists between the number of elderly retired patients requiring some level of daily or weekly scheduled monitoring of these health problems and the physicians in the area. This gap is predicted to widen by 100% in the next few years as more and more people reach the age and health level that requires more attention from physicians (Eldercare Workforce Alliance, 2015). Current data shows the population to be at roughly 135,000 people. Within the community, 10% of the population have diabetes and associated complications while 31% suffer from obesity with associated complications (Data USA, 2016). The areas supports a rather large retiree community as it is home to an active Air Force base. These demographic groups may be served better and faster by utilizing the monitoring services if they are linked to the above diseases and complications. This alone will greatly reduce recurring complications and alleviate long physician appointment wait times. Intervention programs may also be initiated earlier while under monitoring if the conditions worsen. This can be reinforced by the fact that long waits for local physician visits for routine medical monitoring such as blood pressure, weight management, diabetic monitoring, etc. (Vanderwerf, 2016). These monitoring tasks may be eliminated from the physician’s office through the use of a dedicated telehealth/telemonitoring program.
- #5 Some disparities will undoubtedly exist when introducing a system such as this into a small retirement type community such as Abilene Texas. One such disparity may be that not every health insurance provider utilized in the area will support the use of telehealth services. Current Medicaid coverage may not cover the cost of using the system. Other payers may not even recognize the patient’s home as an originating site for the use of this service (Vanderwerf, 2016). This disparities may initially cause some delays in the implementation of services but due to the rural type setting of some of the residents, the system may qualify for federal funding through the U.S. Department of Health & Human Services Telehealth Network Grant Program (TNGP) (U.S. Department of Health & Human Services, 2016). The establishment of the telehealth program will help to ensure healthcare equity within the system by across the diverse population of the local community by providing the necessary care and services need to all participating. This will be accomplished by providing multi-lingual support to cover all language barriers that may exist within the community. Different religions view healthcare differently and observe many different practices to stay in touch with their elected faith obligations. These beliefs will be observed and practiced by the staff whenever necessary in order to maintain religious diversity within the program.
- #6 The current Health Information Technology (HIT) utilized within the local area offices and hospitals will need to be surveyed to ensure that the most reliable, up-to-date software and system hardware is being utilized in order to ensure that no immediate breakdowns will occur when the system is brought online. Of course when planning the organization, all guidance suggested in the ISO/TS Health Informatics, Telehealth Services Quality Planning Guidelines (International Organization for Standardization, 2016) will be used and adhered to in order to ensure success. With proper planning, this system should fit seamlessly into the local healthcare community. The expected outcome would be to lower the burden of patient load on the physicians by removing and replacing the simple monitoring tasks with that of the telehealth systems. The daily/weekly results can be monitored 24 hours a day, 7 days a week by certified/trained staff that will document and notify the physicians whenever certain conditions set by the physician are met. Where ethical guidelines are concerned, the program will utilized and adhere to the standards set forth by the National Association of Healthcare Quality in the NAHQ Code of Ethics and Standards of Practice (National Association for Healthcare Quality, 2016).
- #7 Logic Model for West Texas Telehealth Program In establishing a new tele-health service, West Texas Telehealth, organizational stakeholders will play a valuable part in ensuring the for-profit company is successful. The initial identification of organizational stakeholders for this company are investors, partners, management, employees, suppliers, local physicians/hospitals/facilities, and customers. As local physicians/hospitals/facilities and customers do have an impact on the organization, they are considered stakeholders, but internal members would be considered “organizational stakeholders (Harrington, 2009). Investors and partners will have an important role in this endeavor as they supply the financial backing necessary to implement any and all chosen plans or paths. Next, managers and employees will be on the frontline working with the local healthcare personnel and customers to ensure that the service being provided is the best possible and that malfunctions and other problems are kept to a minimum so as to not compromise patient safety or privacy. They will be in the best position to identify any obstacles or problems early on that occur within the program as they will be in constant contact with the patients and their respective healthcare teams allowing for real-time feedback to occur. Vendors and suppliers may also be a valuable organizational asset as they may provide updated software/hardware, training, and other telecomm services or equipment as it becomes available. They may also be able to offer maintenance services or contracts for their products that may be significantly less costly than hiring full time positions to do the same thing. Having them as stakeholders with somewhat limited input may be beneficial to both organizations as it allows this one to possibly save or reduce some costs and ensures steady business income for them as they provide these services (Harrington, 2009).
- #8 Anticipated results that can be expected from establishing a telehealth/telemonitoring program can be measured in short, medium, and long term time periods (Longest Jr., 2015). In the immediate or short term time frame, an expectation of raising awareness to medical conditions, improving access to healthcare services and a shortened wait time at physician offices may be seen. Medium term outcomes may be seen in the form of improved compliance with medication or treatment plans for those suffering from things such as diabetes for example. Another benefit or outcome may be an expanded patient base as improved access and current wireless or mobile technology will aid in this endeavor. This service may also help to reduce cancellations for patients needing simple monitoring services as they will be able to do it from home. Long term improvements or outcomes would be improved patient health and safety, shorter wait times at the physician office when it is necessary to see one, and reduction of cost for healthcare services overall as quick intervention may prevent costly emergencies.
- #9 Expected community outcomes will come in several different forms. Raising health awareness in the local area will surely be one of those outcomes. Helping people understand their conditions/illnesses and the best way to monitor and/or treat them will improve their over health and safety. A service such as this does not exist in this local area with the exception of those receiving healthcare from the VHA. This will also help to generate more local revenue as jobs will be created and new services will be opened up in the area to support the program. Lastly, this will impact the community through improving communication efforts between patients, physicians and local hospitals that will ultimately improve patient treatment outcomes (Vanderwerf, 2016).
- #10 The establishment of the telehealth program will help to ensure healthcare equity within the system by across the diverse population of the local community by providing the necessary care and services need to all participating. This will be accomplished by providing multi-lingual support to cover all language barriers that may exist within the community. Religious beliefs or non-belief will be observed as well through cultural training and improvement programs. The collection and use of data will also be used to update and improve services that match the diversity of the clients. This will all hinge on building a foundation that supports cultural competence as part of the overall organization (Longest Jr., 2015).
- #11 In order to provide a viable cost-effective and sustainable telehealth program to the local area several different resources will be necessary. The key to this viability and sustainability will be to not attempt to build the program from scratch but to integrate and utilize those valuable resources that are already in place in the community. The basic equipment requirements for the program will be secure software that will be used to access, transmit, and receive patient data and information between the patients, physicians, and facilities. Utilizing software that is compatible with software already in use in the local facilities and physicians’ offices will be the most economical approach. The next requirement will be the hardware or equipment utilized to monitor the vitals and transmit the information. Again this equipment should be compatible with the local resources and allow for expansion of measurements as the physician or healthcare team deems it necessary. The latest hardware comes equipped with the capability to utilize cell phone technology through a central service that would operate within the telehealth office. This will ensure that no internet or even phone connections are required by the client to utilize the equipment (National Telehealth Policy Resource Center, 2016).
- #12 Budget concessions will be necessary as there are very few community funds for healthcare within the city. The current funding is already stretched very far and has utilized many of the state and federal grants available for the existing services. As this area is comprised of a main city population less than 150,000 and several outlying smaller towns, it fits within the government eligibility requirements for the Telehealth Resource Center Grant Program that is offered by the U.S. Department of Health & Human Services (U.S. Department of Health & Human Services, 2016). This grant funding will supplement the funding received by the investors and shareholders establishing the organization. As this service is mostly new to this area, opportunities for new sources of revenue will be created. This will include the addition of many new job positions from staff member to technical personnel. The financial sustainability may be enhanced by seeking further partnership with the Veterans Health Administration in providing local service to their eligible clients for the telehealth program as their closest service center is over 200 miles away. Expense reductions from within the community may be had in the form of service fee reductions from local communications companies.
- #13 When establishing the framework to measure the effectiveness of the program, several metrics will be necessary. There are some key areas that will be monitored within the program. Socioeconomic aspects will look at costs and benefits gained or lost within the program. Next, health domain will provide key data from each health operation within the system that is specific to the patient. Health services data will validate the need to continue, update, or discontinue services that do not benefit the program. Telehealth technologies data showing full capabilities versus bottlenecks or problem areas will be used as well. Environmental settings will also play a part in the measuring of success of the program. These will contain things such as how often local storms or weather will affect connectivity within the network (National Telehealth Policy Resource Center, 2016).
- #14 Tools that will be used to measure the effect of reducing health care disparities will fall in line with that recommended by the Institute of Medicine. The most prominent is the Race/Ethnicity/Language (R/E/L) Data (Robert Wood Johnson Foundation, 2014). This data looks to identify any sub-groups within the local community that may be experiencing health care disparities based on any one of the three aforementioned criteria. This data will also help to identify if the program itself is effective in eliminating any of the existing disparities within the community. This stratified data may also be used to determine the root causes of the identified disparities allow interventions and corrections to be properly installed within the system (Robert Wood Johnson Foundation, 2014). Other tools to be used would be the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program as it utilizes patient surveys to assess their experiences with providers and service agents allowing them to identify strengths and weaknesses and make necessary corrections or adjustments in order to maintain a higher level of quality and patient safety and satisfaction throughout the year (Agency for Healthcare Research and Quality, 2016). The Quality and Safety Review System (QSRS) will use structured collected data to identify and measure any adverse events that occur within the system (Agency for Healthcare Research and Quality, 2016).
- #15 With proper planning, this system should fit seamlessly into the local healthcare community. The expected outcome would be to lower the burden of patient load on the physicians by removing and replacing the simple monitoring tasks with that of the telehealth systems. The program will help to ensure healthcare equity within the system by addressing the needs of the diverse population of the local community and providing the necessary care and services needed to all participating.
- #16 Questions slide
- #17 References Agency for Healthcare Research and Quality. (2016). Quality Measure Tools & Resources. Retrieved from https://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/index.html Data USA. (2016). Taylor County Texas. Retrieved from https://datausa.io/profile/geo/taylor-county-tx/#health Eldercare Workforce Alliance. (2015). Caring for older adults. Retrieved from https://eldercareworkforce.org/files/State_Issue_Briefs_2014/TX_State_Issue_Brief_-_2.14.pdf Harrington, H. J. (2009). The Organization’s Stakeholders: Resource or Obligation? Retrieved from http://www.qualitydigest.com/magazine/2009/may/column/organization-s-stakeholders-resource-or-obligation.html International Organization for Standardization. (2016, March 22). Health informatics --Telehealth services -- Quality planning guidelines. Retrieved from http://www.iso.org/iso/catalogue_detail?csnumber=53052 Longest Jr., B. B. (2015). Health program management: From development through evaluation (2nd ed.). San Francisco, CA: Jossey-Bass.
- #18 References continued National Association for Healthcare Quality. (2016). NAHQ Code of Ethics and Standards of Practice. Retrieved from http://www.nahq.org/Quality-Community/content/codeethicspractice.html National Telehealth Policy Resource Center. (2016). National Telehealth Policy Resource Center. Retrieved from http://www.cchpca.org/national-telehealth-policy-resource-center Robert Wood Johnson Foundation. (2014, April). Using Data to Reduce Disparities and Improve Quality: A Guide for Health Care Organizations. Retrieved from http://www.solvingdisparities.org/sites/default/files/data%20issue%20brief.pdf U.S. Department of Health & Human Services. (2016). Telehealth Resource Center Grant Program. Retrieved from https://www.hrsa.gov/ruralhealth/programopportunities/fundingopportunities/?id=bd201808- a31c-4266- b52e-50278bd612f9 Vanderwerf, M. (2016). 10 Critical Steps for a Successful Telemedicine Program. Retrieved from http://www.amdtelemedicine.com/downloads/10_steps.pdf