Learn how Hahnemann University Hospital reduced readmissions at the Center for Advanced Heart Failure Care by over 20%. This is a follow up to our Fall 2014 webinar with more data and outcomes to reveal. During this discussion, you’ll learn the positive impact a Readmissions Reduction program can have for a hospital including financial, care delivery, and care team collaboration improvements.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
Objectives:
1.Review the changes in Accreditation Canada expectations for implementing MedRec beginning in 2014.
2.Overview of changes to the ROP structure, for Medication Reconciliation ROPs in the leadership and service-based standards.
3.Direct organizations to additional information, resources, and support.
Click the link to read more http://bit.ly/10LqxjQ
This document summarizes a transitional care workgroup meeting held on July 12, 2013. The meeting included introductions and presentations on transitional care evidence and measuring patient-centered outcomes. Participants discussed a vignette about a patient being discharged from the hospital to identify questions patients would have about participating in a new transitional care program. The group's objectives were to understand transitional care broadly and narrow the topic by prioritizing important questions from multiple stakeholder perspectives. Breakout sessions allowed for submitted questions and discussion of proposed research topics. The meeting concluded with recapping next steps and welcoming further input.
PFCC Methodology and Practice: Deliver Ideal Care Experiences and Outcomes…By...EngagingPatients
The document describes the Patient and Family Centered Care (PFCC) methodology used at UPMC, a large integrated health system. The six-step PFCC methodology involves: 1) defining the care experience, 2) forming a guiding council, 3) observing the current state through shadowing, 4) identifying touchpoints through a working group, 5) creating a shared vision for an ideal experience, and 6) implementing improvement projects. The methodology aims to improve outcomes and experiences by engaging patients and families in co-designing care and breaking down silos between care providers. Examples of successful PFCC projects that improved discharge processes and communication through bedside rounding are provided.
Creating a standard of care for patient and family engagementChristine Winters
Nationally-recognized governance expert Beth Daley Ullem addresses the state of patient engagement in heathcare and provides a vision for establishing a minimum standard of care for patient engagement programs.
This document summarizes two presentations from a webinar on approaches to medication reconciliation using technology. The first presentation describes Toronto East General Hospital's implementation of electronic medication reconciliation using their Cerner EHR system. The second presentation describes Whitehorse General Hospital's use of Iatric Software's Patient Discharge Instructions system to conduct medication reconciliation at admission and discharge when an EHR is not available. Both implementations have improved medication reconciliation processes but also face challenges around physician engagement, customization of reports, and integration with other systems.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
Objectives:
1.Review the changes in Accreditation Canada expectations for implementing MedRec beginning in 2014.
2.Overview of changes to the ROP structure, for Medication Reconciliation ROPs in the leadership and service-based standards.
3.Direct organizations to additional information, resources, and support.
Click the link to read more http://bit.ly/10LqxjQ
This document summarizes a transitional care workgroup meeting held on July 12, 2013. The meeting included introductions and presentations on transitional care evidence and measuring patient-centered outcomes. Participants discussed a vignette about a patient being discharged from the hospital to identify questions patients would have about participating in a new transitional care program. The group's objectives were to understand transitional care broadly and narrow the topic by prioritizing important questions from multiple stakeholder perspectives. Breakout sessions allowed for submitted questions and discussion of proposed research topics. The meeting concluded with recapping next steps and welcoming further input.
PFCC Methodology and Practice: Deliver Ideal Care Experiences and Outcomes…By...EngagingPatients
The document describes the Patient and Family Centered Care (PFCC) methodology used at UPMC, a large integrated health system. The six-step PFCC methodology involves: 1) defining the care experience, 2) forming a guiding council, 3) observing the current state through shadowing, 4) identifying touchpoints through a working group, 5) creating a shared vision for an ideal experience, and 6) implementing improvement projects. The methodology aims to improve outcomes and experiences by engaging patients and families in co-designing care and breaking down silos between care providers. Examples of successful PFCC projects that improved discharge processes and communication through bedside rounding are provided.
Creating a standard of care for patient and family engagementChristine Winters
Nationally-recognized governance expert Beth Daley Ullem addresses the state of patient engagement in heathcare and provides a vision for establishing a minimum standard of care for patient engagement programs.
This document summarizes two presentations from a webinar on approaches to medication reconciliation using technology. The first presentation describes Toronto East General Hospital's implementation of electronic medication reconciliation using their Cerner EHR system. The second presentation describes Whitehorse General Hospital's use of Iatric Software's Patient Discharge Instructions system to conduct medication reconciliation at admission and discharge when an EHR is not available. Both implementations have improved medication reconciliation processes but also face challenges around physician engagement, customization of reports, and integration with other systems.
Objective
1.Understand how building a coordinated cross sectoral team impacts the patient experience during transitions.
2.Learn how hospital, case managers, nursing home and pharmacy came together to change the Medication Reconciliation process resulting in reduced polypharmacy and hospital visits due to medication adverse effects.
3.Recognize the impact of BOOMR (BARRIE COORDINATED CROSS SECTORAL MEDICATION RECONCILIATION) on system efficiencies, inter-professional communication and resident, family and staff satisfaction.
4.Learn about a new tool designed for patients to help engage them and their health care providers in a conversation about their medications.
WATCH: http://bit.ly/1Q3MGp8
Purpose of the Call:
By the end of this webinar you will: •Hear about the changes to the MedRec in Home Care GSK
•Hear about the broader home care concepts as it relates to MedRec
•Receive practical tips and insights from the field
Digital engagement of discharged ED patients through asynchronous surveys is important for several reasons:
1) Contacting patients after discharge through digital means rather than phone calls improves patient safety and satisfaction while reducing costs. Automating the process allows clinicians to efficiently address patient wellbeing issues.
2) Surveys that check on patient status and experience provide opportunities to identify care gaps, prevent return visits, and improve care quality over time based on patient feedback.
3) Hospitals are increasingly focused on patient experience metrics that link to value-based reimbursement and consumer loyalty. Digital surveys can enhance hospitals' understanding of the patient perspective in a low-cost, consistent manner.
Over half of patients at a rehabilitation hospital reported wanting greater involvement in their care decisions. To address this, the hospital conducted patient and family shadowing where observers followed patients to experience care from their perspective. This identified themes like explanations during rounds and involvement in discharge plans. A post-intervention survey found a statistically significant improvement in patients feeling involved in care decisions and clinically relevant improvements in understanding doctor explanations and recommending the hospital. Engaging medical leaders and balancing data with reflection time led doctors to change practices without formal rules.
The Beryl Institute 2013 State of the Patient Experience Benchmarking StudyEngagingPatients
This document summarizes the key findings of a survey of over 1,000 US hospitals regarding their efforts to improve the patient experience. It finds that while patient experience remains a top priority, hospitals feel somewhat less positive about their progress than two years ago. Most hospitals now have a formal definition and structure for patient experience. Leadership support and HCAHPS scores are the top factors driving patient experience work. Hospitals continue focusing on communication, noise reduction, and discharge processes to improve patient experience.
Objectives:
By the end of this call, you will be able to:
•Describe the processes of Root-Cause Analysis (RCA) and Multi-Incident Analysis (MIA) and their role in quality improvement
•Compare and contrast the different approaches to collecting hospital-acquired VTE data
•Identify an approach suitable for improving patient safety at your institution
Purpose of the Call:
Horizon, Moncton, NB will:
1.Demonstrate the timeline for the development of a provincial bilingual medication reconciliation form and process
2.Identify how technology provided an avenue for a multi-site team collaboration
3.Distinguish the key elements in a provincial bilingual medication reconciliation form
Saskatoon Health Region Home Care, SK will:
1.Share how they developed a nurse driven, paper-based MedRec program to support home care clients in medication management.
2.Outline their current MedRec process
3.Showcase their current Med Rec/BPMH form and data collection form for the audit process.
Watch the recording here: http://bit.ly/1fOTJwt
•Understand the Accreditation Canada requirements for medication reconciliation at discharge
•Learn from the experience of patients and receiving healthcare providers
•Gain insight into practical strategies for communicating accurate medication information at discharge
READ MORE: http://bit.ly/1ja1gxY
This document summarizes a webinar for selecting topics for a national ICU collaborative initiative in 2016-17. It discusses the results of a survey where pain, agitation, and delirium (PAD) and end-of-life care were the top choices. Potential Topic 1 provides an overview of how end-of-life care could be improved across the ICU continuum. Potential Topic 2 reviews evidence that consistent pain assessment and management paired with sedation protocols can reduce length of stay and complications. The webinar participants then decided to focus on improving PAD management in 2016-17.
Access the webinar here:
http://bit.ly/1eio3ka
Purpose of the Call:
1.Discuss the results of the pan-Canadian survey of existing practices with respect to the use of technology to support Medication Reconciliation (MedRec)
2.Describe the steps and considerations for transitioning to electronic MedRec (eMedRec)
3.Identify factors that support and impede successful migration of paper MedRec to eMedRec.
4.Discuss the lessons learned from research and other organizations.
5.Introduce the toolkit to support healthcare providers in making a safe and effective transition from paper MedRec to eMedRec.
This resource summarizes the eight recommendations outlined in the Institute of Medicine's a new consensus study entitled, Improving Diagnosis in Health Care. The recommendations are aimed at making diagnoses more accurate, reliable, efficient, and safe. This work is a continuation of the IOM’s Quality Chasm series.
PCMH implementation, highly associated with important outcomes for both patients and providers. The rate of emergency department visits was significantly
lower in sites with more PCMH effective implementation. Efficient PCMH implementation favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services.
The document discusses expanding the role of registered nurses (RNs) in primary care settings. It describes how RNs can take on responsibilities like complex care management, active schedule management, using data to monitor patient outcomes, and conducting co-visits with providers to increase access to care. Co-visits allow RNs to address minor issues while providers briefly review cases. The approach has led to improved access and patient satisfaction at Community Health Center, Inc.
Purpose of the Call:
Women's College Hospital is an academic ambulatory hospital. The speaker will share their hospital’s journey as they sought to implement best practices for medication reconciliation from other settings customized for the ambulatory environment.
Read more and watch the webinar recording: http://bit.ly/1sxHIUP
The AHSN has supported health and care partners in responding to the COVID-19 pandemic in several ways:
1) It established a knowledge-sharing group to facilitate discussion on PPE reprocessing between trusts facing shortages. This supported the rapid development and testing of a validated PPE reprocessing method.
2) It helped expedite the regulatory approval process for a new personal respirator, working with partners to achieve BSI certification within 12 weeks. This will improve PPE availability.
3) It is capturing examples of innovations and changes implemented during the crisis to understand improvements that could be maintained, such as increased telemedicine and digital technologies in care homes. The goal is to inform recovery planning and establish a more
Patient engagement is evolving to include a composite of practices that impact patient behaviors and health. Contemporary models of patient engagement include the HIMSS 5 phases of patient engagement and the Regional Primary Care Coalition's 6 dimensions of patient engagement. Meaningful Use Phase 3 identifies key priorities around patient access to health records and secure messaging. Barriers to patient engagement include defining engagement and integrating diverse engagement tools and technologies.
The slides cover the AHSN's response to the Covid-19 pandemic, and provides a review of 2019-20.
There are also case studies where AHSN staff returned to the frontline NHS, to support our colleagues with the response to Covid-19. All documents can be viewed or downloaded below.
Bill Gillespie, Chief Executive of Wessex AHSN, said: "Thanks to the trusted relationships we have built with regional and national partners over the past eight years, we have been in a strong position to provide a solid, adaptive response to the crisis.
"Along the way, we have discovered that staff at every level of our partner organisations have enormous depths of creativity and commitment; and that the public are more willing than we ever imagined to welcome technology and innovation into their care.
"Our own AHSN staff have also shown a huge willingness to take on new roles, to work almost entirely virtually; and, for some, to step back into frontline roles or play a part in key national Covid projects. We’d like to thank them for their amazing commitment over the past few months."
An integrated urgent response hub aims to reduce pressure on emergency departments and improve access to urgent care. Key issues include workforce shortages and a lack of coordination between services. The document outlines steps to develop a hub, including defining local needs, engaging stakeholders, setting up a strategy group, and creating governance structures. Measurement of the hub's performance on access, clinical effectiveness, and patient experience will be important. The goal is to provide additional urgent capacity at the primary care level through new integrated multidisciplinary teams.
Bookends of the Patient Experience: Improvement Strategies from Admission to ...TraceByTWSG
In this webinar, Yvonne Chase of Mayo Clinic shares strategies to improve patient experience across the continuum of care - from pre-service to post-servcie activities. This presentation shares tools and processes used to streamline patient access, coordinate patient care and conduct patient follow-up post discharge - all while monitoring patient interactions to ensure clear and accurate communication from the first point of contact to the last.
Purpose of the call:
To learn about:
•successful strategies and approaches to engage patients and caregivers in MedRec,
•how teams effectively dialogue with patients and their caregivers on the benefits of having an accurate medication list, and
•the development of paper and electronic tools and resources created for patients and their caregivers to create and maintain their medication lists.
Watch the webinar http://bit.ly/1fnE61V
Power Point Developed to Help Agriculture Operations to Understand Where the Market is Today, Where it Will be Tomorrow. The Importance of Sanitation and How Cleaning Can Stop the Spread of Many Different Greenhouse Bacteria, Fungi and Virus.
Santa Fe Indonesia E-Newsletter Vol.2 - 2016Adita Bella
The document discusses Ramadan, the Muslim holy month of fasting, and provides information and etiquette tips for non-Muslims interacting with Muslims during this time. Some key points include:
- Ramadan involves fasting from dawn to dusk for 30 days and is a time for spiritual reflection.
- Expatriates may see household staff take time off to visit family and restaurants see more business.
- Non-Muslims can still eat in front of fasting Muslims but should be understanding if they decline invitations to work lunches.
- Joining the post-fast meal (iftar) is encouraged to experience the communal celebration.
- Simple greetings like "Ramadan Mubarak" are
Objective
1.Understand how building a coordinated cross sectoral team impacts the patient experience during transitions.
2.Learn how hospital, case managers, nursing home and pharmacy came together to change the Medication Reconciliation process resulting in reduced polypharmacy and hospital visits due to medication adverse effects.
3.Recognize the impact of BOOMR (BARRIE COORDINATED CROSS SECTORAL MEDICATION RECONCILIATION) on system efficiencies, inter-professional communication and resident, family and staff satisfaction.
4.Learn about a new tool designed for patients to help engage them and their health care providers in a conversation about their medications.
WATCH: http://bit.ly/1Q3MGp8
Purpose of the Call:
By the end of this webinar you will: •Hear about the changes to the MedRec in Home Care GSK
•Hear about the broader home care concepts as it relates to MedRec
•Receive practical tips and insights from the field
Digital engagement of discharged ED patients through asynchronous surveys is important for several reasons:
1) Contacting patients after discharge through digital means rather than phone calls improves patient safety and satisfaction while reducing costs. Automating the process allows clinicians to efficiently address patient wellbeing issues.
2) Surveys that check on patient status and experience provide opportunities to identify care gaps, prevent return visits, and improve care quality over time based on patient feedback.
3) Hospitals are increasingly focused on patient experience metrics that link to value-based reimbursement and consumer loyalty. Digital surveys can enhance hospitals' understanding of the patient perspective in a low-cost, consistent manner.
Over half of patients at a rehabilitation hospital reported wanting greater involvement in their care decisions. To address this, the hospital conducted patient and family shadowing where observers followed patients to experience care from their perspective. This identified themes like explanations during rounds and involvement in discharge plans. A post-intervention survey found a statistically significant improvement in patients feeling involved in care decisions and clinically relevant improvements in understanding doctor explanations and recommending the hospital. Engaging medical leaders and balancing data with reflection time led doctors to change practices without formal rules.
The Beryl Institute 2013 State of the Patient Experience Benchmarking StudyEngagingPatients
This document summarizes the key findings of a survey of over 1,000 US hospitals regarding their efforts to improve the patient experience. It finds that while patient experience remains a top priority, hospitals feel somewhat less positive about their progress than two years ago. Most hospitals now have a formal definition and structure for patient experience. Leadership support and HCAHPS scores are the top factors driving patient experience work. Hospitals continue focusing on communication, noise reduction, and discharge processes to improve patient experience.
Objectives:
By the end of this call, you will be able to:
•Describe the processes of Root-Cause Analysis (RCA) and Multi-Incident Analysis (MIA) and their role in quality improvement
•Compare and contrast the different approaches to collecting hospital-acquired VTE data
•Identify an approach suitable for improving patient safety at your institution
Purpose of the Call:
Horizon, Moncton, NB will:
1.Demonstrate the timeline for the development of a provincial bilingual medication reconciliation form and process
2.Identify how technology provided an avenue for a multi-site team collaboration
3.Distinguish the key elements in a provincial bilingual medication reconciliation form
Saskatoon Health Region Home Care, SK will:
1.Share how they developed a nurse driven, paper-based MedRec program to support home care clients in medication management.
2.Outline their current MedRec process
3.Showcase their current Med Rec/BPMH form and data collection form for the audit process.
Watch the recording here: http://bit.ly/1fOTJwt
•Understand the Accreditation Canada requirements for medication reconciliation at discharge
•Learn from the experience of patients and receiving healthcare providers
•Gain insight into practical strategies for communicating accurate medication information at discharge
READ MORE: http://bit.ly/1ja1gxY
This document summarizes a webinar for selecting topics for a national ICU collaborative initiative in 2016-17. It discusses the results of a survey where pain, agitation, and delirium (PAD) and end-of-life care were the top choices. Potential Topic 1 provides an overview of how end-of-life care could be improved across the ICU continuum. Potential Topic 2 reviews evidence that consistent pain assessment and management paired with sedation protocols can reduce length of stay and complications. The webinar participants then decided to focus on improving PAD management in 2016-17.
Access the webinar here:
http://bit.ly/1eio3ka
Purpose of the Call:
1.Discuss the results of the pan-Canadian survey of existing practices with respect to the use of technology to support Medication Reconciliation (MedRec)
2.Describe the steps and considerations for transitioning to electronic MedRec (eMedRec)
3.Identify factors that support and impede successful migration of paper MedRec to eMedRec.
4.Discuss the lessons learned from research and other organizations.
5.Introduce the toolkit to support healthcare providers in making a safe and effective transition from paper MedRec to eMedRec.
This resource summarizes the eight recommendations outlined in the Institute of Medicine's a new consensus study entitled, Improving Diagnosis in Health Care. The recommendations are aimed at making diagnoses more accurate, reliable, efficient, and safe. This work is a continuation of the IOM’s Quality Chasm series.
PCMH implementation, highly associated with important outcomes for both patients and providers. The rate of emergency department visits was significantly
lower in sites with more PCMH effective implementation. Efficient PCMH implementation favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services.
The document discusses expanding the role of registered nurses (RNs) in primary care settings. It describes how RNs can take on responsibilities like complex care management, active schedule management, using data to monitor patient outcomes, and conducting co-visits with providers to increase access to care. Co-visits allow RNs to address minor issues while providers briefly review cases. The approach has led to improved access and patient satisfaction at Community Health Center, Inc.
Purpose of the Call:
Women's College Hospital is an academic ambulatory hospital. The speaker will share their hospital’s journey as they sought to implement best practices for medication reconciliation from other settings customized for the ambulatory environment.
Read more and watch the webinar recording: http://bit.ly/1sxHIUP
The AHSN has supported health and care partners in responding to the COVID-19 pandemic in several ways:
1) It established a knowledge-sharing group to facilitate discussion on PPE reprocessing between trusts facing shortages. This supported the rapid development and testing of a validated PPE reprocessing method.
2) It helped expedite the regulatory approval process for a new personal respirator, working with partners to achieve BSI certification within 12 weeks. This will improve PPE availability.
3) It is capturing examples of innovations and changes implemented during the crisis to understand improvements that could be maintained, such as increased telemedicine and digital technologies in care homes. The goal is to inform recovery planning and establish a more
Patient engagement is evolving to include a composite of practices that impact patient behaviors and health. Contemporary models of patient engagement include the HIMSS 5 phases of patient engagement and the Regional Primary Care Coalition's 6 dimensions of patient engagement. Meaningful Use Phase 3 identifies key priorities around patient access to health records and secure messaging. Barriers to patient engagement include defining engagement and integrating diverse engagement tools and technologies.
The slides cover the AHSN's response to the Covid-19 pandemic, and provides a review of 2019-20.
There are also case studies where AHSN staff returned to the frontline NHS, to support our colleagues with the response to Covid-19. All documents can be viewed or downloaded below.
Bill Gillespie, Chief Executive of Wessex AHSN, said: "Thanks to the trusted relationships we have built with regional and national partners over the past eight years, we have been in a strong position to provide a solid, adaptive response to the crisis.
"Along the way, we have discovered that staff at every level of our partner organisations have enormous depths of creativity and commitment; and that the public are more willing than we ever imagined to welcome technology and innovation into their care.
"Our own AHSN staff have also shown a huge willingness to take on new roles, to work almost entirely virtually; and, for some, to step back into frontline roles or play a part in key national Covid projects. We’d like to thank them for their amazing commitment over the past few months."
An integrated urgent response hub aims to reduce pressure on emergency departments and improve access to urgent care. Key issues include workforce shortages and a lack of coordination between services. The document outlines steps to develop a hub, including defining local needs, engaging stakeholders, setting up a strategy group, and creating governance structures. Measurement of the hub's performance on access, clinical effectiveness, and patient experience will be important. The goal is to provide additional urgent capacity at the primary care level through new integrated multidisciplinary teams.
Bookends of the Patient Experience: Improvement Strategies from Admission to ...TraceByTWSG
In this webinar, Yvonne Chase of Mayo Clinic shares strategies to improve patient experience across the continuum of care - from pre-service to post-servcie activities. This presentation shares tools and processes used to streamline patient access, coordinate patient care and conduct patient follow-up post discharge - all while monitoring patient interactions to ensure clear and accurate communication from the first point of contact to the last.
Purpose of the call:
To learn about:
•successful strategies and approaches to engage patients and caregivers in MedRec,
•how teams effectively dialogue with patients and their caregivers on the benefits of having an accurate medication list, and
•the development of paper and electronic tools and resources created for patients and their caregivers to create and maintain their medication lists.
Watch the webinar http://bit.ly/1fnE61V
Power Point Developed to Help Agriculture Operations to Understand Where the Market is Today, Where it Will be Tomorrow. The Importance of Sanitation and How Cleaning Can Stop the Spread of Many Different Greenhouse Bacteria, Fungi and Virus.
Santa Fe Indonesia E-Newsletter Vol.2 - 2016Adita Bella
The document discusses Ramadan, the Muslim holy month of fasting, and provides information and etiquette tips for non-Muslims interacting with Muslims during this time. Some key points include:
- Ramadan involves fasting from dawn to dusk for 30 days and is a time for spiritual reflection.
- Expatriates may see household staff take time off to visit family and restaurants see more business.
- Non-Muslims can still eat in front of fasting Muslims but should be understanding if they decline invitations to work lunches.
- Joining the post-fast meal (iftar) is encouraged to experience the communal celebration.
- Simple greetings like "Ramadan Mubarak" are
1) El documento presenta varias ecuaciones que describen la dinámica de un sistema de masas conectadas por resortes.
2) Se proporcionan ecuaciones para calcular la fuerza, aceleración y velocidad de cada masa en función de sus masas y la constante del resorte.
3) El documento analiza el comportamiento del sistema para diferentes configuraciones de masas y constantes del resorte.
Current-day programming languages include constructs to embed meta-data in a program’s source code in the form of annotations. More than mere documentation, these annotations are used in modern frameworks to map source- level entities to domain-specific ones. A common example being the Hibernate Object-Relational Mapping framework that relies on annotations to declare persistence configurations. While the presence of annotations extends the base semantics of the language, it also imposes restrictions on the annotated program. In this paper we consider the manner in which annotations affect automated refactorings, and in particular how they break their behavior preservation. As refactorings, during their condition checking phase, ignore the annotation’s restrictions they can no longer guarantee the preservation of the domain-specific mappings. To address this problem, we propose to make the restrictions of the annotations explicit, and use them to steer the refactoring process. A prototype extension of the Eclipse IDE’s refactoring engine is used to demonstrate our approach.
Robotic renal transplantation first european case boggiMerqurio
This case report describes the first robotic kidney transplantation performed in Europe using the daVinci surgical system. A kidney from a 56-year-old mother was transplanted into her 37-year-old daughter laparoscopically. The surgery lasted 154 minutes, including 51 minutes of warm ischemia for the kidney graft. Urine production started immediately after reperfusion and renal function remained optimal at the 3-month follow-up. The robotic system allowed the performance of the kidney transplantation through small incisions and provided 3D visualization and wristed instruments, facilitating the vascular anastomoses. Further experience is needed but robotic surgery may become more common for solid organ transplants.
Este documento proporciona información biográfica y profesional sobre varios cantantes populares como Rihanna, Maroon 5, Lady Gaga y Katy Perry. Resume sus carreras musicales, logros, álbumes destacados y éxitos.
This document provides notes for a 92-part lecture series on the life of Jacob from Genesis. It includes:
- An overview of the heptamerous (seven-part) structure of Genesis, with the Jacob narrative corresponding to the sixth day of creation.
- A table of contents listing the titles of each of the 92 lectures.
- Excerpts from some of the lectures discussing themes in specific chapters of Genesis related to Jacob's life, such as his blessing, marriage to Rachel and Leah, wrestling with God, and reuniting with Esau.
The document analyzes the symbolic significance of the Jacob narrative in the broader context of Genesis and argues it depicts Jacob as a true
Este documento proporciona instrucciones para crear una fotocaricatura animada en Etoys en 8 pasos: 1) obtener una foto, 2) crear un proyecto en Etoys, 3) seleccionar partes de la foto, 4) dibujar objetos, 5) colocar imágenes en un contenedor, 6) animar los objetos, 7) colapsar el contenedor y colocar imágenes sobre la foto, y 8) reproducir la animación. El objetivo es crear una caricatura animada de una foto usando varias herram
Georgia Common Core Coach CCGPS Edition, English Language Arts, Grade 2TriumphLearningNY
Scaffolded Common Core content for your early learners.
Teacher-led instruction and guided practice—all heavily scaffolded—ensure that students can capably engage with complex text, on grade level. Careful modeling and repeat reading lead to fluency. Phonics, word-building, connecting short vowels to consonants to read words—all foundational skills have been carefully considered and kick off each reading lesson.
BONUS! Our Home-School Connection booklet provides a crucial bridge between content covered in the classroom and practice at home—and encourages important family involvement. (One FREE Home-School Connection booklet for each Common Core Coach ™ student book!)
O documento resume as seguintes informações:
1) A cidade de Oriente realizará um passeio ciclístico no dia 30 de novembro como parte das comemorações do aniversário da cidade, com o objetivo de incentivar atividades físicas e a preservação ambiental.
2) A prefeitura de Pompeia está organizando eventos e decoração para o Natal, incluindo enfeites nas praças públicas.
3) Haverá um sarau musical sobre a cultura africana no dia 22 de novembro em Pompe
Proyecto de investigación visual. Tornello YaninaYanina Tornello
Este documento presenta el proyecto final de Yanina Tornello para el Instituto de Formación Docente Continua sobre el tema de la "Infancia Consumida". El proyecto aborda la problemática de la trata de personas con fines de explotación sexual, que interrumpe la infancia de las víctimas. A través de una producción visual y una campaña de concientización, el proyecto busca generar reflexión y prevención sobre este tema.
This document summarizes Dorota Shortell's presentation on smart goods technologies. It discusses Simplexity, an engineering company working on smart products. It presents two case studies: the Microsoft Band smartwatch and Bowflex dumbbells that track workout data. For each, it describes the product, technical challenges overcome like size and durability, and needs in further technology like more powerful sensors and position tracking. It concludes that future smart products will need to affect the physical world through integrated manipulators and feedback sensors while addressing challenges like energy efficiency and security.
This document discusses customer relationship management (CRM) and whether it is right for companies. It defines key terms like customer, loyalty, and discusses how the digital marketplace has impacted operational excellence, product leadership, and customer intimacy. Specifically, it notes that access to more information online has led to easier product comparisons and commoditization, while a lack of human interaction online makes developing customer loyalty and intimacy more difficult. However, using customer data and technology to better understand and respond to customer needs can still help improve loyalty.
Este documento describe los ninjas tal como aparecen en la obra Naruto. Explica que un ninja puede usar su chakra, una energía interna, para realizar ataques y técnicas. Describe los diferentes tipos de entrenamiento de chakra que realizan los ninjas para aprender a moldear y controlar su chakra, así como los diferentes tipos y usos del chakra.
This document summarizes hepatitis E surveillance data from Germany. It notes that hepatitis E is a notifiable disease and laboratories report cases to local health departments. There has been a steep increase in autochthonous (locally acquired) cases since 2001. Genotype 3 strains are most common in Germany. A population-based study found an overall prevalence of hepatitis E antibodies of 16.8%, indicating around 320,000 infections per year. Risk factors identified include contact with pigs and pork products, as there is a high rate of hepatitis E virus detection in pigs and pork products in Germany. Improved prevention in the veterinary sector could help reduce infection rates.
El documento describe la estructura y composición de la atmósfera terrestre. Explica que la atmósfera está compuesta principalmente de nitrógeno (78%) y oxígeno (21%), y describe brevemente las cuatro capas (troposfera, estratosfera, mesosfera y termósfera) que la componen. También resume los principales componentes del aire como el dióxido de carbono y la humedad relativa.
Este documento describe un proyecto escolar sobre el acoso escolar que utilizó películas para crear conciencia sobre el tema. El proyecto involucró a profesores, estudiantes y familias a través de cuestionarios, visionado de películas, guías didácticas y cineforos. El objetivo era prevenir el acoso escolar trabajando el tema en todos los niveles educativos y evaluar el impacto del proyecto para mejorarlo en el futuro.
Reflexión en torno a los cambios producidos en nuestra sociedad a lo largo de los últimos años, y cómo estos cambios afectan a la gestión del conocimiento actual.
Roadmap to the Patient-Centered Medical HomePYA, P.C.
This document provides an overview of the patient-centered medical home (PCMH) model and how to implement it. It defines PCMH and its core standards and requirements for certification. It outlines the benefits of PCMH including improved quality, lower costs, and increased patient satisfaction. It discusses financial and operational considerations for practices transitioning to PCMH, and provides guidance on implementing specific PCMH functions like quality improvement, access to care, transitional care management, referral tracking, pre-visit planning, and population health management. The presentation aims to provide medical practices a roadmap to achieving PCMH recognition and reaping its benefits.
Anne Bracken Univ of South AL - aco rural healthSamantha Haas
1) Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other care providers who come together voluntarily to give coordinated high quality care to their patients.
2) ACOs aim to improve care and lower costs through improved care coordination and preventative care. They are paid for keeping their patients healthy instead of paying for each test and procedure.
3) For ACOs to be successful, providers need organizational capabilities like managing risk, using electronic health records, tracking performance measures, and engaging patients in self-care.
Avident Health created by doctors to allow better teamwork in healthcare and to engage and educate patients. More teamwork leads to value: Better quality at lower cost.
Chronic Care Management (CCM): Understand how to capture incremental revenueDiagnotes, Inc.
By now you’ve likely heard that qualifying physicians can receive approximately $42/patient/month from CMS for non-face-to-face care management of patients with two or more chronic conditions. And, in many cases, with the right tracking and reporting, you may be able to capture this revenue for work your team is already doing. In just 30 minutes, you will understand the chronic care management program requirements and see how easy it is to capture and report qualifying activities.
This document discusses the patient-centered medical home (PCMH) model and its benefits. It provides examples of how the PCMH approach coordinates care through a team-based approach focused on managing patient populations, uses data to drive decisions and improve outcomes, and shifts care away from episodic visits to proactive health management. Studies show the PCMH approach can reduce costs through lower utilization of emergency rooms, hospitals, and specialty care while improving quality of care and patient outcomes.
This document discusses digital health and its implications for pharmacy. It defines digital health as the integration of technologies into healthcare to prevent, diagnose, treat and manage diseases as well as encourage wellness. It provides examples of different types of digital health including patient-centered mobile apps, disease-centered remote monitoring devices, and drug-centered sensors. The document discusses how digital health is improving healthcare quality and access while benefiting various stakeholders. However, it notes barriers to adoption include a lack of physician and consumer knowledge. Overall it argues digital health is vital to the future of healthcare.
Amplifying the High-Touch of Specialty Pharmacy through Mobile and Web-Based ...Avella Specialty Pharmacy
Amplifying the High-Touch of Specialty Pharmacy through Mobile and Web-Based Tools. Learn more about medication adherence and mobile health tools from Avella Specialty Pharmacy: http://www.avella.com/medication-adherence
Using Patient Registries and Automated Patient Outreach to Qualify for NCQA L...Phytel
The document discusses using patient registries and automated patient outreach to help medical practices qualify for level 3 recognition as a patient-centered medical home according to NCQA standards. It describes how the Phytel system can mine practice data to identify patients for recommended care, contact patients via automated outreach scripts, and generate reports on quality measures and financial results to document improved performance. Using these tools helped one practice profiled achieve the highest level of NCQA medical home qualification.
This document discusses how a community paramedic program supports the goals of accountable care organizations (ACOs) in achieving the "Triple Aim" of improving patient care, improving population health, and reducing costs. It provides examples of how community paramedics can coordinate care between primary care, hospitals, and other partners to reduce emergency department visits and hospital readmissions. The document also outlines various payment models that reimburse for services like care coordination that community paramedic programs provide.
This document summarizes discussions from a series of panel discussions on the future of post-acute healthcare. Key concerns discussed include the need for better coordination and pathways between acute and post-acute care to reduce hospital readmissions, ensuring clinical staff in skilled nursing facilities have sufficient skills and training, understanding new models like Accountable Care Organizations, managing increased utilization of managed care plans with lower reimbursement rates, and navigating changes to state Medicaid systems. Potential solutions focus on developing partnerships across settings, sharing clinical information, participating in advocacy, and using technology and analytics to improve coordination and decision making.
This document discusses hospital readmission rates. It provides background information on hospital readmissions, noting that readmissions result in longer hospital stays and more healthcare resource use. The document then presents three PICOT questions related to reducing hospital readmission rates in elderly patients through various interventions like virtual follow-up, physical follow-up, and effective communication systems. Finally, it provides references in APA style.
More than half of hospitals faced penalties for excess readmissions under the Hospital Readmission Reduction Program. The average penalty increased from 0.61% last year to 0.73% of Medicare payments this year, and the percentage of penalized hospitals rose from 66% to 78%. Transitional care programs aim to reduce readmissions by improving communication between providers, educating patients on medication and care plans, and ensuring follow-up visits occur. Measures of success include rates of readmission, follow-up visits, and patient understanding of their care.
Healthcare Payers are increasingly looking for advanced solutions to lower overall healthcare cost and provide a better patient experience. A payer that puts the customer at the center requires seamless integration across communication channels and functions, and a holistic view of the enterprise.
Patient Engagement is growing in importance as consumer expectations of healthcare providers change and as portals and other technologies improve. Early studies show affects on outcomes for patient engagement technologies
This document provides information about Paul Grundy, the director of healthcare transformation at IBM and president of the Patient Centered Primary Care Collaborative. It discusses his background and accomplishments in leading the patient-centered medical home model. It also summarizes evidence that implementing medical home interventions can reduce costs and improve outcomes by decreasing hospital days, ER visits, and costs while increasing medication adherence. Specific examples from studies in Pennsylvania, Michigan, and New York are highlighted that show reductions in costs and utilization from medical home programs.
DCS provides communications, marketing, events, and outreach services for healthcare delivery organizations, government, non-profit, and other health-related entities working to engage and educate the workforce, patients, and communities of care. Visit thinkdcs.com
Integrating Care Transitions Strategies Through Enterprise Process, People, a...Think DCS
The document discusses strategies for integrating care transition processes, people, and technology to reduce hospital readmissions. It provides objectives on developing readmissions reduction programs across service lines and implementing dashboards to track outcomes. The root causes of ineffective care transitions are identified as accountability, communication, and patient education breakdowns. Strategies are presented to address these causes through optimizing processes, engaging stakeholders, and utilizing technology. Metrics for evaluating financial and clinical impacts are also outlined.
At the mHealth Summit 2013, Thompson Boyd, Physician Liaison of Hahnemann University Hospital, introduced PatientReminder– a care coordination initiative created with Digital Collaboration Solutions (DCS).
Mass HIway Implementation Grants Presentation - March 2013Think DCS
This document provides an overview and summary of information for applicants to the Massachusetts eHealth Institute's (MeHI) HIway Implementation Grant program. It discusses MeHI and the Massachusetts Health Information Highway (Mass HIway), the goals of the grant program, requirements for applications, evaluation criteria, and the application process. The overall goal of the grants is to demonstrate measurable improvements in care quality, population health, and cost containment through use of health information exchange on the Mass HIway.
The document discusses a presentation given by The HIT Community on workflow reengineering for electronic health record (EHR) implementations. It provides an overview of workflow reengineering and healthcare processes impacted by EHRs. It also gives an example of reengineering the diagnostic test ordering workflow, identifying the original process, data, roles, EHR functions, and benefits of changes. The presentation aims to provide guidance on conducting workflow analyses and redesigns to improve EHR implementation success.
The document discusses budgeting for electronic health record (EHR) implementation and ongoing support. It provides information on sources of funds such as government incentives and increased reimbursements. It also discusses uses of funds including direct costs of implementation and indirect costs like staff training. The document emphasizes that accurately accounting for costs and benefits is critical to the budgeting process and long term sustainability of EHR systems. It provides examples of cost-benefit analyses and case studies of organizations that have implemented EHRs.
The document discusses meaningful use attestation and the process for receiving EHR incentive payments from the government. It outlines the three main steps: 1) registration in the EHR incentive program, 2) meeting meaningful use criteria using certified EHR technology, and 3) attesting that meaningful use criteria have been met. The document provides an overview of meaningful use goals and stages, EHR certification, eligibility for incentives, and the registration process.
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
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Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
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Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
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How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
2. Reducing Readmissions to Improve Revenue, Care and Collaboration
2
Learning Objectives
Demonstrate the positive impact reducing 30-day readmissions from
enhanced patient engagement through mobile/email appointment reminders
to a patient and their care team such as a family member.
Describe lessons learned introducing a new technology on existing
processes, existing roles and existing technologies
Illustrate other uses and opportunities for this new channel of multi-way
communications as a means to engage patients and other important
members of their care team.
State how a new technology can be integrated into clinical workflows to
achieve significant improvement in an important quality and financial metric
related to a CMS initiative.
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
3. • Magnet® designation by the American Nurses
Credentialing Center (ANCC) Magnet Recognition
Program®.
• Recognized by the American Heart Association as a
leader in stroke and heart failure treatments.
• Named top 50 Best Hospital 2014-2015 U.S. News
and World Reports
• Affiliate of Drexel University College of Medicine
• Hahnemann University Hospital is part
of Tenet Pennsylvania, which also
includes St. Christopher’s Hospital
for Children.
• To learn more about Hahnemann, visit
www.hahnemannhospital.com
Hahnemann University
Hospital is a 496-bed
academic medical center at
Broad and Vine Streets in
Philadelphia, Pennsylvania.
The hospital is a tertiary care
institution that specializes in
cardiac services, heart
failure, OB/GYN, orthopedics,
medical, surgical and
radiation oncology, bone
marrow transplantation, renal
dialysis and
kidney/pancreas/liver
transplantation.
3
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
5. PatientReminder™
VULNERABLE
PERIOD
In Hospital Physician’s OfficeAt Home
APPOINTMENT
MADE
DISCHARGE
DAY
APPOINTMENT
DAY
DISCHARGE TO
APPOINTMENT DAY
PROBLEM
CMS Readmission Penalty based on readmissions for five conditions:
• Heart Failure
• Acute MI
• Pneumonia
• COPD
• Knee and Hip Replacement
• CABG expected FY2016
Medication Duplication • Missing Medications (Co Pays/Deductibles • Needs Samples) • Medication Titration
Dietary Compliance • New Social/Economic Issues • Specialty Appointments/Referrals
Issues that can be addressed during a follow-up appointment
5
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
6. VULNERABLE
PERIOD
In Hospital Physician’s OfficeAt Home
Text/Phone/email • Language of Choice • Device of Choice • Patient/Family/Friends/PCP/Visiting Nurse, etc.
Mobile • Tablets • PC • Home Phone • Fax
APPOINTMENT
MADE
DISCHARGE
DAY
APPOINTMENT
DAY
DISCHARGE TO
APPOINTMENT DAY
APPOINTMENT ADHERENCE
Patients & Families reminded about follow-up appointment
PATIENTS & FAMILY
ENROLLED
FOLLOW-UP
APPOINTMENT
APPOINTMENT
DAY
PATIENTS & FAMILY
MESSAGED
FAMILYpatient
Program proactively messages patient and caregivers
Remember to bring your:
• Medications (bottles) and supplements
• Discharge Papers
• Referral
6
PatientReminder™
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
7. Pilot at a Glance
• 368 Heart Failure (HF) patients across 784 discharges
• Enrolled Center for Advanced Heart Failure Care inpatients, sending
text/phone/email appointment reminders for post discharge appointments
• Tracked appointment adherence and readmissions for patients who were
messaged and for those who were not.
• Initial Study Period – 10 Months*
– November 2013 through September 2014
• Baseline readmission rate – 26.7%
– 10 month rate preceding the study
• Deployed Cloud based HIPPA compliant platform to manage messaging
across devices and roles.
* Pilot was extended from an initial 6 month pilot
7
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
8. Participants by Zip Code
8
Philadelphia, PA
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
9. Participants by Income and Zip Code
9
Pennsylvania
Philadelphia, PA
New Jersey
Delaware
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
10. Program Enrollment by Median Income
10
0 20 40 60 80 100 120 140
Less than $32,984
$32,985 to $47,727
$47,728 to $67,106
$67,108 to $99,321
$99,322 to $200,001
Number Enrolled
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
11. MANAGE
APPOINTMENT
ADHERENCE
& REDUCE
READMISSIONS
DEVICES & LANGUAGE OF CHOICE
CARE
TEAM
FAMILY &
FRIENDS
patient
DASHBOARD & PATIENT APPOINTMENT TRACKING
HOSPITAL DISCHARGE TEAM
PatientReminder™ SOLUTION
11
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
12. Patient, family members
& care team
Text Message, Voicemail
& Email
Mobile enabled
Bi-directional - confirm
or contact to reschedule
Manage Patient
Appointment
Adherence
Easy to Deploy
Technology
Automated
Appointment
Reminder
Integrated into discharge
process
Real-time reporting &
management dashboard
Individual patient level
tracking
Identify highest
readmission risks
HIPAA Compliant
Cloud-Based – cost effective,
simple to deploy and maintain
Scalable - # of patients,
conditions and clinical sites
Stand-alone or integrated with
other healthcare information
systems
PatientReminder™ FEATURES
12
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
13. 13
Patient Phone Call
“Hello,
This is an appointment reminder from
Hahnemann Hospital.
If you have already confirmed this appointment,
please consider this a courtesy reminder only.
The Center for Advanced Heart Failure Care at
Hahnemann Hospital says you have an
appointment on 10/9/2013 3:38 PM.
We are on the 7th floor of the Hospital at Broad
and Vine in Center City.
Remember to bring your:
• Medications (bottles) and supplements
• Discharge papers
• Referral
Also make sure your transportation is arranged.
If you need to reschedule or have any questions
with this appointment, please call us at 215-
762-4200.
Press 1 to confirm the appointment.
Thank you!”
Patient
Patient’s Niece is also authorized to receive
text reminders (see next slide)
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
14. 14
Thank you for Confirming
C
Reminder for your
appointment with Dr. Eisen
on 10/25/2013 4:15 PM
Please reply “C” to confirm,
or call 215-762-4200 to
reschedule.
Patient Text Message
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
15. Results to Date through January 30, 2015
TARGET - 2.8% Decrease
30-Day Readmissions
Subject to CMS Readmission Penalty
N=541 Discharges 95% Confidence +- 4.21% Data through January 30, 2015
15
21.3%
16.0%
26.7%
0 0.1 0.2 0.3
Pilot - Not
Messaged Group
Pilot - Mobile
Messaged Group
Baseline
10.7% Decrease
5.3% Decrease
ACTUAL
• 10.7% Decrease
• 40.0%* Improvement over Baseline
• 24.9% Improvement over Not Messaged
* 10.7% ÷ 26.7% = 40.0%
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
16. • Intervention patients had lower rehospitalization rates
at 30 days and at 90 days than control subjects.
• Intervention patients had lower rehospitalization rates
for the same conditions that precipitated the index
hospitalization at 90 days and at 180 days than
control subjects.
• Mean hospital costs were lower for intervention
patients vs. control subjects at 180 days.
• Coaching chronically ill older patients and their
caregivers to ensure that their needs are met during
care transitions may reduce the rates of subsequent
rehospitalization
Care Interventions Lower Readmissions
16
The Care Transitions Intervention
(The Coleman Study)
The Care Transitions Intervention, Archives of Internal Medicine/Volume 166,
September 25, 2006 pages 1822-1828
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
17. 17
$$The Care Transitions Intervention, Archives of Internal
Medicine/Volume 166, September 25, 2006 pages 1822-1828
The Care Transitions Intervention (The
Coleman Study)
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
18. • Patients who received the RED experienced a 30
percent lower rate of hospital utilization within 30
days of discharge compared to patients receiving
usual care.
• One readmission or ED visit was prevented for every
seven patients receiving the RED.
• RED patients cost an average of $412 less in the 30
days following hospital discharge than patients who
did not receive the RED. This represents a 33.9
percent lower observed cost for this group.
Why should hospitals use the RED?
18
Project RED
AHRQ Publication No. 12(13)-0084 March 2013
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
19. Components of Project RED
19
1. Ascertain need for and obtain language assistance.
2. Make appointments for follow up care (e.g., medical appointments, post discharge tests/labs).
3. Plan for the follow up of results from tests or labs that are pending at discharge.
4. Organize post discharge outpatient services and medical equipment.
5. Identify the correct medicines and a plan for the patient to obtain them.
6. Reconcile the discharge plan with national guidelines.
7. Teach a written discharge plan the patient can understand.
8. Educate the patient about his or her diagnosis and medicines.
9. Review with the patient what to do if a problem arises.
10. Assess the degree of the patient’s understanding of the discharge plan.
11. Expedite transmission of the discharge summary to clinicians accepting
care of the patient.
12. Provide telephone reinforcement of the discharge plan
AHRQ Publication No. 12(13)-0084 March 2013
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
20. American Heart Association Study
• Examined association between outpatient
follow-up within 7 days post discharge
from Heart Failure hospitalizations and
readmission within 30 days.
• Study population of 225 hospitals and
30,136 patients.
• Compared % of early follow-ups per
hospital and then correlated with 30-day
readmission rate for heart failure.
• Hospitals who achieved an early Physician
follow-up experienced a 2.8% decrease in
30 Day Readmissions.
Faster follow-up decreases readmissions
20
Relationship Between Early Physician Follow-up and 30-Day Readmission Among
Medicare Beneficiaries Hospitalized for Heart Failure
JAMA, May 5, 2010—Volume 303, No. 17
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
21. Impact of 2.8% Decrease in Readmission on Revenues
Readmissions Penalties for
Hospitals with $100,000,000
in Medicare Payments.
Penalties impact ALL
Medicare Reimbursement.
SAVE OVER $3,000,000 $3,101,257
FY13
(June thru
Sept)
FY14 FY15 FY16 FY17
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
$782,667
$1,550,629
Life to date investment
Sample Readmissions
Risk Assessment ROI Figures
Medicare revenue recapture
@ 100% achievement
Medicare revenue recapture
@ 50% achievement
21
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
22. Center for Outcomes Research and Evaluation,
Yale-New Haven Hospital
Diagnose and Timing of 30-Day
Readmissions After Hospitalization for
Heart Failure, Acute Myocardial
Infarction, or Pneumonia
• From 2007 to 2009, Out of 1,330,157
patients admitted for CHF, 329,308 were
readmitted within 30 days. (24.8% rate)
• The proportion of patient readmitted for the
same condition was 35.2% after the index
HF hospitalization.
• The majority of the patients (61%) were
readmitted within 15 days of
hospitalization.
• Age, sex, race was not a factor
Diagnoses and Timing of 30-Day Readmissions After Hospitalization for Heart Failure, Acute
Myocardial Infarction, or Pneumonia, Kumar Dharmarajan, MD, MBA
JAMA, January 23/30, 2013—Vol 309, No. 4 p 355-363
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
23. Thirty-Day Readmissions by Day
HEART FAILURE, ACUTE MI, AND PNEUMONIA READMISSIONS
JAMA, January 23/30 2013
0
1
2
3
4
5
6
7
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Percentageof30-Day
Readmissions
Days Following Hospital Discharge
JAMA. 2013;309(4):355-363. doi:10.1001/jama.2012.216476.
61% Readmissions for
Heart Failure Patients
0-15 Days
Figure 1. Thirty-Day Readmissions by Day (0-30) Following Hospitalization for Heart Failure,
Acute Myocardial Infarction, or Pneumonia.
Data 2006 - 2009
Days 0-
3
Days 0-
7
Days 0-15
Percentage of all readmissions, 13.4%
Percentage of all readmissions, 31.7%
Percentage of all readmissions, 61.0%
Heart Failure Hospitalization
23
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
24. 0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Not Messaged
Messaged
Days Following Hospital Discharge
Data through September 30 , 2014
Percentageof30-Day
Readmissions
60% Readmissions
for Heart Failure
Patients 0-15 Days
Messaged – 19%
Not Messaged – 41%
Days 0-3
Days 0-7
Days 0-15
Percentage of all readmissions, 6%
Percentage of all readmissions, 20%
Percentage of all readmissions,
60%
24
Thirty-Day Readmissions by Day
Hahnemann Pilot Experience
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
25. Days between Discharge, Readmissions
and Follow-up appointments
• Average length of stay at home between discharge and ATTENDED
(showed up) their 1st follow-up appointment – 15 Days
– Messaged patients – 9 Days
– Not Messaged patients – 19 Days
• Average Days between Discharge and subsequent Readmissions –
15 Days
– Messaged encounters – 16 Days
– Not Messaged encounters – 14 Days
Staff making the appointments are blind as to whether patient was to be messaged or not
For over 550 encounters:
25
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
26. Preferred Method of Communication
Text
57%
Email
1%
Phone
42%
26
As of September 30, 2014
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
27. Impact of 7 Day Follow-up
Messaged patients/Days between discharge and appointment
(patient showed up)
11%
31%
40%
33%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
1-7 Days 8-14 Days 15-21 Days 22-30 Days
Readmission Rates
Average days
between
Readmissions
(15)
35%
of patients
6%
of patients
14%
of patients
45%
of patients
27
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
28. Not Messaged
Not Confirmed
22.8%
Messaged
Not Confirmed
15.4%
Messaged
Confirmed
8.8%
0.0% 5.0% 10.0% 15.0% 20.0% 25.0%
Readmissions
Impact of Messaging
Difference in Readmissions based on level of engagement
28
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
29. Impact of Messaging
Difference in Appointment adherence based on level of engagement
Not Messaged
Not Confirmed
46.7%
Messaged
Not Confirmed
67.8%
Messaged
Confirmed
68.4%
0.0% 20.0% 40.0% 60.0% 80.0%
Attended
(Patient showed up)
29
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
30. Not Messaged
Not Confirmed
11.8%
Messaged
Not Confirmed
4.0%
Messaged
Confirmed
5.3%
0.0% 5.0% 10.0% 15.0%
Cancellations
Impact of Messaging
Difference in Cancellations based on level of engagement
30
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
31. Pilot Readmissions Tightly Concentrated Among Few
Patients
31
# of
Readmissions
Patients
# of
Readmissions
1 Readmission 33 33
2 Readmissions 15 30
3 Readmissions 6 18
4 Readmissions 1 4
5 Readmissions 1 5
Totals 56 90
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
32. Pilot Readmissions Tightly Concentrated Among Few
Patients
32
# of
Readmissions
Patients
# of
Readmissions
1 Readmission 33 33
2 Readmissions 15 30
3 Readmissions 6 18
4 Readmissions 1 4
5 Readmissions 1 5
Totals 56 90
23 57
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
33. 63% of Total Readmissions from 8.8% of Patients
33
% of
Patients
% of total
Readmissions
1 Readmission 12.6% 36.6%
2 Readmissions 5.7% 33.3%
3 Readmissions 2.3% 20.0%
4 Readmissions .4% 4.4%
5 Readmissions .4% 5.5%
Totals 21.4% 100%
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
34. 34
% of
Patients
% of total
Readmissions
1 Readmission 12.6% 36.6%
2 Readmissions 5.7% 33.3%
3 Readmissions 2.3% 20.0%
4 Readmissions .4% 4.4%
5 Readmissions .4% 5.5%
Totals 21.4% 100%
These are the people that are adversely bending the cost curve
8.8% 63.2%
63% of Total Readmissions from 8.8% of Patients
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
35. 63% of Total Readmissions from 8.8% of Patients
These are the people that are adversely bending the cost curve
35
# of
Readmissions
Patients
% of
Patients
# of
Readmissions
% of total
Readmissions
1 Readmission 33 12.6% 33 36.6%
2 Readmissions 15 5.7% 30 33.3%
3 Readmissions 6 2.3% 18 20.0%
4 Readmissions 1 .4% 4 4.4%
5 Readmissions 1 .4% 5 5.5%
Totals 56 21.4% 90 100%
8.8% 63.2%23 57
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
36. 30% of Total Readmissions from 3.1% of Patients
36
# of
Readmissions
Patients
% of
Patients
# of
Readmissions
% of total
Readmissions
1 Readmission 33 12.6% 33 36.6%
2 Readmissions 15 5.7% 30 33.3%
3 Readmissions 6 2.3% 18 20.0%
4 Readmissions 1 .4% 4 4.4%
5 Readmissions 1 .4% 5 5.5%
Totals 56 21.4% 90 100%
8 of these patients (3.1%) are responsible for 30% of all readmissions
These are the people that are adversely bending the cost curve
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
37. Discharges Subject to Penalty by Median
Income
37
212, 54%
63, 16%
60, 16%
47, 12%
9, 2%
Less than $32,984
$32,985 to $47,727
$47,728 to $67,106
$67,108 to $99,321
$99,322 to $200,001
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
38. 30-Day Readmissions by Median Income
38
20
5
5
4
0
34
11
10
2
0
Less than $32,984
$32,985 to $47,727
$47,728 to $67,106
$67,108 to $99,321
$99,322 to $200,001
Messaged Readmissions Not Messaged Readmissions
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
39. Readmission Roadmap
1. Implement mobile appointment reminder to improve
appointment adherence
– Immediate impact and return on investment
Where could one go from here?
39
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
40. Readmission Roadmap
1. Implement mobile appointment reminder to improve
appointment adherence
– Immediate impact and return on investment
2. Consider piloting Medication Adherence program
– CMS estimates that 11% of hospital readmissions occur due to medication
non-adherence, estimated to cost nearly $100 billion annually*
Where could one go from here?
40
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
41. Readmission Roadmap
1. Implement mobile appointment reminder to improve
appointment adherence
– Immediate impact and return on investment
2. Consider piloting Medication Adherence program
– CMS estimates that 11% of hospital readmissions occur due to medication
non-adherence, estimated to cost nearly $100 billion annually*
3. Enable care team collaboration
– Connect care teams and share relevant information between all stakeholders
– PCP underutilized resource!
Where could one go from here?
41
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
42. Readmission Roadmap
1. Implement mobile appointment reminder to improve
appointment adherence
– Immediate impact and return on investment
2. Consider piloting Medication Adherence program
– CMS estimates that 11% of hospital readmissions occur due to medication
non-adherence, estimated to cost nearly $100 billion annually*
3. Enable care team collaboration
– Connect care teams and share relevant information between all stakeholders
– PCP underutilized resource!
4. Enhance the patient and caregiver experience
– Leverage traditional care with technology
• Acute Care Clinicians • Pharmacy • Respiratory therapy
• Community based Clinicians • Physical therapy • Social worker
• Durable Medical Equipment
(DME)
• Primary Care access • Speech therapy
• Occupational therapy • Primary Care Physician • Visiting Nurse
Highest Readmitters need a greater proportion of
traditional care complemented with technology.
Where could one go from here?
42
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
43. Improve Patient Care Team Coordination
in the Community
PatientNURSE
DOCTOR FAMILY
HOME CARE
PROVIDERS
POST-ACUTE
CARE/REHAB PHARMACY
NURSE
Every step in the patient experience journey is critical. By enhancing the post-discharge
process, hospitals can improve overall satisfaction scores while reducing penalties.
CLOUD BASED
HIPPA COMPLIANT
MOBILE ENABLED
COMMUNITY CENTERED
PATIENT CARE TEAM COORDINATION
43
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015
44. Conclusions – Mobile Technology Works
• Mobile technology has a role in readmissions reduction
– Messaged Patients:
• Are MORE ENGAGED and Readmitted Less Often
• Show up for their Outpatient Appointments at a Higher Rate, Cancel Less
• Mobile technology helps to facilitate early and timely follow-up
– Early Follow-up within 7 days Reduces 30-day Readmissions
• Mobile technology enables patient engagement to support:
– Appointment and Medication Adherence & Transition of Care
Coordination
– Community Care Coordination across the Patient Care Team
• Smallest number of patients responsible for highest percentage
of readmissions
– Require Multi-disciplinary Care with High Touch, along with
Technology
– Intense Management and Stakeholder Accountability
44
Copyright 2015 Digital Collaboration Solutions, LLCMay 2015