The Pregnancy Care ECHO at University of Utah Health Care was launched in June 2015 to improve care for pregnant women. It provides a forum for midwives and maternal-fetal medicine specialists to discuss challenging patient cases and recommendations. Of the 50 cases presented, 39 have been by the internal midwife group. This has helped establish clearer guidelines around which cases midwives can safely manage. It has formalized communication between provider groups and increased operational efficiency at the large academic medical center.
The article discusses how the Comprehensive Care Physicians (CCP) model proved to improve patient care and reduce utilization for patients at increased risk for hospitalization.
The article discusses how the Comprehensive Care Physicians (CCP) model proved to improve patient care and reduce utilization for patients at increased risk for hospitalization.
Physician Characteristics - EHRs and Meaningful Uselindseylarue
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Dr. Richard A May, MD, PhD, D.H.Sc. Certificate Antimicrobial Stewardship Module 9 - The CMS Core Performance Measures for Community Acquired Pneumonia - CAP - 87297 13912-1
In first of two-part series, Pamela Greenhouse explores the differences and similarities of the Patient and Family Centered Care Methodology and Practice (PFCC M/P) and leean process improvement approachs, such as Lean, Six Sigma and Toyota. She believes that the PFCC M/P can be the unifying theme for health care, incorporating both process improvement and performance improvement.
Physician Characteristics - EHRs and Meaningful Uselindseylarue
Research assessing the characteristics of physicians who use electronic health record systems and how these characteristics affect meaningful use of electronic systems.
Dr. Richard A May, MD, PhD, D.H.Sc. Certificate Antimicrobial Stewardship Module 9 - The CMS Core Performance Measures for Community Acquired Pneumonia - CAP - 87297 13912-1
In first of two-part series, Pamela Greenhouse explores the differences and similarities of the Patient and Family Centered Care Methodology and Practice (PFCC M/P) and leean process improvement approachs, such as Lean, Six Sigma and Toyota. She believes that the PFCC M/P can be the unifying theme for health care, incorporating both process improvement and performance improvement.
The conceptual foundation of nursing as an independent profession required that many of the structural considerations applied to like professions also be applied to nursing. Issues of professional self-direction, decision making, standard-setting, and professionalgovernance were explored through time.Initial efforts to define and design governance structures began in a number of health settings across the United States.Initial efforts considered the independence of nursing and operating models to support this began in a highly decentralized manner.
Objective: To evaluate the utility of a targeted lecture in improving FP awareness amongst clinicians.
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: Best Practices for Patient Safety in ObstetricsCures MB
Obstetrics, the field of medicine dedicated to the care of pregnant individuals and their unborn
babies.The foundation of safe obstetric care begins with comprehensive prenatal care. E
The Use of Health Information Technology to Improve Care and .docxpelise1
The Use of Health Information Technology to Improve Care and
Outcomes for Older Adults
Kathryn H. Bowles, PhD, FAAN, FACMI,
van Ameringen Professor in Nursing Excellence, Director of the Center for Integrative Science in
Aging, University of Pennsylvania School of Nursing, Philadelphia, PA
Patricia Dykes, PhD, FAAN, FACMI, and
Senior Nurse Scientist, Director of the Center for Patient Safety Research and Practice; Director
of the Center for Nursing Excellence, Brigham and Women’s Hospital, Boston, MA
George Demiris, PhD, FACMI
Alumni Endowed Professor in Nursing; Professor in Biomedical and Health Informatics, School of
Medicine; Director, Clinical Informatics and Patient Centered Technologies; Graduate Program
Director, Biomedical and Health Informatics University of Washington, Seattle, Washington
Introduction
Using health information technology (HIT) to improve care and outcomes for older adults is
a growing program of research propelled by recent transformative policies such as the
Health Information Technology for Economic and Clinical Health (HITECH) Act
(Blumenthal, 2010; Institute of Medicine, 2011) and the Institute of Medicine report, "The
Future of Nursing: Leading Change, Advancing Health." (Institute of Medicine, 2010). Both
documents call for the implementation of electronic health records (EHR) and HIT solutions
to improve the safety, quality and efficiency of care. Several nurse scientists are at the
forefront of advancing this work, particularly using electronic health records, decision
support and telehealth. This commentary highlights examples of recent research (2010–
2014) led by nurse scientists using HIT to improve patient safety, and the quality and
efficiency of patient care. We also discuss future opportunities for Gerontological nurse
scientists interested in blending the care of older adults and HIT and suggest strategies to
increase our capacity to engage in such innovative research.
Using the EHR to improve outcomes for older adults
Recent incentives provided by the HITECH Act have resulted in rapid growth in the
development and implementation of the EHR. Nurse led studies are beginning to
demonstrate that effective use of the EHR can improve outcomes of relevance to older
adults such as pressure ulcers and falls. Dowding and colleagues evaluated the impact of an
integrated EHR in 29 Kaiser Permanente hospitals on process and outcome indicators for
patient falls and hospital acquired pressure ulcers (Dowding, Turley, & Garrido, 2012).
They found that the EHR system was associated with improved documentation of both fall
and pressure ulcer risk assessments and statistically significant improvements for pressure
ulcer risk assessment documentation. They demonstrated that improved documentation
using the EHR was associated with a 13% decrease in hospital acquired pressure ulcer rates.
HHS Public Access
Author manuscript
Res Gerontol Nurs. Author manuscript; avai.
The Use of Health Information Technology to Improve Care and .docx
EBP2016_poster_HOLLOMAN1
1. PROGRAM DESCRIPTIONINTRODUCTION
The care of pregnant women is managed by an array of
providers at University of Utah Health Care (UUHC) ranging
from Certified Nurse Midwives to Maternal Fetal Medicine
obstetricians. This continuum of care options give patients a
variety of choices in how to manage their pregnancy. Utilizing
midwifery services is becoming an increasingly more popular
option for women with a low-risk pregnancy of complications,
and with good reason.
According to a 2009 Cochrane meta-analysis* (12,276 women)
looking at midwife-led care versus care by an obstetrician or
family physician, midwifery care was found to have as good or
better outcomes in every parameter. Under midwife care
women had less need for anesthesia, episiotomies,
instrumental birth (such as forceps or vacuum).
Despite the advantages of access to various levels of care at
UUHC, there still remain questions about which patients
should be referred to a maternal fetal medicine specialist and
which cases can be co-managed safely and effectively by the
nurse midwife group. This is one of the issues that the
Pregnancy Care ECHO helps address.
The Pregnancy Care ECHO at UUHC was launched in June 2015
and has since grown to be one of the most popular ECHO
sessions at University of Utah Health Care. To date, 50 patient
presentations have been conducted—providing useful
recommendations of care for 44 unique patients.
In addition to serving providers using the traditional ECHO
model, the Pregnancy Care ECHO seeks to improve operational
efficiency at University of Utah Health Care by better outlining
which care providers can handle certain types and levels of
cases. Additionally, Project ECHO formalizes communication
between various provider groups at UUHC through the use of
written recommendations that are uploaded to patients’
charts—as opposed to less formal phone calls, which largely
go undocumented.
Of these provider groups, the BirthCare HealthCare (i.e.,
midwife) group has been an example of how Project ECHO can
be used to increase operational efficiency and patient
satisfaction in a large academic medical center.
Of the 50 patient presentations which have occurred at the
Pregnancy Care ECHO, 39 of them have been conducted by the
BirthCare HealthCare group.
University of Utah Health Care - TeleHealth Services, University
of Utah Department of Obstetrics & Gynecology Clinicians and
Staff, University of Utah Project ECHO Staff, the ECHO Institute
ACKNOWLEDGEMENTS
DISCUSSION
Like other ECHOs, the regularly scheduled consultation forum
provides a forum in which participants can receive formal
feedback about challenging patient cases. Interaction with the
BirthCare HealthCare group, however, differs in the sense that
it builds upon an existing relationship between the midwife
group and the maternal fetal medicine group at University of
Utah Health Care.
Using the technology facilitated by Project ECHO, this
relationship has become more formal and standardized in its
communication and co-management of patient care.
Screenshot of Dr. Lauren Theilen’s presentation on
Preeclampsia Recurrence Risk and Prevention
Pregnancy Care ECHO Schedule
Visit http://healthcare.utah.edu/echo/ob-clinic.php for the most current list of clinical updates
of patient presentations conducted by
internal midwife group.78%
By documenting the cases that are being presented by the
midwife group at our Pregnancy Care ECHO, we hope to amass
data regarding the types of patients that are being presented
by the midwife group. This information, in conjunction with
documentation that shows safe and successful management of
these conditions by midwives may eventually positively affect
policy at both an organizational and potentially state level—
particularly in drawing clearer guidelines in the types of cases
midwives can manage.
SAMPLE of Pregnancy Care Didactic
UUHC VALUE EQUATION
The Pregnancy Care ECHO increases value in many ways—one of
which involves increasing quality and service by facilitating more
regular, formal interactions between UUHC’s midwife group and
the maternal fetal medicine group.
POTENTIAL FUTURE IMPLICATIONS
PROGRAM DESCRIPTION (cont’d)
*Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led
versus other models of care for childbearing women. Cochrane
Database of Systematic Reviews 2008, Issue 4.
REFERENCES
PREGNANCY CARE ECHO:
Facilitating Physician & Midwifery Pregnancy Co-Management
Jordan Holloman, MBA, MHA1, Leah Willis, MS1, Terry Box, MD1, Erin Clark, MD2
Project ECHO1, Division of Obstetrics & Gynecology2
University of Utah Health Care
Extension for Community Healthcare Outcomes
