This document summarizes the benefits of highly organized primary care and medical homes. It discusses how organizing primary care into teams that focus on population health, care coordination, planned care for chronic conditions, and quality improvement can improve health outcomes, reduce costs, and enhance the patient experience. The document provides examples from Cambridge Health Alliance that show improved quality metrics, decreased hospital and emergency room use, and reduced costs after implementing a primary care reform model centered around medical homes and accountable care.
Presentation by Kirby Farrell, President and CEO, Broad Axe Technology Partners and Andy Archer, MSc, MBA, Vice President, Broad Axe Technology Partners
Presentation 211 a beth stephens_the utilization of a communication and treat...The ALS Association
The document discusses the utilization of a Communication and Treatment Preference (CTP) assessment tool to guide care for patients with ALS. The CTP tool collects information on patient's legal documents, decision-making preferences, treatment goals, and preferences for receiving medical information. Data from 39 ALS patients who completed the CTP assessment showed that while most had legal documents, their specific treatment goals and information needs varied. Using the CTP helped clinicians better align treatment discussions with each patient's unique preferences and priorities.
Presentation by Bonnie Britton, MSN, RN, ATAF Telehealth Program Administrator, Vidant Health and Seth VanEssendelft, Vice-President for Financial Services, Vidant Medical Center
This document summarizes the benefits of highly organized primary care and medical homes. It discusses how organizing primary care into teams that focus on population health, care coordination, planned care for chronic conditions, and quality improvement can improve health outcomes, reduce costs, and enhance the patient experience. The document provides examples from Cambridge Health Alliance that show improved quality metrics, decreased hospital and emergency room use, and reduced costs after implementing a primary care reform model centered around medical homes and accountable care.
Presentation by Kirby Farrell, President and CEO, Broad Axe Technology Partners and Andy Archer, MSc, MBA, Vice President, Broad Axe Technology Partners
Presentation 211 a beth stephens_the utilization of a communication and treat...The ALS Association
The document discusses the utilization of a Communication and Treatment Preference (CTP) assessment tool to guide care for patients with ALS. The CTP tool collects information on patient's legal documents, decision-making preferences, treatment goals, and preferences for receiving medical information. Data from 39 ALS patients who completed the CTP assessment showed that while most had legal documents, their specific treatment goals and information needs varied. Using the CTP helped clinicians better align treatment discussions with each patient's unique preferences and priorities.
Presentation by Bonnie Britton, MSN, RN, ATAF Telehealth Program Administrator, Vidant Health and Seth VanEssendelft, Vice-President for Financial Services, Vidant Medical Center
This document discusses Vidant Health's telehealth and care transitions program. It describes how the program aims to shift the focus from hospital care to coordinating patient care transitions. It outlines the risk stratification process used to determine which services patients receive, from remote patient monitoring and daily biometrics for high-risk patients, to telephonic follow-up for low-risk patients. It provides data on outcomes for patients in the program, showing reductions in hospitalizations, bed days, and costs after participating in the program.
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.
Enabling Remote Patient Monitoring: Opportunities and Challenges at Bio2Devic...Akhsar Kharebov
Personal medical devices track an ever increasing amount of patient information away from the hospital. Coupled with quantitative self devices such as fitness trackers or calories counters, provide valuable information as the condition of a patient. Digital Health is growing a new realm of opportunities for biospace professionals. Yet challenges exist. Medical information software are archaic and siloed. Medical system is slow to adopt.
Advancing Team-Based Care: Complex Care Management in Primary CareCHC Connecticut
This webinar investigated the ways that team members can contribute to the care of patients with complex medical and/or social needs. The focus was on developing the expanded care team and ensuring ready communication between the core and expanded care teams. Models for effective care management were presented.
This webinar was presented May 5, 2016 3:00 p.m. Eastern Time
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
Presentation 223 rebecca brittain als tele health_ a patient centered approa...The ALS Association
This document discusses the development of an ALS tele-health program that allows patients to receive multidisciplinary care through virtual clinic visits. A nurse was trained to conduct remote assessments using video conferencing equipment. Standardized assessment tools were identified or developed for each discipline. The nurse would visit patients' homes to record exams and gather data, which was then reviewed virtually by the care team. An evaluation found high patient and provider satisfaction with the tele-health approach, which expanded access to care for patients unable to attend in-person clinics. The program aims to continue improving the process and identifying sustainable funding.
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.
Can we solve the adult primary care shortage without more physicians? CHC Connecticut
Tom Bodenheimer,of the Center for Excellence in Primary Care at UCSF Dep’t of Family and Community Medicine talks about addressing the primary care shortage at the 2014 Weitzman Symposium
Objectives:
1.Introduce the Measuring and Monitoring of Safety Framework to a Canadian healthcare audience
2.Describe how the framework would work in Canada
BiomedHealthtech is engaged in serving the healthcare industry since 1989 and now introduce Remote Monitoring Technologies (RMT) which is a new concept of Patient Monitoring designed to meet the demands of Modern Healthcare and thus reduce the Mortality Rate.
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.
Nursing Handoff, Internet in Education projectRobert Ross
Nursing hand-off communication involves exchanging patient information between shifts to ensure continuity of care. It is defined as communication that allows nurses to transfer responsibility for a patient and includes asking questions to clarify care. Poor hand-off communication has been linked to up to 65% of sentinel events and is critical for patient safety. Elements of an effective hand-off include the patient's name, diagnosis, medications, vital signs, labs, and changes in condition.
Patient & Family Advisory Councils: the Business Case for Starting a PFAC & P...EngagingPatients
This webinar was presented on March 12, 2015 by Barbara Lewis. It looks at the prevalence and roles that Patient & Family Advisory Councils (PFACs) are playing in U.S. hospitals today, and builds a business case for their implementation:
Evidence demonstrates that communication is one of the leading contributors to adverse events. Transitions of care epitomize this challenge.
WATCH ON DEMAND: https://goo.gl/M1ovsS
As patients and families impacted by harm, we imagine progressive approaches in responding to patient safety incidents – focused on restoring health and repairing trust.
We can change how we respond to healthcare harm by shifting the focus away from what happened, towards who has been affected and in what way. This is your opportunity to hear about innovative approaches in Canada, New Zealand, and the United States that appreciate these human impacts.
This interactive webinar is hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute and the Canadian arm of the World Health Organization Patients for Patient Safety Global Network.
ChenMed is a privately held primary care group that focuses on low-income adults over 55 with multiple chronic conditions. Their care model includes 400-450 patients per physician, on-site pharmacy services, intensive care coordination, and global risk-based payments from Medicare Advantage plans.
ChenMed has achieved outcomes like lower hospitalization rates compared to national benchmarks. Their strategy for scaling includes developing a physician culture focused on relationships and accountability, value-based workflows supported by technology, and selective integration within local healthcare markets. Physician panel management tools, interdisciplinary care teams, and managing transitions of care across settings are key parts of their model.
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.
The document discusses the doctor-patient relationship (DPR), which is the core element of medical ethics. Effective communication, empathy, trust, informed consent, and respecting professional boundaries are fundamental to building a strong DPR. Historically, the relationship has been more paternalistic, but it is now more consumer-focused and emphasizes patient autonomy. Maintaining a good DPR is important for treatment outcomes, especially for chronic illnesses, and can be improved through active listening, reassurance, and agreeing on care plans.
This document provides an overview of an orientation session on Making Every Contact Count (MECC). The session aims to provide staff with information on the MECC toolkit and principles, identify opportunities to promote health and wellbeing to clients, and produce a vision statement for health promotion. Staff will learn about the economic and personal benefits of self-care approaches and prevention of poor health. The session also discusses creating a culture of health promotion across organizations to improve outcomes and reduce health inequalities.
This document discusses Vidant Health's telehealth and care transitions program. It describes how the program aims to shift the focus from hospital care to coordinating patient care transitions. It outlines the risk stratification process used to determine which services patients receive, from remote patient monitoring and daily biometrics for high-risk patients, to telephonic follow-up for low-risk patients. It provides data on outcomes for patients in the program, showing reductions in hospitalizations, bed days, and costs after participating in the program.
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.
Enabling Remote Patient Monitoring: Opportunities and Challenges at Bio2Devic...Akhsar Kharebov
Personal medical devices track an ever increasing amount of patient information away from the hospital. Coupled with quantitative self devices such as fitness trackers or calories counters, provide valuable information as the condition of a patient. Digital Health is growing a new realm of opportunities for biospace professionals. Yet challenges exist. Medical information software are archaic and siloed. Medical system is slow to adopt.
Advancing Team-Based Care: Complex Care Management in Primary CareCHC Connecticut
This webinar investigated the ways that team members can contribute to the care of patients with complex medical and/or social needs. The focus was on developing the expanded care team and ensuring ready communication between the core and expanded care teams. Models for effective care management were presented.
This webinar was presented May 5, 2016 3:00 p.m. Eastern Time
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
Presentation 223 rebecca brittain als tele health_ a patient centered approa...The ALS Association
This document discusses the development of an ALS tele-health program that allows patients to receive multidisciplinary care through virtual clinic visits. A nurse was trained to conduct remote assessments using video conferencing equipment. Standardized assessment tools were identified or developed for each discipline. The nurse would visit patients' homes to record exams and gather data, which was then reviewed virtually by the care team. An evaluation found high patient and provider satisfaction with the tele-health approach, which expanded access to care for patients unable to attend in-person clinics. The program aims to continue improving the process and identifying sustainable funding.
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.
Can we solve the adult primary care shortage without more physicians? CHC Connecticut
Tom Bodenheimer,of the Center for Excellence in Primary Care at UCSF Dep’t of Family and Community Medicine talks about addressing the primary care shortage at the 2014 Weitzman Symposium
Objectives:
1.Introduce the Measuring and Monitoring of Safety Framework to a Canadian healthcare audience
2.Describe how the framework would work in Canada
BiomedHealthtech is engaged in serving the healthcare industry since 1989 and now introduce Remote Monitoring Technologies (RMT) which is a new concept of Patient Monitoring designed to meet the demands of Modern Healthcare and thus reduce the Mortality Rate.
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.
Nursing Handoff, Internet in Education projectRobert Ross
Nursing hand-off communication involves exchanging patient information between shifts to ensure continuity of care. It is defined as communication that allows nurses to transfer responsibility for a patient and includes asking questions to clarify care. Poor hand-off communication has been linked to up to 65% of sentinel events and is critical for patient safety. Elements of an effective hand-off include the patient's name, diagnosis, medications, vital signs, labs, and changes in condition.
Patient & Family Advisory Councils: the Business Case for Starting a PFAC & P...EngagingPatients
This webinar was presented on March 12, 2015 by Barbara Lewis. It looks at the prevalence and roles that Patient & Family Advisory Councils (PFACs) are playing in U.S. hospitals today, and builds a business case for their implementation:
Evidence demonstrates that communication is one of the leading contributors to adverse events. Transitions of care epitomize this challenge.
WATCH ON DEMAND: https://goo.gl/M1ovsS
As patients and families impacted by harm, we imagine progressive approaches in responding to patient safety incidents – focused on restoring health and repairing trust.
We can change how we respond to healthcare harm by shifting the focus away from what happened, towards who has been affected and in what way. This is your opportunity to hear about innovative approaches in Canada, New Zealand, and the United States that appreciate these human impacts.
This interactive webinar is hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute and the Canadian arm of the World Health Organization Patients for Patient Safety Global Network.
ChenMed is a privately held primary care group that focuses on low-income adults over 55 with multiple chronic conditions. Their care model includes 400-450 patients per physician, on-site pharmacy services, intensive care coordination, and global risk-based payments from Medicare Advantage plans.
ChenMed has achieved outcomes like lower hospitalization rates compared to national benchmarks. Their strategy for scaling includes developing a physician culture focused on relationships and accountability, value-based workflows supported by technology, and selective integration within local healthcare markets. Physician panel management tools, interdisciplinary care teams, and managing transitions of care across settings are key parts of their model.
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.
The document discusses the doctor-patient relationship (DPR), which is the core element of medical ethics. Effective communication, empathy, trust, informed consent, and respecting professional boundaries are fundamental to building a strong DPR. Historically, the relationship has been more paternalistic, but it is now more consumer-focused and emphasizes patient autonomy. Maintaining a good DPR is important for treatment outcomes, especially for chronic illnesses, and can be improved through active listening, reassurance, and agreeing on care plans.
This document provides an overview of an orientation session on Making Every Contact Count (MECC). The session aims to provide staff with information on the MECC toolkit and principles, identify opportunities to promote health and wellbeing to clients, and produce a vision statement for health promotion. Staff will learn about the economic and personal benefits of self-care approaches and prevention of poor health. The session also discusses creating a culture of health promotion across organizations to improve outcomes and reduce health inequalities.
This document summarizes a presentation about an interdisciplinary outpatient pain management program. The program was developed in response to high rates of chronic pain in post-acute populations and new regulations surrounding opioid prescriptions. The program utilizes 10 collaborating disciplines including physicians, psychologists, physical therapists, nurses, and social workers. Key aspects of the program include comprehensive assessments, a pain contract, urine drug screening, and emphasis on non-pharmacological treatments. Initial results after one year include improved capacity for adjunct treatments, integration of new specialists, and fewer demanding patients due to clear guidelines.
The business of providing treatment for obstructive sleep apneaBradley Eli
sleep treatment specialists is a specialty practice in San Diego dedicated to treating sleep disordered breathing. CHAP accredited and provides all non surgical treatments for sleep apnea, snoring and sleep disordered breathing. Dr Bradley Eli DMD, MS is the specialist director and owner of the facility
Clinical reasoning and patient centered care in physiotherapyzualias
This document discusses clinical reasoning and patient-centered care in physiotherapy. It defines clinical reasoning as the process physiotherapists use to collect information, generate hypotheses, diagnose and treat patients. Key elements include generating hypotheses about factors limiting a patient's abilities and capacities. Patient-centered care involves respecting patient preferences and values and ensuring they guide treatment decisions. The document also outlines the subjective and objective assessment process, analysis, treatment planning, intervention, evaluation and review that take place in a physiotherapy session.
This document provides an overview of palliative care including its history, definitions, key attributes, antecedents, consequences, barriers, importance to nursing practice, and support from research and government. It describes how palliative care began in the UK and US in the 1960s-70s and has since expanded. Key goals of palliative care include individualized patient care, family support, interdisciplinary teamwork, trust, safety, and effective communication.
Non pharmacological treatment of SUD.pptxRobinBaghla
This document summarizes non-pharmacological approaches for treating substance use disorders. It discusses the stages of motivation according to the Transtheoretical Model and common psychotherapies used, including cognitive behavioral therapy, motivational interviewing, motivational enhancement therapy, 12-step facilitation therapy, family/group therapy, and relapse prevention. Key aspects of each approach are outlined such as developing motivation, teaching coping skills, and addressing ambivalence about change. The goals are to enhance commitment to treatment and support patients in maintaining abstinence.
This is a slide show about how including the patient perspective as decisions are made about their health care - improves the quality of care being given in the Medical setting.
Advancing Team-Based Care: Achieving Full Integration of Behavioral Health an...CHC Connecticut
This webinar highlighted ways to fully integrate behavioral health care into primary care. The role of nurses, medical assistants, behaviorists, lay health workers, and primary care providers was discussed along with the use of clinical dashboards and warm hand-offs.
This webinar was presented May 19, 2016 3:00 p.m. Eastern Time
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London
Implementing ICU Rehab Program Part 1 Roundtable 2014whitchur
Implementing an early mobilization program in the ICU can improve patient outcomes by decreasing length of stay and ventilator days while also improving functional outcomes. However, there are several barriers to implementation including lack of leadership, staffing, knowledge, and appropriate referrals as well as over-sedation, delirium, and safety concerns. Successful programs require a multidisciplinary team approach with buy-in from all specialties, evidence-based research, administrative support, dedicated resources, and a culture change toward early mobilization and rehabilitation. Standardized processes around education, communication, protocols, and data tracking can help drive implementation.
This document discusses palliative care and advance care planning. It defines palliative care as specialized care focused on relieving symptoms and stress for patients with serious illnesses. Advance care planning involves discussing goals, values and treatment preferences with medical providers and family. Early research shows palliative care can improve quality of life and symptoms for patients with serious illness. The document encourages having conversations about values and goals, completing advance directives, and revisiting discussions over time.
Clinical reasoning and patient centered care in physiotherapyzualias
This document discusses clinical reasoning and patient-centered care in physiotherapy. It defines clinical reasoning as the process physiotherapists use to collect and evaluate patient data to make judgments about diagnosis and treatment. Patient-centered care actively involves patients in decisions about their care. The document also outlines the components of documentation for patient care, including subjective assessment, objective assessment, analysis, plan, intervention, evaluation and review. Thorough documentation is important for legal protection, communication between healthcare providers, and ensuring quality patient care.
This document provides an overview of the history and development of nursing as a profession. It discusses how nursing has evolved from focusing primarily on providing comfort and care to also emphasizing health promotion and prevention. Key figures who helped establish nursing standards and education are highlighted, such as Florence Nightingale, who opened the first nursing school. The roles, responsibilities, and scope of nursing practice are also outlined, as well as the importance of critical thinking and use of the nursing process in clinical decision making. Professional nursing organizations and trends that continue to shape the profession are also reviewed.
Weitzman 2013 Relative patient benefits of a hospital-PCMH collaboration with...CHC Connecticut
Anuj K Dalal presents information on a PCORI research grant: Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions.
Long-term care involves a variety of services to support people with chronic illnesses or disabilities. It can be provided at home, in assisted living facilities, or in nursing homes. The responsibilities of nurses in long-term care settings include assessing residents' needs, developing and implementing care plans, providing direct care, communicating with residents and other staff, and managing other personnel. Proper long-term care requires a holistic approach and involvement from residents, families, social workers, nurses, rehabilitation specialists, and other care providers.
The document discusses the roles and responsibilities of community health nurse practitioners, midwifery nurse practitioners, and the conceptual foundations behind advanced practice nurses. It outlines the history and development of nurse practitioners, defining them as registered nurses who have obtained advanced education and clinical training to provide primary care, make diagnoses, and prescribe treatment plans under a specialty certification. The duties of community health and midwifery nurse practitioners are described in addition to the educational requirements, certifications, legal issues, and conceptual frameworks that guide advanced nursing practice.
Readiness for change and the stages of change modelHayleyLoschiavo
The theory of readiness for change is derived from the Transtheoretical Model of behavior change. It conceptualizes an individual's process of recovery across stages of change depending on their expressed readiness. Readiness involves desires, intentions, and commitments to alter a targeted behavior based on personal motivations and goals. It is influenced by beliefs, self-efficacy, locus of control, and other intrapersonal and social factors. Assessing an individual's readiness uses techniques like developing rapport, discussing visions for change, and measuring readiness on scales. Treatment planning aims to encourage and empower individuals to progress through the stages of change by setting SMART goals and preventing relapse. Readiness assessments are useful for conditions like eating disorders where ambivalence is common
Similar to Using Coaching to Reduce Readmissions, Costs and Improve Care_eQHealth Solutions (20)
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
Using Coaching to Reduce Readmissions, Costs and Improve Care_eQHealth Solutions
1. Using Coaching to Reduce Costs
and Improve Care
Laurie Robinson, RN, CPE, CPUR
Director of Care Coordination Services
2. What will you learn today?
• You will learn to identify:
– Drivers of re-hospitalization and
interventions used to reduce
re-hospitalization
– The roles of the coach and the patient in
the coaching relationship
– Patients appropriate for coaching
– Differences in roles of the coach and the
Care Coordinator.
3. Why do we do this?
Patient Outcome
On coach follow up patient Coaching
states “It is really Interaction
working. I have not
smoked and I feel better. During coaching session,
Oh and I did get that COPD patient
appointment for my lung contemplating smoking
doctor to talk about my cessation
lung test.”
Patient Activation
• Reviewed smoking
Patient Outcome
cessation options and
• Patient called MD coached on discussion
with MD
• Medication added
• Patient agreed to discuss at
• Patient continues to be
follow up appointment and
smoke free 50 plus year smoker with severe contracted not to smoke until
COPD the appointment
Patient Activation
• Patient discusses Patient Activation
heightened anxiety • Discussed at follow up
since he stopped appointment
smoking
• Chantix ordered
• Coached encouraged
patient on important • Continues not to
messages to relay to smoking
MD
5. What is Driving Re-hospitalization?
• Fragmentation of data
• Inappropriate end of life care
• Medication issues
• At-risk patients not properly identified at
discharge
• Lack of post-discharge follow-up
• Lack of disease-specific protocols
• Lack of patient self-management
• Lack of community awareness
6. Designing Interventions to Address
Drivers
Driver Intervention
Fragmented Documentation Coaching, Transfer Documents
Inappropriate End of Life Care Coaching, Discharge Risk Assessment
Tool
Medication Errors Coaching, Personal Health Record
High Risk Patients Poorly Identified Discharge Risk Assessment Tool
Lack of Post Discharge Follow-up Coaching, Care Coordination, Follow-up
Scheduling
Lack of Disease Specific Protocols Protocol Improvement Project
Poor Patient Self Management Coaching, Care Coordination, Personal
Health Record
Lack of Community Awareness Community outreach campaign
7. Transition Coaching
• Models
– Care Transitions Intervention (Eric Coleman, MD, MPH)
– Transitional Care Model (Mary Naylor, PhD, RN)
– eQHealth Solutions - Care Coordination/
Transitions Coaching
• Focus
– Empowering the patient
– Patient-centered goals
– Tools that focus on the patient
– Medication reconciliation
– Discharge plan of care
– Making follow-up appointments
– Recognizing red flags
9. eQHealth Model Conceptual
Framework
• Prochaska Stages of Change
• Bandura Social Learning Theory/Self Efficacy
• Erikson Stages of Development
• Miller & Rollnick Motivational Interviewing
• Thorndike Laws of Learning
• Stewart PITS Model of Education/Patient
Literacy
10. The Patient as the Solution
• Moving from provider centered to patient
centered care
• Handing off to the patient and caregivers
• Using tools to support good decision making
This is hard and it requires us to think and
act differently.
11. What is Transition Coaching?
• Empowering and encouraging the patient on
self care
• The Patient and/or the Care Givers are the
doers
12. How Does Coaching Differ from
Care Coordination?
Care Coordination Coach
Recommends services as Encourages the patient to
appropriate and assist patients discuss options with the
with accessing these services. physician, case manager and
treatment team.
Assists the patient with access Coaches the patient to schedule
to providers and sets up the follow up appointment and
appointments. May attend refers the patient to the plan for
appointments and treatments as network questions.
appropriate.
Assists the patient by setting up Coaches the patient to assess
transportation services and options for transportation and
other community resources. empowers the patient to set up
their transportation.
13. eQHealth Solutions Transition
Coaching
• The coach visits the patient in the hospital
• Follow up phone calls at intervals; day 2, 7, 14, 21, 30
and 45 post discharge.
• Each session focuses on the post discharge plan of
care, medications, post discharge physician visit,
warning signals, Personal Health Record and patient
centered goal.
• Patient Tools are used to reinforce teaching.
• RBC; shared knowledge.
Personal Goal: “To be able to watch my grandson
play soccer from the side of the field and not my car.”
14. The Hospital Interaction
• Patient’s role is expert in self
• Coach builds relationship
• Coach and patient share knowledge
• Motivational Interviewing
• Education; PITS Model of delivery
• Building on successes
• Preparing for treatment plan handoff to the patient or
caregiver at discharge
• Patient sets personal goal
Personal Goal: “I want to be able to
get back to church on Sundays.”
15. Telephonic Follow Up
• Coach contacts the patient and focuses on the
coaching components:
– Education reinforced
– Medications
– Warning signs
– Plan of care
– Follow up
– Personal Goal
16. Coaching Tools
• Hospital Discharge “To Do List ”
• Educational tools and homework
• Personal Health Record
• Medication Reconciliation
• Warning Signals
• Plan of Care
• Follow up Appointment
• Personal Goal
17.
18. Who is Appropriate for Coaching?
• Patients who can participate in self care or
who have a willing caregiver
19. Who is not Appropriate for Coaching?
• Nursing home patients
• Hospice patients
• Patients who need coordination of services by
a clinician
• Patients or caregivers must be able
to activate for themselves
20. How Does Care Coordination Differ From
Coaching?
Care Coordination Coach
Recommends services as Encourages the patient to
appropriate and assist patients discuss options with the
with accessing these services physician, case manager and
treatment team
Assists the patient with access Coaches the patient to schedule
to providers and sets up the follow up appointment and
appointments. Attends refers the patient to the plan for
appointments when needed network questions
Assists the patient by setting up Coaches the patient to assess
transportation services and options for transportation and
other community resources empowers the patient to set up
their transportation
21. Care Coordination; When
Coaching is Not Enough
• Care coordination is holistic case management
approach:
– Manages the condition and the co-morbidities
– Manages both clinical and psycho-social needs
– Manages and monitors based on a comprehensive
plan of care
– Manages the transitions across care settings
– Manages by incorporating elements of coaching to
foster behavior change
22. Matching Services to Meet the
Patient’s Need
High Acuity Care
Coordination
Patient and or family
High Moderate require coordinator
Acuity Care assistance for navigation.
Coordination Co-morbidities requiring
Patient and or family clinical intervention.
navigate for self but Requires assistance with
Moderate Acuity require coordinator post discharge needs
Coaching assistance. Co- daily or even multiple
morbidities requiring times a day. Frequent
Navigates for self or exacerbations may be
has a caregiver that clinical intervention.
Requires assistance prolonged. End stage
navigates minimally disease.
for patient. Co- with post discharge
morbidities stable. needs 3 or more times
Low Acuity Requires assistance a week. Frequent
Coaching up to 2-5 times a week exacerbations may be
with post discharge prolonged.
Navigates for self care needs.
or has caregiver Exacerbation
that navigates expected to resolve
minimally for the short term
patient. Co-
morbidities stable.
Independent to
minimal assistance
with care needs.
23. Coordinated Care is Safe, Efficient
and Cost Effective
• Care Coordination results in
• Behavior modification long-term sustainability
• Provider adoption of evidence based practice
guidelines
• Reduced cost and increased quality of care for
the patient, payor, provider and the community
• Population management when supported by
technology and customized reporting
24. Technology Links to Care
Coordination
• Technology enhances care coordination by
providing
– Organization
– Efficiency
– Structure
– Process flow
– Care Maps
– Quality and consistency
– Reporting
29. Things to consider
– Common Pitfalls
• Staffing
• Program design and integration
• Information transfer
• Real time data availability
• Training and operations
• Population management
Don’t expect different results if you do the same
thing and just call it something different.
30. “We did the best we could, with what we knew,
and when we knew better, we did better.”
- Maya Angelou