Phones,
Forms
RN:
Assessments
Social
Worker
Front Desk:
Check-in,
Check-out
Pharmacist
HIV Medical Homes Resource Center
Team-Based Care Workflow
Preventive
Med
Intervention
Chronic
Disease
Monitoring
Medication
Refill
New Acute
Complaint
Test Results
Provider
Healthcare
Support
Team
Case
Manager
Mental Health
Provider
Referral to
Specialist
after
Assessment
Certified
Medical
Assistant
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay.
Reducing Readmissions and Length of Stay | VITAS HealthcareVITAS Healthcare
Pain management is first and foremost in a hospice patient’s plan of care. Hospice provides comfort and quality of life near the end of life, and hospice providers are experts at managing pain. The goal of this webinar is to help healthcare professionals understand all aspects of a patient’s pain as a symptom near the end of life, and how to utilize an interdisciplinary approach to provide the most effective pain management.
The goal of this webinar is to help hospice and healthcare professionals understand the history, philosophy and practice of hospice care and palliative care, including common myths and misconceptions, common diagnoses for hospice referrals, identification of hospice-eligible patients, reimbursement for hospice services, and the benefits of advance care planning and early referrals.
This research paper outlines the idea of cost-effective health care, which minimizes 'unnecessary' patients tests and procedures that do not improve patient outcomes. The analysis focused on examining current trends in cost-effective health care, the rise of modern medical technologies involved in cost-effective health care, and the benefits of the U.S. implementing a cost-effective health care system. Mrs. McCallister and Dr. Pahwa were instrumental in the formation of this paper.
The goal of this webinar was to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay.
Reducing Readmissions and Length of Stay | VITAS HealthcareVITAS Healthcare
Pain management is first and foremost in a hospice patient’s plan of care. Hospice provides comfort and quality of life near the end of life, and hospice providers are experts at managing pain. The goal of this webinar is to help healthcare professionals understand all aspects of a patient’s pain as a symptom near the end of life, and how to utilize an interdisciplinary approach to provide the most effective pain management.
The goal of this webinar is to help hospice and healthcare professionals understand the history, philosophy and practice of hospice care and palliative care, including common myths and misconceptions, common diagnoses for hospice referrals, identification of hospice-eligible patients, reimbursement for hospice services, and the benefits of advance care planning and early referrals.
This research paper outlines the idea of cost-effective health care, which minimizes 'unnecessary' patients tests and procedures that do not improve patient outcomes. The analysis focused on examining current trends in cost-effective health care, the rise of modern medical technologies involved in cost-effective health care, and the benefits of the U.S. implementing a cost-effective health care system. Mrs. McCallister and Dr. Pahwa were instrumental in the formation of this paper.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
Hospitals are charged with the dual task of keeping patients well while also keeping patients safe. The two are inextricably linked, as patient safety concerns often tie directly into patient health concerns — hand hygiene, transitions of care and medication errors are a few such concerns that come to mind.Looking prospectively, these concerns, and many others, will flow into the next calendar year. Some of the patient safety issues are long established, and will remain in the forefront of healthcare's mind for years to come. Here, in no particular order, are 10 important patient safety issues for providers to consider in the upcoming year.
A Change in Behavior: Delirium, Terminal Restlessness, or Dementia, A Pragmat...VITAS Healthcare
This webinar leverages evidence-based data to help physicians and healthcare professionals differentiate delirium, terminal restlessness and dementia-related agitation in patients as they near the end of life.
Written by Adele Allison, National Director of Government Affairs, SuccessEHS.
The shape of the U.S. health care industry is changing every day, and this presentation sheds light on some interesting statistics including Primary Care Providers, The American Patient, Health Care and the U.S. Economy and more.
The goal of this webinar was to help hospice and healthcare professionals understand the ethics and application of artificial nutrition and hydration (ANH) for patients near the end of life.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
The clinical case study of a patient with advanced COPD who has multiple comorbid conditions and develops sepsis provides the backdrop for two potential clinical pathways—sepsis and post-sepsis syndrome—and explores the natural history and indicators of poor prognosis in both conditions.
Robert A.S. Suntay
Robert Abad Santos Suntay is the co-founder and managing director of Carewell – the Cancer Resource and Wellness Community Foundation, Inc. Carewell is a volunteer-driven, non-stock, non-profit organization that provides support, education, and most important: hope – to persons with cancer and their loved ones.
Carewell provides psycho-social support resources and programs that enable all persons affected by cancer to cope more successfully with the myriad demands of the illness. Carewell offers support groups and counseling, medical consults and referrals, wellness and fun activities, talks and seminars, and access to information and support from around the world thanks to The Cancer Support Community – a global network of cancer support organizations of which Carewell is a member.
Prior to his involvement at Carewell, Bobbit Suntay was a longtime educator. He was formerly the high school principal of Xavier School, and an assistant professor of education and managing director of the Ateneo de Manila University Center for Educational Development. He is currently a board member of The Beacon School, The Beacon Academy, and The Principals’ Center at Harvard University.
Patient-Centered Medical Home: The Call to ActionGreenway Health
The Patient-Centered Medical Home (PCMH) is becoming widely acknowledged as the key to health care reform. Learn about the history and impetus behind this care delivery model, the ways in which it can strengthen the physician-patient relationship b moving from episodic care to coordinated care and the potential for increased reimbursements as an NCQA-certified PCMH.
National Drug Early Warning (NDEWS) webinar: A more dangerous heroin: Emergin...Dan Ciccarone
This presentation, to an international web audience, was presented alongside one by Dr Wilson Compton, Deputy Director of the National Institute on Drug Abuse. Sponsored by NDEWS, it explores the structural reasons for the emerging heroin overdose epidemic and ways to address it.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
Hospitals are charged with the dual task of keeping patients well while also keeping patients safe. The two are inextricably linked, as patient safety concerns often tie directly into patient health concerns — hand hygiene, transitions of care and medication errors are a few such concerns that come to mind.Looking prospectively, these concerns, and many others, will flow into the next calendar year. Some of the patient safety issues are long established, and will remain in the forefront of healthcare's mind for years to come. Here, in no particular order, are 10 important patient safety issues for providers to consider in the upcoming year.
A Change in Behavior: Delirium, Terminal Restlessness, or Dementia, A Pragmat...VITAS Healthcare
This webinar leverages evidence-based data to help physicians and healthcare professionals differentiate delirium, terminal restlessness and dementia-related agitation in patients as they near the end of life.
Written by Adele Allison, National Director of Government Affairs, SuccessEHS.
The shape of the U.S. health care industry is changing every day, and this presentation sheds light on some interesting statistics including Primary Care Providers, The American Patient, Health Care and the U.S. Economy and more.
The goal of this webinar was to help hospice and healthcare professionals understand the ethics and application of artificial nutrition and hydration (ANH) for patients near the end of life.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
The clinical case study of a patient with advanced COPD who has multiple comorbid conditions and develops sepsis provides the backdrop for two potential clinical pathways—sepsis and post-sepsis syndrome—and explores the natural history and indicators of poor prognosis in both conditions.
Robert A.S. Suntay
Robert Abad Santos Suntay is the co-founder and managing director of Carewell – the Cancer Resource and Wellness Community Foundation, Inc. Carewell is a volunteer-driven, non-stock, non-profit organization that provides support, education, and most important: hope – to persons with cancer and their loved ones.
Carewell provides psycho-social support resources and programs that enable all persons affected by cancer to cope more successfully with the myriad demands of the illness. Carewell offers support groups and counseling, medical consults and referrals, wellness and fun activities, talks and seminars, and access to information and support from around the world thanks to The Cancer Support Community – a global network of cancer support organizations of which Carewell is a member.
Prior to his involvement at Carewell, Bobbit Suntay was a longtime educator. He was formerly the high school principal of Xavier School, and an assistant professor of education and managing director of the Ateneo de Manila University Center for Educational Development. He is currently a board member of The Beacon School, The Beacon Academy, and The Principals’ Center at Harvard University.
Patient-Centered Medical Home: The Call to ActionGreenway Health
The Patient-Centered Medical Home (PCMH) is becoming widely acknowledged as the key to health care reform. Learn about the history and impetus behind this care delivery model, the ways in which it can strengthen the physician-patient relationship b moving from episodic care to coordinated care and the potential for increased reimbursements as an NCQA-certified PCMH.
National Drug Early Warning (NDEWS) webinar: A more dangerous heroin: Emergin...Dan Ciccarone
This presentation, to an international web audience, was presented alongside one by Dr Wilson Compton, Deputy Director of the National Institute on Drug Abuse. Sponsored by NDEWS, it explores the structural reasons for the emerging heroin overdose epidemic and ways to address it.
This presentation was given on April 7, 2014 as part of FMCC 2014. Andrew Bazemore, MD, MPH serves as the Director of the Robert Graham Center for Policy and p[provided an update on studies in family medicine and primary care.
Slides from a talk at Ryerson University Health Service Management program's 1st Annual Symposium by Dr. Michael Rachlis.
Reproduced here with permission
Peter L. Slavin, M.D., 2015 Leadership in Academic Medicine Lectureuabsom
Peter L. Slavin, M.D., president of Massachusetts General Hospital, presented “The Future of Academic Medicine” on Thursday, Aug. 6 as the featured speaker for the 2015 Leadership in Academic Medicine Lecture, sponsored by UAB Medicine.
The goal of this webinar was to educate healthcare professionals about advance directives and advance care planning,
including the types and purposes of legal documents that govern patients’ decisions and
preferences.
Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14Douglas Green
Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
Blazing New Trails: Shifting the Focus on Alcohol and Drugsnashp
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Authors: Barbara Cimaglio, Sally Fogerty, BSN, M.Ed., John C. Higgins-Biddle, Ph.D.
Health Care: Understanding the Future, a Canadian Perspective by Carolyn Benn...neelumaggarwal
In April of 2010, the Canada US Business Council (formerly the Canadian Club of Chicago), hosted Dr. Carolyn Bennett, Liberal Critic for Health, Parliament of Canada. This talk gave the Canadian perspective on health care in addition to showing the similarities and differences between the two health care systems.
The goal of this webinar was to educate healthcare professionals about advance directives and advance care planning, including the types and purposes of legal documents that govern patients’ decisions and preferences.
Edwina Rogers, executive director of Patient-Centered Primary Care Collaborative, began her presentation by highlighting the movement to advance medical homes.
With the U.S. being the number one in the world for the cost of healthcare and ranked number 37 in the quality category, something needs to change. Rogers discussed the broad stakeholder support and participation for the movement, as well as the incredible volunteer involvement. The four ‘centers’ include: the Center to Promote Public-Payer Implementation, the Center for Multi-Stakeholder Demonstration, the Center for eHealth Information Adoption and Exchange and the Center for Health Benefit Redesign and Implementation. Medical Homes will provide superb access to care, patient engagament in care, clinical information systems, care coordination, team care, patient feedback and publically available information.
Edwards explained that the Obama administration believes the medical homes concept is the best way to approach healthcare reform. The U.S. House of Representatives has showed great support for the movement and is helping develop and allocate funds for a five-year pilot program. She expressed her enthusiasm for the movement and her prediction that the medical home model is certainly the future of health care.
A complete version of Rogers’ presentation on the Patient-Centered Primary Care Collaborative is available online.
Mobile Health at Ochsner: The Apple HealthKit and Epic EMR IntegrationRahlyn Gossen
These slides are from the April 2, 2015 meeting of Health 2.0 New Orleans with special guest Jonathan Wilt, the Assistant Vice President of the Center for Innovation at Ochsner Health System. Jonathan spoke about Ochsner's Health System's integration of Apple HealthKit with the Epic EMR.
Audio is here: http://www.youtube.com/watch?v=UsSKui7m4VY
2 8 5L e a r n I n g o b j e c t I v e sC H A P T E R.docxlorainedeserre
2 8 5
L e a r n I n g o b j e c t I v e s
C H A P T E R 1 0
Q U A L I T Y M A N A G E M E N T I N
T H E P H Y S I C I A N P R A C T I C E
Quality and reliability are system properties.
—W. Edwards Deming
➤ Articulate the nature of performance management.
➤ Describe the approaches to performance improvement.
➤ Appreciate the impact of variation on performance.
➤ Discuss the components of the Triple Aim.
➤ Describe process improvement.
In t r o d u c t I o n
One of the most important issues to address in the medical practice is the quality and
safety of the care provided to patients. The Institute of Medicine (IOM 2001), a presti-
gious branch of the National Institutes of Health, stated in its landmark report Crossing the
Quality Chasm: A New Health System for the 21st Century, “In its current form, habits, and
environment, American health care is incapable of providing the public with the quality
health care it expects and deserves.”
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EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 4/16/2020 7:48 PM via SUNY CANTON
AN: 1839064 ; Wagner, Stephen L..; Fundamentals of Medical Practice Management
Account: s8846236.main.ehost
F u n d a m e n t a l s o f M e d i c a l P r a c t i c e M a n a g e m e n t2 8 6
Another historic IOM (2000) report, To Err Is Human: Building a Safer Health
System, indicated that a shocking number of people—an estimated 44,000 to 98,000 per
year—are harmed by the healthcare system. A more recent study found that this number
has increased since publication of the 2000 IOM report despite substantial efforts to
improve. Medical errors have now become the third leading cause of death in the United
States (Makary and Daniel 2016).
The complexity of medical service and the inconsistency with which these services
are delivered, not to mention the fragmented nature of the system, have led to a number
of quality concerns (Mosadeghrad 2014), including a lack of systematic approaches to care
delivery and quality improvement. Efforts to improve quality in the medical profession
have a long tradition of focusing on individual performance versus system performance.
Exhibit 10.1 illustrates the potential flaw in this thinking. The bell-shaped curve, P-1,
represents the overall performance of any given system. Curve P-2 illustrates an improved
system of performance where the median performance is moved from M-1 to M-2. If an
organization seeks to improve by only focusing on the low performers, it experiences only
a small improvement, shown as I-1. By improving th ...
The Value Proposition of Hospice | VITASVITASAuthor
The goal of this webinar was to help hospice and healthcare professionals discover the evidence-based benefits of hospice care, while gaining key insights on hospice eligibility guidelines, how hospice differs from other types of care, and how the Medicare Hospice Benefit helps patients facing advanced illness.
Similar to HIV and Primary Care Transformation baltimore 5 21 (20)
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
HIV and Primary Care Transformation baltimore 5 21
1. HIV and Primary Care
Transformation: RWCA and the
PCMH
Steve Bromer, MD
Department of Family and Community
Medicine
UCSF
2. Goals
Why does the US healthcare system need the
PCMH?
Why should RWCA clinics transform into
PCMHs?
What is the PCMH model and how close are
RWCA clinics to it?
3. ARS: What role do you play in your clinic?
Provider (Physician or Mid-level)
Medical Assistant
Front Office
Administrator
RN
Social Worker
Pharmacist
Other
4. ARS: My practice setting
Primary Care Practice with HIV Care referred
out
Primary care practice with integrated HIV
program
HIV Specialty Practice with integrated primary
care
HIV Specialty Practice with Primary Care
referred out
5. ARS: Choose the reason
A. To learn more about the Patient Centered Medical
Home (PCMH) as a way to transform our practice
B. To learn more about the details of becoming
accredited/recognized as a PCMH
C. My boss made me come and Baltimore is a cool
city
D. To learn about how concepts from the PCMH apply
to multiply diagnosed populations
6. ARS: Choose the statement you agree with
most:
HIV patients need excellent HIV specialty care and
primary care is not as important for good outcomes
HIV patients need excellent primary care and the
HIV specialty care is not as important for good
outcomes
Both HIV Specialty care and primary care are
important for good outcomes
With today’s medications, HIV patients will do well
regardless of the quality of their healthcare
7.
8.
9.
10. Mortality Amenable to Health Care
Deaths per 100,000 population*
1997/98
150
2002/03
130
116
109
99
100
76
81
88
84
89
89
97
71
71
74
74
77
80
82
84
93
96
128
115
113
97
88
50
65
90
115
106
134
82
84
101
103
103
104
Fr
an
ce
Ja
p
Au an
st
ra
lia
Sp
ai
n
Ita
Ca ly
na
d
No a
Ne
r
th way
er
la
n
Sw d s
ed
e
Gr n
ee
c
Au e
s
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rm
an
y
Fi
Ne
n
w la nd
Ze
al
De and
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nm
ite
d
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ng
do
m
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la
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r
ite tug
a
d
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at
es
0
* Countries’ age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections.
Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health
Organization mortality files (Nolte and McKee 2008).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008.
110
11. Abundant research evidence indicates that
health systems and regions with a strong
foundation of primary care have:
Better population health outcomes
Better quality of care
More preventive care
Lower costs
More equitable care and mitigation of health
disparities
12. Primary Care Strength and Premature Mortality in 18
OECD Countries
10000
PYLL
Low PC Countries*
5000
High PC Countries*
0
1970
1980
Year
1990
2000
*Predicted PYLL (both genders) estimated by fixed effects, using pooled cross-sectional time series design. Analysis controlled
for GDP, percent elderly, doctors/capita, average income (ppp), alcohol and tobacco use. R 2(within)=0.77.
Source: Macinko et al, Health Serv Res 2003; 38:831-65.
15. A Functional Definition of
Primary Care:
Barbara Starfield Framework
first Contact
Comprehensive
Continuity
Coordination
16. But the Primary Care Foundation
in the US is Crumbling
Plummeting numbers of
new physicians entering
primary care and
burnout among PCPs
Growing problems of
access to primary care
and “medical
homelessness”
Dysfunctional systems
that are not delivering
the goods in primary care
17. ARS: Approximately what percentage of
adults report difficulty getting a prompt
appointment, phone advice, or
night/weekend care without going to the
ER?
10%
25%
50%
75%
90%
18. ARS: What is the average time before
patients are interrupted when making
initial statements to their primary care
physician?
2 seconds
23 seconds
58 seconds
98 seconds
120 seconds
19. ARS: What percentage of patients leave the
office visit without understanding what
their physician said?
10%
25%
50%
75%
90%
20. Poor clinician/patient relationships
73% of adults surveyed reported difficulty getting a
prompt appointment, phone advice, or
night/weekend care without going to the ER.
Public views on of US health system organization, Commonwealth Fund, 2008
23 seconds: Average time before patients were
interrupted when making initial statement of their
problem to their primary care physician.
Marvel et al. JAMA 1999;281:283
50% of patients leave the office visit without
understanding what their physician said.
Schillinger et al. Arch Intern Med 2003;163:83
20
21. ARS: What percentage of people in the US
with HTN are poorly controlled?
10%
25%
50%
75%
90%
22. Inconsistent Quality
• What percent of people in the US have poorly
controlled
Hypertension?
Diabetes?
Cholesterol?
25%, 50%, 75%??
50% of people with hypertension, 80% of people
with high cholesterol, 43% of people with diabetes
are poorly controlled.
Egan et al. JAMA 2010; 303(20):2043-2050, Ford, Internat’l J Cardiol 2010;140:226, Cheung et
al. Am J Med 2009;122:443
23. The problem: panel sizes too large for
primary care physicians to manage alone
A primary care physician with an panel of 2500
average patients will spend 7.4 hours per day
doing recommended preventive care.
Yarnall et al. Am J Public Health 2003;93:635
A primary care physician with an panel of 2500
average patients will spend 10.6 hours per day
doing recommended chronic care.
Ostbye et al. Annals of Fam Med 2005;3:209
Average panel size in the US is 2300 patients
Alexander et al. J Gen Intern Med 2005; 20:1079-83.
23
24. Recognition That Reform and Revitalization of
Primary Care is Essential for ACA and Health Care
Reform to Achieve Its Goals
25. The President
Wants
More and Stronger
Primary Care
“It used to be that most of us had a family doctor; you would
consult with that family doctor; they knew your history, they
knew your family, they knew your children, they helped deliver
babies. How do we get more primary physicians, number one;
and number two, how do we give them more power so that
they are the hub around which a patient-centered medical
system exists, right? ” June 8, 2010, Town Hall with Seniors
26. Senator Orrin Hatch
Senate Finance Committee Roundtable
Reforming America’s Health Care Delivery System
April 21, 2009
“The US is first in providing
rescue care, but this care has
little or no impact on the
general population. We must
put more focus on primary
care and preventive medicine.
How do we transform the
system to do this?”
27. Randy MacDonald, Sr VP
House Ways and Means Hearing April 29, 2009
“I will start with the very last question asked by the
committee--what is the single most important thing to fix in
healthcare? Primary care. Strengthen primary care -transform it and pay differently using a model like the
Patient Centered Medical Home.”
Congressman: “And the second issue?”
“Well, if you don't fix the first issue and do not have a
foundation of powerful primary care then you can do
nothing else. You have to fix primary care before you can
even begin to address a second issue.”
28. A 20 th Primary Care
Model Will Not Meet
the Demands of 21 st
Century!
29. Ryan White: an Unintentional Home Builder
“An unintended consequence…. of the RW Care
Act has been the establishment of the
comprehensive delivery of multiple services for
patients with a complex disease….medical
homes for the HIV-infected person…..”
“The act created in his (Ryan White’s) memory,
unintentionally created medical homes that are
the best examples of how all of us should receive
primary care.”
Saag, M. The AIDS Reader, April 24, 2009
31. Workforce The Looming Crisis in HIV Care:
Who Will Provide the Care?
“In a survey conducted by HIVMA and the
Forum for Collaborative HIV Research, a
majority of Ryan White Part C-funded
programs reported increasing caseloads and
serious challenges recruiting and retaining
HIV clinicians.
Reimbursement and a lack of qualified
providers were the top two barriers cited.”
HIV Medicine Association, 2010
32. ARS
Workforce: How long have you worked in the
HIV/AIDS field?
1. This is my first year
2. 1-5 years
3. 5-10 years
4. 10-15 years
5. 15-20 years
6. More than 20 years
34. Engagement in HIV Care
Vital Signs: HIV Prevention Through Care and Treatment -- United States. MMWR December 2,
2011/60(47);1618-1623
HIV Medical Homes Resource Center
35. Will a 20 th Century
Model of HIV Care
Meet the Demands of
the 21 st Century
Epidemic?
36. Joint Principles of the Patient Centered
Medical Home
February 2007
American Academy of Family Physicians
American Academy of Pediatrics
American College of Physicians
American Osteopathic Association
37. Transforming the Delivery of
Primary Care:
The Patient Centered Medical Home
Ongoing Relationship with
provider for first-contact,
continuous, and comprehensive
care;
Health Care Team that
collectively cares for the patient;
Whole-person Orientation,
including acute, chronic,
preventive, and end-of-life care;
Coordinated Care across all
elements of the health care
system and the patient’s
community;
38. Transforming the Delivery of
Primary Care:
The Patient Centered Medical Home
Quality and Safety through
evidence-based medicine and clinical
decision-support tools, information
technology, registries, and
continuous quality improvement;
Enhanced Access, achieved
through such systems as open
scheduling, expanded hours, and
new options for communication
between patients, their physician,
and practice staff; and
Payment Reform to reflect the
added value that a PCMH provides to
patients.
40. Evidence on Value of New Primary Care Models:
Case Study of
Group Health Cooperative of Puget Sound
Patient Centered Medical Home model piloted at
one site in 2007
Avg PCP panel size reduced from 2327 to 1800
Longer face-to-face visits and scheduled time for
phone and email encounters
Increased team staffing and teamwork
HIT
Panel management
41. Group Health PCMH Pilot:
Controlled Evaluation 12 Month Outcomes
Improved continuity of care
Better patient experiences (6 of 7 measures)
Better composite quality of care score
Reductions in ED visits and Ambulatory Care
Sensitive Hospitalizations
No difference in total costs at year 1 (lower total
costs by year 2)
Source: R Reid et al. Am J Managed Care 2009;15:e71
42. Group Health PCMH Pilot:
Effect on Clinic Staff
40%
34.5%
35%
Percent with High
Level Emotional
Exhaustion
33.3%
p=.02
30.0%
30%
25%
Baseline
20%
12 Months
15%
9.7%
10%
5%
0%
Control Sites
PCMH Site
43.
44. Change Concepts for the PCMH
Engaged Leadership
Quality Improvement Strategy
Empanelment
Continuous and Team-based Healing Relationship
Organized, Evidence-Based Care
Patient-Centered Interactions
Enhanced Access
Care Coordination
Wagner, EH et al, Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical
Homes; February, 2012
45. The Building Blocks of High-Performing
Primary Care: lessons from the field
23 high-performing practices
Intensive visits to 7 West Coast practices
Discussions with and observations of
clinicians, RNs, MAs, front desk, leaders
High-performing practices look about the
same, with variation in the details
10 building blocks -- the foundation of these
practices
Willard R, Bodenheimer T: CHCF April 2012
47. Change Concepts
Building Blocks
NCQA Recognition
Engaged Leadership
Data for Improvement
Enhance Access/Continuity
Quality Improvement
Strategy
Empanelment, Panel size
management
Identify/Manage Patient
Populations
Empanelment
Team-based Care
Plan/Manage Care
Continuous and Team-based
Healing Relationships
Population Management
Provide Self-Care
Support/Community
Resources
Organized Evidence-based
Care
Continuity of Care
Track/Coordinate Care
Patient-Centered Interaction
Prompt Access to Care
Measure/Improve
Performance
Enhanced Access
Expanded Access Template
Care Coordination
Mission with objectives and
goals
Care coordination with
Medical Neighborhood
Trained Leaders
48. DATA/Quality Improvement Strategy
Formal QI process
Defined metrics
Optimized HIT
Robust data collection
Reporting systems to
share data
Strategic decisions
about metrics
HIV Medical Homes Resource Center
Are we Data Driven
organizations?
Do we use real-time
data on important
clinical/operational
data to guide day-today actions?
Grant requirement to
have CQI, robust
metrics, early adopter
of registry, variable
HIT capacity
49. Empanelment
Assign all patients to
provider panel
Balance supply and
demand
Use panel data to
manage population
Prioritizes patients
seeing own PCP
Clear
denominator at
panel level
HIV Medical Homes Resource Center
Is empanelment a
deliberate process
where we can use
provider panels for
quality data , proactive
care and to actively
manage supply and
demand?
Empanelment not
specific grant
requirement, often
happens because of
structure of practice
50. Team-Based Care
Are our teams organized
around getting the work
done with an explicit
vision and clear
principles? With defined
workflows, skills training
and ground rules?
Patients are connected
to a Care Team
Roles/tasks defined
Culture shift to
share-the-care.
Flexible, functional
teams, with clearly
defined roles
HIV Medical Homes Resource Center
Multi-disciplinary
Teams are central to
RWCA
52. 4. Team-based Care
Why does teambased care matter?
Align roles to meet
population needs
Non-clinician teammembers contribute to
continuous healing
relationship
Build capacity to make
timely access possible
Foundation for the
Template of the future
53. Traditional Methods of Managing Work Flow
Preventive
Med
Intervention
Chronic
Disease
Monitoring
Medication
Refill
New Acute
Complaint
Test Results
Provider
Healthcare
Support
Team
Case
Manager
Mental Health
Provider
Referral to
Specialist
after
Assessment
Certified
Medical
Assistant
54.
55.
56. Team-based care
• Culture shift: share the care
Stable teamlets
• Co-location
Staffing ratios
Standing orders/protocols
• Defined workflows and roles – workflow mapping
• Training, skills checks, and cross training
• Ground rules
• Communication – healthy huddles, terrific team
meetings and constant conversation
57. Team-based care: stable teamlets
Patient
panel
Clinician/MA
teamlet
Patient
panel
Clinician/MA
teamlet
Patient
panel
Clinician/MA
teamlet
Health coach, behavioral health professional, social
worker, RN, pharmacist, panel manager, complex care
manager
1 team, 3 teamlets
58. Prompt Access to Care
24/7 access to care
team, patient-centered
scheduling
options, address
barriers to access
Balance supply and
demand, open access,
multiple channels of
access
HIV Medical Homes Resource Center
Do we have a patientcentered approach to
access?
After hours
coverage, +/- use of
advanced access tools
60. Population Management/Panel
Management
Plan care according to
need, manage high-risk
patients, point-of-care
reminders
Robust population
management, Selfmanagement,
Complex Case
management, planned
visits
HIV Medical Homes Resource Center
Are we able to focus at
the population level and
proactively assign
resources where
needed? Is data used in
day-to-day care?
Case Management key
feature of RWCA, client
level data, selfmanagement support
61. Care Coordination
Link patient with
community
resources, referral
tracking, coordination of
specialty care
Management of care
transitions, behavioral
health services,
communication of
results
HIV Medical Homes Resource Center
How good are we at
managing the care that
happens outside of our
four walls?
Comprehensive
model of care, often
under one-roof,
expectation that
transitions are
tracked
64. Summary
Both Primary Care and the RWCA are at a
crossroad
PCMH is one model of transformation
RWCA clinics have many components of PCMH
There is much to learn from PCMH model and
high performing primary care
Our health care system will have to change to
meet our goal of an AIDS Free Generation
HIV Medical Homes Resource Center
65. Roadmap for Medical Home Resource Center
PCMH concepts in
RWCA Clinics– Action
Planning
Change Management of
Improvement
Opportunities
PCMH Certification
Strategic Planning Workshops
TA and Virtual Learning Community for practice change
TA to support certification
Year 1
Year 2
Year 3
Editor's Notes
Steve: It is going to help us to tailor our presentation by getting some demographic information on you and your practice setting. We have two questions
There are many ways to tell a story. In medicine we like these kind of picture, a bar graph with data points, but there are many ways to represent reality. This represents a picture of an unsustainable health care system one that is undermining the economy, So if you had to choose a picture of what this represents, What would it be, a more graphical image to represent this reality, the picture created by this data – what would it be?
This graph compares our costs to other industrial countries. This is per capita spending, almost twice what other countries spend. Maybe we are a rich country so that is ok but then the percent of GDP should be the same – iit isn’t again almost twice what other similar countries spend.
This adds up to 18 hours. Yikes. That doesn’t include acute care: like when you have the flu, a broken bone, etc. Or lunch.
Back in 2009 MichaelSaag wrote this in a beautiful article in the AIDS reader We have built many of the components of a Medical Home. Easy to say – oh yes, we do that, and we do that. We need to be proud of the good work we do. Can we do better? Do we have the components of a house, to extend the metaphor, without the fitting together to make a home? One of the issues we have struggled with in developing the resource center is the balance between supporting transformation of your practices along the lines of the MH vs, the support needed to certify as a PCMH. What I would like you to do for the next 20 minutes is to focus on transformation of your practice, identifying area for improvement
So lets take the change concepts from Ed Wagner and compare them side by side with requirements of RWCA grantees
Our building blocks to high performing primary care were developed as a roadmap to guide practices during transformation. Transforming to a primary care medical home requires more than checking boxes and capturing screen shots. After over 20 unique site visits to high performing practices in the United States, we saw strikingly similar practices that we were able to identify through data collection, observations, and interviews with leaders, clinicians, pharmacists, and staff including nurses, medical assistants, and clerks. Our analysis revealed recurring themes - structures, systems and practices that were shared across sites. It is from these shared practices that we developed the building blocks of high performing care.
This is a busy slide and not meant to be read , I am using it to make a point about medical home concepts– I have listed the key concepts for the PCMH from several sources. The first are the Change Concepts by Ed Wagner, The second column is the building block identified in Tom Bodenheimer’s article and the third