Presentation by Kirby Farrell, President and CEO, Broad Axe Technology Partners and Andy Archer, MSc, MBA, Vice President, Broad Axe Technology Partners
Presentation by Bonnie Britton, MSN, RN, ATAF Telehealth Program Administrator, Vidant Health and Seth VanEssendelft, Vice-President for Financial Services, Vidant Medical Center
In this webinar, you will learn:
How we approach intervention campaigns: a framework
The science of behavior change and how it can be applied to increase the probability of desired outcomes
How Altarum’s ACE Measure can help predict consumer behaviors and design successful intervention campaigns
Speakers:
Ryan Rossier, Medullan
Chris Duke, Altarum
Josh Klapow, ChipRewards
The Importance of Paid Search In Omnichannel CampaignsMediaPost
Highmark Health is focused on building the health care of the future through technology and a variety of media such as search, television and radio. In fact radio’s influence is more pronounced for how it drives prospects to search, which in turn leads to completed appointments. Join Erin Mcglynn, senior digital marketing analyst at Highmark Health, as she walks through how the company uses multiple channels to help increase new patient appointments.
Presentation by Mike Brett, MD, Medical Director for LIFE Programs, Lutheran Senior Life and Kelly Besecker, Vice President, Sales & Marketing, A-Frame Digital
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.
The Population Health Management Market 2015Lifelog Health
Population health management is a problem term because it can mean something different to each person who hears it. However, I believe that the words capture the overall spirit and energy of healthcare reform in a unique way. Providers are thinking big when it comes to a patient’s engagement, responsibility, and preventative care, and they’re leveraging technology to do it. I discuss an overall picture of PHM, present some useful technology, and tell a few PHM stories herein.
Gamification as a means to manage chronic diseaseEngagingPatients
UPMC is exploring ways to better engage patients through shared decision making and new approaches to encourage patients and their families to take control of their health. This presentation describes a pilot program UPMC has initiated to leverage gamification as a means to manage chronic heart failure.
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
A campaign that started with a trade ad that enticed doctors, nurses and recipients to visit a landing page offering vital information about Medtronic and its work with the American Heart Association. This was all part of an email campaign that was deemed a success. The response and open rates turned out to be much higher than industry averages.
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.
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
Presentation by Kirby Farrell, President and CEO, Broad Axe Technology Partners and Andy Archer, MSc, MBA, Vice President, Broad Axe Technology Partners
Presentation by Bonnie Britton, MSN, RN, ATAF Telehealth Program Administrator, Vidant Health and Seth VanEssendelft, Vice-President for Financial Services, Vidant Medical Center
In this webinar, you will learn:
How we approach intervention campaigns: a framework
The science of behavior change and how it can be applied to increase the probability of desired outcomes
How Altarum’s ACE Measure can help predict consumer behaviors and design successful intervention campaigns
Speakers:
Ryan Rossier, Medullan
Chris Duke, Altarum
Josh Klapow, ChipRewards
The Importance of Paid Search In Omnichannel CampaignsMediaPost
Highmark Health is focused on building the health care of the future through technology and a variety of media such as search, television and radio. In fact radio’s influence is more pronounced for how it drives prospects to search, which in turn leads to completed appointments. Join Erin Mcglynn, senior digital marketing analyst at Highmark Health, as she walks through how the company uses multiple channels to help increase new patient appointments.
Presentation by Mike Brett, MD, Medical Director for LIFE Programs, Lutheran Senior Life and Kelly Besecker, Vice President, Sales & Marketing, A-Frame Digital
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.
The Population Health Management Market 2015Lifelog Health
Population health management is a problem term because it can mean something different to each person who hears it. However, I believe that the words capture the overall spirit and energy of healthcare reform in a unique way. Providers are thinking big when it comes to a patient’s engagement, responsibility, and preventative care, and they’re leveraging technology to do it. I discuss an overall picture of PHM, present some useful technology, and tell a few PHM stories herein.
Gamification as a means to manage chronic diseaseEngagingPatients
UPMC is exploring ways to better engage patients through shared decision making and new approaches to encourage patients and their families to take control of their health. This presentation describes a pilot program UPMC has initiated to leverage gamification as a means to manage chronic heart failure.
Michigan Hospital Association Governance meetingMary Beth Bolton
Patient centered medical home activities in MI and Nationally and the opportunity to improve quality outcomes by increased access to primary care doctors who outreach members who are missing preventive and chronic care services.
A campaign that started with a trade ad that enticed doctors, nurses and recipients to visit a landing page offering vital information about Medtronic and its work with the American Heart Association. This was all part of an email campaign that was deemed a success. The response and open rates turned out to be much higher than industry averages.
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.
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
Background: A unique statewide multipayer initiative in Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) with diabetes as an initial target disease. it is and one of the largest PCMH multipayer
initiatives.
Results: During the first intervention year (May
2008–May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician
Practice Connections Patient-Centered Medical Home
(PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based
complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients.
Conclusions: Transforming primary care delivery through
implementation of the PCMH and CCM supported
by multipayer infrastructure
"'I am proud that MaineCare has been working in partnership with other payers to advance payment reform through greater investment in primary care to both improve outcomes for patients and reduce preventable high cost spending in emergency departments and avoidable inpatient admissions.
– Mary C. Mayhew, Commissioner, Maine Department of Health & Human Services
A new 2014 Patient-‐Centered Primary Care Collaborative
analysis found that the patient-‐centered medical home (PCMH) is having a significant impact on reducing costs
of care,unnecessary emergency department (ED) and
hospital visits, as well as increasing the provision of preventive services and improving population health. Among the report’s findings, approximately 60% of the PCMH evaluations reported decreases in cost of care or use of unnecessary/avoidable services, while approximately 30% reported improvements in population health.
Primary Care spend in the State of Rhode island and its impact on overall cost trend a report worth reading for sure
Primary care Spend in RI went up from 47 million in 2008 to 67 million in 2013
BUT !!!
Total Spend went down from 823 Million in 2008 to 661 Million in 2013
Partial and Incremental PCMH Practice Transformation: Implications for Qualit...Paul Grundy
Experience of BCBS Michigan in Building medical homes
Based on the observed relationships for partial implementation,full implementation of the PCMH model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults. Full PCMH implementation is also associated with a 12.2 percent higher preventive composite score, but no reductions in costs for pediatric populations. Incremental improvements in PCMH model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population.
Conclusions. Estimated effects of the PCMH model on quality and cost of care
appear to improve with the degree of PCMH implementation achieved and with incremental improvements in implementation.
OVERVIEW -- Care by Design - Putting Care back into healthcare the University of Utah experience in building PCMH level care over the decade of 2001 to . 2011
The Multi-StakeholderPatient Centered Medical Home - Movement For Primary Car...Paul Grundy
Paper by Paul Grundy, Senator Kay R. Hagan, AARP President Jennie Chin Hansen and UCSF Dept of Family Med chair Kevin Grumbach on the moment to transform Primary care using the joint principles of the PCMH
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
Better to Best Patient Centered Medical HomePaul Grundy
Better to best -- consensus meeting between large employers, HHS, CMS, DOD OPM, hospitals, Primary care association, AMA, healthcare plans around the elements that add value in the Patient Centered medical home. coordination of care, access to care Health information technology and payment reform.
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
Summary -- Patient Centered Medical Home the Necessary Foundation for Accountable Care and Population Management.
In the next 10 years, we will be living in 1) mobile world 2) in the middle of an aging and chronic disease epidemic and 3) data. But , we will also have the ability to analyze data in a cognitive way this will do for doctors’ minds what X-ray and medical imaging have done for their vision. How? By turning data into actionable information. Take, for instance, IBM’s intelligent supercomputer, Watson. Watson can analyze the meaning and con-text of human language and quickly process vast amounts of information. With this in-formation, it can suggest options targeted to a patient’s specific circumstances.
We need the basic foundation to support this transformation a system integrator where data at the level of a patients flows and is held accountable and that model is the Patient Centered Medical Home. (PCMH) starts to happen when clinicians/ healers step up to comprehensive relationship based care empowered by tools to manage the data and communicate effectively. This move to PCMH level care requires the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system and all of that is power by data made into meaningful information.
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
The Patient-Centered Medical Home (PCMH) lies at the center of the effort to get at population health, integrated and coordinated care. PCMH is where the Primary care healer leads an organization that delivers clinician-led primary care, with comprehensive, accessible, holistic, coordinated, evidence-based coordination and management. In the USA this is now the standard in the US Veterans Administration and the US Military and under the ACA.
Providers know that successful care coordination is key to enhancing patient outcomes and better personalizing their experience. At its root, care coordination starts with effective communication, and healthcare organizations are increasingly turning to innovative technology solutions to solve their needs. To improve their care teams’ communication, coordination, and data capture capabilities, two of New York City’s leading healthcare organizations worked with two cutting edge tech solutions providers to design and implement innovative pilots as a part of the New York Digital Health Accelerator program. Utilizing real-life case studies, the panelists will discuss the design and implementation of the pilots, and lessons learned from their participation in the program.
• Anuj Desai - Vice President of Market Development, New York eHealth Collaborative
• Joseph Mayer, MD - Founder & CEO, Cureatr Inc.
• Patricia Meisner, MS, MBA - CEO & Co-Founder, ActualMeds
• Ken Ong, MD, MPH - Chief Medical Informatics Officer, New York Hospital Queens
• Victoria Tiase, MSN, RN - Director, Informatics Strategy, NewYork-Presbyterian Hospital
New York eHealth Collaborative Digital Health Conference
November 17, 2014
Patient Engagement is more that an patient portal
Connected Health tools are available to enhance engagement
Personalization is needed to engage
How patient engagement technologies fit with population health
Helping those lacking health and digital literacy and access
The future is bright for Personal Connected Health
Key Principles and Approaches to Populaiton Health mManagement - HAS Session 21Health Catalyst
Population Health Management is in its early stages of maturity, suffering from inconsistent definitions and understanding, and is overhyped by vendors and ill-defined by the industry. And yet, many systems are moving forward in innovative pioneering ways to address this growing trend. In this session, you will hear from two very different, successful health systems: a physician-led group and a large integrated delivery system. They will share their best practices, learnings, and different approaches to population health management.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
Jeff Thompson, Washington State Health Care Authority
David Downs, Engaged Public
David Swieskowski, Mercy ACO Mercy Clinics, Inc.
Lisa Weiss, High Value Healthcare Collaborative
Kate Chenok, Pacific Business Group on Health
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
Patient-centered medical homes (PCMHs) are intended to actively provide effective care by physician-led teams, Where patients take a leading role and responsibility. Objective: To determine whether the Walter Reed PCMH has reduced costs while at least maintaining if not improving access to and quality of care, and to determine
whether access, quality, and cost impacts differ by chronic condition status. Design, setting, and patients: This study
conducted a retrospective analysis using a patient-level utilization database to determine the impact of the Walter Reed PCMH on utilization and cost metrics, and a survey of enrollees in the Walter Reed PCMH to address access to care and quality of care. Outcome measures: Inpatient and outpatient utilization, per member per quarter costs, Healthcare Effectiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communication, and customer service are included. Results: Costs were 11% lower for those with chronic conditions compared to 7% lower for those without. Since treating patients with chronic conditions is 4 times more costly than treating patients without such conditions, the vast majority of dollar savings are attributable to chronic care.
PCMH implementation, highly associated with important outcomes for both patients and providers. The rate of emergency department visits was significantly
lower in sites with more PCMH effective implementation. Efficient PCMH implementation favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services.
A systematic review of the challenges to implementation of the patient-centre...Paul Grundy
review the available literature to identify the major challenges and barriers to implementation and adoption of the patient-centred medical home (PCMH) model, topical in current Australian primary care reforms. documents the key challenges and barriers to implementing the PCMH model in United States family practice. It provides valuable
evidence for Australian clinicians, policymakers, and
organisations approaching adoption of PCMH elements
within reform initiatives in Australia.
Effective integration of specialty practices into medical neighborhoods is likely to require several important environmental precursors. First, a sound infrastructure
design can connect PCMHs to the spectrum of surrounding
specialty practices. An aligned information architecture
will be vital to adequate patient access, care coordination, and communication. Second, a patient centered
neighborhood will rely on an organizational culture that
supports shared learning and transparency of performance and cost data among participating practices. Third, payment incentives will have to be aligned around shared accountability for outcome and cost. Responsibility
for outcomes and total cost of care will have to rest not only with primary care clinicians, but also with specialists who perform(often expensive) procedures and specialty services.The launch of the NCQA’s PCSP recognition program is a sign of a new phase of delivery system reform
Care by design magill lloyd successful turnaroundPaul Grundy
The University of Utah purchased a 100-clinician, 9-practice multispecialty primary care network in 1998. The university projected the network to earn a profit the first year of its ownership in a market with growing capitation; however, capitation declined and the network incurred up to a $21 million operating loss per year. This case study describes the financial turnaround of the network.
Care by design 2 bodenheimer teams 2 utah chapterPaul Grundy
Putting Care back into healthcare the University of Utah experience in building PCMH level care. this talks about the team base experice as written up in 2007 by Tom Bodenheimer.
New zealand cantabury timmins-ham-sept13Paul Grundy
This is a great example of a community in New Zealand of the interrogation of social services and healthcare. They are changing the demand curve and getting away from “we need more and more resources to see more patients”. The language we use, very deliberately, is “right care, right place, right time”. Once you start getting the whole
system to work as one system, it starts flushing out unnecessary expenditure. So you can do more and/or do it better.’ worth a read.
I did a visit to new zealand in 2003 and did a number of talks from 2003 to 2005 on the transformation taking place in new zealand. back in NZ in 2014 so looked at those early slide so impressed with the leadership and the robust primary care
, patients reported higher overall satisfaction at a primary care practice that adopted the patient-centered medical home model along with lean process changes and physician payment reform.
.......................................................................................................
South central foundation Alaska
If you are in a mechanical manufacturing environment then hitting a target is a matter much like the throwing of a rock – figuring out speed trajectory
If you are in a messy, human, complex, adaptive environment it is like throwing a
bird at a target – it is all about the ‘attractor’
Healthcare mostly throws birds at targets and only thinks about the throwing part than wonders why the Human fails to hit the target
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
I reland feb 2014
1. The Foundation for Reenginering
Healthcare
Patient Centered Medical Home
Paul Grundy MD, MPH
IBM‘s Director Healthcare Transformation
President Patient Centered Primary Care Collaborative
2. Paul Grundy MD MPH Bio
•
•
•
•
•
•
•
•
“Godfather” of the Patient Centered Medical Home
IBM Global Director Healthcare Transformation
President of PCPCC
Member Institute of Medicine
Member Board ACGME
Professor Univ. of Utah Department Family Medicine
Winner NCQA national Quality Award
A Leader of MOH level taskforce primary care transformation 8
nations: USA, Canada, New Zealand, Australia, Holland,
Denmark, UK, Belgium,
• Univ. of California MD, John Hopkins Trained
3. Away from Episode of Care to Management of Population
Hospital
Population
Health
Per
Capita
Cost
System Integrator
Patient
Experience
Public Health
Community Health
The System Integrator
Creates a partnership across the
medical neighborhood
Drives PCMH primary care redesign
Offers a utility for population health
and financial management
4. Smarter Healthcare
36.3%
Drop in hospital days
32.2%
Drop in ER use
12.8%
Increase Chronic Medication use
-15.6%
Total cost
10.5%
Drop Inpatient specialty care costs
18.9%Ancillary costs down
15.0%Outpatient specialty down
Outcomes of Implementing Patient Centered Medical
Home Interventions: A Review of the Evidence from
Prospective Evaluation Studies in the US - PCPCC Oct 2012
5. Rural New York
• Commercial/ASO insurance cost decreased
from $380 per-patient-per-month in 2009 to
$316 in 2012
• Costs for Medicaid patients dropped from $334
to $266, according to a recent “risk adjusted”
analysis.
http://poststar.com/news/local/medical-home-program-gains-traction/article_5811380c
6. PCMH Lower Costs
Aug 5th 2013 Pennsylvania
• 44% reduction in hospital costs
• 21% reduction in overall medical costs.
• 160 PCMH practices Pennsylvania from 2008 to 12
• Number of patients with poorly controlled diabetes
declined by 45%.
Jeffrey Bendix
modernmedicine.com/
7.
8. PCMH Michigan –
Aug 11th 2013
• 19.1% lower rate of adult hospitalization.
• 8.8% lower rate of adult ER visits.
• 17.7% lower rate ER visits (children under age 17)
• 7.3% lower rate of adult high-tech radiology usage
VS other non-PCMH designated primary care
physicians.
3,017 Physicians
. Medical home physicians help patients avoid ERs
and admissions by evening hour appointments,
weekend and same-day appointments
http://www.crainsdetroit.com/article/20130811/NEWS/308119989/blue-cross-touts-155-million-in-savings-with-medical-home-project
9. WellPoint PCMH Preliminary Year 2 Highlights In Sept
Issue Health affairs 2012
•
•
15% decrease in total ER visits/1000, compared to
4% increase in control group
•
Specialty visits/1000 remained around flat
compared to 10% increase in control group
•
Colorado
18% decrease in acute IP admissions/1000,
compared to 18% increase in control group
Overall Return on Investment estimates
ranged between 2.5:1 and 4.5:1
NEW HAMPSHIRE
New York
10. Trajectory to Value Based Purchasing:
Achieving Real Care Coordination and
Outcome Measurement
Source: Hudson Valley Initiative
11. TODAY’S CARE
PCMH CARE
My patients are those who make
appointments to see me
Our patients are the population
community
Care is determined by today’s
problem and time available today
Care is determined by a proactive plan
to meet patient needs with or without
visits
Care varies by scheduled time and
memory or skill of the doctor
Care is standardized according to
evidence-based guidelines
I know I deliver high quality care
because I’m well trained
We measure our quality and make
rapid changes to improve it
Patients are responsible for
coordinating their own care
A prepared team of professionals
coordinates all patients’ care
It’s up to the patient to tell us what
happened to them
We track tests & consultations, and
follow-up after ED & hospital
Clinic operations center on meeting
the doctor’s needs
A multidisciplinary team works at the
top of our licenses to serve patients
11
Slide from Daniel Duffy MD School of Community Medicine Tulsa Oklahoma
12. • 1/3 less cardiac intervention needed
• 60% less complication Diabetes
13. FFM-2 Feb 2014
• 1. Pursue Electronic Patient Management and
engagement rather than Electronic Patient Records
• 2. Bring to bear upon every patient encounter what is
known rather than what a particular provider knows.
• 3. Make it easier to do it right than not to do it at all.
• 4. Continually challenge providers to improve their
performance.
• 5. Infuse new knowledge and decision-making tools
throughout an organization instantly.
14. • 6. Establish and promote continuity of care with
patient education, information and plans of care.
• 7. Enlist patients as partners and collaborators in
their own health improvement.
• 8. Evaluate the care of patients and populations of
patients longitudinally.
• 9. Audit provider performance based on the
Consortium for Physician Performance Improvement
Data Sets.
• 10. Create multiple case-management tools which are
integrated in an intuitive and interchangeable fashion
giving patients the benefit of expert knowledge about
specific conditions while they get the benefit of a
global approach to their total health
15. Build your own corporate PCMH
$805 $804
$765
Per Employee Per Month
Health Costs
Post Implementation
Actual client data: Midwest Hospital
with 12,135 employees 1 year selffunded for group health
17
$569
Copyright 2011 by IBM
17. Defining the Care Centered on Patient
Superb Access
to Care
Patient Engagement
in Care
Clinical Information
Systems, Registry
Care Coordination
Team Care
Communication
Patient Feedback
Mobile easy to use
and Available
Information
18. OPM Carrier Letter Feb 5th 2013
Patient Centered Medical Homes (PCMH) within the
Federal Employees Health Benefits (FEHB) Program
• A growing body of evidence supports investment in
PCMH – SO we are!!
• there must be a plan for all FEHB lives
enrolled in the practice to be included in a reasonable
timeframe.
• ACA 2334
23. MobileFirst Remote Sensing
Mobile Sensing emotion for mental health status -- analyzes facial expressions
Mobile Sensing position for asthma -- integrates GPS into inhalers
Mobile Sensing motion for Alzheimer’s -- monitoring gait
Mobile Sensing ingestion of medications. activated by stomach fluid
Mobile Sensing for sleep disorders -- tracks breath, heart rate, motion
Mobile Sensing for diabetes. continuous monitoring iPhone non invasive sensor.
Mobile Sensing for readmission prevention -- BP, weight, pulse, ekg
Mobile Sensing for exercise wellness -- benefit design feedback
24. Practice transformation away from episode of care
Master Builder
Preventive
Medicine
Chronic Disease
Monitoring
Medication
Refills
Acute Care
Test Results
DOCTOR
Master Builder
Case
Manager
Behavioral
Health
Medical
Assistants
Nursing
Source: Southcentral Foundation, Anchorage AK
25. PCMH Parallel Team Flow Design
The glue is real data not a doctors Brain
Chronic
Disease
Monitoring
Medication
Refills
Healthcare
Support
Team
Point of
Care Testing
Acute
Care
Test
Results
Case
Manager
Preventive
Medicine
Clinician
Provider
Chronic
Disease
Compliance
Barriers
Acute
Mental
Health
Complaint
Medical
Assistants
Behavioral
Health
Source: Southcentral Foundation, Anchorage AK
26. Healthcare will Transform
• Data Driven
• Every patient has a plan
• Team based
• Managing a Population
Down to the Person
27. Payment reform requires more than one method, you
have dials, adjust them!!!
“fee for health”
fee for value
“fee for outcome”
“fee for process”
“fee for belonging
“fee for service”
“fee for satisfaction”
28. New $ Dials
• Complex Chronic Care Management payment
codes. authorize payments to physicians for the
work that goes into managing complex patients
outside of their actual office visits.
• House Energy and Commerce Committee Bill
repeals SGR moving Medicare payments away
from FFS toward new, innovative models.
•
29. Benefit Redesign - Patient Engagement Different Strategies for
Different Healthcare Spend Segments
Those with
severe, acute
illness or injuries
Those with
chronic illness
% Total
Healthcare
Spend
Those who are well or
think they are well
% of Members
29
29
30. PCMH 2.0 in Action
A Coordinated
Health System
Hospitals
PCMH
Specialists
Community Care Team
Nurse Coordinator
Social Workers
Dieticians
Community Health Workers
Care Coordinators
PCMH Public Health Prevention
HEALTH WELLNESS
Public Health
Prevention
35
Health IT
Framework
Global Information
Framework
Evaluation
Framework
Operations
Copyright 2011 by IBM
31. FFM_2
• Practices Features -- - Emphasis on care coordination and
system navigation, System Integrator, PCMH role for family
physician in integrated system - Big push on population health
management - Large care teams with PCP + a variety of other
professions, e.g., nursing, pharmacy, public health and mental
health.
• Technology Use - Better population health data stemming
from centralized data based EHR through integrated system. Adoption of telemedicine, Establish Primary Care Technology
Center (PCTC), a research and training entity, to fuel adoption
of efficacious technology in practice, patient engagement tools.
Modern, flexible, sophisticated system, developed in
partnership with technology providers. -Multi-modal
communication w/ patients .
32. • Building a Workforce -- Training in the use of
population health management, data management
and public health tools - Dual degrees – MD + MBAs,
MPHs - .Add’l training in interprofessional
collaboration, EHR data usage, and integrated
practice management.
• Research Focus -- Conclusive evidence about
system wide quality improvement and cost savings of
robust primary care.- Rise of Continuum-Based
Research Networks, applied research efforts to
improve clinical pathways. - Research builds case for
reductions in Total Cost of Care (at system level),
research into technologies most inpactful on Triple
Aim. - FM becomes trusted source of best practices to
meet Triple Aim, .Focus on issues that relate to
patients owning their own health through patient
experience and engagement research
33. • Collaboration -- - Family medicine’s partnership with payers
and the integrated systems, to exchange ideas about how to
best deploy family physicians and represent their colleagues’
interests to these systems - Subspecialists – to ensure great
working relationships within systems. - Primary care
professionals – to achieve the best possible outcomes in
service of Triple Aim. Payers, particularly CMS – to ensure
success of alternative payment pilots.- Primary Care Nurse
Practitioners (to work together in pursuit of expanded role of
Primary Care, Technology manufacturers) to provide advice on
how to improve technology in use by FPs,
• Key Investments -- Curricular overhaul and research effort to
prepare residents for work in integrated systems, tools for data
being made into actionable information in population
management, advance clinical decision support
34. Reengineering for Health Care
Three types of businesses undertake reengineering:
• Those at the peak of their game & ambitious executives
• those that reengineer to stay ahead, and
• those in deep trouble.
The US health care system is in trouble, and rather than
single reforms, it needs and is getting reengineered.
• 7 days to 4 hours # of deals increased a 100 fold
JAMA - Feb 2013, Ari Hoffman, MD, Ezekiel J. Emanuel, MD, PhD
35. Benefit Redesign
• Cost 2013 $16,351 emp on ave paying $4,565
• Federal government Final Rules wellness incentives.
• Smoker --employer may increase your insurance
premiums by up to 50 percent.
• Overweight, you may look at a 30 percent surcharge.
• And employers may also reduce premiums by up to
30 percent for normal weight.
36. benefit design reference pricing
• California Public Employees' Retirement
System (CalPERS), from 2008 to 2012.
• insurer sets limits on the amount to be paid for
a procedure, with employees paying any
remaining difference.
• Shift by Patients from high to low cost 55.7%
• Hospitals reduced their prices by an ave of
20%.
• Accounted for $2.8 million in savings in 2011
http://content.healthaffairs.org/content/32/8/1392.abstract
Health Aff August 2013 vol. 32no. 8 1392-1397