MEASURE Evaluation’s Health Information System Strengthening ModelMEASURE Evaluation
This PowerPoint presentation provides an updated overview of MEASURE Evaluation’s Health Information System Strengthening Model, or the HISS Model. The slides describe the purpose of the model and each of the model’s areas and sub-areas.
This OECD report, launched on January 10, 2017, systematically reviews strategies put in place by countries to limit ineffective spending and waste. Further information: http://www.oecd.org/health/health-systems/tackling-wasteful-spending-on-health-9789264266414-en.htm.
Professor Sue Hill OBE, Chief Scientific Officer for Englandrightcare
We are excited to introduce the NHS Atlas of Variation in Diagnostic Services, the latest publication in the series of impressive NHS Atlases, which have highlighted variation in the provision of healthcare services.
Diagnostic services are of great importance in the NHS because, when used correctly, they support or rule out potential diagnoses, and underpin the effective and efficient management of patient pathways.
Unwarranted variation in the rates of diagnostic testing is of the utmost relevance to individual patients with the over-use, as well as under-use, of diagnostic tests being potentially serious issues. For example, effective capacity planning in imaging services should enable improved patient access balanced against the need to avoid over-use of interventions that have the potential to cause harm, such as ionising radiation.
MEASURE Evaluation’s Health Information System Strengthening ModelMEASURE Evaluation
This PowerPoint presentation provides an updated overview of MEASURE Evaluation’s Health Information System Strengthening Model, or the HISS Model. The slides describe the purpose of the model and each of the model’s areas and sub-areas.
This OECD report, launched on January 10, 2017, systematically reviews strategies put in place by countries to limit ineffective spending and waste. Further information: http://www.oecd.org/health/health-systems/tackling-wasteful-spending-on-health-9789264266414-en.htm.
Professor Sue Hill OBE, Chief Scientific Officer for Englandrightcare
We are excited to introduce the NHS Atlas of Variation in Diagnostic Services, the latest publication in the series of impressive NHS Atlases, which have highlighted variation in the provision of healthcare services.
Diagnostic services are of great importance in the NHS because, when used correctly, they support or rule out potential diagnoses, and underpin the effective and efficient management of patient pathways.
Unwarranted variation in the rates of diagnostic testing is of the utmost relevance to individual patients with the over-use, as well as under-use, of diagnostic tests being potentially serious issues. For example, effective capacity planning in imaging services should enable improved patient access balanced against the need to avoid over-use of interventions that have the potential to cause harm, such as ionising radiation.
Evaluation of IC initiatives - challenges, approaches and evaluation of Engla...Sax Institute
This presentation from Nicholas Mays, Professor of Health Policy, Director, Policy Innovation Research Unit, Department of Health Services Research & Policy focuses on the challenges, approaches and evaluation of England's Pioneers.
Margaret MacAdam: Achieving real care co-ordination - lessons from CanadaThe King's Fund
Margaret MacAdam, Associate Professor at the University of Toronto, gives a background to integrated care in Canada, and explains how the PRISMA integrated service delivery model has helped to improve the health, empowerment, and satisfaction of frail older people in the community.
FTC Spring Privacy Series: Consumer Generated and Controlled Health DataBrian Ahier
Increasingly, consumers are taking a more active role in managing and generating their own health data. For example, consumers are researching their health conditions and diagnosing themselves online. Consumers are also uploading their information into personal health records and apps that allow them to manage and analyze their data, and utilizing connected health and fitness devices that regularly collect information about them and transmit this information to other entities.
The movement of health data outside the traditional medical provider context has many potential benefits; however, it also raises potential privacy concerns. The seminar will address questions such as:
What types of websites, products, and services are consumers using to generate and control their health data, and how are consumers using them?
Who are the companies behind these websites, products, and services, what are their business models, and what does the current marketplace look like?
How can consumers benefit from these companies’ websites, products, and services?
What actions are these companies taking to protect consumers’ privacy and security?
What do consumers expect from these companies regarding privacy and security protections?
Do consumers differentiate between these companies and those that offer traditional medical products and services that are covered by HIPAA?
What restrictions, if any, do advertising networks and others impose on tracking of health data?
DELSA/GOV 3rd Health meeting - Gijs VAN DER VLUGT, Camila VAMMALLE, Claudia H...OECD Governance
This presentation by Gijs VAN DER VLUGT, Camila VAMMALLE and Claudia HULBERT was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
Something In my head for a while, Its probably a little dramatic.
Probably ripe for implementation in India.
The reference by no means are complete, prepared the ppt over an extended period, lost track of references or was too lazy to search for them.
Will me more than glad to add them(references) if provided.
Telemedicine A BRIGHT FUTURE for hospitality.akriti singh
TELEMEDICINE is a kind of mobile hospital and is very helpful, especially in remote areas , like small towns and villages.
There is no need of Doctor to be present everywhere when u can connect with any doctor from your place only !!! TELEMEDICINE provides us this facility.
Evaluation of IC initiatives - challenges, approaches and evaluation of Engla...Sax Institute
This presentation from Nicholas Mays, Professor of Health Policy, Director, Policy Innovation Research Unit, Department of Health Services Research & Policy focuses on the challenges, approaches and evaluation of England's Pioneers.
Margaret MacAdam: Achieving real care co-ordination - lessons from CanadaThe King's Fund
Margaret MacAdam, Associate Professor at the University of Toronto, gives a background to integrated care in Canada, and explains how the PRISMA integrated service delivery model has helped to improve the health, empowerment, and satisfaction of frail older people in the community.
FTC Spring Privacy Series: Consumer Generated and Controlled Health DataBrian Ahier
Increasingly, consumers are taking a more active role in managing and generating their own health data. For example, consumers are researching their health conditions and diagnosing themselves online. Consumers are also uploading their information into personal health records and apps that allow them to manage and analyze their data, and utilizing connected health and fitness devices that regularly collect information about them and transmit this information to other entities.
The movement of health data outside the traditional medical provider context has many potential benefits; however, it also raises potential privacy concerns. The seminar will address questions such as:
What types of websites, products, and services are consumers using to generate and control their health data, and how are consumers using them?
Who are the companies behind these websites, products, and services, what are their business models, and what does the current marketplace look like?
How can consumers benefit from these companies’ websites, products, and services?
What actions are these companies taking to protect consumers’ privacy and security?
What do consumers expect from these companies regarding privacy and security protections?
Do consumers differentiate between these companies and those that offer traditional medical products and services that are covered by HIPAA?
What restrictions, if any, do advertising networks and others impose on tracking of health data?
DELSA/GOV 3rd Health meeting - Gijs VAN DER VLUGT, Camila VAMMALLE, Claudia H...OECD Governance
This presentation by Gijs VAN DER VLUGT, Camila VAMMALLE and Claudia HULBERT was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
Something In my head for a while, Its probably a little dramatic.
Probably ripe for implementation in India.
The reference by no means are complete, prepared the ppt over an extended period, lost track of references or was too lazy to search for them.
Will me more than glad to add them(references) if provided.
Telemedicine A BRIGHT FUTURE for hospitality.akriti singh
TELEMEDICINE is a kind of mobile hospital and is very helpful, especially in remote areas , like small towns and villages.
There is no need of Doctor to be present everywhere when u can connect with any doctor from your place only !!! TELEMEDICINE provides us this facility.
Clinical Decision Support in Mechanical Ventilation- Egyptian Critical Care S...Dr.Mahmoud Abbas
Clinical Decision Support in Mechanical Ventilation- Egyptian Critical Care Summit. Presented by Dr Lluis Blanch
Egyptian Critical care Summit is the leading medical event and exhibition in Egypt
Presentation of Dr. Lluis Blanch at 10th Pulmonary Medicine Update Course, Cairo, Egypt. Pulmonary Medicine Update Course is organized by Scribe : www.scribeofegypt.com
Constance Johnson & Randy Brown - Supporting Chronic Disease Management in a ...SeriousGamesAssoc
Randy Brown, VP, Virtual Heroes Division Manager, ARA
Constance Johnson, Associate Professor and Senior Research Faculty in the Center for Nursing Research, Duke University School of Nursing
This presentation was given at the 2016 Serious Play Conference, hosted by the UNC Kenan-Flagler Business School.
Since little is known about the efficacy of health interventions in a VE, this study, conducted by Duke and Virtual Heroes, constitutes an innovative step in exploring how this type of environment can be suused to facilitate self-management behaviors in those with chronic diseases, in this case, diabetes. This program has good potential to improve care in an easily disseminated model that promotes cost-effective resource utilization.
Jak Zostać AWS Certified Solutions ArchitectMirek Burnejko
Nowi specjaliści z certyfikacją AWS Certified Solutions Architect Associate powstają w Polsce każdego dnia. I dobrze. Są bardzo potrzebni. Jeżeli nie wiesz jak zacząć przygotowania, to zapraszam do prezentacji. Tu szybkie wideo - https://www.youtube.com/watch?v=4d7KPpqVNWc
Risk Factors for many Chronic Diseases can begin early in life. Evidence shows that making Lifestyle Changes can Prevent Disease Progression and delay the Aging Process.
Tailoring Software Process Capability/Maturity Models for Telemedicine SystemsLuigi Buglione
Developing high-quality asynchronous store-and-forward telemedicine systems (ASFTSs) remains a challenge. However, there is no accepted understanding as to what are the important quality characteristics for this type of software system and/or what defines a mature software process for producing high-quality ASTFSs. Through adopting a multi-step research methodology, we define a quality model for ASFTSs indicating relevant quality characteristics and their priority for this specific type of software system based upon ISO/IEC 25010. We, then, propose an extended software process capability/maturity model based on ISO/IEC 15504 and ISO/IEC 12207 to meet these particular quality requirements. The resulting model can be used to both guide the development and the evaluation of such systems. We expect that the availability of such a customized model will facilitate the development of high-quality ASFTSs, reducing related risks and improving the quality of telemedicine services.
Tony O'Connor: Integrating Marketing Data into Decision Making, 30 June 2014Nuffield Trust
In this slideshow, Tony O’Connor, National Director for Patients and Information, Department of Health discusses integrating marketing data into decision making.
Tony O’Connor spoke at the Nuffield Trust event: The future of the hospital, in June 2014.
Health system strengthening – what is it, how should we assess it, and does i...ReBUILD for Resilience
This presentation was given to the UK's Department for International Development on 30th July 2019.
Comprehensive reviews of health system strengthening interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. In our talk, we will reflect on the process of undertaking such an evidence review for DFID recently (attached again), drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spill-over effects and their contribution to meeting over-arching health system process goals. We will make some initial suggestions about such goals, to reflect the features that characterise a ‘strong health system’. We will highlight current findings on ‘what works’ but also that these are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to re-think evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks and methods can support more coherent HSS investment.
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
Evidence on Improving Health Service Delivery in Developing CountriesIDS
This presentation by David Peters of the Future Health Systems Consortium was given at the Global Symposium on Health Systems Research in November 2010.
Diabetes Management Policy Proposal
Miatta Teasley
Capella University
NHS-FPX6004 Health Care Law and Policy
Professor Georgena Wiley
May 19, 2022
Click to edit Master title style
Click to edit Master title style
Hello and welcome to today's presentation on drug error regulatory policy proposals. This presentation is intended to provide you, your stakeholders, with all pertinent information regarding the need for an institutional policy to reduce medication errors in medical centers. We will also go over the scope of the recommendations, strategies for addressing medication errors, and stakeholder involvement in putting these strategies into action.
Policy Proposal
Diabetes Management
2
Click to edit Master title style
Click to edit Master title style
This proposal revolves around creating and implementing strategies that will help Med’s caregivers be able to improve on patient care regarding diabetes.
Presentation Outline
Policy on Managing Medication Errors
Need for a Policy
Scope of Policy
Strategies to Resolve Mediation Errors
Role of the Hospital Staff
Positive impact on Working Conditions
Issues in the Application of Strategies
Alterative Perspectives on Mitigating Medication Errors
Stakeholder Participation
3
Click to edit Master title style
Click to edit Master title style
The presentation highlights key functions in any policy implementation process. The steps this presentation takes appear in the order as indicated here. We will start y looking at
Policy on Managing Medication Errors then
Need for a Policy followed by
Strategies to Resolve Mediation Errors. Then the
Role of the Hospital Staff and the
Positive impact on Working Conditions. Also, we will look at
Issues in the Application of Strategies and the
Alterative Perspectives on Mitigating Medication Errors and finally,
Stakeholder Participation
Policy on Managing Medication Errors
4
Health practitioners should create and advance engaging policies
Many Healthcare departments require modernization
Healthcare policies should be adjusted to meet defined benchmarks
Key stakeholders are vital for successful implementation of proposed policies
Click to edit Master title style
Click to edit Master title style
When advocating for organizational regulation changes about federal, state, or local health care guidelines or rules and regulations, healthcare practitioners should be able to create and advance an engaging and logical policy and guideline parameters that will provide a segment, a group, or an entire institution to correct and shed light on issues of accomplishment and execute developments in the quality and safety of medical management.
Despite being recognized as one of the greatest health insurance carriers for people over 65, several departments need to be modernized. The most pr.
Shared Governance in Nursing services on 18.1.23.pptxanjalatchi
he critical concept of nursing shared governance is shared decision making between the bedside nurses and nurse leaders, which includes areas such as resources, nursing research/evidence-based practice projects, new equipment purchases, and staffing.
Shared Governance in Nursing services on 18.1.23.pptxanjalatchi
The critical concept of nursing shared governance is shared decision making between the bedside nurses and nurse leaders, which includes areas such as resources, nursing research/evidence-based practice projects, new equipment purchases, and staffing
Working better together: community health and primary careNHS Confederation
This slide pack captures the main points from a workshop on integrated working between primary care and community health services. The workshop was organised by the NHS Confederation Community Health Services Forum in partnership with the National Association of Primary Care, in September 2014
Implementing The Chronic Disease Management Framework - Shared Care - M Goulbourne - 29 Oct07
1. Implementing the Chronic Disease
Prevention and Management Framework
Moving from Operational Independence to Shared Care
Michelle Goulbourne
Global Perspectives on Chronic Disease Prevention and Management
2007 Conference Calgary, Alberta
October 29, 2007
3. Overview
Chronic Disease in the Canadian Context
Implementing the Chronic Disease Prevention and Management Framework
in Canada
Regionalization
Discontinuities in Care
Impact on Performance
Implementation Experiences
Current State
Future State
The Road Towards Shared Care
Conceptual Model
Operational Model
Innovations Across Canada
4. Chronic Disease in the Canadian Context
In Canada chronic disease is a major Percent of adults with at least
cause of death and disability. one of six chronic conditions*
The leading four preventable diseases
cardiovascular, cancer, respiratory and
diabetes, cost an estimated 45 billion
dollars annually.
Two out of three adult Canadians have
one or more of the major risk factors
associated with a preventable chronic
disease.
(MOHLTC 2007)
*Hypertension, heart disease, diabetes, arthritis, lung problems,
and depression
2004 Commonwealth Fund International Health Policy Survey
5. Chronic Disease Prevention and Management
Framework Goals
Nationally, Chronic Disease Prevention Management policy frameworks
have been based on the Chronic Care Model developed by the Group
Health McColl Institute for Healthcare Innovation in Seattle (Wagner et al. 2001).
Expanded versions of this model have been adopted because of their
focus on health promotion and a coordinated systems approach to disease
prevention and management are thought to provide important
opportunities for:
1. Reducing care discontinuities
2. Increasing prevention behaviors
3. Improving population health
4. Reducing cost
Implementing the CDPM framework for such long lasting sustainable
improvements is a challenge that requires a comprehensive system-wide,
multi-leveled approach to change.
6. Regional Deployment of the CDPM Framework
Regional deployment of the CDPM
framework requires that within each
region, local health care organizations:
Make systematic efforts to improve
prevention and management of chronic
disease.
Engage in delivery system design with
a focus on prevention, improved access,
continuity of care and flow through the
system.
Facilitate personal skills and self-management support among the population by
empowering individuals to build skills for healthy living and coping with disease.
Develop healthy public policy and supportive environments by creating and
implementing policies that will improve individual and population health and address
inequities.
(MOHLTC 2007)
7. Implementing the CDPM Framework
Literatures on strategy and organizational improvement suggest that we are not
so good at implementing what we design or at developing the new capabilities
the organization needs to survive and thrive – hence the need to become better
at designing and implementing organizations that can carry out our purposes
and provide settings where we can develop and thrive (Mohrman 2007).
8. Voices From The Field – Structural Issues
This CDPM framework, while insightful, shares no concrete information
organizations can draw upon which shows them how they can build bridges
to integrate organizational silos.
“Chronic disease programs in state public health agencies across the United States are
increasingly taking action to integrate activities across single-disease program lines.
The perceived benefits of program integration are the motivating force behind these
actions, but there is little documentation about how to integrate programs, what the
benefits are to program integration, and what barriers exist (Yach et al. 2004, p.
2616).”
9. Voices From The Field – Process Issues
Implementation is described as being a difficult process.
“Although the evidence base for some of these elements is incomplete, it is clearly a
comprehensive and promising way to conceptualize a path to better care for people
with chronic conditions. The problem is that we have no complete examples of an
implemented CCM and no specifics about the best care changes to make or the most
effective change process to use for implementing them…there is little or no information
about the relationship between the presence of CCM elements and indicators of care
quality (Solberg et al. 2006, p.311).”
10. Voices From The Field – Governance Issues
The Reality: Divergent Values and Independent Action
When organizations
have been tasked with Individual agencies may demonstrate territoriality and
moving from single perceive a “loss of glory” (reluctance to share credit for
achievements).
disease to multiple
chronic disease Resource costs involved in creating partnerships inhibit
frameworks in the collaboration. Fear that collaborations may impact on
absence of a central independent fundraising activities.
coordinating structure, Problems integrating programs as each program may be
they do not always governed by different policies, service terms and day-to
respond to to-day operations - creating a “silo effect”.
environmental
Difficulties maintaining smaller or underfunded programs
uncertainty by engaging when they are integrated with established fully funded
in collaborations. programs.
(Robinson, Farmer, Elliot and Eyles 2007)
11. Summary of CDPM Implementation Issues
Governance
Leadership to help build and support inter-organizational bridges.
Structure
Complete examples about implemented CDPM frameworks
Evidence to support all parts of the framework
Best, most effective, care changes
Relationship between CDPM elements and quality indicators
Process
How to integrate programs and services across diseases
How to build bridges across organizational silos
12. Regionalization
Across Canada, provincial efforts have paralleled global approaches in
trying to deal with health system uncertainty by establishing regional
care delivery organizations to create a more integrated, coordinated
and patient oriented healthcare delivery system.
13. Healthcare Regionalization in Canada
In Canada Regional Health Authorities (RHA‟s) exist as autonomous organizations.
Relationships with health care providers are characterized by accountability
agreements.
Are responsible for healthcare administration, planning and coordination within
specific geographic regions.
Have appointed or elected boards and are responsible for the funding and
delivery of community and institutional programs and services such as CDPM
within their regions (Kirby 2002).
Governance models under which provincial RHAs operate varies across provinces.
Within each province, the level of centralization may have implications for CDPM
activities and performance outcomes.
14. Incomplete Integration and Coordination
Despite sharing similar objectives, provincial health system transformations have
produced RHAs that differ in size, structure, scope of responsibility and
accountabilities .
While all RHAs manage hospital services, only some RHAs oversee laboratory
services, long-term care, home care and a variety of other services.
No provincial authority contracts physician services, manage prescription drug
programs or cancer services.
That these important care partners remain under the jurisdiction of provincial
and territorial portfolios has implications for provision of integrated service
delivery and coordinated CDPM care in the community.
Considerable local level variation exists in the way CDPM is implemented and the
levels of success attained.
15. Results Discontinuities in CDPM
CDPM progress is hampered by care discontinuities associated with poor system
integration and coordination.
1. Gaps in governance impede system capability to develop integrative policies
and local level partnerships across hospitals, physician and community health
stakeholders that will improve access to care, increase quality and health
service delivery.
2. Lack of technological integration results in a loss of information about patient
and family characteristics and histories.
3. Quality gaps in service integration and coordination remove opportunities for
communicative interactions and knowledge transfer between patients, families
and specific providers.
The impact of these discontinuities is evident
in our performance on global quality measures.
17. Country Rankings
Overall Performance Ranking* 1.0-2.66
2.67-4.33
4.34-6.0
NEW UNITED UNITED
SICKER ADULTS AUSTRALIA CANADA GERMANY ZEALAND KINGDOM STATES
OVERALL RANKING (2007) 3.5 5 2 3.5 1 6
Quality Care 4 6 2.5 2.5 1 5
Right Care 5 6 3 4 2 1
Safe Care 4 5 1 3 2 6
Coordinated Care 3 6 4 2 1 5
Patient-Centered Care 3 6 2 1 4 5
Access 3 5 1 2 4 6
Efficiency 4 5 3 2 1 6
Equity 2 5 4 3 1 6
Long, Healthy, and Productive Lives 1 3 2 4.5 4.5 6
Health Expenditures per Capita, 2004 $2,876* $3,165 $3,005* $2,083 $2,546 $6,102
* 2003 Data Source: Calculated by Commonwealth Fund based on the Commonwealth Fund 2004 International Health Policy Survey, the
Commonwealth Fund 2005 International Health Policy Survey of Sicker Adults, the 2006 Commonwealth Fund International Health P olicy
Survey of Primary Care Physicians, and the Commonwealth Fund Commission on a High Performance Health System National Scorecard.
19. Public Investment per Capita in
Health Information Technology (HIT) as of 2005
$192.79
$200
$150
$100
$50 $31.85
$21.20
$4.93 $0.43
$0
United Canada Germany Australia United
Kingdom States
Source: The Commonwealth Fund, calculated from Anderson, G.F., Frogner, B., Johns, R.A., and Reinhardt, U.
“Health Care Spending and Use of Information Technology in OECD Countries,” Health Affairs, 2006.
20. Primary Care Doctors Use of Electronic Patient
Medical Records, 2006
Percent of physicians
98
100 92 89
79
75
50 42
28
23
25
0
NET NZ UK AUS GER US CAN
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
21. Primary Care Practices with Advanced
Information Capacity, 2006
Percent reporting 7 or more out of 14 functions*
100
87 83
75 72
59
50
32
25 19
8
0
NZ UK AUS NET GER US CAN
*Count of 14: EMR, EMR access other doctors, outside office, patient; routine use electronic ordering tests, prescriptions,
access test results, access hospital records; computer for reminders, Rx alerts, prompt tests results; easy to list diagnosis,
medications, patients due for care.
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
22. Practice Use of Electronic Technology, 2006
Percent reporting
AUS CAN GER NET NZ UK US
routine use of:
Electronic ordering
65 8 27 5 62 20 22
of tests
Electronic
prescribing of 81 11 59 85 78 55 20
medication
Electronic access to
76 27 34 78 90 84 48
patients‟ test results
Electronic access to
patients‟ hospital 12 15 7 11 44 19 40
records
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
24. Patient Reports on Reminders for Preventive
Care, 2004
Percent of adults receiving preventive care reminders
75
49 50
50 44
37 38
25
0
AUS CAN NZ UK US
2004 Commonwealth Fund International Health Policy Survey
25. Physicians Reporting Routinely Sending Patients
Reminder Preventive/Follow-Up Care Notice, 2006
Percent of physicians
Yes, using a manual system Yes, using a computerized system
100
5
14
75 18
16
50 93
24 83
65 61 32
25
20 28
18
0 8
AUS CAN GER NET NZ UK US
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
27. Sicker Adults Given Self-Management Plan, 2005
Percent of sicker adults with chronic conditions* whose
doctor gave plan to manage care at home
100
65
58 56
50
50 45
37
0
CAN US NZ AUS UK GER
* Adult reported at least one of six conditions: hypertension, heart disease, diabetes, arthritis, lung problems (asthma,
emphysema, etc.), or depression.
Data: 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults (Schoen et al. 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006 27
28. Received Recommended Care
for Chronic Condition, Sicker Adults, 2005
Percent received
AUS CAN GER NZ UK US
recommended care:
Hypertension* 78 85 91 77 72 85
Diabetes** 41 38 55 40 58 56
* Blood pressure and cholesterol checked.
** Hemoglobin A1c and cholesterol checked, and feet and eyes examined.
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
30. Doctors‟ Reports of Care Coordination Problems,
2006
Percent saying their patients
“often/ sometimes” AUS CAN GER NET NZ UK US
experienced:
Records or clinical information
not available at time of 28 42 11 16 28 36 40
appointment
Tests/procedures repeated
10 20 5 7 14 27 16
because findings unavailable
Problems because care was not
well coordinated across 39 46 22 47 49 65 37
sites/providers
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
31. Percent of Doctors Reporting Practice Is Well
Prepared to Care for Chronic Diseases, 2006
Percent of physicians
reporting “well AUS CAN GER NET NZ UK US
prepared”:
Patients with multiple
69 55 93 75 67 76 68
chronic diseases
Patients with mental
50 40 70 65 48 55 37
health problems
Source: 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians
33. Implementation Experiences - Lessons Learned
Successful Implementation - Prerequisites Barriers to Successful Implementations
Organizations in the health care Absence of integrative governance
community recognize that the and policy
successful implementation of CDPM
initiatives across providers may Links all stakeholders groups.
require Administrative and clinical
Integrative governance accountabilities (Goulbourne 2007).
Local leadership Deployment of chronic disease care
Cross-disease planning models in community settings suggest
Strategy that organizations need help with:
Multi-level partnerships the strategic operationalization of
Knowledge sharing integration dimensions ,
Goal sharing
the relational coordination of
Information technology
process factors (Robinson et al 2007;
Funding (Calnan et al. 2006, Robinson et al. Solberg et al 2006; Yach et al. 2004).
2007, Solberg et al. 2006, Wensing 2006).
34. Conceptual Model
The complex sustainable integrated care delivery system solutions we seek
require the implementation of „multisectoral, multidisciplinary and
multicomponent’ initiatives.
„Synergy, as it is manifested in the thoughts, relationships and actions within
the healthcare community, reflects the one aspect of collaboration that gives
partnerships that are able to achieve it a unique competitive advantage.‟
(Lasker et al. 2001)
35. Conceptual Model for CDPM Implementation
(Goulbourne 2007)
Shared goals,
a synchrony of efforts
and a synergy of effects.
Vertical
Integration
of
Structures
Horizontal Integration of Knowledge, Differentiation of Tasks and Services
36. Operational Model
A recent structured review of health care organizational interventions
revealed that benefits to clinical performance, patient outcomes and cost
reductions are empirically associated with transformations that include the
revision of professional roles (increased medical roles to nurses and a
widened scope of practice for pharmacists) and the use of computer systems
for knowledge management (Wensing et al. 2006).
38. Shared Care
Shared care’ is the term that describes increasing the ability of…primary care
services, particularly GPs and pharmacists, to work more effectively…
www.cambsdaat.org/treatment/shared_care.html
The term shared care is used to describe the joint provision of care, not
necessarily in the same place or at the same time, by members of the primary
care team and of a specialist team. Shared care schemes generally focus on
diabetes, asthma and antenatal care, but several other conditions such as
inflammatory bowel disease and hypertension might benefit from components
of the shared care approach.
Priority Areas: First round Evaluation of Shared Schemes (Department of Health 2003)
http://www.dh.gov.uk/en/Policyandguidance/Researchanddevelopment/A-
Z/Primaryandsecondarycareinterface/DH_4015532
39. Governance, Networks and Synergy
Governance is commonly recognized as Interior Health – Regional Health
being an important component to Authority, British Columbia Chronic
Disease Prevention Strategy
collaboration and functioning
partnerships. Integrated Service Plan & Primary
Care Collaborative
The type of governance structure involved PHC/CDM Director, Advisory Committee,
Change Management Team
in CDPM implementations is important.
Integration of clinical and community health
Governance structures shape the nature and Negotiated physician involvement and
composition of the partnerships, mode of participation via an alternate payment model
decision-making and impacts on the ways in Link stakeholders and processes to provincial
initiatives
which partner perspectives, resources, skills Translate provincial innovations to regional
and knowledge are combined. and local levels
Governance is said to have a “profound Established Chronic Disease Health
Improvement Networks (6)
impact” of the level of synergy within the Multiple disease orientation
partnership (Lasker, Weiss and Miller 2001, Touati et al. Interdisciplinary team
2007). Patient education and self-management
support
(Ockenden and Cheema 2004)
40. Collaborative Care:
Enhancing Clinical Service Network Link Overlap
Community based coalitions or sub-
networks may provide space where
organizations can develop levels of Acute Care
Integrative
synergy, exchange knowledge and Technology
work together to pursue shared goals.
Stronger cooperative ties are more
Patients Physicians
likely to develop among small clusters
of organizations than among multiple Shared
Community Primary
organizations in a broadly based Care Care Care
network (Provan and Sebatstian 1998). (EMR)
Pharmacists Nurses
Family Health Teams enhancing the
efficient use of health care resources.
Extra-Mural Program, New Brunswick
a provincial home health-care program Ambulatory
which is supported by a multidisciplinary Care
network of hospitals, health centres and
programs involved in health promotion,
education and the provision of
comprehensive health care services. (Goulbourne 2007)
41. New Roles for Pharmacists in Primary Care
and Community Care Settings
Fraser Health Authority – Medication Management
New Roles and Collaborations Program, British Columbia Commenced in 2005
across Acute, Primary and Pharmacist performs home visits to assess medication
Community Health Care regimens
Settings. Target → Seniors recently discharged from hospitals
and clients high risk for drug related problems (6 or
Pharmacist deployed into new more medications)
settings where their drug expertise Make recommendations to alleviate problems
is used to: (prescribing pre-measured blister-packed medications,
or eliminating unnecessary medications)
Enhance patient medication Pharmacists also perform academic detailing
practices, physician prescribing and
drug monitoring under treatment. Grand River Hospital Corporation and New Vision Family
Health Team, Kitchener Ontario Commenced in 2006
Enhance patient safety and Pharmacist has a shared care role across acute (.5FTE)
optimal outcomes. Reduce the cost and primary care (.5FTE) sectors
of patient non-adherence
Pharmacist provides drug information to
(readmissions), adverse drug events interdisciplinary clinical team
and after surgical intervention care.
Collaborates in the development and deployment of
chronic disease prevention and management programs
42. We are doing better.
We will continue to do better.
43. References
Goulbourne M. (2007). “Chronic Disease Prevention and Management: Examining regional
governance, network structures and outcomes.” (draft document)
Kirby, M. (2002). “The Health of Canadians: The Federal Role Final Report. “ Ottawa: The
Standing Senate Committee on Social Affairs, Science and Technology.
Lasker Roz D., Weiss Elisa S., et al. (2001). "Partnership Synergy: A Practical Framework for
Studying and Strengthening the Collaborative Advantage." The Millbank Quarterly 79(2): 179-
205.
Ministry of Health and Long Term Care. (2007). “Ontario‟s Chronic Disease Prevention and
Management Framework : Work of a Steering Committee. Presentation by Meera Jain,
February 2007, Grimsby Ontario.
Mohrman S.A. (2007). "Having Relevance and Impact: The Benefits of Integrating the
Perspectives of Design Science and Organizational Development." The Journal of Applied
Behavioral Science 43(1): 12-22.
Ockenden, G. and Cheema G. (2004) “Addressing the Need for Improvement. The IH Chronic
Disease Management Plan 2004-2006”. Government of British Columbia.
Provan Keith G. and Sebastian J.G. (1998). “Networks within Networks: Service Link Overlap,
Organizational Cliques, and Network Effectiveness." Academy of Management Journal 41(4):
453-463.
44. References Continued
Robinson Kerry, Farmer Tracy, et al. (2007). "From Heart Health Promotion to Chronic Disease
Prevention: Contributions of the Canadian Heart Health Initiative." Preventing Chronic Disease:
Public Health Research, Practice, and Policy 4(2): serial online.
Solberg Leif I., Crain Lauren A., et al. (2006). "Care Quality and Implementation of the Chronic
Care Model: A Quantitative Study." Annals of Family Medicine 4(4): 310-316.
Touati Nassera, Roberge Daniele, et al. (2007). "Governance, Health Policy Implementation and
the Added Value of Regionalization." healthcare Policy 2(3): 97-114.
Wagner E.H., Austin B.T., et al. (2001). "Improving chronic illness care: translating evidence into
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Wensing Michel, Wollersheim Hub, et al. (2006). "Organizational interventions to implement
improvements in patient care: a structured review of reviews." Implementation Science 1(2):
online journal.
World Health Organization. (2005). WHO Global Forum on Chronic Disease Prevention and
Control: Final report of the meeting convened in Ottawa, Canada 3-6 November 2004. N. D.
a. M. H. Department of Chronic Diseases and Health Promotion, World Health Organization and
the Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, WHO.
Yach Derek, Hawkes Corinna, et al. (2004). "The Global Burden of Chronic Diseases." Journal of
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