The document provides tips for leading quality and safety improvements, noting that leaders need to prioritize high-cost problems, lead improvement processes using systematic methods, and monitor outcomes to evaluate savings and spread successful changes. It emphasizes using data to motivate improvements and setting measurable targets to track progress and savings from reductions in waste and avoidable harm.
When digital medicine becomes the medicine (2/2)Yoon Sup Choi
The study assessed the quality and accuracy of care provided by 8 major commercial telemedicine companies for common acute illnesses. Standardized patients presented 6 conditions and completed 599 virtual visits total. The completeness of histories and physical exams ranged from 51.7-82.4% across companies. Correct diagnoses were provided in 65.4-93.8% of visits. Adherence to clinical guidelines for management decisions was 54.3% overall but varied significantly between conditions and companies, from 34.4-66.1% across companies. Greater variation was seen for viral infections than musculoskeletal conditions. This suggests the quality of telemedicine can differ substantially between providers.
This document discusses using an electronic medical record (EMR) to support clinical research. It outlines how EMR data can be used throughout the research process, including determining study feasibility, including data in grant applications, patient recruitment, study interventions, data collection, and assessing study outcomes. While EMRs provide rich clinical data and can streamline aspects of research, the data was primarily collected for clinical care so requires validation for research purposes. Fully integrating research workflows into EMRs remains a challenge.
Quest Diagnostics is the leading provider of diagnostic testing, information and services. It touches over 150 million patient lives each year through comprehensive and innovative diagnostic testing services. The company aims to be the undisputed world leader in diagnostic testing, information and services by profitably growing faster than the industry and expanding its operating income and international operations. It plans to achieve this through delivering superior patient experiences, leading in medical innovation, leveraging its assets and capabilities, expanding its diagnostic scope and geographic reach, and reducing costs.
The document summarizes a team's final project presentation for a medical device startup called MammOptics. The team includes four members with engineering and business backgrounds working to develop a non-invasive, non-radiative breast cancer detection technology using optical spectroscopy. The presentation covers the initial technology and business model hypotheses, testing the value proposition with hospitals and doctors, and outlines the steps needed for product development, clinical trials, reimbursement, and company financing.
1) Electronic medical records have the potential to transform medicine by serving as a platform for clinical decision support, personalized medicine, and precision medicine approaches through integration of diverse data sources.
2) Registries built from EMR data can be used to study conditions, compare treatment effectiveness, and recruit for clinical trials, with the goal of reducing the lag time between research and practice.
3) Advances in predictive modeling, diagnostic and treatment algorithms, and artificial intelligence may help optimize clinical decision making if effectively integrated into clinical workflow and EMRs.
Quest Diagnostics is the leader in diagnostic testing and information services in the United States. It touches over 150 million patient lives each year through comprehensive diagnostic testing services that help diagnose, monitor, predict, prevent, and treat diseases. Quest aims to be the undisputed world leader in diagnostic testing, information, and services through strategies focused on delivering superior patient experiences, leading medical innovation, leveraging its assets and capabilities, expanding diagnostic scope, and expanding its geographic reach.
The document discusses errors in medicine and what can be done to address them. It notes that medication errors are among the most commonly reported events, with estimates that wrong site surgeries occur in the US every day. The document advocates adopting evidence-based protocols and procedures to improve safety culture, as well as using accreditation processes to encourage continuous quality improvement and adherence to standards. It provides several examples of patient safety solutions that have been developed to target specific issues like medication management, patient identification, and hand-off communication.
When digital medicine becomes the medicine (2/2)Yoon Sup Choi
The study assessed the quality and accuracy of care provided by 8 major commercial telemedicine companies for common acute illnesses. Standardized patients presented 6 conditions and completed 599 virtual visits total. The completeness of histories and physical exams ranged from 51.7-82.4% across companies. Correct diagnoses were provided in 65.4-93.8% of visits. Adherence to clinical guidelines for management decisions was 54.3% overall but varied significantly between conditions and companies, from 34.4-66.1% across companies. Greater variation was seen for viral infections than musculoskeletal conditions. This suggests the quality of telemedicine can differ substantially between providers.
This document discusses using an electronic medical record (EMR) to support clinical research. It outlines how EMR data can be used throughout the research process, including determining study feasibility, including data in grant applications, patient recruitment, study interventions, data collection, and assessing study outcomes. While EMRs provide rich clinical data and can streamline aspects of research, the data was primarily collected for clinical care so requires validation for research purposes. Fully integrating research workflows into EMRs remains a challenge.
Quest Diagnostics is the leading provider of diagnostic testing, information and services. It touches over 150 million patient lives each year through comprehensive and innovative diagnostic testing services. The company aims to be the undisputed world leader in diagnostic testing, information and services by profitably growing faster than the industry and expanding its operating income and international operations. It plans to achieve this through delivering superior patient experiences, leading in medical innovation, leveraging its assets and capabilities, expanding its diagnostic scope and geographic reach, and reducing costs.
The document summarizes a team's final project presentation for a medical device startup called MammOptics. The team includes four members with engineering and business backgrounds working to develop a non-invasive, non-radiative breast cancer detection technology using optical spectroscopy. The presentation covers the initial technology and business model hypotheses, testing the value proposition with hospitals and doctors, and outlines the steps needed for product development, clinical trials, reimbursement, and company financing.
1) Electronic medical records have the potential to transform medicine by serving as a platform for clinical decision support, personalized medicine, and precision medicine approaches through integration of diverse data sources.
2) Registries built from EMR data can be used to study conditions, compare treatment effectiveness, and recruit for clinical trials, with the goal of reducing the lag time between research and practice.
3) Advances in predictive modeling, diagnostic and treatment algorithms, and artificial intelligence may help optimize clinical decision making if effectively integrated into clinical workflow and EMRs.
Quest Diagnostics is the leader in diagnostic testing and information services in the United States. It touches over 150 million patient lives each year through comprehensive diagnostic testing services that help diagnose, monitor, predict, prevent, and treat diseases. Quest aims to be the undisputed world leader in diagnostic testing, information, and services through strategies focused on delivering superior patient experiences, leading medical innovation, leveraging its assets and capabilities, expanding diagnostic scope, and expanding its geographic reach.
The document discusses errors in medicine and what can be done to address them. It notes that medication errors are among the most commonly reported events, with estimates that wrong site surgeries occur in the US every day. The document advocates adopting evidence-based protocols and procedures to improve safety culture, as well as using accreditation processes to encourage continuous quality improvement and adherence to standards. It provides several examples of patient safety solutions that have been developed to target specific issues like medication management, patient identification, and hand-off communication.
This document provides an outline for a presentation on electronic medical records (EMRs). It begins with defining the components of an EMR, including labs, admissions/discharge/transfer data, orders, radiology, notes, and billing. It then discusses the history and adoption of EMRs from the 1960s to present. The document reviews studies showing the effectiveness of EMRs in improving quality of care and achieving treatment standards. It also outlines how EMR data is structured in databases and data warehouses and describes common health data standards like ICD, CPT, LOINC, SNOMED, and HL7. The presentation covers meaningful use incentives and provides examples of using EMR data for research studies.
Using the Bigtown Simulation Model to Predict the Impact of Enhanced Seven Day Services on Hospital Performance and Patient Outcomes
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Deprescribing and Consent, a presentation by Órla Kelly, (Solicitor and Pharmacist,Cantillons Solicitors, Cork, Ireland) and Professor Nina Barnett (Consultant Pharmacist, Care of Older People,
London North West Healthcare NHS Trust, Medicines Use and Safety Team, Specialist Pharmacy Service, Visiting Professor, Institute of Pharmaceutical Science, Kings College London)
Indoor patients’ satisfactory influential factors’ on healthcare services of ...HeenaRaffi1
This document discusses a study on factors influencing indoor patient satisfaction with healthcare services at small and medium-sized multi-specialty hospitals in Tiruchirappalli, India. The study examined patient satisfaction across four dimensions: healthcare services, supportive services, auxiliary services, and peripheral services. Adequate ward arrangements had the highest average patient satisfaction score. Statistical analysis found significant associations between overall patient satisfaction and all measured healthcare service factors. A neural network model with 7 input layers, 20 covariates layers, 1 hidden layer, and 1 output layer accurately modeled patient satisfaction based on socio-demographic and service quality factors.
The document summarizes the progress of Team 21's bio-hybrid vascular graft project. It describes initial market research identifying unmet needs for small diameter vascular grafts. Through customer interviews, the team refined their target markets from coronary artery disease grafts to prioritizing peripheral artery disease grafts. Key lessons included identifying referring physicians as important influencers and pursuing CE mark in the EU followed by FDA approval. The team ended their canvas update at a higher level of investment readiness and prepared to apply for further STTR funding.
1) The study reviewed 122 malpractice claims from 4 insurers involving missed or delayed diagnoses in the emergency department.
2) 79 claims (65%) involved missed ED diagnoses that harmed patients, with 48% resulting in serious harm and 39% in death.
3) The leading causes of missed diagnoses were failures to order appropriate diagnostic tests or perform adequate exams, incorrect test interpretations, and failures to order appropriate consultations. The most common contributing factors were cognitive errors, patient factors, lack of supervision, and excessive workload.
Objectives:
1.Review the changes in Accreditation Canada expectations for implementing MedRec beginning in 2014.
2.Overview of changes to the ROP structure, for Medication Reconciliation ROPs in the leadership and service-based standards.
3.Direct organizations to additional information, resources, and support.
Click the link to read more http://bit.ly/10LqxjQ
A Clinical Decision Support System For Alzheimer´s Disease and Other Related ...Flavio Luiz Seixas
The document discusses a clinical decision support system called SIADe for diagnosing dementia, Alzheimer's disease, and mild cognitive impairment. It lists participating institutions and outlines the agenda which includes motivation, objectives, clinical decision modeling, achievements, and future work. The motivation discusses the aging population and high prevalence of dementia. The objective is to design a decision support system to aid in diagnosis. It will use a knowledge base, inference engine, and mobile app for physicians. Clinical decision modeling involves identifying diagnostic guidelines, preprocessing patient records, building a Bayesian network model, and evaluating model performance. The system aims to address information overload and integrate evidence-based knowledge to help physicians with clinical decision making.
This document discusses capacity planning for radiation treatment machines at Cancer Care Ontario. It provides background on Cancer Care Ontario's role in managing radiation treatment services and current capacity. Between 2000-2012, the number of linear accelerators (linacs) grew from 65 to 100 across Ontario. The document discusses Cancer Care Ontario's Radiation Treatment Capital Investment Strategy (RTCIS) for determining needs. Forecasting shows demand for cancer treatments increasing to 42% of cases in 2020 and 48% in 2031, requiring additional linacs. The recommendation is to add 16 linacs between 2013-2017 in phases at various cancer centers based on forecasted demand.
The document is a presentation about polyclinic waiting time problems and solutions at Tawam Hospital in the UAE. It introduces the presenter and states that the presentation will be divided into four parts: an overview, study results, current and proposed processes, and recommendations/conclusions. It provides background on Tawam Hospital and defines waiting time. It discusses implementation of a Health Information System (HIS) and benefits, as well as research aims, methodology involving questionnaires, and results showing specialists are satisfied with HIS but it is not the main cause of delays. Results of patient questionnaires show waiting times at various stages with most waiting over 60 minutes for required service.
Wool Labs uses proprietary technologies and analyses to uncover real world opinions, experiences, and behaviors of patients and physicians from online sources to answer questions, solve problems, and predict future events. They monitor entire disease categories and online conversations to identify patient safety issues, evaluate treatment experiences, and understand factors influencing medication adherence. Wool Labs' services organize large amounts of online data to provide both qualitative and quantitative insights into patient experiences with drugs, medical devices, and clinical care.
This document summarizes the experience of Odette Cancer Centre in evaluating and implementing Elekta VMAT for prostate cancer patients. Key points:
1) Planning studies showed VMAT could significantly reduce treatment delivery times for prostate cases compared to IMRT and tomotherapy, without compromising dosimetry.
2) After extensive commissioning and quality assurance testing, Odette began treating their first prostate cancer patients with VMAT in 2011.
3) Initial results confirmed VMAT decreases treatment time from around 6 minutes for IMRT to around 90 seconds for a single-arc VMAT plan.
4) Faster treatment times with VMAT are expected to allow Odette to treat more patients per
IRJET- Hospital Admission Prediction: A Technology SurveyIRJET Journal
This document summarizes research on using machine learning techniques to predict hospital admissions from emergency departments. It first provides background on how emergency department overcrowding can negatively impact patients and the need to improve patient flow. It then reviews 10 previous studies that used methods like logistic regression, decision trees, random forests and neural networks to predict admissions. Three algorithms (gradient boosted machine, random forest, decision tree) were implemented and evaluated on a hospital dataset, with random forest achieving the best performance. The paper concludes that admission prediction can help hospitals plan resources and reduce crowding.
A clinical decision support system (CDSS) is an interactive computer program that uses patient data to generate advice to help clinicians make decisions. A CDSS uses a dynamic knowledge base and rules derived from experts to make suggestions, which clinicians can then use along with their own expertise to determine diagnoses and treatments. CDSS systems are used at the point of care to assist clinicians before, during, and after making diagnoses. They work by taking in patient data, applying medical knowledge, and providing recommendations to aid clinical decision making.
The past few years have heralded much excitement around the uses of Point of Care Testing (PoCT). With advancements in electronics, the miniaturization and digitization of technology has spilled over into the realm of medical diagnostics. Through portable, transportable and handheld instruments, PoCT is the ability to bring the diagnostic capabilities of a laboratory to the patients’ bedsides. It is effectively a potential solution to some of the health problems that India faces, especially in the context of the heavy burden of infectious diseases that plagues it and its large rural population with limited or no access to testing facilities.
Gautam Singh - Application of Bayesian Classifier for the Diagnosis of Dental...Gautam Singh
This document describes a study that developed a Bayesian classifier to diagnose dental diseases based on patient-reported pain parameters. Researchers collected data on 14 pain parameters and 10 common dental diseases from 10 dentists evaluating 40 cases each. They analyzed the data, identified significant predictors, and developed a naive Bayesian classifier. They then used a hill climbing algorithm to create a learned Bayesian classifier, which achieved an average accuracy of 72% in diagnosing diseases based on pain parameters alone. This accuracy was seen as clinically useful for dentists.
Harman Deep is pursuing an MBA in Finance and Marketing from PCTE Baddowal, Ludhiana. He has internship experience in inventory management at Classic Wears Pvt. Ltd. and has conducted market surveys for auto parts. He has achieved academic and extracurricular success including 2nd position in a youth festival, 37th rank in an entrance exam, and 1st prize for product innovation.
El documento describe un taller de dibujo del cuerpo humano utilizando diferentes técnicas como grafito, aguarrás, pastel y lápiz. Los dibujos fueron realizados por Rocío Corona.
This document provides an outline for a presentation on electronic medical records (EMRs). It begins with defining the components of an EMR, including labs, admissions/discharge/transfer data, orders, radiology, notes, and billing. It then discusses the history and adoption of EMRs from the 1960s to present. The document reviews studies showing the effectiveness of EMRs in improving quality of care and achieving treatment standards. It also outlines how EMR data is structured in databases and data warehouses and describes common health data standards like ICD, CPT, LOINC, SNOMED, and HL7. The presentation covers meaningful use incentives and provides examples of using EMR data for research studies.
Using the Bigtown Simulation Model to Predict the Impact of Enhanced Seven Day Services on Hospital Performance and Patient Outcomes
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
Deprescribing and Consent, a presentation by Órla Kelly, (Solicitor and Pharmacist,Cantillons Solicitors, Cork, Ireland) and Professor Nina Barnett (Consultant Pharmacist, Care of Older People,
London North West Healthcare NHS Trust, Medicines Use and Safety Team, Specialist Pharmacy Service, Visiting Professor, Institute of Pharmaceutical Science, Kings College London)
Indoor patients’ satisfactory influential factors’ on healthcare services of ...HeenaRaffi1
This document discusses a study on factors influencing indoor patient satisfaction with healthcare services at small and medium-sized multi-specialty hospitals in Tiruchirappalli, India. The study examined patient satisfaction across four dimensions: healthcare services, supportive services, auxiliary services, and peripheral services. Adequate ward arrangements had the highest average patient satisfaction score. Statistical analysis found significant associations between overall patient satisfaction and all measured healthcare service factors. A neural network model with 7 input layers, 20 covariates layers, 1 hidden layer, and 1 output layer accurately modeled patient satisfaction based on socio-demographic and service quality factors.
The document summarizes the progress of Team 21's bio-hybrid vascular graft project. It describes initial market research identifying unmet needs for small diameter vascular grafts. Through customer interviews, the team refined their target markets from coronary artery disease grafts to prioritizing peripheral artery disease grafts. Key lessons included identifying referring physicians as important influencers and pursuing CE mark in the EU followed by FDA approval. The team ended their canvas update at a higher level of investment readiness and prepared to apply for further STTR funding.
1) The study reviewed 122 malpractice claims from 4 insurers involving missed or delayed diagnoses in the emergency department.
2) 79 claims (65%) involved missed ED diagnoses that harmed patients, with 48% resulting in serious harm and 39% in death.
3) The leading causes of missed diagnoses were failures to order appropriate diagnostic tests or perform adequate exams, incorrect test interpretations, and failures to order appropriate consultations. The most common contributing factors were cognitive errors, patient factors, lack of supervision, and excessive workload.
Objectives:
1.Review the changes in Accreditation Canada expectations for implementing MedRec beginning in 2014.
2.Overview of changes to the ROP structure, for Medication Reconciliation ROPs in the leadership and service-based standards.
3.Direct organizations to additional information, resources, and support.
Click the link to read more http://bit.ly/10LqxjQ
A Clinical Decision Support System For Alzheimer´s Disease and Other Related ...Flavio Luiz Seixas
The document discusses a clinical decision support system called SIADe for diagnosing dementia, Alzheimer's disease, and mild cognitive impairment. It lists participating institutions and outlines the agenda which includes motivation, objectives, clinical decision modeling, achievements, and future work. The motivation discusses the aging population and high prevalence of dementia. The objective is to design a decision support system to aid in diagnosis. It will use a knowledge base, inference engine, and mobile app for physicians. Clinical decision modeling involves identifying diagnostic guidelines, preprocessing patient records, building a Bayesian network model, and evaluating model performance. The system aims to address information overload and integrate evidence-based knowledge to help physicians with clinical decision making.
This document discusses capacity planning for radiation treatment machines at Cancer Care Ontario. It provides background on Cancer Care Ontario's role in managing radiation treatment services and current capacity. Between 2000-2012, the number of linear accelerators (linacs) grew from 65 to 100 across Ontario. The document discusses Cancer Care Ontario's Radiation Treatment Capital Investment Strategy (RTCIS) for determining needs. Forecasting shows demand for cancer treatments increasing to 42% of cases in 2020 and 48% in 2031, requiring additional linacs. The recommendation is to add 16 linacs between 2013-2017 in phases at various cancer centers based on forecasted demand.
The document is a presentation about polyclinic waiting time problems and solutions at Tawam Hospital in the UAE. It introduces the presenter and states that the presentation will be divided into four parts: an overview, study results, current and proposed processes, and recommendations/conclusions. It provides background on Tawam Hospital and defines waiting time. It discusses implementation of a Health Information System (HIS) and benefits, as well as research aims, methodology involving questionnaires, and results showing specialists are satisfied with HIS but it is not the main cause of delays. Results of patient questionnaires show waiting times at various stages with most waiting over 60 minutes for required service.
Wool Labs uses proprietary technologies and analyses to uncover real world opinions, experiences, and behaviors of patients and physicians from online sources to answer questions, solve problems, and predict future events. They monitor entire disease categories and online conversations to identify patient safety issues, evaluate treatment experiences, and understand factors influencing medication adherence. Wool Labs' services organize large amounts of online data to provide both qualitative and quantitative insights into patient experiences with drugs, medical devices, and clinical care.
This document summarizes the experience of Odette Cancer Centre in evaluating and implementing Elekta VMAT for prostate cancer patients. Key points:
1) Planning studies showed VMAT could significantly reduce treatment delivery times for prostate cases compared to IMRT and tomotherapy, without compromising dosimetry.
2) After extensive commissioning and quality assurance testing, Odette began treating their first prostate cancer patients with VMAT in 2011.
3) Initial results confirmed VMAT decreases treatment time from around 6 minutes for IMRT to around 90 seconds for a single-arc VMAT plan.
4) Faster treatment times with VMAT are expected to allow Odette to treat more patients per
IRJET- Hospital Admission Prediction: A Technology SurveyIRJET Journal
This document summarizes research on using machine learning techniques to predict hospital admissions from emergency departments. It first provides background on how emergency department overcrowding can negatively impact patients and the need to improve patient flow. It then reviews 10 previous studies that used methods like logistic regression, decision trees, random forests and neural networks to predict admissions. Three algorithms (gradient boosted machine, random forest, decision tree) were implemented and evaluated on a hospital dataset, with random forest achieving the best performance. The paper concludes that admission prediction can help hospitals plan resources and reduce crowding.
A clinical decision support system (CDSS) is an interactive computer program that uses patient data to generate advice to help clinicians make decisions. A CDSS uses a dynamic knowledge base and rules derived from experts to make suggestions, which clinicians can then use along with their own expertise to determine diagnoses and treatments. CDSS systems are used at the point of care to assist clinicians before, during, and after making diagnoses. They work by taking in patient data, applying medical knowledge, and providing recommendations to aid clinical decision making.
The past few years have heralded much excitement around the uses of Point of Care Testing (PoCT). With advancements in electronics, the miniaturization and digitization of technology has spilled over into the realm of medical diagnostics. Through portable, transportable and handheld instruments, PoCT is the ability to bring the diagnostic capabilities of a laboratory to the patients’ bedsides. It is effectively a potential solution to some of the health problems that India faces, especially in the context of the heavy burden of infectious diseases that plagues it and its large rural population with limited or no access to testing facilities.
Gautam Singh - Application of Bayesian Classifier for the Diagnosis of Dental...Gautam Singh
This document describes a study that developed a Bayesian classifier to diagnose dental diseases based on patient-reported pain parameters. Researchers collected data on 14 pain parameters and 10 common dental diseases from 10 dentists evaluating 40 cases each. They analyzed the data, identified significant predictors, and developed a naive Bayesian classifier. They then used a hill climbing algorithm to create a learned Bayesian classifier, which achieved an average accuracy of 72% in diagnosing diseases based on pain parameters alone. This accuracy was seen as clinically useful for dentists.
Harman Deep is pursuing an MBA in Finance and Marketing from PCTE Baddowal, Ludhiana. He has internship experience in inventory management at Classic Wears Pvt. Ltd. and has conducted market surveys for auto parts. He has achieved academic and extracurricular success including 2nd position in a youth festival, 37th rank in an entrance exam, and 1st prize for product innovation.
El documento describe un taller de dibujo del cuerpo humano utilizando diferentes técnicas como grafito, aguarrás, pastel y lápiz. Los dibujos fueron realizados por Rocío Corona.
Con motivo del 10º aniversario de la Fundación Hospital Calahorra,
el Consejero de Salud, D. José Ignacio Nieto García, en nombre del Presidente del
Gobierno de La Rioja, D. Pedro Sanz Alonso, tiene el placer de invitarle a la II Jornada
Encuentro Hospitales, que tendrá lugar el próximo viernes 26 de noviembre,
a las 9:30 horas, en el Palacio de Congresos y Auditorio de La Rioja, Riojaforum.
This document discusses importing official and OpenStreetMap (OSM) datasets into a local PostGIS database for the Brest Metropole Oceane region of France. It involves using tools like shp2pgsql, ogr2ogr, and osm2pgsql to import the shapefiles and OSM data. The datasets are then compared using buffer analysis on the ways to identify roads from the official data to import into OSM where the roads are less than 50% covered by OSM data.
El narcocorrido es un subgénero de la música norteña que exalta o conmemora figuras y eventos relacionados con el narcotráfico, principalmente escuchado en el norte de México y sur de Estados Unidos. Aunque está prohibida su transmisión en radiodifusoras mexicanas, se difunde a través de piratería de CD y su reproducción a alto volumen en público por narcotraficantes. Los estados donde más se escucha son Sinaloa y Chihuahua, y los artistas actuales más populares incluyen
El documento ofrece instrucciones para navegar el aula virtual y correo institucional de la universidad. Primero, se debe acceder a la página de pregrado y dar clic en "aulas virtuales" e ingresar el ID y contraseña de Génesis. Luego se puede actualizar la información personal, participar en foros, comunicarse con compañeros y docentes a través de mensajes, acceder a tareas pendientes, y revisar el correo institucional ingresando a la URL estudiantes.uniminuto.edu. Finalmente, se explica
The document describes unconventional uses for plungers including using them as toilet paper holders, clothes hangers, book shelves mounted on walls, ash trays, and even devices for catching rats and roaches. It suggests that plungers can be used for fun activities like parties and can solve problems that have occurred since 1932, implying plungers have many unexpected practical and entertaining purposes beyond their normal function of unclogging drains.
This document summarizes Principal Financial Group's third quarter 2014 earnings call. It provides non-GAAP financial measures to help investors understand the company's normal ongoing operations. These measures are also used internally for goal setting and compensation. The document discusses strong investment performance across time periods. It highlights earnings and growth in different business segments, including retirement services, guaranteed income, Principal Global Investors, and international operations. Normalizing items are identified to show the underlying growth in operating earnings.
EPFO will pay a 9.5% rate for 2010-11 after discovering a hidden surplus of Rs. 158 crore. Food inflation jumped to 15% due to supply constraints from heavy rains affecting production in states like Punjab and Haryana. Banks have reintroduced special deposit schemes with higher interest rates to attract more small savers. The RBI hiked its repo and reverse repo rates, which may make loans more expensive for corporates and individuals. The Sensex may top 20,000 next week due to continued foreign investor inflows over the past six months. Bharti Airtel awarded IBM a $1.5 billion contract to manage its IT operations across 16 African countries. SBI said it won
The HP government is planning to merge loss-making public sector undertakings (PSUs) with the State's Industrial Development Corporation to improve their financial situation. Reliance Retail plans to open at least three cash-and-carry outlets in the next 6-8 months in Tier-II cities. Vijay Mallya's fertilizer company scrapped its Rs. 500 crore plan to set up a unit to sell fruits and vegetables. Bharti entered the mobile handset business through its subsidiary Beetel, launching eight phones priced between Rs. 1,750-7,000 available through 4,000 outlets. Intex Technologies will enter the television segment, pricing its products under the Intex brand
Este documento compara los costos y beneficios ambientales de usar productos de limpieza ecológicos de la marca Hogares Ecológicos en lugar de productos convencionales. Calcula que al cambiar a los productos ecológicos se pueden ahorrar $995,203 y evitar 182 empaques contaminantes. Al usar estos productos más sustentables, los consumidores pueden reducir su huella ecológica y contribuir a problemas ambientales como el calentamiento global y la contaminación del agua.
Structural engineers play an important role. A positive attitude is valued in employees. The document does not provide much additional context or information to summarize further in 3 sentences or less.
ACE Insurance Contractors Ltd is an insurance company located in London, England that provides various insurance services and products. They have been in business for over 25 years and have a team of experienced insurance agents and adjusters. ACE Insurance Contractors Ltd aims to offer their clients comprehensive and affordable insurance coverage.
Quality in critical care aims to provide care that is safe, effective, patient-centered and improves outcomes. There is global variation in critical care resources and processes. Quality improvement is important as substandard critical care can harm patients and waste resources. Quality can be measured through indicators related to ICU structure, care processes and patient outcomes. Checklists and tools from WHO help standardize processes and improve quality.
1) The document discusses a project called HTAIm (Health Technology Assessment and Implementation) which aims to support better decisions in healthcare through evaluating health technologies.
2) HTAIm was designed through literature reviews, stakeholder consultations, and iterative model building. It provides a blueprint for conducting health technology assessments that consider local context.
3) Case studies show HTAIm can identify low-value care and reduce costs, such as through an aged care emergency program that avoided ambulance transfers and ED presentations, saving $920,000 annually.
Effective Falls and Fracture Management within Primary Care: a qualitative ge...UKFacultyPublicHealth
This document summarizes a study that explored general practitioners' perspectives on managing falls and fractures in older patients. Through interviews with 17 GPs, the study identified several key themes: falls prevention is a high priority but GPs face barriers like a lack of integration between primary and secondary care, incomplete awareness of available services, and complex referral pathways that consume valuable time. Opportunities exist at both the population and individual levels through public health initiatives, risk stratification, and targeting interventions to high-risk groups. Overall, the study highlights the ongoing challenge of falls management within primary care given its time constraints and role as the frontline of the overstretched NHS.
This document provides an overview of commissioning for value in healthcare. It discusses highlighting unwarranted variation in quality, outcomes, activity and spend using tools like the NHS Atlas of Variation. It emphasizes empowering patients through shared decision making using decision aids. It also covers engaging clinicians and commissioners to shift from "rationing" to "rational commissioning" and using information and insights to drive action and sharing of best practices. The goal is to increase value by focusing on health outcomes relative to total costs.
The document summarizes a hospital's venous thromboembolism (VTE) prophylaxis program over 7 years. It shows that the program reduced hospital-acquired deep vein thrombosis and pulmonary embolism by over two-thirds, saving over $6 million in costs. Moving forward, the hospital aims to further improve prophylaxis practices by focusing on areas like daily ambulation and administering prophylaxis in the emergency department and throughout a patient's care. The goal is continuous quality improvement to help more patients and potentially achieve outcomes like preventing all hospital-acquired infections.
Infection Prevention Practices on the Healthcare Frontier: Emerging Models of...bden129
This document summarizes an educational session on infection prevention in emerging ambulatory care delivery models. It discusses trends driving the shift to outpatient care like declining inpatient volumes and growing outpatient encounters. Emerging models described include micro-hospitals, ambulatory surgery centers, and "hospital at home" programs. These models require new staffing approaches for infection prevention. The document outlines challenges for infection preventionists in these settings and resources available to assist them.
The document discusses opportunities and challenges for personalized medicines and sickle cell disease treatments. It provides an overview of current limited treatment options for sickle cell disease and highlights several new treatment options currently under development or approval, including Novartis' crizanlizumab, Global Blood Therapeutics' voxelotor, and gene therapies. It notes obstacles to access like high drug costs, long review processes, Canada's drug pricing system, and the small market size. The presentation calls on stakeholders to work together to improve access and education.
ICN Victoria presents Dr Dashiell Gantner, research fellow at the Monash University in Melbourne. Here he talks about translating ICU research into clinical practice.
Professor Michael Thick, Chief Medical Officer and Chief Clinical Information...Investnet
This document discusses quality, safety, and productivity in healthcare. It notes that 66% of hospitals provide inadequate care and adverse safety incidents occur at a rate of 1 in 10, unchanged for 30 years. Four groups of patients are identified with different attitudes towards health. Quality is multidimensional, involving treatment outcomes, safety, and patient experience. Technology has potential to transform care if it enables interoperability and embraces disruptive innovations. Clinical leadership and engagement are needed to effectively lead change in the healthcare system.
Michael Thick, Chief Medical Officer and Chief Clinical Information Officer, ...Investnet
This document discusses quality, safety, and productivity in healthcare. It notes that 66% of hospitals provide inadequate care and adverse safety incidents occur at a rate of 1 in 10, unchanged for 30 years. Four groups of patients are identified with different attitudes towards health. Quality is multidimensional, involving treatment outcomes, safety, and patient experience. Technology has potential to transform care if it enables interoperability and embraces disruptive innovations. Clinical leadership and engagement are needed to effectively lead change in the healthcare system.
The document discusses identifying problems in healthcare quality and reducing waste. It begins by outlining the six aims of quality healthcare: safe, timely, effective, efficient, equitable, and patient-centered. It then discusses various sources of waste in the healthcare system, including overtreatment, failures of care coordination, failures to execute best practices, excessive administrative complexity, pricing failures, and fraud/abuse. Specific estimates are given for the amount of waste from each category, totaling hundreds of billions of dollars annually. The document emphasizes the opportunity for improvement that exists and stresses the importance of focusing on problems we can directly address and fix.
This document discusses the importance of collaborative care and care coordination for healthcare delivery systems. It notes that solo practice is no longer a sustainable business model and that fee-for-service payments have limitations. The document provides evidence that care coordination can reduce costs through fewer hospital admissions and readmissions without worse health outcomes. It also shows that patients experience a lack of communication and information sharing between their different doctors. To improve care coordination, mobile access to patient data and collaborative workflows are seen as critical, as mobile devices are increasingly how physicians access information. The right devices and secure mobile computing are needed to enable these new care coordination models.
Case Study "Using Real Time Clinical Data To Support Patient Risk Stratification in The Clinical Care Setting"
HealthInfoNet operates the statewide health information exchange in Maine. The exchange currently manages clinical and patient care encounter information on 97 percent of the residents of the State of Maine. The information is gathered in real time, standardized, and aggregated at a patient specific level to support treatment. For the past three years, HealthInfoNet has worked with HBI Solutions, Inc of Palo Alto, CA to utilize this real time clinical and encounter data to support the development of predictive analytic tools that risk stratify patient populations and individual patients for future incidence of disease, cost, and both inpatient and ambulatory care encounters. These real time predictive models have now been used in clinical care settings for a year. The presentation will cover both lessons learned to date from implementing and optimizing real time predictive analytic tools and the early finding of the impact that the use of these tools is having on patient care management, utilization and outcome.
Devore Culver
Executive Director & CEO
HealthInfoNet
This document discusses several enduring problems in healthcare systems including uncertainty about clinical effectiveness due to poor quality research, persistent variations in clinical practice, patient safety issues, reluctance to manage skill mix, and poor outcome measurement. It also outlines some achievements of the UK healthcare system such as the establishment of NICE to evaluate clinical and cost effectiveness, introduction of targets to reduce wait times, and beginning to benchmark safety incidents. However, it notes continuous reorganizations have not been properly evaluated and there is a need for greater focus on improving average performance and ensuring best practices are universally adopted.
Point Value Descriptive TitlePurpose and Analytical .docxLeilaniPoolsy
Point Value Descriptive Title
Purpose and
Analytical
Technique(s)
Summary of Results
Summary of
Conclusions
Error Analysis
Professional
Presentation
2
Title is complete and
informative, and written
in a scientific tone
A general purpose and
all relevant analytical
techniques are given
using the correct
scientific terminology
All major numerical
results are given with
correct units and
significant figures - All
important descriptive
results are given with
appropriate context
Conclusions are made
based on the results, any
accepted values are
given for comparison,
and percent error values
are provided
Errors are given,
followed through the
calculations, and the
effect on the result is
explained - Errors are
used to explain
deviations from the
expected results
Abstract is typed, proof
read, and printed on an
appropriate medium
1
Title is informative and
appropriate, yet is
somewhat incomplete,
contains errors, or is
written in an unscientific
tone
Purpose or techniques
are partially incomplete
or use layman's terms
Result section is mostly
complete, but some
relevant results are
omitted, or incorrect
units or significant
figures are used
Conclusion section is
mostly complete, but
some relevant
conclusions are omitted
Errors are given, but not
followed through the
calculations, or not used
to explain results
Abstract contains several
errors, or has
handwritten edits
0
Title is absent, or neither
informative nor
appropriate
Section is absent or not
relevant to the
experiment
Section is absent, less
than half complete, or
not relevant to the
experiment
Section is absent, less
than half complete, or
not relevant to the
experiment
Section is absent or not
relevant to the
experiment
Abstract is handwritten,
contains numerous
errors, or otherwise
unacceptably presented
Rubric for a Scientific Abstract
In general, abstracts will be graded on the six criteria below (column headings), worth two points each.
The resulting points out of 12 will be converted to a gradebook score out of five.
Score = (
5
/12 ) × Points
Some rules for it:
1. Font size 12, times new roman style.
2. 600 words
About Abstracts:
An abstract is a brief, written summary of the specific idea or concepts to be presented, and a statement of their relevance to practice or research.
This is one type to write abstracts:
Research abstracts: include a brief description of the author’s original objective or hypothesis research methodology, including design, participant characteristics and procedures, major findings, and conclusions or implications for dietetics.
All words should write by yourself, no quote from any website or paper.
Please check abstract grading rubric for get higher grade. Thanks.
PRACTICE APPLICATIONS
Business of Dietetics
Hospital-Acquired Conditions: Knowing, Preventing,
and Treating .
Health Valley Event Presentatie Rob ten HoedtHealth Valley
1. Rob ten Hoedt, President of Medtronic Europe, gave a presentation on the medical technology industry and Medtronic's role in innovation in Europe.
2. Key trends in European healthcare include aging populations, rising costs, and a focus on prevention and chronic disease management outside hospitals.
3. Medtronic is developing innovative solutions like implantable devices, biologics, and wireless technologies to treat conditions like heart disease, diabetes, and neurological disorders.
Optical sensing techniques for quality control of cathetersmbaltazar
This document discusses using optical spectroscopy techniques like reflectance spectroscopy for quality control testing of antimicrobial coatings on catheters. It describes how one catheter manufacturer is using an Ocean Insight spectrometer setup to measure coating concentration and uniformity onsite, providing a faster and less destructive alternative to traditional HPLC testing. The spectrometer measurements showed high correlation to HPLC results, demonstrating its effectiveness for ensuring catheter coating quality meets standards. Preventing device infections is important for patient safety and reducing healthcare costs.
Getting started at the national level from demonstration to spreadProqualis
This document summarizes a presentation on implementing and scaling patient safety programs nationally in Scotland. It discusses how Scotland implemented a national patient safety program across all hospitals to reduce mortality and adverse events. Key points included establishing clear aims to reduce mortality by 15% and adverse events by 30%, implementing improvement programs in five areas, achieving significant reductions in outcomes like ventilator-associated pneumonia and central line infections, and creating the conditions for large-scale change through establishing aims, priorities, measurement, resources, and testing and spreading new learning.
The document discusses the benefits of mobile device connectivity for healthcare. It notes that over 30% of physicians make decisions with incomplete information, and mobile technologies could eliminate 11-30% of office visits. Remote monitoring is shown to reduce costs and hospital admissions for conditions like diabetes, congestive heart failure, and COPD. Widespread use of remote monitoring for chronic conditions could save over $200 billion in healthcare costs over 25 years. Standards-based WiFi technologies can effectively support remote patient monitoring.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Tests for analysis of different pharmaceutical.pptx
*Jc conf23jun2010 copy
1. “Leading EIVI ”
Evidence Informed Value
Improvement
Details download from
http://homepage.mac.com/johnovr/FileSharing2.html
John Øvretveit,
Director of Research, Professor of Health Innovation and
Evaluation, Karolinska Institutet, Stockholm, Sweden
6/25/2010
1
2. Question to you…
Do you know any quality
activities or projects which save
money?
or bring-in more money than they
cost
Please ask the person next to you
2
3. The “new normal”
We must cut costs… and raise quality
Quality activities cost…
which ones pay for themselves
or make savings/extra income?
Accreditation?
Chronic care model?
Falls prevention?
Anti-biotic prophylaxis before surgery?
Choose value improvements 3
4. What is a “Value Improvement”?
POSTERS IN HOSPITAL TOILET
“Safety cameras record pictures of personnel
not washing hands after using toilet” Problem cost-
5. Examples:
“Read back” now used consistently to confirm message
received and understood
Patient Pathway redesign, using less clinician time & fewer
delays
“A change which saves money and
suffering…caused by poor organisation or
under-supported providers”
Evidence-based = proven and likely to improve
5
our service value
6. Evidence – the search
problems and potential savings
solutions and their “spend costs”
Evidence of savings or losses
for implementers, or others, now or later
6
7. Evidence and experience I will share
Quality economics research & projects in Sweden and
Norway 1999-2009
2009: 5 systematic reviews of research and book
7
8. What did I find, from the search?
Guess one – hands up:
All quality and safety improvements save
money?
No improvements save money?
Some quality and safety improvements save
money?
Which ones, for whom, and when? 8
10. Patient: 84 year old, obstructive airways
disease and heart failure
- Stable at home, fiercely independent
- Supported with regular visits to primary care by son,
and home cleaner,
and cat “Matty” 6/25/2010 10
11. Health care experience
10am Friday fall at home - breaks hip
14.00 admitted ER
17.00 internal medicine unit
Change of medications
Weekend - no operations
Monday – orthopaedic surgeon informed
late
Tuesday am operation
6/25/2010 11
12. Health care experience
Friday - isolated due to MRSA developing
in wound on arm from fall
Discharged 1 week later with no
information to PHC
Readmitted 2 weeks later with weight loss,
pneumonia and infected wound
6/25/2010 12
13. 6 weeks – what the numbers do not show
6/25/2010 13
14. Estimates
$17.4b costavoidable re-hospitalizations for older
patients,(50% preventable by better coordination (Jenks et al 2009)
25% of hospital days and clinical procedures inappropriate
25% of radiological tests not necessary (UK Royal College of Radiologists)
€415bn/yr “wasted on outmoded and inefficient medical
procedures in the US” Juran study
the cost of poor quality care will likely exceed $1 trillion by 2011
40% medications unnecessary (Rand USA studies)
€330m medicines returned to pharmacies for disposal each
year UK (BMJ 2002)
15. Estimates
..by our current very
conservative estimates,
only 44 % of all
resources consumed in
health care delivery
add value.
Thus 56 % – represents
potentially recoverable
waste
16. Poor quality and safety - types
Under-coordination
500 GPs - 70% reported late discharge summaries “often” or “very often”, 90%
reporting it “compromised clinical care” and 68% “compromised patient safety ”. One
summary arrived 11 years late
The slips “in-beween” – music is the space between the notes
Chassin et al 1986:
Over-use (no medical benefit) Tests and antibiotics.
Under-use of effective treatments
anticoagulant to prevent thrombi (also 79% of eligible heart attack
survivors fail to receive beta blockers)
Miss-use (esp miss diagnosis 10%-15%) (anticoagulant to
1
prevent thrombi)
6
17. Adverse events – avoidable injury & costs
Typical Loss, to the average provider (medicare payment)
(longer length of stay and extra treatments):
pressure ulcer $2,400;
postoperative sepsis $16,000;
postoperative embolism and deep vein thrombosis
$8,500;
postoperative hemorrhage $6,000;
Iatrogenic pneumothorax $10,200
NB - Even after reimbursement for the extra treatment
(see also HFMA 2006).
17
18. Three targets for QI and cost reduction
1 High Cost Adverse Events:
avoidable patient suffering
and waste
2 Process improvement
3 Waste
as revealed by Lean quality methods and
reports (eg UK NIII productive ward, 10 high
impact) 1
8
19. Where to look for avoidable poor quality/high
ICU, ER, OR, Radiology,
cost
Hospitals Outpatients, Discharge planning
& all “in betweens”
Primary health Diagnosis, avoidable referrals and
care admissions, prescribing, chronic
care and multiple morbidity
Nursing homes Pressure ulcers, falls, prescribing,
avoidable admissions, MRSA, shift
Health/welfare handovers
Transfers and patient information
system handovers, chronic care &19 multiple
20. Can you fill in the numbers / year for your
Type of event service? 2
1 3 Cost
Number Cost of /yr
/yr event
(average, to the
service)
Hospital acquired
infection (HAI)?
Adverse drug event
Patient falls?
Pressure ulcers? 2
Wrong site surgery? 0
6/25/2010
21. Johns suggestion
Get more informed about high cost problems, from:
1) Research on problems, costs, possible waste,
elsewhere but likely in your service
2) Your data from: discharge and admissions data,
reports, review of medical charts (JC tracer method, IHI
trigger tool).
Special focus on ICU, ER, OR, Radiology, Outpatients
3)Estimate 10 highest cost from a) cost/problem, b)
frequency
2
6/25/2010
1
22. Reminder
But will cost of solution be more?
Savings depend on the solution
“spend cost”
4) Estimate cost to reduce problem by
25% and 50% - next
2
6/25/2010
2
25. Solutions – do they work, and do they cost more than the
problem?
– do they work, and do they cost more than the
problem?
1)Effectiveness evidence
Clinical practices: AHRQ 2001 11 “Nike list”
Timely antibiotics before surgery
Barrier precautions before
central line catheters, etc)
2
2) Less evidence about organisational 5
26. Solutions
3) Less evidence of effectiveness of
implementation strategies
Eg training, reminders, etc?
4) Little evidence of costs of solutions
In one service
In a variety
2
6
27. Others reported experience
Falls resulting in fractures av cost $30,000
30% over 65 with a fall-related fracture die
“An investment of $25,000 in a fall prevention program yielded
$115,000 in savings in fracture care”
Nosocomial infections cost a minimum of $5,000 per episode.
“An investment of $1,000 in hand hygiene yielded $60,000 in
avoided care costs”
Calculation details not given
(Source: Bagian reports from VHA (in AHRQ 2008)
28. Our Swedish research – Service accountants using
routine data - Savings in first year
100,000€ Better coordinated care planning before
discharge in hospital geriatric unit (1.035.410 SEK)
14,000€ Review of medications in one home for older
people (146 334 SEK) (73€ per patient/year (732 SEK).
71,000 – 630,000€ Emergency unit patient vita signs
assessment improvement between (713 298 SEK and 6 317 270 SEK in the
first year)(depending on assumptions)
24,000€ yr1, 65,000€ yr2 Reducing sphincter injury in
delivery from 5,3%-3,9% (239 122 SEK (2006 first year) and 652 836SEK
(2007).
29. Return on Investment – Managed care QIROI
Selected 10 Medicaid managed care organizations QI for high-
risk high-cost patient populations
12/ 1 - A complex case management program to treat adults
with multiple comorbidities
6/ 1 - case management for children with asthma with high ER
use or inpatient admissions
1.2/ 1 intervention for high-risk pregnant mothers
1.1/ 1 program for adult patients with diabetes
3 broke even,
3 cost between 18 and 26 times more than they saved (Greene 2008)
30. Savings or extra income depends on
How effectively and completely you make the
change
motivation, project management and expertise
Step 2: “change into cash”
can you use the saved bed days, time or
materials to increase income through treating
more patients?
Or redeploy staff/beds, or charge higher price?
3
Does your payer measure quality,
6/25/2010
0
31. Financing system disincentives
Mary case : discharge early - no information, readmission
with acute pneumonia - No quality measures
Triple incentive for poor quality
Save on early discharge (lower LOS, DRG based fixed income)
Paid for readmission
Save on costs of time to give info to PHC and cost of system for
this
(No finance to invest in improvement)
Paid to treat illness caused by healthcare
3
or poor coordination
1
Eg readmissions due to poor treatment or early discharge
32. The summary
up to 50% of your costs - potential savings
But
1) Spend cost of solution? - for your service
(25% effective?)(how effective in your service?)
2) Turn this into cash savings or extra income?
- change 2
= you have to make estimates, and then track
for sure 3
6/25/2010
2
33. Next - “Leading EIVI”
“We realized that if we just cut out cost, more often than
not we’re reducing quality.
What we’ve learned is that if we reduce cost by reducing
waste, we actually improve quality” Dr Gary Kaplan. CEO VMMC
What do leaders need to do?
Which leaders?
Level?
Role?
service manager accountable for resources;
clinical leader professionally accountable;
3
quality/safety officer
6/25/2010
3
35. Findings : Your actions depend on
1) Role
Position/role: level, general manager or clinical leader
2) The QS task
Type of quality and safety work QA/QI simple, radical -
many departments/professions
3) Context
Internal , External
= Leader development/support to enable different actions
and tasks, for different QS objectives, in different
contexts. 3
5
36. .
Agreement about steps for different types of improvement,
Less about how many of the tasks the leader does, with or
without consultation.
- evidence that more successful improvement is where the
leader creates a social process
- tasks are shared and exchanged at different times,
- leaders role is to start and sustain this process.
- how they do this depends on the situation
BUT clinical professionals do not see this “organisational
work” as their best use of time, and have no skills for it3
6/25/2010
6
37. What a leader needs – 7 things
1 Get knowledge
AEs or sub-optimal quality in our service?
Classification of range of problems, for data collection
Data: frequency, volume of patients affecting, potential cost
2 Get motivation
Benefits for me? Convince with credible data by credible
source
3 Prioritise and set targets
Understand which improvements could reduce avoidable harm
save money or increase income, in your service
3
7
38. What is needed – 7 things
4 Lead process for improvement
enlist project team, with senior sponsor and clinical champion,
expert facilitation, using systematic methods appropriately
5 Monitor and progress
team reports, managers remove blocks (or lay down team)
6 Evaluate savings and outcomes
track costs, spend costs, potential savings, real savings/increase
in income
7 Sustain and spread
Procedures, training and supervision, document and
roll-out
3
8
39. Success depends on more than the leader’s efforts and
skill
Seed Gardener/planting & nurture Climate / soil
Your change?
Change idea Implementation actions
+ + Context
Evidence + Implementation + Environment 39
6/25/2010
40. Motivation Incentives and Culture
Are employees motivated to give extra effort
to QI?
Incentives (reinvest savings?)
Attitudes
and culture?
4
0
41. Engagement – does the rational work?
PPT presentation – potential partnership opportunity
Our individual challenges – ageing, economy, partner to
reproduce
What others have done
The benefits
Lower costs
Taxation advantages
Evidence says its good for our health and for the kids
What you need to do
Take questions and answers now 4
Or…Or appeal to the heart – how good they are, their importance,
1
42. 10 top tips for leading improvement
1 No measure = no use
Ask “when will a measurable change in outcome, costs or intermediate
indicator be seen?
How much this will cost and save?
2 Stop any activity which cannot say this.
3 Improvement and innovation efforts take time
to change what people do
and to make a measurable difference to patient care
4 Check, stop, or speed it
Know how to tell if its not working – intermediate measures
5 Finish off
4 and
Look for what people have started which is likely to produce results
finish it off 2
43. Top tips 6-10 for leading improvement
6 Doctor and manager must lead it
Interest and motivate them
Make sure they use the methods appropriately
7 Be a Viking
Steal and apply – use changes and implementation approaches proven in
services like yours
8 Don’t loose in translation
Adapt to adopt but don’t loose the active ingredient
9 Free the talent and side step the negatives
Find the “can doers” and support them to show the doubters that it works
10 Work on the head and the heart 4
Rational steps and methods, driven by people upset by poor quality
3
44. Conclusions
High cost of poor quality
Some effective targeted solutions, little
evidence of “spend cost”
Some certain savings, but depends on
implementation skill
Financing system rewards poor quality
4
4
48. Click Links to web Site Quality Safety &
Tools
Johns web site with papers and tools
http://homepage.mac.com/johno
vr/FileSharing2.html
4
6/25/2010
8
49. Resources
Assess if a change will work in our organisation.
From AHRQ http://www.innovations.ahrq.gov
a)Based on good evidence and experience b) Clear advantage
compared to current, c) Compatible with current system and
values d) Simple to implement e) Easy to test before full
commitment, f) Impact of change observable.
Also download: Brach et al 2008 AHRQ “Will it
work here”, downloadable from Johns web site
ACHS folder 4
6/25/2010
9
50. AHRQ 2008 workshop for good overview
Creating a Business Case for Quality Improvement
Research: Expert Views, Workshop Summary, NATIONAL
ACADEMIES PRESS, Washington, D.C.
http://www.nap.edu/catalog/12137.html
51. Calculate
Waste costs
LOS, staff time, materials, loss of income
Spend costs (50% solution)
Cost of time for project team & other costs
Savings - after 1 year starting the project
How much will you have spent?
How much will you have saved?
How long after starting do you start saving?
What are the steps to turn potential into real savings or
extra income?
52. USA literature "The business case for quality"
Reiter KL et al. 2006. “How to develop a business case for quality.”
International Journal for Quality in Health Care; 19(1): 50-55.
Gosfield, A Reinertsen, J (2003) Doing Well By Doing Good: Improving
the Business Case for Quality, The Reinertsen Group Alta, Wyoming
Gross, P et al 2007 The Business Case for Quality at a University Teaching
Hospital The Joint Commission Journal on Quality and Patient Safety
March 2007 Volume 33 Number 3, 163-169.
Leatherman, S et al 2003 The Business Case For Quality: Case Studies
And An Analysis HEALTH A F FA I R S ~ Vo lume 2 2 , Nu mber 2 17-
25
54. Practical recommendation 1 - providers
1 Select quality projects for support
Decide criteria for Q-support
This organisation does not support quality projects or
activities which do not meet these criteria…
…because it takes time and money from activities which are
effective for QI and from clinical care.
Criterion: an estimate of current cost of the problem, likely
spend and potential savings at 1,2,3 yrs.
2 Do estimates.
5
The Steps: cost, spend, save or loss
4
55. Step 1: COST? How much does problem
cost us?
Do you a) waste time or resources, b) loose
income (or patients) with this problem?
eg MRSA case = Yes to a) and to b) if measured and
publically known
eg VAP in ICU = Yes (if paid by item/drg)
5
6/25/2010
5
56. Step 2: EFFECTIVE?
If high cost, is it preventable/reducable?
Someone somewhere has an effective solution
We can implement it effectively
Step 3: SPEND?
Quantify the time and cost of implementation in money
If we can reduce the problem, how much do we need to
spend to reduce it?
Eg 100,000 € to reduce by 10% - and show confidence
range (eg 95% certain 80,000-120,000 €)
5
Personnel time needed, and using other peoples estimates
6/25/2010
6
57. Step 4: SAVE OR LOSS?
Cost - spend = save or loss at 1yr,2yr 3 yr
“Theoretical savings”: less time or materials used
Cash savings: change 2 is using saved time to increase
income or reduce spending
Estimate Time To Pay-Off - 18 months? Or never?
If you will loose money but health system/purchaser
saves
Then take your estimates to them and agree a deal 5
They may fund the project
6/25/2010
7
58. Practical recommendation - Funders/heath
system
1. Change financing system
Measure and fund quality, as well as volume and cost
Better outcomes and prevention saves you money
Require quality data from providers or third parties
Change item of service funding to include quality measures
Don’t pay providers to treat the injuries they cause
Experiment with “bundle payments” for chronic care and long-
episode funding
5
8
59. Practical recommendation - Funders/heath
system
2 Invest in proven value improvements (make your
list)
Give money to implement
Some safety interventions (eg coordination)
Some improvements (eg day surgery, process
imp)
Some chronic illness programmes
(egcollaboratives, or directly to provider project)
5
9
60. Advice
1 Criteria for choosing: Costly problem, effective solution,
implementable (investment, time, support), savings more
than costs
2 In betweens : improve clinical communication and
collaboration between
shifts, professions, services, facilities
3 Leading Value Improvement is more successful
Unites clinicians, managers, purchasers, patients,
politicians
6
0
61. Conclusions
Each person write down and then share in the group:
1. These were the main points…
2. This was new or surprising, for me…
3. The most useful idea for my work was…
4. What I would like to find out more about…
6/25/2010
61
Editor's Notes
UK 100k hospital acquired infections (5k die) in England/yr. (40m) €1.4bnCosts (UK Hoc rprt 2000)
UK 100k hospital acquired infections (5k die) in England/yr. (40m) €1.4bnCosts (UK Hoc rprt 2000)
Searching for a business case for quality in Medicaid managed care Sandra B. Greene Kristin L. Reiter Kerry E. Kilpatrick Sheila Leatherman Stephen A. Somers Allison HamblinHealth Care Manage Rev, 2008, 33(4), 350-360