Kaiser Permanente developed a bundled approach to improve care transitions called the Transition Care Journey. The bundle includes risk stratification, a dedicated phone number for post-discharge questions, standardized discharge summaries, medication management, and follow-up appointments and calls. Implementation of the bundle in Northwest Kaiser led to reductions in readmission rates, medication list errors, and time to primary care follow-up. It also improved communication between hospitalists, primary care physicians, and specialists. The bundled approach is being spread to other Kaiser regions nationally.
Compliatric is excited to continue their “Continuous Compliance" Webinar Series based on the existing Health Center Compliance Manual and the most recently updated Site Visit Protocol. Each month, program requirements are reviewed to assist health centers in understanding the various elements and ensuring continuing compliance. Participants will be able to use these webinars to increase their knowledge of the requirements, and go one step further and utilize the program requirements to improve operational excellence.
As Operational Site Visits (OSVs) resume virtually, it is important for Community Health Centers to maintain continuous compliance. Compliatric is excited to continue their “Compliance Webinar Series” where each month, program requirements are reviewed to assist health centers in understanding various elements. Participants will be able to utilize these webinars to increase their knowledge of the requirements, and also take compliance to the next level.
View The Webinar: https://compliatric.com/continuous-compliance-2022-its-not-just-an-osv-prep-chapters-7-8/
Compliatric is excited to continue their “Continuous Compliance" Webinar Series based on the existing Health Center Compliance Manual and the most recently updated Site Visit Protocol. Each month, program requirements are reviewed to assist health centers in understanding the various elements and ensuring continuing compliance. Participants will be able to use these webinars to increase their knowledge of the requirements, and go one step further and utilize the program requirements to improve operational excellence.
This month’s webinar will focus on the following chapters:
Chapter 7: Coverage for Medical Emergencies During and After Hours
Chapter 8: Continuity of Care and Hospital Admitting
Webinar attendee takeaways will include:
· An understanding of the program requirements, which includes updates to the Site Visit Protocol
· Maintaining continuous compliance - not only based on a site visit
· Improving operational excellence for your Community Health Center
Electronic Health Record System and Its Key Benefits to Healthcare IndustryCalance
This case study discusses how Electronic Health Record can turn out to be a solution to the problems associated with paper based clinical records. It’s a future-proof solution decreasing chances of error and loss while increasing patient-provider communication. Find out the key challenges faced by US health industry, key benefits of EHRs, and how Calance can help developing an HER solution. For more info about Calance, visit http://www.calanceus.com
Compliatric is excited to continue their “Continuous Compliance" Webinar Series based on the existing Health Center Compliance Manual and the most recently updated Site Visit Protocol. Each month, program requirements are reviewed to assist health centers in understanding the various elements and ensuring continuing compliance. Participants will be able to use these webinars to increase their knowledge of the requirements, and go one step further and utilize the program requirements to improve operational excellence.
As Operational Site Visits (OSVs) resume virtually, it is important for Community Health Centers to maintain continuous compliance. Compliatric is excited to continue their “Compliance Webinar Series” where each month, program requirements are reviewed to assist health centers in understanding various elements. Participants will be able to utilize these webinars to increase their knowledge of the requirements, and also take compliance to the next level.
View The Webinar: https://compliatric.com/continuous-compliance-2022-its-not-just-an-osv-prep-chapters-7-8/
Compliatric is excited to continue their “Continuous Compliance" Webinar Series based on the existing Health Center Compliance Manual and the most recently updated Site Visit Protocol. Each month, program requirements are reviewed to assist health centers in understanding the various elements and ensuring continuing compliance. Participants will be able to use these webinars to increase their knowledge of the requirements, and go one step further and utilize the program requirements to improve operational excellence.
This month’s webinar will focus on the following chapters:
Chapter 7: Coverage for Medical Emergencies During and After Hours
Chapter 8: Continuity of Care and Hospital Admitting
Webinar attendee takeaways will include:
· An understanding of the program requirements, which includes updates to the Site Visit Protocol
· Maintaining continuous compliance - not only based on a site visit
· Improving operational excellence for your Community Health Center
Electronic Health Record System and Its Key Benefits to Healthcare IndustryCalance
This case study discusses how Electronic Health Record can turn out to be a solution to the problems associated with paper based clinical records. It’s a future-proof solution decreasing chances of error and loss while increasing patient-provider communication. Find out the key challenges faced by US health industry, key benefits of EHRs, and how Calance can help developing an HER solution. For more info about Calance, visit http://www.calanceus.com
Presentation by Kirby Farrell, President and CEO, Broad Axe Technology Partners and Andy Archer, MSc, MBA, Vice President, Broad Axe Technology Partners
The impact of eHealth on Healthcare Professionals and Organisations: Health Information Management Systems in Modern Health Care. Shemer J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
There are several main dimensions most frequently used to measure hospitals performance via clinical efficiency ( Clinical quality , evidence -based practices , health improvement and outcomes for individual and patients)
Satisfactions Among Admitted Patient of Tertiary Level Hospital in Dhaka City.DR. S A HAMIDI
I am Dr. Saleh Ahmed Hamidi, successfully Conducted a dissertation & also presented by me (08/01/2016) about patient satisfaction level in tertiary level hospital.
Delegation in healthcare and nursing. Delegating a task does not mean that you have absolved yourself of the responsibility of that task. You are still the principal person in charge of the task and how well the job is done ultimately rests on you. This is why a delegation model is essential in the workplace.
This presentation will identify the key phases of a delegation model, and use that model in a case study based in the healthcare setting.
Slides used to deliver presentation on Korean healthcare system overview. Main topics are: payer, healthcare delivery system, regulation, stakeholders.
Presentation by Kirby Farrell, President and CEO, Broad Axe Technology Partners and Andy Archer, MSc, MBA, Vice President, Broad Axe Technology Partners
The impact of eHealth on Healthcare Professionals and Organisations: Health Information Management Systems in Modern Health Care. Shemer J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
There are several main dimensions most frequently used to measure hospitals performance via clinical efficiency ( Clinical quality , evidence -based practices , health improvement and outcomes for individual and patients)
Satisfactions Among Admitted Patient of Tertiary Level Hospital in Dhaka City.DR. S A HAMIDI
I am Dr. Saleh Ahmed Hamidi, successfully Conducted a dissertation & also presented by me (08/01/2016) about patient satisfaction level in tertiary level hospital.
Delegation in healthcare and nursing. Delegating a task does not mean that you have absolved yourself of the responsibility of that task. You are still the principal person in charge of the task and how well the job is done ultimately rests on you. This is why a delegation model is essential in the workplace.
This presentation will identify the key phases of a delegation model, and use that model in a case study based in the healthcare setting.
Slides used to deliver presentation on Korean healthcare system overview. Main topics are: payer, healthcare delivery system, regulation, stakeholders.
Pamela Larson, MPH
Director of Consumer Health
Kaiser Permanente Internet Services
iHT² case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices.
An Overview of Kaiser Permanente - Integration and Information Systems in Hea...Empreender Saúde
Apresentação da Kaiser Permanente para o Brazilian Healthcare Trek: Mission Silicon Valley.
What is Kaiser Permanente?
Kaiser Permanente is committed to helping shape the future of health
care. We are recognized as the largest integrated delivery system in the
U.S. and one of the leading health care providers and not-for-profit
health plans.
Our strategy is to excel in providing high-quality, affordable health care
through our integrated delivery system, our investment in technology,
and our vision of supporting Total Health.
Our Mission and Vision
Mission: to provide high-quality, affordable
health care services and to improve the
health of our members and the communities
we serve.
Vision: To be a leader in Total Health by
making lives better.
7 regions serving 8 states and the District of
Columbia
More than 9.3 million members
More than 17,000 physicians and 174,000
employees (including 48,000 nurses)
38 hospitals (co-located with medical
offices)
608 medical offices and other outpatient
facilities
70 years of providing care (opened in 1945)
Two Examples of Program Planning, Monitoring and EvaluationMEASURE Evaluation
Presented by Laili Irani, Senior Policy Analyst for the Population Reference Bureau, as part of the Measuring Success Toolkit webinar in September 2012.
For more information contact: Slideshare@marcusevans.com
Presentation delivered by Donna Medina, Regional Director,OSF Hospice and Homecare Foundation at the marcus evans Home Care Leadership Summit held on July 13 & 14 2015 in Palm Beach FL.
Purpose of the Call:
1.Provide background information about the PDiF initiative, outcomes and key lessons learned.
2.Identify how one organization addressed the obstacles patients face with respect to safe medication management after they are discharged from hospital.
3.Challenge all health care providers to incorporate discharge medication reconciliation into their assessment from the day of admission throughout the patients’ hospital stay.
4.Challenge pharmacists to expand their role in discharge medication reconciliation.
Watch the webinar: http://bit.ly/1ql1O2N
Objective
1.Understand how building a coordinated cross sectoral team impacts the patient experience during transitions.
2.Learn how hospital, case managers, nursing home and pharmacy came together to change the Medication Reconciliation process resulting in reduced polypharmacy and hospital visits due to medication adverse effects.
3.Recognize the impact of BOOMR (BARRIE COORDINATED CROSS SECTORAL MEDICATION RECONCILIATION) on system efficiencies, inter-professional communication and resident, family and staff satisfaction.
4.Learn about a new tool designed for patients to help engage them and their health care providers in a conversation about their medications.
WATCH: http://bit.ly/1Q3MGp8
How are advances in social science being used to improve HCAHPS scores? Join Carol Packard, PhD, for key actions you can take to improve patient satisfaction scores, while improving clinical outcomes and reducing costs.
Reducing Readmissions and Length of Stay | VITAS HealthcareVITAS Healthcare
Pain management is first and foremost in a hospice patient’s plan of care. Hospice provides comfort and quality of life near the end of life, and hospice providers are experts at managing pain. The goal of this webinar is to help healthcare professionals understand all aspects of a patient’s pain as a symptom near the end of life, and how to utilize an interdisciplinary approach to provide the most effective pain management.
•Understand the Accreditation Canada requirements for medication reconciliation at discharge
•Learn from the experience of patients and receiving healthcare providers
•Gain insight into practical strategies for communicating accurate medication information at discharge
READ MORE: http://bit.ly/1ja1gxY
Transforming End of Life Care in Acute Hospitals AM Workshop 2: AMBER Care Bu...NHS Improving Quality
Transforming End of Life Care in Acute Hospitals AM Workshop 2: AMBER Care Bundle by Dr Irene Carey, Susanna Shouls, Guy’s and St Thomas’ NHS Foundation Trust
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
Implementation of Timely and Effective Transitional Care Management ProcessesCHC Connecticut
Join us to discuss best practices for integrating daily follow-ups for patients recently hospitalized for health emergencies. Effectively following up with patients is a critical responsibility for integrated care teams.
Experts will share how their teams respond to patients to identify care gaps and support the transition of care. Workflow descriptions will provide participants with the tools to support their work to adapt specific steps into their model of team-based care.
Panelists:
• Mary Blankson, DNP, APRN, FNP-C, FAAN, Chief Nursing Officer, Community Health Center, Inc.
• Veena Channamsetty, MD, FAAFP, Chief Medical Officer, Community Health Center, Inc.
• Bibian Ladino-Davis, Behavioral Health Coordinator, Weitzman Institute
As patients and families impacted by harm, we imagine progressive approaches in responding to patient safety incidents – focused on restoring health and repairing trust.
We can change how we respond to healthcare harm by shifting the focus away from what happened, towards who has been affected and in what way. This is your opportunity to hear about innovative approaches in Canada, New Zealand, and the United States that appreciate these human impacts.
This interactive webinar is hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute and the Canadian arm of the World Health Organization Patients for Patient Safety Global Network.
This interactive webinar is part of the world tour series designed by the World Health Organization's Patients for Patient Safety (PFPS) Global Network and hosted by Patients for Patient Safety Canada, the patient-led program of the Canadian Patient Safety Institute, a WHO Collaborating Centre on Patient Safety and Patient Engagement.
The goal of this virtual discussion is to explore practical solutions for keeping seniors safe. The ideas are drawn from real life experiences noting how COVID-19 impacted seniors, their loved ones as well as healthcare workers and leaders.
The focus of the discussion is on identifying safety risks together with practical solutions for seniors who live at home, in residences and long-term care facilities.
After hearing the perspectives of patients, providers and leaders from Indigenous communities on how they perceive safety and what solutions are/ can be implemented, we will leave the session with at least one practical idea for engaging all patients, families and/or the public in improving patient safety.
Healthcare providers and leaders will address three types of silences in healthcare: organizational silence, patient-related silence, and provider to provider silence.
Read More: www.conquersilence.ca
Healthcare providers and leaders will address three types of silences in healthcare: organizational silence, patient-related silence, and provider to provider silence.
Read More: www.conquersilence.ca
Enhanced Recovery After Surgery (ERAS®) is the Enhanced Recovery After Surgery (ERAS®) is the implementation of patient-focused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidencefocused, standardized, evidence-based, interdisciplinary perioperative guidelines.
Learn more about Enhanced Recovery Canada:
http://ow.ly/hR3j30jsnjR
Dr. Dee Mangin, Professor of Family Medicine and the Associate Chair and Director, Research, at McMaster University, will join practicing pharmacist, and Vice President, Pharmacy Affairs, Sandra Hanna of the Neighbourhood Pharmacy Association of Canada to discuss medication risks, deprescribing and the dangers of polypharmacy in this one hour webinar. Learn more at www.asklistentalk.ca
Joshua Myers, Terry Brock - Fraser Health (BC) - We Want to Hear from You: Fraser Health Real-Time Experience Survey
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
Cathy Masuda, Leslie Louie - BC Children's Hospital, an Agency of the Provincial Health Services Authority -Patient's View: Engaging Patients and Families in Patient Safety Incident Reporting
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
Alberta Health Services: Family Volunteers or Advisors Gathering Real-time Patient Experiences
Leading organizations in Canada invite, listen and act on feedback from patients in their care to improve the safety and quality of care. Explore the three award-winning practices linked below then join us in a conversation to learn more about each approach and reflect on how you may apply it in your organization. This webinar promises practical ideas to help you engage patients in making care safer.
This final webinar will emphasise the importance of understanding the problem before brainstorming solutions to better ensure a match between barriers and the solutions.
MORE INFO: http://bit.ly/2KctiLH
The fourth webinar picks-up directly from the third session, focusing on the next key step to inform implementation initiatives: identifying barriers and enablers to implementation.
READ MORE: http://bit.ly/2kIxtQo
The fifth webinar continues the momentum of the series as it focuses on providing concrete approaches for identifying barriers and enablers, emphasising behaviour change approaches.
READ MORE: http://bit.ly/2LOwbj0
Please join CPSI as we conclude our Human Factors webinar series with our final presentation Collaborative "Spaces" and Health Information Technology Design
Professor Benedetta Allegranzi,World Health Organisation
Dr. Benedetta Allegranzi is a specialist in infectious diseases, tropical medicine, infection prevention and control and hospital epidemiology. She currently works at the World Health Organization HQ (Service Delivery and Safety department), leading the "Clean Care is Safer Care" programme. Since 2013, Dr Allegranzi has gathered the title of professor of infectious diseases in the official Italian professorship list and is adjunct professor attached to the Institute of Global Health at the Faculty of Medicine, University of Geneva, Switzerland. She closely collaborates with the team at the IPC and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals (Geneva, Switzerland), as well as with the Armstrong Institute for Patient Safety and Quality, John Hopkins University, (Baltimore, USA) for clinical research projects. She is currently involved in the leadership on the WHO Ebola Response in the field of IPC and supervises IPC activities in Sierra Leone and Guinea. She has experience in clinical management of infectious diseases and tropical medicine, and clinical research in healthcare settings in both developing and developed countries. She has thorough skills and experience in training and education.
She is also the author or coauthor of more than 150 scientific publications, including articles published in high-profile medical journal such as the Lancet, Lancet Infectious Diseases, New England Journal of Medicine and the WHO Bulletin, and six book chapters.
Lori Moore joined GOJO Industries in 2013 as a Clinical Application Specialist. In this position, she provided leadership and support to healthcare organizations as they implemented electronic compliance monitoring (ECM) to more accurately measure hand hygiene performance. She has been a trusted partner to hospital key stakeholders in the development, design and implementation of hand hygiene improvement efforts. Areas of expertise include root cause analysis with targeted solutions, just-in-time coaching and ECM software data analytics. In January 2017, she transitioned to the position of Clinical Educator for Healthcare.
She began her professional career in healthcare in 2010 as a registered nurse in the medical intensive care unit at the Cleveland Clinic Foundation (where she continues to work on the weekends). Her passion for patient safety and quality of care sparked her interest in infection prevention, and she worked as an infection preventionist prior to joining GOJO.
Lori has a well-rounded academic background which includes a Bachelor’s of Arts in Management from Malone College, a Bachelor’s of Science in Nursing from the University of Akron, and a Master’s degree in Public Health from the University of Akron. She is a member of the Association for Professionals in Infection Control and Epidemiology, American Society of Professionals in Patient Safety, and the American Medical Writers Association. She has also earned the credential of Certified Health Education Specialist (CHES) and Certified Professional in Patient Safety (CPPS).
The third interactive webinar in the series builds on the second session by focusing on the question: once we have evidence to justify implementing a new patient safety initiative, what next?
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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1. Kaiser Permanente: Transition Care
Performance and Strategies
Carol Ann Barnes, PT, DPT, GCS
carbarne@gmail.com
October, 2014
April 2009
Netta Conyers-Haynes,
Principal Consultant, Communications
2. Agenda for today
Kaiser Permanente Transitions Strategy
The Problem
The Approach
NW Case Study
Outcomes across KP
Spread
Questions/Discussion
3. Kaiser Permanente
8 regions serving 9 states and
the District of Columbia
9+ million members
16,600 physicians
173,000 employees
37 medical centers (with
hospitals)
Nearly 600 medical offices
(ambulatory care buildings)
$47.0 billion operating revenue
(2011)
Slide 3
4. SSlliiddee 44
About KP HealthConnect® and My Health
Manager
KP HealthConnect® is the largest civilian deployment of
an electronic health record
As of March 2010, all Kaiser Permanente medical facilities are
equipped with KP HealthConnect
Kaiser Permanente has received 36 Stage 7 Awards, more than
any health system in the nation
My Health Manager
KP’s Personal Health Record linked to KP HealthConnect
More than 3.3 million users (as of Dec. 2012)
2012 My Health Manager User Stats
• Appointments scheduled online: 3.1M
• Prescription refills: 11.8M
• Secure email messages to doctors: 13.3M
• Lab results viewed: 32.3M
• KP mobile app downloads: 460,000
5. It seems like
members are
catapulted out
of the hospital
The problem
NW Transitions Improvement Kickoff
Arthur Hayward MD
6. Transitions: Whose job is it?
Transitions Department?
Primary Care?
Specialty Care?
Hospitalists?
Continuing Care?
Quality Department?
Resource Stewardship?
UM Department?
The patient…..
7. KP Approach: Transition Care Journey
2012
•Contract Hosp.
•SNF
•Transitions 201
Slide 7
2008 2009 2010 2011
•Interviewed Patient
•Human Centered
Transitions Redesign
•Kick-Off meeting
•Readmission Diag.
•Video Ethnography
•Grants to Regions
•Transitions Bundle-
Creation and Testing
•Standard Measures
•Results
•Bundle Spread
•Transitions 101
What Patients Need? Operational Change
Regional Outcomes
Patient Centered
Transition Bundle
Created
Tested
Implemented
Spread
National Tools
•Small grant $$’s
•Consultation/Support
•Transition Summit
•Readmit Diagnostic
•Measurement
•Transitions 101 series
•Transitions Wiki:
13,000 page views
8. Deep Dive Readmission Diagnostic
CHART
REVIEWS
MD
INTERVIEWS
RN/ MD
Team FINAL
ASSESSMENTS
Synthesis of 3 different
data sources
PATIENT OR
CAREGIVER
INTERVIEWS
9. Diagnostic Results
Number of Patients Patient Perspective System Perspective
What Factors Led to Readmission
70
60
50
40
30
20
10
0
None mentioned Hard to get in
touch with
someone at KP
Hard to get
appointments
Did not receive
clear
explanation of
what to do at
home
Did not
understand
medications
Percent of Patients
Where we can work on transition care?
* From Patient Interview, n=115
7
6
5
4
3
2
1
0
Access to
Palliative Care
Services
Multiple
Readmissions
Failed to identify
Frail Living
Situation
F/U
Appointment
too late
CHF Medications
10. Member’s perspective….
The main thing was
not knowing who
to call…so I called
911.
10
My primary care
provider did not
know I was in the
My primary care
provider did not
know I was in the
hospital.
hospital.
There were too
many new meds and
I didn’t understand
There were too
many new meds and
I didn’t understand
the changes.
the changes.
The main thing was
not knowing who
to call…so I called
911.
I just wanted to go
home, I didn’t pay as
much attention as I
should have to the
nurse.
I just wanted to go
home, I didn’t pay as
much attention as I
should have to the
nurse.
11. Physician’s perspective….
Outpatient physicians
were not always getting
timely information from
both the hospitals and
SNF’s
Outpatient physicians
were not always getting
timely information from
both the hospitals and
SNF’s
11
12. Chart Review….
The medication lists
were not always accurate
or in understandable
language.
The hospital
medication list matched
what the patient was
actually taking 57% of the
time.
The medication lists
were not always accurate
or in understandable
language.
The hospital
medication list matched
what the patient was
actually taking 57% of the
time.
12
14. Who are you going to call?
14
Over half of the
time, 911 was only
phone number
Over half of the
time, 911 was only
phone number
listed
listed
15. Setting the AIM
AIM
Create an integrated end to end transitions process for
ALL KPNW members to keep them safely at home (or at a
care facility) after a hospitalization.
Objectives
Reduce 30-day readmission rates from 12.1% to 10% for
members receiving the intervention
HCAHPS in 90th percentile
Increase % of patients that get a PCP appointment in 5
days
16. The NW Transition Care Bundle
What does the patient need? Transition Bundle Elements
I will have what I need when I return home. 1. Risk Stratification with tailored care
I know when I should call and what number
16
to use when I need help.
2. Specialized phone number on DC
Instructions
My regular doctor will know what happened
to me in the hospital.
3. Standardized Same Day Discharge
Summary
I understand my medications, how to take
them, and why I need them.
4. Pharmacist reviewing medications in
hospital (Hi risk PharmD phone call)
I will see my doctor soon after my
hospitalization. I know someone will check
on me when I am home.
5. Follow Up
MD appointments made in hospital within 5
(high risk) to 10 days.
RN follow up Call within 72 hours.
RN case management 30 days (high risk)
17. Bundle Element #1 - Risk
Stratification
“I will have what I
need when I
return home”
“I will have what I
need when I
return home”
Which patients are at
Which patients are at
high risk for
readmission?
high risk for
readmission?
Physician or RN believes
the patient may be at risk
Physician or RN believes
the patient may be at risk
for readmission
for readmission
OR
OR
Heart Failure diagnosis
Heart Failure diagnosis
OR
OR
Prior hospitalization
within the last 30 days?
Prior hospitalization
within the last 30 days?
18. Bundle Element #2 – Special Transitions
phone number
“I know when to call and what
phone number to call if I need
help”
Special phone number on
DC instructions for use
between discharge and
seeing PCP
Calls are answered within
17 seconds 24/7 and triaged
by an advice nurse
RN can manage 50% of the
calls. The hospitalist or
specialist on call are
paged for the others.
I’m
confused!
I’m
confused!
I can
help!
I can
help!
to Patient Patient has has a a question
to discharge instructions.
or concern & refers
or concern & refers
RN can manage 50%
of the calls. An MD is
paged for the rest.
RN can manage 50%
of the calls. An MD is
paged for the rest.
Call a special phone number
that is answered 24/7
Call a special phone number
that is answered 24/7
19. Bundle element #2:
Special Transitions phone number
Pilot Call Types
42%
13%
29%
4%
4%
4%
4%
Routine Symptoms
Emergent Symptoms
Medications
Incision Issue
Vomiting
Pain
Fever
20. Bundle Element #3 – Standardized
D/C Summary
20
My regular doctor
will know what
happened to me in
My regular doctor
will know what
happened to me in
the hospital
the hospital
Hospitalists, PCP’s and
Specialists collaborated
to create a simple DC
Summary completed
the day the patient
leaves the hospital, that
everyone loves.
Hospitalists, PCP’s and
Specialists collaborated
to create a simple DC
Summary completed
the day the patient
leaves the hospital, that
everyone loves.
22. Bundle Element #4 - Medications
Hospital
ONE process MD/RN on admissions
RN teaching/teach back
Pharmacist reviews (high risk)
Patient friendly language
22
Home
RN follow-up call/review
Pharmacist calls patients at home
(high risk)
PCP
SNF
Transition Pharmacist reviews meds for
100% of patients going to SNF
I understand my
medications, how to
take them and why
I understand my
medications, how to
take them and why
I need them.
I need them.
23. Bundle Element #5 – Follow Up
Follow-up Appointments
Made upon discharge
High risk patients in 5 days
Medium risk patients in 10 days
Follow-up Calls
RN follow up within 72 hours
RN case management within 30
days (high risk)
23
I will see my
doctor soon after
I will see my
doctor soon after
my
my
hospitalization.
hospitalization.
24. Slide 24
NW Ongoing Readmission Review
MD reviews every
readmission
Sends cases to quality
chiefs = Improved
quality
Examples of Findings
•10% preventable
•ID patients that did not get call
•Reduced readmit for constipation
•Identified cluster infections
•Improved Palliative Care connect
•Medication errors
•HF patients need additional f/u
25. Results
Readmission Rate (Sunnyside Hospital):
o Overall the readmission rate is 9.1%
o Both commercial and Medicare readmission rates are 7.1% and
11.5% respectively, the lowest of all KP regions
o In HEDIS 90th percentile
Discharge medication list errors:
o Down from 57% to 19% overall – most are fixed before
discharge by a Transition pharmacist
Discharge templates:
o Medicine, Specialty Care and SNF have a standardized template
which is used over 90% of the time
25
26. Results
Follow up
o The average time to follow up with their PCP has gone from 9.7
days to 6.9 days
Physician Review
o Monthly single MD reviewer of all readmissions. Feedback
provided on those readmissions which may have been
preventable. This has resulted in improvements in
communication and processes within the Medicine and Specialty
Care Departments.
Satisfaction
o HCAHPS scores are continuing to improve
o Discharge Composite in HEDIS 90th percentile
26
27. Success factor: Ongoing Governance
Transitions leadership team
Cross settings
Cross disciplines
Patient is part of team
Twice monthly 30 minute meeting
• Hot Topics
• Ad hoc
60 minute meeting
• Review data
• Readmission Rate Report
• Patent Readmission Feedback
• Readmission Review
• Dashboard (when in production)
28. HEDIS All Cause 30-Day Hospital Readmissions Ratio – By Region & Hospital
Population = Commercial & Medicare, HEDIS Measurement Period1
• Q4-2013 and Q1-2014 results are based on 2014 HEDIS PCR Specifications which include the
following updates: (1) exclusion of Medicare Hospice Members from the denominator (2)
inclusion of same day admission/discharges from the denominator. For Q4-13, there was on
average about a 3.7% increase for the Commercial O/E ratio and 2.5% increase for the Medicare
O/E ratio which may be attributable to the specification changes.
• The average Observed/Expected Readmissions ratio for all Plans for performance year 2013 will
not be released by NCQA until later this year.
• The all-Plan Commercial average (PY 2012) was 0.83. All Regions except Northern and Southern
California performed better than the 2012 average for the rolling year ending in Q1 2014.
• The all-Plan Medicare average (PY 2012) was 0.90. All Regions performed better than 2012 average
for the rolling year ending in Q1 2014.
1 Data sources vary across regions: MIA (CA), DSS (HI), & Regional sources (CO, GA, MAS, and NW).
NW Westside results are included in the NW Region results since Q3-13.
Hawaii’s decrease in O/E between 2013Q3 and 2013Q4 can be attributed to a change in programming logic
(per NCQA specification clarification) that increased the risk adjustment for expected readmissions.
2 Beginning with Q4-12 data, Georgia is using a different data system (Verisk) than what was utilized for prior measurement periods.
3 O/E Ratios for Medicare is not being reported for MAS and therefore the overall KP Medicare total excludes MAS; MAS was not required to report Medicare
readmissions for HEDIS.
KPNQC Big Q Overview Privileged and Confidential 28
29. NW Transitions Bundle Spread
•All regions have adopted the Transition Bundle
•44% increase in bundle elements at strong implementation in one year
Transition Bundle Elements NW CO SC MA OH GA NC HI
Risk stratification-tailored care
Follow-up call 48 hours
Timely physician follow-up appointments
scheduled in hospital
Medication reconciliation redundancies
across settings
Standardized same-day DC summary
Special transition phone number on DC
instructions (24/7 expedited; immediate access to
RN/physician)
P
Implementation
Phase Testing Phase
P yet Planning
Phase
No activity
Strong
Implementation
It takes persistence
The Journey takes time but the results are good
30 day readmission rates trending down,
All HCAHPs measure in “Leaving the Hospital” are trending up. Good patient satisfaction!
Patients have much quicker access to MD after hospitalization (55% patients leaving the hospital have an appointment in 5 days)
Spread:
Transitions improvement underway in all regions
Standardized the 30 day readmission rate measure.
Created National Transitions Network with over 700 clinicians as members: video library, virtual tools, webinars, updates, and consultations.
Definitions:
Strong Implementation: Implemented reliably on entire population group (eg all medical discharges, all SNF discharges, all people over 65, all HF patients)
Implementation: Implemented and intended for an entire population group but not reliable yet.
Testing phase: Piloting the intervention (eg one hospital unit, one physician, one pharmacist)
Planning: Part of a plan to implement
No action yet