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This document summarizes research on nurse staffing ratios and advanced practice registered nurse (APRN) practice. It discusses how understaffing leads to poor patient outcomes and burnout. Most states require staffing committees but only California has laws on patient to nurse ratios. Research shows higher ratios increase mortality and costs. Proposed legislation in New Jersey and at the federal level aims to improve ratios and widen APRN scope to enhance quality and access to care.
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The document summarizes research that shows a link between nurse staffing levels and patient outcomes. Several studies are cited that demonstrate higher nurse-to-patient ratios are associated with lower hospital infection rates, fewer complications, decreased mortality rates, and better financial performance. The research indicates specific staffing targets, such as a ratio of 1 nurse for every 4 patients, could prevent tens of thousands of patient deaths annually. The evidence consistently shows improved patient outcomes and safety when there are sufficient nursing staff to care for fewer patients per nurse.
Competition or Collaboration - 2015 Policy Prescriptions® Symposium
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
The Cost of PH - How Do We Manage This?
This document discusses the high costs associated with pulmonary hypertension (PH) from multiple perspectives, including direct healthcare costs, indirect costs, and costs to individuals and society. Hospitalizations are identified as a major driver of costs. Earlier diagnosis and treatment, risk-guided escalation of therapy, and care at specialized centers can help reduce costs by preventing hospitalizations and disease progression. While medications and care are costly, lack of treatment results in poor outcomes and increased costs over time. Assistance programs help many patients afford needed therapies.
Adding Value to the EMR: A Clinical Perspective
Known for leading large-scale healthcare improvement using data and analytics to drive positive change, Dr. Charles Macias speaks to creating greater value in the EMR through analytics. This approach has done more to increase value than many other cost-reduction efforts.
In this webinar you will 1) Explore each component of the value equation, 2) learn how TCH has increased the value of its healthcare using data to drive quality an ever more important need of those facing capitated or value–based care reimbursements and 3) consider a new ROI equation for systems who have invested heavily in their EMRs
Health Information Exchange ( usage and benefits )
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Student of Master of Science in Data Science for Healthcare ( International Program ) ( Clinical Epidemiology and Biostatistics, Mahidol University, Thailand )
DATA-DRIVEN INNOVATIONS IN HEALTHCARE SERVICES
DATA-DRIVEN INNOVATIONS IN HEALTHCARE SERVICESInternational Society of Service Innovation Professionals
This document discusses three ways data-driven innovations can improve healthcare services:
1) Using text analysis of patient comments to improve medication management between hospitals and homes.
2) Developing a neural network model to provide individual clinical decision support for kidney transplant outcomes.
3) Applying natural language processing to physician notes to improve prediction of readmissions for COPD patients.
The author concludes that advanced analytics provides opportunities to innovate patient care and discusses collaborations with other researchers.kathleen_tong_docto
This document summarizes a presentation on using remote monitoring devices like the CardioMEMS pulmonary artery pressure sensor to manage heart failure patients. The sensor transmits pressure readings to clinicians who can then contact patients if pressures exceed thresholds. Trials found remote monitoring reduced heart failure hospitalizations and improved quality of life. However, limitations include the invasiveness of the sensor and lack of data on benefits outside structured heart failure clinics. Overall, remote monitoring will likely be part of chronic disease management in the future according to the presentation.
Palliative vs. Hospice Care - READ THIS
I didn't know this option of Palliative care existed prior to my mother's passing earlier this year of colorectal cancer. However, I do now know about it and want to share it with all of you
Palliative vs Hospice Care
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
The Problem Collaboration
This document discusses using linked health data to identify problems and improve patient outcomes and efficiency. It describes an example where data on epilepsy patients was analyzed across multiple hospitals, finding wide variability in referrals to seizure clinics and follow-up care. A simple pathway was then implemented at three sites to ensure epilepsy patients seen in the emergency department received a neurology appointment within two weeks. Individual reports were provided to hospitals, and the document suggests this approach could also be applied to issues around alcohol use and COPD.
U of T Department of Family & Community Medicine PEARLS 2014
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Physician age and outcomes in elderly patients in hospial in the US: observat...
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- Readmission rates did not meaningfully vary with physician age, while costs of care were slightly higher among older physicians. The results suggest that differences in practice patterns or quality measures between physicians of varying experience levels could influence patient outcomes.
Big Data as a game-changer of clinical research strategies by Rafael San Migu...
Geriatrics Medicine constitutes a clinical research field in which big data, statistical analysis, machine-learning and visualization techniques can provide relevant, solid and lasting benefits, including performance optimization and enhancements in quality of care.
Those benefits translate into improvement of patients' quality of life, cost rationalization and better use of resources in the public health system.
In this talk, authors will explain how they have used the aforementioned tools with elderly patients' data to realize those benefits.
Session presented at Big Data Spain 2015 Conference
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http://www.bigdataspain.org
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By Courtney Baechler, MD. A discussion about the Penny George Institute and its goal to empower patients using the mind-body-spirit approach to health, encouraging a philosophy of wellness at any stage of care. The Penny George Institute has become a national leader in holistic health care and is an important component of Allina Health efforts to achieve health care transformation through the Triple Aim.
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This document summarizes research on the impact of nurse staffing levels and education on patient outcomes. It finds that hospitals with fewer patients per nurse and more BSN-educated nurses have lower mortality and complication rates. Specifically, adding one more patient per nurse increases the risk of death by 7% and having 10% more BSN nurses lowers the mortality rate by 7%. The document recommends avoiding policies that replace RNs with less educated assistants and emphasizes the need for adequate nurse staffing to improve quality of care and reduce costs.
Cardiovascular Telehealth
By Marc Newell, MD. A discussion about the rapidly evolving TeleHealth program at Minneapolis Heart Institute that promises to increase access to and timeliness of specialty care in communities across the region. “This is an innovative strategy that allows more patients to be seen closer to home, and have more access to subspecialty care. We need to transform how and where we deliver care so we can focus on prevention and chronic disease management.”
Why improving the patient experience with advanced care options matters
This document summarizes a presentation about improving patient experience with advanced cardiac care options and how patient satisfaction scores relate to quality of care. It discusses how patient satisfaction is assessed using surveys like HCAHPS and tied to hospitals' Medicare reimbursement. While patient satisfaction often correlates with better communication, it is a complex issue and may not fully capture the quality of medical care. When discussing advanced care options, truly informed consent requires addressing patients' values, prognosis, fears and ensuring they understand their medical condition and choices.
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This document summarizes a research study on motivation and certification rates among allied health professionals. The study aims to increase certification rates among allied health professionals at a hospital by 2 years post-implementation of a motivation program, and describe the perceived value of certification before and after the program. Baseline data found that 55% of respondents were certified, with most from respiratory therapy. Survey results showed non-certified professionals perceived certification as slightly more valuable than certified professionals. The researchers will implement interventions like recognition programs and evaluate certification rates in 2 years.
SLC CME- Evidence based medicine 07/27/2007
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Competition or Collaboration - 2015 Policy Prescriptions® Symposium
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Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
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Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
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These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
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Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
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Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort. Pollen and Fungal allergy: aeroallergy.pdf
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
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Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
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Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Legilsative issue
- 1. Staffing Ratios & APRN Practice
- 2. Does this Sound Familiar? • “Bob is low-censused, but Jane just called in sick. Now we’re expecting three new admissions and that patient is coding.” – You, the RN, are forced to put in extra work – You fall behind, leave late, or make a mistake – Then you’re blamed for not being efficient • Before long, the RN is written up and is looking for a new job… where the same thing happens
- 3. US Legislation • California is the only state with comprehensive patient to nurse (PTN) staffing laws that apply to all units • Other states require hospitals to have staffing committees responsible for staffing – IL, CT, NV, OH, OR, TX, WA • Others considering legislation: DC, NY, TX, FL, IA, MN • (Nurse Staffing Plans & Ratios, 2014)
- 4. Significance of the Issue • Reports showed that each patient added to RN workload led to an increase in mortality by 7%, following common surgeries • Research also shows that increased RN levels led to a decrease in mortality in patients who had an acute MI • Mortality reductions associated with increased PTN were most significant in hospitals that were already severely understaffed • Reduced workload led to higher staff retention and lower turnover – Leads to decrease in overhead and training costs • (Aiken, et al. 2010)
- 5. Is it Cost-Effective Legislation? • Hospitals complain about being already squeezed and adding another nurse increases costs • 8:1 PTN was associated with the lowest cost, but highest in mortality. Every decrease in patient increment by one, led to lower mortality, but higher costs • Cost associated with saving one life when PTN reduced to 7:1 was over $45,000. Cost associated with saving one life when PTN reduced to 4:1 was over $140,000. • Research shows that lower PTN ratios does NOT save money, but costs less than any other patient safety intervention – For example, thrombolytic therapy or a PAP testing costs exorbitantly more ($180,000 per life saved and $430,000 per life saved, respectively) than reducing staffing costs – If a hospital decided, for economic reasons, to stop providing thrombolytic therapy or PAP testing, physicians would never refer to that hospital. – Lower PTN is a patient safety intervention, and when compared to other safety interventions is actually still more cost effective. • (Rothberg, et al. 2005)
- 6. The Quality of Care • Physicians agree that deficient nursing staffing results in decreased quality of care • Staffing shortages led to RN burnout in 40% of hospitals – Job dissatisfaction in hospitals is 4x higher than the average US worker – 1/5 nurses intend to leave their job • Increased emotional exhaustion and increased job dissatisfaction in nurses correlated with increased PTN • 168 hospitals in Pennsylvania found: – RNs in hospitals with 8:1 PTN were 2.29x more likely than 4:1 ratio to show emotional exhaustion and 1.75x more likely to be dissatisfied • (Aiken, et al. 2002)
- 7. NJ A2548 • Synopsis: New Jersey state assembly bill, introduced February 21, 2012, which institutes minimum RN staff standards for hospitals and other healthcare facilities • Highlights: – 5:1 PTN medical-surgical units – 4:1 PTN stepdown, telemetry, or immediate care – 1:1 PTN for trauma services in the ED – 1:6 PTN psychiatry units – Facilities must utilize a staffing system to ensure appropriate staffing • Desired outcome: – Improved quality of care and improved patient safety via improved PTN ratios – This bill would be associated with improving access to care and the costs mentioned earlier that are associated with PTN issues
- 8. S. 382- Improving Access to Care: APRN Scope • Synopsis: Senate bill, introduced February 26, 2013, amends title XVIII (Medicare) to broaden PA, NP, & CNS scope of practice • Highlights: – These clinicians can supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs • Desired outcome: – This bill would increase access to care for all patients, but especially in rural areas, and addresses primary care shortage – The bill would widen the scope of APRNs, giving them more knowledge, more autonomy, and more respect in the healthcare industry