This document provides an overview of Parr (Predictive Admission Risk and Resource tool) in practice in Northern Ireland. Parr is a risk stratification tool that analyzes hospital admission data to identify high-risk patients for proactive case management. The summary discusses key statistics on hospital utilization in Northern Ireland and describes how Parr identifies high-risk referrals to case management services. It also summarizes components of a study evaluating the effectiveness of Parr in reducing hospital admissions and bed days through targeted case management interventions.
Avado CEO Dave Chase's presentation to the Collaborative Health Consortium's weekly Pilots and Collaborations Webinar. Dave is doing some leading edge thinking on collaborative care.
This document provides an overview and introduction to NHS Continuing Healthcare. It discusses the difference between health care and social care, and how the NHS Continuing Healthcare framework determines if a person has a "primary health need" and is eligible for fully funded NHS care. The key steps in the NHS Continuing Healthcare process include using the Fast Track Pathway Tool, Checklist, and Decision Support Tool to assess a person's needs and make a recommendation about their eligibility.
This document provides an overview of NHS Continuing Healthcare. It discusses the differences between health care and social care, and outlines the framework and tools used to determine eligibility for NHS Continuing Healthcare, including the Fast Track Pathway Tool, Checklist, and Decision Support Tool. The document emphasizes that eligibility is based on the level of an individual's care needs and whether their primary need is for health care rather than social care. It provides guidance on assessing needs against the criteria of nature, intensity, complexity and unpredictability to determine if someone has a primary health need.
Spotlight on continuing health care in strokeNHS Improvement
Stroke patients often have complex needs that make them eligible for NHS continuing healthcare (CHC) funding. However, the CHC process can be time-consuming and delay discharge from hospitals. Several recommendations are provided to streamline the process, including designating a coordinator, integrating social workers into care teams, and conducting assessments in post-acute settings rather than hospitals. Examples from hospitals in England demonstrate how roles like discharge coordinators and computer systems can reduce duplication and speed up the process.
The document discusses patient relationship management (PRM) and its benefits for healthcare providers. It outlines key healthcare trends driving the need for PRM, such as rising costs, patient choice, and emphasis on quality and satisfaction. PRM helps providers improve patient flow, outcomes and experience by facilitating communication across clinical systems. The presentation includes a case study of a UK healthcare provider that implemented PRM in phases to control patient interactions, interface with clinical systems, optimize resource use, and eventually enable chronic disease management.
Challenges and Changes in Home Care Presentation March 6-7 2009BCAGCP
The document discusses homecare services in Vancouver Community, outlining key challenges and changes. It provides details on accessing services, the homecare structure, services provided like nursing and rehabilitation. Programs for hospice, chronic disease management, and emerging practices partnering with primary care are mentioned. Overall challenges include an aging population, complex patient needs, and a shifting of care to the community with early hospital discharges.
Martin Bardsley & Adam Steventon: Stemming demand: how best to track the impa...Nuffield Trust
The document discusses approaches for evaluating interventions aimed at reducing demand for emergency healthcare services using routine data. It summarizes challenges with traditional evaluation methods and proposes using existing data sets to continuously monitor outcomes over time for broad groups of users, developing accurate comparison groups, and exploiting linked data sets. Key approaches discussed are a randomized controlled trial of a telecare intervention and using case controls derived from routine data to account for issues like regression to the mean.
Avado CEO Dave Chase's presentation to the Collaborative Health Consortium's weekly Pilots and Collaborations Webinar. Dave is doing some leading edge thinking on collaborative care.
This document provides an overview and introduction to NHS Continuing Healthcare. It discusses the difference between health care and social care, and how the NHS Continuing Healthcare framework determines if a person has a "primary health need" and is eligible for fully funded NHS care. The key steps in the NHS Continuing Healthcare process include using the Fast Track Pathway Tool, Checklist, and Decision Support Tool to assess a person's needs and make a recommendation about their eligibility.
This document provides an overview of NHS Continuing Healthcare. It discusses the differences between health care and social care, and outlines the framework and tools used to determine eligibility for NHS Continuing Healthcare, including the Fast Track Pathway Tool, Checklist, and Decision Support Tool. The document emphasizes that eligibility is based on the level of an individual's care needs and whether their primary need is for health care rather than social care. It provides guidance on assessing needs against the criteria of nature, intensity, complexity and unpredictability to determine if someone has a primary health need.
Spotlight on continuing health care in strokeNHS Improvement
Stroke patients often have complex needs that make them eligible for NHS continuing healthcare (CHC) funding. However, the CHC process can be time-consuming and delay discharge from hospitals. Several recommendations are provided to streamline the process, including designating a coordinator, integrating social workers into care teams, and conducting assessments in post-acute settings rather than hospitals. Examples from hospitals in England demonstrate how roles like discharge coordinators and computer systems can reduce duplication and speed up the process.
The document discusses patient relationship management (PRM) and its benefits for healthcare providers. It outlines key healthcare trends driving the need for PRM, such as rising costs, patient choice, and emphasis on quality and satisfaction. PRM helps providers improve patient flow, outcomes and experience by facilitating communication across clinical systems. The presentation includes a case study of a UK healthcare provider that implemented PRM in phases to control patient interactions, interface with clinical systems, optimize resource use, and eventually enable chronic disease management.
Challenges and Changes in Home Care Presentation March 6-7 2009BCAGCP
The document discusses homecare services in Vancouver Community, outlining key challenges and changes. It provides details on accessing services, the homecare structure, services provided like nursing and rehabilitation. Programs for hospice, chronic disease management, and emerging practices partnering with primary care are mentioned. Overall challenges include an aging population, complex patient needs, and a shifting of care to the community with early hospital discharges.
Martin Bardsley & Adam Steventon: Stemming demand: how best to track the impa...Nuffield Trust
The document discusses approaches for evaluating interventions aimed at reducing demand for emergency healthcare services using routine data. It summarizes challenges with traditional evaluation methods and proposes using existing data sets to continuously monitor outcomes over time for broad groups of users, developing accurate comparison groups, and exploiting linked data sets. Key approaches discussed are a randomized controlled trial of a telecare intervention and using case controls derived from routine data to account for issues like regression to the mean.
What We're Working On Now: Getting the "System" to be a Real System for Heart...3GDR
The document discusses the efforts of Partners HealthCare to create an integrated system for managing heart failure patients. It outlines several components of the heart failure program including enrollment numbers in remote monitoring programs over time, readmission outcomes, and an overview of the heart failure population within Partners. It also discusses challenges in patient identification, engagement, determining the most effective care delivery approach, managing patients efficiently across different care settings and providers, and integrating different systems and communications channels.
The document discusses the need to reform the US healthcare delivery system. It notes rising costs, a large uninsured population, and quality and safety issues. The Affordable Care Act aims to address these problems through insurance expansion and regulation, quality initiatives, and a shift to value-based care through tools like Accountable Care Organizations. Seton Health Alliance in Central Texas was selected as a Pioneer ACO and is working to clinically integrate providers to coordinate care and be financially responsible for patient outcomes.
The future of market access – the local picture PM Society
David Thorne, CEO of Newcastle West CCG, discussed the challenges and opportunities for clinical commissioning groups in shaping local healthcare. He outlined the CCG's responsibilities to identify local health needs, meet national priorities, commission services through performance-managed contracts, and maintain budgets and public confidence in the NHS. Thorne also described Newcastle West CCG's population as aging with high dependency on benefits and life expectancies comparable to developing nations. Key health issues included cancers, heart disease, and COPD. The presentation emphasized using local data and engaging with patients, providers and other stakeholders to design effective local care pathways.
An electronic early warning score system was proposed to address the shortcomings of a manual paper-based system. The electronic system would calculate scores based on recorded vital sign observations and trigger alerts and escalation pathways for deteriorating patients. The system could be deployed on mobile devices at bedsides or fixed iPads to facilitate real-time data entry and alerts. It leverages an existing electronic medical record platform already in use in New Zealand to provide an integrated, feasible solution.
This document discusses integrated care in Redbridge and the development of "polysystems" to improve care coordination and outcomes. It notes that Redbridge has many primary care providers, acute trusts, community providers and voluntary organizations. It proposes establishing several "polysystems", centered around GP practices, to function as local care delivery networks. These polysystems will promote population health, maximize independence for those with long-term needs, and improve acute care. They will be accountable for quality, access and costs and incentivized through aligned data and governance structures integrating primary, community and social care.
This document discusses interprofessional rounding teams and strategies to improve teamwork and communication. It provides background on how interprofessional healthcare teams can improve patient outcomes. Checklists, care pathways, and interprofessional education are presented as potential solutions. Checklists have been shown to reduce medical errors and mortality. Care pathways, while challenging to implement, can standardize care and reduce prescribing errors. Brief interprofessional education sessions have been found to improve collaboration attitudes and skills among professionals. Overall, the document advocates for interprofessional rounding teams and strategies to enhance communication and teamwork across disciplines.
www.charisma.ro
www.totalsoft.ro
Charisma Medical Software is a modular software solution that integrates and optimizes the processes, the flows, the operational and financial activities specific to hospitals, clinics, pharmacies and medical laboratories. The product offers the possibility of electronic tenders for selecting the suppliers of drugs, instruments, repairs, consumable items or food, while being integrated with HL7 transmission protocol for retrieving and processing data from laboratory analyzers or third party applications.
We at Boehringer Ingelheim know that there are many issues affecting health care in the United States. In this presentation Dr. Lee Sacks of Advocate Health takes a look at accountable care organizations (ACOs) and their role in health care reform. Understanding the Implications of Accountable Care Organizations for Patients and Providers, was a web conference given on July 31, 2012 and which we hope will provide offer an understanding of best practices among ACOs and tips for helping constituents adopt and participate in ACOs.
The document discusses how Kaiser Permanente improves health care quality through integrated teams. It describes Kaiser Permanente's model of providing comprehensive, high-quality and affordable care through integrated multi-specialty medical groups and hospitals. The model is enabled by a fully integrated electronic medical record system and performance measurement tools that support coordinated, population-based care and continuous quality improvement.
This document highlights the work being led by NHS Improvement to support the delivery of the National Cancer Survivorship Initiative (NCSI) vision for those living with and beyond cancer. This survivorship agenda is a priority which was outlined in the Cancer Reforms Strategy (2007) and Improving Outcomes: A Strategy For Cancer (2011)
(Published May 2011)
There has been a rise in social care and mental health issues putting pressure on emergency services. The aging population accounts for 40% of the rise in admissions. There is also an increase in short stay admissions and elective procedures putting strain on hospitals. Ambulance calls have risen 6.5% annually, with 60% resulting in emergency transport. Solutions proposed include improving transfer to other services like nursing homes, minor injury units, and increasing primary care involvement in triaging patients. Overall there is a need for better integration between primary, emergency and social care services to appropriately manage the rising demand.
The document summarizes the Special Care Center, a service created by AtlantiCare to provide coordinated care for patients with chronic conditions. The Special Care Center aims to (1) manage chronic conditions effectively through a patient-centered medical home model, (2) reduce healthcare costs by focusing on preventative care and avoiding unnecessary emergency visits and hospitalizations, and (3) improve patient outcomes by providing integrated care, health coaching, open access to providers and services, and an emphasis on the patient experience. Since opening in 2007, the Special Care Center has expanded its services and grown to over 2,600 enrolled patients.
Samir Sinha: Canadian innovation in caring for older adultsNuffield Trust
This document provides an overview of innovations in caring for older adults across the continuum of care in Canada. It introduces the Acute Care for Elders (ACE) strategy, an integrated care model shown to deliver better outcomes for patients and the healthcare system. The document describes how Mount Sinai Hospital in Toronto implemented an ACE strategy through interprofessional teams and programs across inpatient, outpatient and home-based settings. Evaluations show the ACE strategy at Mount Sinai reduced length of stay, increased rates of patients returning home, and improved patient satisfaction and staff experience with geriatrics care.
Conor Burke & Lucy Moore: Learning from an integrated care organisationNuffield Trust
This document discusses integrated care and the role of an integrated care organization called Whipps Cross University Hospital Trust. It notes that Whipps Cross aims to reduce outpatient appointments by 20% and elective procedures by 6% through decommissioning, while shifting 40% of A&E visits, 12% of electives, and 42% of outpatient appointments to prevent chronic conditions and improve acute quality. The document advocates changing systems rather than changing within systems to drive real improvement. It outlines PolySystems' goals of promoting community health, maximizing independence for those with long-term needs, and improving non-critical acute care. PolySystems aims to achieve improved outcomes using strategies like care navigation, improved coordination, and increased access
Towards best practice in interventional radiologyNHS Improvement
Towards best practice in interventional radiology draws together the findings from visits to interventional radiology (IR) services at proposed major trauma centres in England during 2011/12. This record of their major findings provides a definitive read for trust chief executives and commissioners to help better inform IR service reviews. (June 2012)
Enabling community and patient centred care, pop up uni, 11am, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Introduction to Telemedicine: Dr Shweta Gaurshweta gaur
This document discusses telehealth and telemedicine. It defines telehealth as referring to both clinical and non-clinical services, while telemedicine only refers to clinical services. It then provides an introduction to the growth of telemedicine in India through technological advancements. It discusses the objectives, needs, examples and current state of telemedicine in India, highlighting projects by organizations like ISRO and hospitals to increase access to healthcare in rural areas through telemedicine.
Medicare's Value Based Purchasing program redistributes hospital payments based on quality performance scores to incentivize better care. Hospitals will have funding reduced by up to 2% by 2017 if they do not meet targets for clinical process, patient experience and outcome measures. This represents a shift from fee-for-service payments to a model emphasizing value, quality outcomes, and total cost of care. For pharmacy, it implies demands to work across care settings, coordinate care beyond health system walls, and actively engage patients in their care as part of optimizing value-based care.
The Patient Journey Record System (PaJR) uses lay care guides to remotely monitor patients with chronic illnesses through daily phone calls. The calls analyze patients' health and social situations to predict health risks and chances of hospitalization. PaJR has completed Phase 1, comparing hospitalization rates between monitored patients and controls. Phase 2 is an ongoing regional trial monitoring over 130 patients. Preliminary results show the control group has approximately 3 times higher unplanned admission rates. PaJR aims to detect health issues earlier to reduce avoidable hospitalizations through low-cost monitoring and support.
The Patient Journey Record System (PaJR) uses lay care guides to remotely monitor patients with chronic illnesses through daily phone calls. The calls analyze patients' health and social situations to predict health risks and the need for hospitalization. PaJR has completed Phase 1, which found lower hospitalization rates among monitored patients compared to controls. Phase 2 is ongoing in two sites and continues to recruit more patients and controls. Preliminary results again show lower admission rates for monitored patients. The system aims to detect health issues earlier through closer monitoring to reduce avoidable hospitalizations and shift care to the community.
What We're Working On Now: Getting the "System" to be a Real System for Heart...3GDR
The document discusses the efforts of Partners HealthCare to create an integrated system for managing heart failure patients. It outlines several components of the heart failure program including enrollment numbers in remote monitoring programs over time, readmission outcomes, and an overview of the heart failure population within Partners. It also discusses challenges in patient identification, engagement, determining the most effective care delivery approach, managing patients efficiently across different care settings and providers, and integrating different systems and communications channels.
The document discusses the need to reform the US healthcare delivery system. It notes rising costs, a large uninsured population, and quality and safety issues. The Affordable Care Act aims to address these problems through insurance expansion and regulation, quality initiatives, and a shift to value-based care through tools like Accountable Care Organizations. Seton Health Alliance in Central Texas was selected as a Pioneer ACO and is working to clinically integrate providers to coordinate care and be financially responsible for patient outcomes.
The future of market access – the local picture PM Society
David Thorne, CEO of Newcastle West CCG, discussed the challenges and opportunities for clinical commissioning groups in shaping local healthcare. He outlined the CCG's responsibilities to identify local health needs, meet national priorities, commission services through performance-managed contracts, and maintain budgets and public confidence in the NHS. Thorne also described Newcastle West CCG's population as aging with high dependency on benefits and life expectancies comparable to developing nations. Key health issues included cancers, heart disease, and COPD. The presentation emphasized using local data and engaging with patients, providers and other stakeholders to design effective local care pathways.
An electronic early warning score system was proposed to address the shortcomings of a manual paper-based system. The electronic system would calculate scores based on recorded vital sign observations and trigger alerts and escalation pathways for deteriorating patients. The system could be deployed on mobile devices at bedsides or fixed iPads to facilitate real-time data entry and alerts. It leverages an existing electronic medical record platform already in use in New Zealand to provide an integrated, feasible solution.
This document discusses integrated care in Redbridge and the development of "polysystems" to improve care coordination and outcomes. It notes that Redbridge has many primary care providers, acute trusts, community providers and voluntary organizations. It proposes establishing several "polysystems", centered around GP practices, to function as local care delivery networks. These polysystems will promote population health, maximize independence for those with long-term needs, and improve acute care. They will be accountable for quality, access and costs and incentivized through aligned data and governance structures integrating primary, community and social care.
This document discusses interprofessional rounding teams and strategies to improve teamwork and communication. It provides background on how interprofessional healthcare teams can improve patient outcomes. Checklists, care pathways, and interprofessional education are presented as potential solutions. Checklists have been shown to reduce medical errors and mortality. Care pathways, while challenging to implement, can standardize care and reduce prescribing errors. Brief interprofessional education sessions have been found to improve collaboration attitudes and skills among professionals. Overall, the document advocates for interprofessional rounding teams and strategies to enhance communication and teamwork across disciplines.
www.charisma.ro
www.totalsoft.ro
Charisma Medical Software is a modular software solution that integrates and optimizes the processes, the flows, the operational and financial activities specific to hospitals, clinics, pharmacies and medical laboratories. The product offers the possibility of electronic tenders for selecting the suppliers of drugs, instruments, repairs, consumable items or food, while being integrated with HL7 transmission protocol for retrieving and processing data from laboratory analyzers or third party applications.
We at Boehringer Ingelheim know that there are many issues affecting health care in the United States. In this presentation Dr. Lee Sacks of Advocate Health takes a look at accountable care organizations (ACOs) and their role in health care reform. Understanding the Implications of Accountable Care Organizations for Patients and Providers, was a web conference given on July 31, 2012 and which we hope will provide offer an understanding of best practices among ACOs and tips for helping constituents adopt and participate in ACOs.
The document discusses how Kaiser Permanente improves health care quality through integrated teams. It describes Kaiser Permanente's model of providing comprehensive, high-quality and affordable care through integrated multi-specialty medical groups and hospitals. The model is enabled by a fully integrated electronic medical record system and performance measurement tools that support coordinated, population-based care and continuous quality improvement.
This document highlights the work being led by NHS Improvement to support the delivery of the National Cancer Survivorship Initiative (NCSI) vision for those living with and beyond cancer. This survivorship agenda is a priority which was outlined in the Cancer Reforms Strategy (2007) and Improving Outcomes: A Strategy For Cancer (2011)
(Published May 2011)
There has been a rise in social care and mental health issues putting pressure on emergency services. The aging population accounts for 40% of the rise in admissions. There is also an increase in short stay admissions and elective procedures putting strain on hospitals. Ambulance calls have risen 6.5% annually, with 60% resulting in emergency transport. Solutions proposed include improving transfer to other services like nursing homes, minor injury units, and increasing primary care involvement in triaging patients. Overall there is a need for better integration between primary, emergency and social care services to appropriately manage the rising demand.
The document summarizes the Special Care Center, a service created by AtlantiCare to provide coordinated care for patients with chronic conditions. The Special Care Center aims to (1) manage chronic conditions effectively through a patient-centered medical home model, (2) reduce healthcare costs by focusing on preventative care and avoiding unnecessary emergency visits and hospitalizations, and (3) improve patient outcomes by providing integrated care, health coaching, open access to providers and services, and an emphasis on the patient experience. Since opening in 2007, the Special Care Center has expanded its services and grown to over 2,600 enrolled patients.
Samir Sinha: Canadian innovation in caring for older adultsNuffield Trust
This document provides an overview of innovations in caring for older adults across the continuum of care in Canada. It introduces the Acute Care for Elders (ACE) strategy, an integrated care model shown to deliver better outcomes for patients and the healthcare system. The document describes how Mount Sinai Hospital in Toronto implemented an ACE strategy through interprofessional teams and programs across inpatient, outpatient and home-based settings. Evaluations show the ACE strategy at Mount Sinai reduced length of stay, increased rates of patients returning home, and improved patient satisfaction and staff experience with geriatrics care.
Conor Burke & Lucy Moore: Learning from an integrated care organisationNuffield Trust
This document discusses integrated care and the role of an integrated care organization called Whipps Cross University Hospital Trust. It notes that Whipps Cross aims to reduce outpatient appointments by 20% and elective procedures by 6% through decommissioning, while shifting 40% of A&E visits, 12% of electives, and 42% of outpatient appointments to prevent chronic conditions and improve acute quality. The document advocates changing systems rather than changing within systems to drive real improvement. It outlines PolySystems' goals of promoting community health, maximizing independence for those with long-term needs, and improving non-critical acute care. PolySystems aims to achieve improved outcomes using strategies like care navigation, improved coordination, and increased access
Towards best practice in interventional radiologyNHS Improvement
Towards best practice in interventional radiology draws together the findings from visits to interventional radiology (IR) services at proposed major trauma centres in England during 2011/12. This record of their major findings provides a definitive read for trust chief executives and commissioners to help better inform IR service reviews. (June 2012)
Enabling community and patient centred care, pop up uni, 11am, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Introduction to Telemedicine: Dr Shweta Gaurshweta gaur
This document discusses telehealth and telemedicine. It defines telehealth as referring to both clinical and non-clinical services, while telemedicine only refers to clinical services. It then provides an introduction to the growth of telemedicine in India through technological advancements. It discusses the objectives, needs, examples and current state of telemedicine in India, highlighting projects by organizations like ISRO and hospitals to increase access to healthcare in rural areas through telemedicine.
Medicare's Value Based Purchasing program redistributes hospital payments based on quality performance scores to incentivize better care. Hospitals will have funding reduced by up to 2% by 2017 if they do not meet targets for clinical process, patient experience and outcome measures. This represents a shift from fee-for-service payments to a model emphasizing value, quality outcomes, and total cost of care. For pharmacy, it implies demands to work across care settings, coordinate care beyond health system walls, and actively engage patients in their care as part of optimizing value-based care.
The Patient Journey Record System (PaJR) uses lay care guides to remotely monitor patients with chronic illnesses through daily phone calls. The calls analyze patients' health and social situations to predict health risks and chances of hospitalization. PaJR has completed Phase 1, comparing hospitalization rates between monitored patients and controls. Phase 2 is an ongoing regional trial monitoring over 130 patients. Preliminary results show the control group has approximately 3 times higher unplanned admission rates. PaJR aims to detect health issues earlier to reduce avoidable hospitalizations through low-cost monitoring and support.
The Patient Journey Record System (PaJR) uses lay care guides to remotely monitor patients with chronic illnesses through daily phone calls. The calls analyze patients' health and social situations to predict health risks and the need for hospitalization. PaJR has completed Phase 1, which found lower hospitalization rates among monitored patients compared to controls. Phase 2 is ongoing in two sites and continues to recruit more patients and controls. Preliminary results again show lower admission rates for monitored patients. The system aims to detect health issues earlier through closer monitoring to reduce avoidable hospitalizations and shift care to the community.
Similar to Marina Lupari: An overview of PARR in practice in Northern Ireland (20)
This document discusses the potential impacts of automation on healthcare employment and discusses alternative views beyond job loss. It notes that automation may lead to reconfiguring of healthcare work rather than outright job loss. Examples of existing technologies that have automated tasks in healthcare like pharmacy automation and emerging technologies like decision support systems and personal health tracking are provided. The document advocates that automation could lead to a virtuous cycle in healthcare if it allows workers to focus on tasks that require human skills and judgment.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
This document summarizes the findings of evaluations of the Integrated Care and Support Pioneers Programme in the UK. The evaluations found that while Pioneers aspired to comprehensive system change, their activities focused more narrowly on initiatives like risk stratification and care coordination teams. Progress was difficult to measure against indicators and Pioneers faced challenges from financial pressures and competing priorities. The evaluations concluded that further integration will be challenging under increasing demands on the health system.
The document discusses lessons learned from the Southwark and Lambeth Integrated Care (SLIC) program in London. Key points:
- SLIC aimed to reduce hospital admissions and care home placements for older adults through risk stratification, holistic assessments, and care management.
- Success required agreement on the problem, dedicated teams, funding shifts to support community care, and leadership development.
- Future programs need a strong business case, co-design with citizens, and a dedicated "engine room" team to drive local transformation.
Effectiveness of the current dominant approach to integrated care in the NHSNuffield Trust
Jonathan Stokes of the Greater Manchester Primary Care Patient Safety Translational Research Centre presents a systematic review of case management in integrated care.
Providing actionable healthcare analytics at scale: Understanding improvement...Nuffield Trust
This document discusses measurement for quality improvement. It explains that measurement in improvement aims to provide a basis for action to improve processes and outcomes, rather than just estimating parameters. Improvement measures should be simple, specific, and available in real-time. Statistical process control methods are important to separate normal variation from changes resulting from interventions. Examples are provided of run charts measuring improvements in recording BMI for mental health patients and compliance with care bundles. The document advocates making the theories behind improvement efforts more explicit.
Ramani Moonesinghe, Associate National Clinical Director for Elective Care at NHS England, discusses the use of data for monitoring care quality at various levels within the system.
This document discusses using statistical process control (CUSUM) charts to monitor mortality rates at the level of individual general practitioners and health authorities. It describes how CUSUM charts could potentially have detected Harold Shipman, a GP who murdered over 200 patients, by spotting outliers in the routine mortality data. The document also discusses challenges in risk adjusting outcomes to account for differences in patient characteristics and casemix between providers. Accurately adjusting for factors like age, comorbidities, and emergency status is important for fair comparisons but difficult using only administrative data.
Martin Utley, Director of the Clinical Operational Research Unit at University College London, reflects upon his involvement in the launch of specific tools to monitor care quality for paediatric cardiac surgery.
Evaluating new models of care: Improvement Analytics UnitNuffield Trust
Martin Caunt, Improvement Analytics Unit Project Director and NHS England and Adam Steventon, Director of Data Analytics at The Health Foundation share insights into how they have approached evaluating new models of care.
Lisa Annaly, Head of Provider Analytics at the Care Quality Commission, discusses lessons learned from the CQC as they have worked to monitor care quality over time.
- Real-time monitoring of healthcare services requires defining both a reporting window and data window to accurately capture demand, activity, and wait times.
- Using only a reporting window (e.g. a single month) to request data can result in invalid or misleading performance metrics, as it does not account for patients with long wait times.
- Defining a larger data window that includes all patients requested before the end of the reporting window and reported after the start avoids this problem, but requires a counterintuitive data request.
- Without properly defining both windows, real-time monitoring can provide an inaccurate picture of service performance and falsely suggest the need for more resources.
Monitoring quality of care: making the most of dataNuffield Trust
Chris Sherlaw-Johnson, Senior Research Analyst at the Nuffield Trust, introduced the Monitoring quality of care conference and gives an overview of some of the approaches that we've been using at the Trust to identify where care quality has been improving, especially for frail and older people.
Providing actionable healthcare analytics at scale: Insights from the Nationa...Nuffield Trust
Christopher Boulton, Falls and Fragility Fracture Audit Programme Manager at the Royal College of Physicians and Rob Wakeman, Clinical Lead for Orthopaedic Surgery at the National Hip Fracture Database talk about what they have learned by analysing the national hip fracture database.
Providing actionable healthcare analytics at scale: A perspective from stroke...Nuffield Trust
Benjamin Bray, Research Director and the Sentinel Stroke National Audit Programme, presents at the Monitoring quality of care conference about stroke care analytics.
New Models of General Practice: Practical and policy lessonsNuffield Trust
Nuffield Trust policy researchers Rebecca Rosen and Stephanie Kumpunen present findings from our upcoming report on large scale general practice models.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- 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
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Marina Lupari: An overview of PARR in practice in Northern Ireland
1. An overview of Parr in
practice in Northern
Ireland.
Marina Lupari
Head of nursing- research &
development, NHSCT/PhD student, UU
2. Key Statistics for Northern Ireland
1.8 people living in N. Ireland
160k emergency admissions to hospital each
year.
Over 700k attendances at A&E Depts.
Our Ambulance service provides over 350k
journeys, of which 88k are emergencies.
5 integrated Health & Social Care Trusts.
3.
4. About the NHSCT
The Northern Health and Social Care Trust provides
a broad range of health and social care services.
The Northern Health and Social Care Trust became
operational on 1 April 2007, combing 3 legacy trusts.
It is geographically the largest trust in Northern
Ireland and operates from approximately 150
locations, serving a population of 443k people.
The Trust employs approximately 14,000 staff. We
have an annual budget of £550 million.
We provide a range of services from nine hospitals
and a large number of community based settings
including people's own homes.
5. Drivers for Change - 2004
The Health Economy had recognized a need for
tighter financial efficiency and cost effectiveness in service
delivery.
better approaches to the management of chronic disease.
These multiple challenges included:
the under-coordination of health services, limited incentives and
training for health care professionals.
poor diagnostic methods, limited disease management
protocols, lack of patient involvement in managing disease.
stove-piped funding mechanisms.
These realities underpinned:
recent efforts to change existing structures and practices in
order to increase service efficiency in chronic disease
management
and improve health outcomes for people living with chronic
illness.
6.
7. Care pathways links between primary, secondary and community care services in
chronic disease management
Primary Care Secondary Care
Patient with suspected Chronic Patients with known Chronic condition –
disease exacerbation of condition
Hospitalisation
Appropriate investigations to
confirm diagnosis
Community Based
Specialist Nurse PARR Assessment
GP referral onwards for support
Continuing Care Nurse Case Finder
(CCN) visits pt at home Case Management Co-ordinator
Patient assessment, review, treatment, education, referral to other professionals services &
support programmes including domiciliary services
Primary Community rehab Chronic Conditions ACAHT- Multi Patient Asst.
Care inc cardiac/ Management acute skills support Technology
Nursing pulmonary rehab programme needs network Group
Team
8. Care pathways links between primary, secondary and community care services in
chronic disease management
Primary Care Secondary Care
Patient with suspected Chronic Patients with known Chronic condition –
disease exacerbation of condition
Hospitalisation
Appropriate investigations to
confirm diagnosis
Community Based
Specialist Nurse PARR Assessment
GP referral onwards for support
Continuing Care Nurse Case Finder
(CCN) visits pt at home Case Management Co-ordinator
Patient assessment, review, treatment, education, referral to other professionals services &
support programmes including domiciliary services
Primary Community rehab Chronic Conditions ACAHT- Multi Patient Asst.
Care inc cardiac/ Management acute skills support Technology
Nursing pulmonary rehab programme needs network Group
Team
9. Overview of the PARR Tool and
Data Preparation Process
Patient admitted/discharged
Activity recorded on Trust PAS
PARR DATABASE
Activity downloaded into PARR Via
Business Objects, Trust Designed MS
Access Database
Sifting & criteria Risk Level Identified
applied
OTHER
PATIENT
DATA APPLIED
CASE FINDING DATABASE CCN Nurse assesses, accepts
THE ‘CASELOAD MANAGEMENT’ PROCESS
10.
11. Initial review of CICM service
Within 1
year
PRIOR
1-2 years to Within 1 year
PRIOR to Referra AFTER
Referral l to Referral
to CCN CCN to CCN
Activity Type service service service
Admissions 110 215 143
Spell Beddays 1466 2307 1903
Avg LoSpell 13.3 10.7 13.3
% of Individuals who had Adms in year
(%/167) 35.3% 68.9% 38.3%
Avg No. of Relevant Adms per individual
(n=167) 0.7 1.3 0.9
Actual No. of Individuals who had relevant
Adms in the year 59 115 64
12. Admissions to UHT by Diagnostic Group
- for those Admissions in both Year BEFORE & AFTER Referral to CCN
Count of Date of Admission Only
35
30
25
20 Post CCN Service
15
10
5
0
Jul
Jul
Jul
Aug
Aug
Apr
Apr
Sep
Feb
Sep
Feb
Jun
Jan
Jun
Jun
Jan
Jun
Dec
Dec
May
May
May
May
Nov
Nov
Mar
Mar
Oct
Oct
2005 2006 2006 2007
2. within 1 year PRIOR to Referral to CCN service 3. within 1 year AFTER Referral to CCN service
Condition
Diabetes Heart Other Resp
Time Banding Years Date of Admission Only
13. Drivers for Change - 2007
Proposal to Centralise the PARR Analysis to allow for the
identification of admissions/activity across different
providers to be integrated.
Trusts moving to “Real Time” recording of Clinical
Diagnoses and thereby aiding the identification of
prospective “Caseload Management” patients in real time.
Regional Unique Identifier now available i.e. HCN to track
individuals across services.
Need to tie in other data sources, i.e. Primary Care activity
such as Attendances at surgery, Out of Hours service
usage, Medications etc. to improve complexity of PARR
Tool (subject to evidence/research).
Organise for N.I. Deprivation Measures to be added to
PARR Tool.
Need to understand full capability of PARR and it’s
application to service provision.
14. Summarisation of key components of
study design & methodology
April 06… June 2008- November 2009 approx
Intervention Group Comparison Group
Locality A (n=295) Locality B (n=295)
Case Usual Care
Management CM Care
Introduced
Data Gathering
Data Gathering Patient specific
Locality A
Patient specific FIM
FIM HR-QOL
HR-QOL Economic Proforma
Economic Proforma Carers Strain Index
Carers Strain Index - Carers Focus group
- Carers Focus group
15. Research Objectives and link to
PARR
Aim- to establish if the introduction of a case management
approach for chronic conditions is effective and/ or cost effective
Does PARR predict patients accurately at risk of
rehospitalisation and how can we move towards prediction of
avoidable rehospitalisations?
What is the relationship between PARR, reduction in
rehospitalisations and the intervention?
Is there any relationship between PARR and the specific chronic
condition, and/or presence of co-morbidities ?
16. “PARR” identified referrals to CICM
Result of Assessment No. %
CCN caseload 1122 33.5%
CCN Discharge 319 9.5%
Mortality 670 20.0%
Renal Failure 27 0.8%
Inappropriate referral CCN 826 24.7%
Other handover 103 3.1%
Palliative care 82 2.4%
PCNT handover 46 1.4%
Service declined 154 4.6%
3349
Position @ Jun09
17. Distribution Chart showing PARR Scores across Research Groups
Count of ID
250
216
199
200
150
100
56
44
50
23
14 10 9 5 4 1 4 1 2 2
0
20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99
Research Group
Control Group Intervention Group
PARR
18. Distribution Chart of Major Chronic Conditions by Research Group
350
295 295
300
250
200 193
186
158
145
150
113 113
100
61
46
50
0
No. in Research Group Asthma COPD Diabetes Heart Failure
Control Group Intervention Group
19. 0
10
20
30
40
50
60
70
80
Asthma
Asthma / Diabetes Count of ID
Asthma / Diabetes /Heart
Failure
Asthma/ COPD
Asthma/ COPD/ Diabetes
Asthma/ COPD/ Diabetes/
Heart Failure
Asthma/ COPD/ Heart
Failure
Control Group
Research Group
Asthma/ Heart Failure
Chronic Conditions
COPD
Drop Page Fields Here
Intervention Group
COPD/ Diabetes
COPD/ Diabetes/ Heart
Failure
COPD/ Heart Failure
Diabetes
Distribution Chart showing the Multiple Co-Morbidities for Research Groups
Diabetes/ Heart Failure
Heart Failure
20. PARR
Chronic Conditions Research Group 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99 Total
Asthma Control Group 4 2 2 1 9
Intervention Group 7 2 9
Asthma / Diabetes Control Group 6 1 1 8
Intervention Group 15 2 17
Asthma / Diabetes /Heart Failure Control Group 3 1 4
Intervention Group 1 2 3
Asthma/ COPD Control Group 1 1 1 3
Intervention Group 2 1 1 4
Asthma/ COPD/ Diabetes Control Group 2 1 1 4
Intervention Group 4 4 8
Asthma/ COPD/ Diabetes/ Heart Failure Intervention Group 2 2
Asthma/ COPD/ Heart Failure Control Group 2 2
Intervention Group 4 1 5
Asthma/ Heart Failure Control Group 10 4 2 16
Intervention Group 12 1 13
COPD Control Group 29 14 3 4 1 51
Intervention Group 47 3 1 2 2 1 1 57
COPD/ Diabetes Control Group 14 4 1 19
Intervention Group 21 4 1 2 28
COPD/ Diabetes/ Heart Failure Control Group 12 5 3 1 1 22
Intervention Group 14 2 1 1 18
COPD/ Heart Failure Control Group 34 6 3 1 44
Intervention Group 50 10 6 2 1 1 1 71
Diabetes Control Group 9 1 3 1 1 15
Intervention Group 7 5 1 1 14
Diabetes/ Heart Failure Control Group 34 5 1 1 41
Intervention Group 15 5 2 1 23
Heart Failure Control Group 39 13 2 2 1 57
Intervention Group 15 3 3 2 23
Grand Total 415 100 37 19 9 5 3 2 590
21. Distribution Chart : Showing "relevant" rehospitalisations
Sum of SumOfAdmissions
100
89
90
80 76
70 63 63
60 51 52
47
50 42
40
30
20
10
0
T0 T3 T6 T9
Yes
Research Group
Control Group Intervention Group
Included in Study T Band
22. Distribution chart: Beddays by Relevant Conditions across Research
Groups
Sum of SumOfLength of Spell1
800
678 699
673
700 632 649
600 560
500
384 367
400
300
200
100
0
T0 T3 T6 T9
Yes
Research Group
Control Group Intervention Group
Included in Study T Band
23. Distribution Chart: Relevant Adms by PARR Score
160 150
140 132
120
100
80
60
48
37
40
18 20 20
16 15
20 11
8 7
1
0
20-29 30-39 40-49 50-59 60-69 70-79 80-89
Yes
Control Group Intervention Group
24. What have we learnt so far ?
We know PARR can predict people at risk of
all rehospitalisations for about 75 % of people
We know PARR and our intervention can
save rehospitalisations / beddays
We know we need to look at how better to
predict those people at risk of avoidable
rehospitalisations
We need to look at the impact of social
deprivation for NI
25. So where to now?
Continue with data analysis
Investigate the relationship of PARR and
avoidable re hospitalisations more fully
DHSSPS have agreed to run PARR across NI
Look at what everyone else is doing and see
how we can improve