Update on Research in Geriatrics Presentation March 6-7 2009
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The document discusses recent advances in geriatric research and care. It highlights the need to implement evidence-based best practices for common geriatric conditions through interprofessional collaboration. This includes guidelines for catheter use, medication management, nutrition, and delirium. It also stresses the importance of a holistic assessment of older patients' mobility, decision-making ability, and community connections to minimize disability and maximize independence.
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EVIDENCE BASED 4
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The purpose of this assignment is to identify individual assessment trends to determine the highest priority concept, conduct a research study of the topic outline in relation to the NCLEX-RN test plan and provide evidence-based research regarding nursing practice. Based upon the category of physiological integrity, the topic of greatest opportunity is “physiological adaptation” which focuses on the client needs category. According the NCLEX-RN test plan (2019), Physiological adaption the nurses manage and provide care for the clients with acute, chronic, or life-threatening physical health conditions. The primary goal of “physiological adaptation” category is to interpret clinical findings, analyze nursing actions as it correlates with the client’s care and take immediate action when needed and evaluate client’s outcomes based on the priority decisions (NSCBN, 2019). This category requires entry level nurses to demonstrate their knowledge, skills, and abilities for the successful completion of the NCLEX-RN test plan into the nursing practice.
Importance
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Healthcare Disparities, Inequalities, and Interventions
This population targets clients with sepsis, diuresis from AKI, respiratory acidosis, burns, and excessive gastrointestinal or wound loses (Kear, 2017). Older Clients with chronic conditions are susceptible to pressure ulcers due to their decrease sensation, cardio output, perfusion, activity, mental status, and fluid and electrolyte imbalances (Macedo at el, 2016). As a client ages their kidney functi ...
Transforming the Office Management of Heart Failure Using the Chronic Disease...
Transforming the Office Management of Heart Failure Using the Chronic Disease...MedicineAndHealthUSA
This document describes a project to transform the management of heart failure patients using a chronic disease model in a family medicine residency program. It discusses shortcomings in current chronic disease management and introduces the chronic care model. The project aims to improve guideline adherence, patient education and self-management, care coordination, and use of an electronic registry to track patients and monitor outcomes. Initial lessons learned include challenges with governance approvals and achieving buy-in from part-time providers during a cultural change.Reducing Stroke Readmissions in Acute Care Setting.docx
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Mobility is Medicine
Loretta Schoen Dillon, PT, DPT, MS
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UTEP Physical Therapy Program
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
011 Am09 Presentations Maddux
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Thomas bodenheimer
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Thomas Bodenheimer
The document discusses lessons from the United States on caring for patients with chronic illnesses. It outlines three key functions of primary care teams: panel management to ensure patients receive evidence-based care, health coaching to support behavior change and medication adherence, and complex care management for high-needs patients. High-functioning teams with roles like registry use, panel managers, and health coaches are shown to improve health outcomes and lower costs compared to usual individual physician care.
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THE DYNAMIC ENVIRONMENT OF HEALTH CAREChapter 1Objecti.docx
THE DYNAMIC ENVIRONMENT OF HEALTH CARE
Chapter 1
Objectives
Describe the present healthcare environment.
Examine megatrends in the environment.
Address organizational survival.
Identify the role of the healthcare practitioner as manager.
Review the classic functions of the manager.
Define and differentiate between management as an art and a science.
Conceptualize the characteristics of an effective manager.
2
Megatrends
Client characteristics
Professional practitioners and caregivers
The healthcare marketplace and settings
Applicable laws, regulations, and standards
The impact of technology
Privacy and security considerations
Financing of health care
Social and cultural factors
Healthcare Regulation
State licensure laws for facilities
State licensure laws for professions
State-mandated healthcare planning
State laws governing reimbursement and insurance
Healthcare Regulation
Federal laws governing reimbursement
Federal laws regarding privacy and security of information
Patient Protection and Affordable Care Act
American Recovery and Reinvestment Act
5
Reimbursement and Payment
Charitable roots and the not-for-profit model
Fee-for-service
Health insurance: Non-profit and commercial
Managed care
Current legislation: Healthcare reform
The Managed Care Era
Providing access to quality care at affordable cost
Primary care physician as “gatekeeper”
Premium costs by limits on services
Arrangements between managed care groups and hospitals
Issues about denial of service or payment
Capitation
Reimbursement system under which provider is paid specific amount of money to look after all the healthcare needs of a given population
Literally, reimbursement based on so much “per head”
Reasons for Restructuring
Desire to achieve greater negotiating clout
Desire to penetrate new markets
Need for improved efficiencies
Desire to express an overall value of promoting comprehensive, readily accessible care
Mergers and Affiliations
MERGER: Two or more corporate entities blend to create one new organization
AFFILIATION: Formal agreement between facilities to coordinate and share activities while remaining separate corporate entities
Range of Service
Note the variety of services and levels of care
Examples:
Adult day care center
Hospice
Urgent care clinic
Impact of Technology
“eVisits” and “digital doctors”
Translational medicine
Data warehousing
Data mining
“Real-time” interventions
Common language and standards: Standard vocabulary and classification systems
National information infrastructure: To capture, access, use, exchange, and store data
Increased use by patients of alternative therapies and interventions
The embedded nurse representative on patient care teams
Rationing; quality-adjusted remaining years
Social and Ethical Factors
Unit supervisor; project manager; department head
Specialized division head
Manager of independent practice
Role of Healthcare Practitioner as Manager
Management Functions
Typ.
Report for KFCoA
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110614 tim warren presentation
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1. Current trends in nursing include changes in the social, medical, and nursing professions due to factors like advances in technology, specialization in medicine, and emphasis on evidence-based practice.
2. Issues in nursing include the nursing shortage, ensuring quality care and patient safety, managing legal/ethical concerns, and addressing an aging population's needs.
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MEDINFO 2013 Panel on Personalized Healthcare and Adherence: Issues and Chall...
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Venue: The 14th World Congress on Medical and Health Informatics will take place in Copenhagen, Denmark.
http://medinfo2013.dk
Moderator: Dr. Marion Ball (IBM Research/JHU); Panelists: Dr. Vimla Patel (NYAM), Dr. Bern Shen (Healthcrowd), Dr. Pei-Yun Sabrina Hsueh (IBM Research)
Organizer: Dr. Pei-Yun Sabrina Hsueh (phsueh@us.ibm.com)
Personalization is key to the delivery of wellness care including preventive measures and disease management regimes, where patients take on increased responsibility for
their own health. While personalized care has already taken a giant leap through genomics, it remains a challenge to understand how individual differences play a role in patient adherence and manage recommended changes accordingly.
Practical methods of creating and evaluating personalized
systems have not been fully established. In particular, the role of data-driven analytics in producing actionable insights for practitioners is unclear, and the use of behavioral data has created additional challenges to the understanding of patient adherence for effective care delivery.
The panel will discuss the challenges that face many countries around personalized care from various perspectives. These range from behavioral aspects such as maintaining good practices, cognitive aspects such as how do individuals make decisions in the lights of good evidence, social aspects such as how to engage patients in sustaining adherence behavior, to technological aspects such as how to evaluate individual applicability of data-driven analytics and personalized technological systems.
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- 1. Cutting Edge: Update on Research Advances in Geriatrics Janet E. McElhaney, MD, FRCPC, FACP Professor of Medicine Allan M. McGavin Chair, Geriatrics Research UBC, PHC and VGH Division Head, Geriatric Medicine
- 3. Seniors’ Health: Adding Life To Years 60 70 80 90 Age 2000’s 1990’s 1980’s
- 4. Chronic diseases increase risk for catastrophic disability Successful Aging Usual Aging Frail Seniors Seniors in LTC
- 5. Risks Associated with Hospitalization 65+ population are hospitalized 3X more often than younger adults; 36% of hospitalizations and 50% of hospital expenditures At discharge, 33% are more disabled 5% die in hospital, 20-30% die in the year after hospitalization Elixhauser A et al; AHRQ Pub. No. 00-0031, HCUP Fact Book No. 1, 2000 Covinksy KE et al; J Am Geriatr Soc; 51:451, 2003 Transforming Seniors Care – what’s not hot but should be
- 8. Demand savings from Seniors Transformation ALC ELOS LOS Acute days that exceed ELOS Prevent 20% of cases from becoming ALC Remove 50% of acute days that exceed ELOS Acute Reduction of acute days by 16,556 per year Total Savings Possible for “Target Group” Includes: CMGs grouped by guideline Seniors aged 70+ VCH residents only Excludes: COPD (CMG 139) & Stroke
- 11. One presentation of dynamic frailty Picture an 82 year old woman who presents in the ED with a cough and increasing SOB while walking with her 3 K-a-day Club on the Sea Wall.
- 12. Dynamic frailty can be a mask that limits our view of possible outcomes Picture an 82 year old woman who presents in the ED with confusion and a cough. She was walking with her 3 K-a-day Club on the Sea Wall 2 days ago .
- 13. Learn to look behind the mask …
- 14. Catastrophic Disability Ferrucci et al. JAMA 277:728, 1997
- 15. Acute Illness: Prevent or Minimize Disability 80 80 80 80 80 Age Cardiovascular Disease Diabetes Osteoporosis Chronic Lung Disease Cognitive Impairment Dynamic Frailty Usual Aging IADL Frailty ADL Frailty
- 16. We’re all in the same boat!
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- 19. Accommodate: Multidisciplinary professionals intervene on an autonomous, parallel basis.
- 20. Cooperate then Coordinate: Interdisciplinary team members cooperate then coordinate assessments and care plans.
- 21. Collaborate: Professionals have a narrower margin of autonomy but the team as a whole is more autonomous and its members better integrated