Dana Stoner, Senior Policy Advisor with Texas Department of State Health Services, shared three examples of "changing the system" at the June 3, 2014 workshop on Designing Healthcare in Texas. The presentation was part of a Medicaid 101 overview and started the two day event sponsored by One Voice Texas, Harris County Healthcare Alliance, and Kinder Institute.
Advancing Health Equity: Building on Community-Based InnovationWellesley Institute
This presentation offers insights on how to advance health equity by building on community-based innovation.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Health Equity Strategy, Interpretation and Other Levers for Driving ChangeWellesley Institute
This presentation outlines effective ways to create change within your community.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...Wellesley Institute
This presentation offers insight into the policy challenges that inhibit health equity.
Bob Gardner, Director of Policy
Steve Barnes, Policy Analyst
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Building Equity and Social Determinants of Health into 'Healthy Communities' ...Wellesley Institute
This presentation provides critical insights on how build equity and healthy communities.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Advancing Health Equity: Building on Community-Based InnovationWellesley Institute
This presentation offers insights on how to advance health equity by building on community-based innovation.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Health Equity Strategy, Interpretation and Other Levers for Driving ChangeWellesley Institute
This presentation outlines effective ways to create change within your community.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
'Wicked' Policy Challenges: Planning, Tools, and Directions for Driving Healt...Wellesley Institute
This presentation offers insight into the policy challenges that inhibit health equity.
Bob Gardner, Director of Policy
Steve Barnes, Policy Analyst
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Building Equity and Social Determinants of Health into 'Healthy Communities' ...Wellesley Institute
This presentation provides critical insights on how build equity and healthy communities.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15Hatfields, Chadwick Court, London
Guidance for commissioners of dementia servicesJCP MH
This guide describes what a good quality, modern dementia service looks like. It has primarily been written for Clinical Commissioning Groups, local authorities, and Health and Wellbeing Boards. It will also be of interest to patients, carers and voluntary sector and provider organisations.
Guidance for commissioners of drug and alcohol servicesJCP MH
This guide has been written to provide practical advice on developing and delivering local plans and strategies to commission the most effective and efficient drug and alcohol services for adults.
Based upon clinical best practice guidance and drawing upon the range of available evidence, it describes what should be expected of a modern drug and alcohol service in terms of effectiveness, outcomes and value for money.
Guidance for commissioners of mental health services for people from black an...JCP MH
This guide describes what ‘good’ mental health services for people from Black and Minority Ethnic (BME) communities look like.
While all of the JCP-MH commissioning guides apply to all communities, there are good reasons (see P9) why additional guidance is required on commissioning mental health services for people from BME communities.
This guide focuses on services for working age adults. However, it could also be interpreted for commissioning specialist mental health services, such as CAMHS, secure psychiatric care, and services for older adults.
Guidance for commissioning public mental health servicesJCP MH
Public mental health services (updated August 2013)
This is the second version of the public mental health guide. It has been revised and updated to include new sources of data and information.
The guide is about the commissioning of public mental health interventions to reduce the burden of mental disorder, enhance mental wellbeing, and support the delivery of a broad range of outcomes relating to health, education and employment.
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London
Presentation by Auditor General - Caroline Spencer, An audit of access to State-managed adult mental health services.
Presented at the Western Australian Mental Health Conference 2019.
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15Hatfields, Chadwick Court, London
Technology-enabled Platform for Proactive Regular Senior-Centric Health Asses...DataNB
Hospitalizations and other negative health events are detrimental to seniors’ health and costly to the healthcare system. Proactive health monitoring may help seniors avoid negative health events and remain safely in their homes for longer. Many seniors do not have the skills, knowledge, or technology to regularly monitor their health at their own at home. Without regular, proactive health monitoring, we cannot identify seniors at risk of negative health outcomes (like hospitalizations) before such events occur. Having trained home support workers (caregivers) use their skills and technology to monitor seniors’ health makes proactive health monitoring more accessible to seniors receiving home care. In this project, trained caregivers use technology to proactively monitor seniors’ health for risk factors that could predict hospitalizations or other negative health outcomes. Seniors’ complete regular health assessments with their caregivers. Caregivers enter the results into a mobile app for analysis. The assessments involve physical health (like weight and blood pressure) and cognitive/mental health (like word recall and quality of life). All equipment is provided in a kit that is stored in the senior’s home. We anticipate that seniors will appreciate regularly checking on their health. Caregivers will benefit from learning new skills and having a new way to positively impact the seniors they care for. We anticipate showing that it is practical to have trained caregivers use technology (secure mobile app) to monitor the health of seniors receiving home care. We also aim to investigate if trends in seniors’ health can predict negative health events, like hospitalizations.
In Spring 2013, we are on the precipice of dramatic, disruptive change in the health field that offers an unprecedented opportunity and challenge to transform health care and population health.
We know that traditional public health approaches along with more and better health care are not enough to improve health outcomes, equity, and cost. We must also:
- implement sustainable, fundamental "upstream" changes that address the root causes of disease and disability; and
- transform the way we deliver health care to ensure access to quality, affordable health care for all.
Enjoy this Bright Spot presentation with David Law of Joy-Southfield Community Development Corporation, which was presented at the 2013 Annual Leadership Conference, co-sponsored by the Center for Health Leadership (CHL) and the California Pacific Public Health Training Center (CALPACT) at UC Berkeley's School of Public Health.
To learn more about this event, please visit:
http://calpact.org/index.php/en/events/leadership-conference
Learn more about CALPACT:
http://calpact.org/
Learn more about the CHL:
http://chl.berkeley.edu/
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
Guidance for commissioners of primary mental health servicesJCP MH
This guide describes what good quality, modern, primary mental health care services look like. It has been written by a group of primary mental health care experts, in consultation with patients and carers. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included.
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15Hatfields, Chadwick Court, London
Guidance for commissioners of dementia servicesJCP MH
This guide describes what a good quality, modern dementia service looks like. It has primarily been written for Clinical Commissioning Groups, local authorities, and Health and Wellbeing Boards. It will also be of interest to patients, carers and voluntary sector and provider organisations.
Guidance for commissioners of drug and alcohol servicesJCP MH
This guide has been written to provide practical advice on developing and delivering local plans and strategies to commission the most effective and efficient drug and alcohol services for adults.
Based upon clinical best practice guidance and drawing upon the range of available evidence, it describes what should be expected of a modern drug and alcohol service in terms of effectiveness, outcomes and value for money.
Guidance for commissioners of mental health services for people from black an...JCP MH
This guide describes what ‘good’ mental health services for people from Black and Minority Ethnic (BME) communities look like.
While all of the JCP-MH commissioning guides apply to all communities, there are good reasons (see P9) why additional guidance is required on commissioning mental health services for people from BME communities.
This guide focuses on services for working age adults. However, it could also be interpreted for commissioning specialist mental health services, such as CAMHS, secure psychiatric care, and services for older adults.
Guidance for commissioning public mental health servicesJCP MH
Public mental health services (updated August 2013)
This is the second version of the public mental health guide. It has been revised and updated to include new sources of data and information.
The guide is about the commissioning of public mental health interventions to reduce the burden of mental disorder, enhance mental wellbeing, and support the delivery of a broad range of outcomes relating to health, education and employment.
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London
Presentation by Auditor General - Caroline Spencer, An audit of access to State-managed adult mental health services.
Presented at the Western Australian Mental Health Conference 2019.
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15Hatfields, Chadwick Court, London
Technology-enabled Platform for Proactive Regular Senior-Centric Health Asses...DataNB
Hospitalizations and other negative health events are detrimental to seniors’ health and costly to the healthcare system. Proactive health monitoring may help seniors avoid negative health events and remain safely in their homes for longer. Many seniors do not have the skills, knowledge, or technology to regularly monitor their health at their own at home. Without regular, proactive health monitoring, we cannot identify seniors at risk of negative health outcomes (like hospitalizations) before such events occur. Having trained home support workers (caregivers) use their skills and technology to monitor seniors’ health makes proactive health monitoring more accessible to seniors receiving home care. In this project, trained caregivers use technology to proactively monitor seniors’ health for risk factors that could predict hospitalizations or other negative health outcomes. Seniors’ complete regular health assessments with their caregivers. Caregivers enter the results into a mobile app for analysis. The assessments involve physical health (like weight and blood pressure) and cognitive/mental health (like word recall and quality of life). All equipment is provided in a kit that is stored in the senior’s home. We anticipate that seniors will appreciate regularly checking on their health. Caregivers will benefit from learning new skills and having a new way to positively impact the seniors they care for. We anticipate showing that it is practical to have trained caregivers use technology (secure mobile app) to monitor the health of seniors receiving home care. We also aim to investigate if trends in seniors’ health can predict negative health events, like hospitalizations.
In Spring 2013, we are on the precipice of dramatic, disruptive change in the health field that offers an unprecedented opportunity and challenge to transform health care and population health.
We know that traditional public health approaches along with more and better health care are not enough to improve health outcomes, equity, and cost. We must also:
- implement sustainable, fundamental "upstream" changes that address the root causes of disease and disability; and
- transform the way we deliver health care to ensure access to quality, affordable health care for all.
Enjoy this Bright Spot presentation with David Law of Joy-Southfield Community Development Corporation, which was presented at the 2013 Annual Leadership Conference, co-sponsored by the Center for Health Leadership (CHL) and the California Pacific Public Health Training Center (CALPACT) at UC Berkeley's School of Public Health.
To learn more about this event, please visit:
http://calpact.org/index.php/en/events/leadership-conference
Learn more about CALPACT:
http://calpact.org/
Learn more about the CHL:
http://chl.berkeley.edu/
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London
Better outcomes, better value: integrating physical and mental health into clinical practice and commissioning
Tuesday 24 June 2014: 15 Hatfields, Chadwick Court, London
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
Guidance for commissioners of primary mental health servicesJCP MH
This guide describes what good quality, modern, primary mental health care services look like. It has been written by a group of primary mental health care experts, in consultation with patients and carers. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included.
The “Project Maanasi” is a mission to deliver mental health and primary care services to poor rural women and children in southern India. The goal of the program has been to provide low cost or free care to villagers, sustained outreach to those who cannot access the clinic, and educate patients and others about seeking care to improve their lives.
Mental Health Policy Briefing: Raising the Priority of California Children wi...LucilePackardFoundation
Mental health services and supports for children with special health care needs (CSHCN) must be a priority for California. This briefing will provide an overview of the mental health services to which CSHCN are entitled, highlight current state policy priorities, and share ways to engage in advocacy efforts. Speakers will be available after the briefing for questions.
Sj47 -The State of Youth Mental Health in VirginiaAnne Moss Rogers
Children’s Mental Health: Challenges and Opportunities--This is the presentation by Margaret Nimmo Crowe to a special subcommittee of the commonwealth, Executive Director for Voices for Virginia’s Children. More info here: http://1in5kids.org/2014/10/29/sj-47-workgroup-takes-childrens-mental-health/
Proposed changes in health care payment, from fee-for-service to alternative, risk-sharing payment models, can have a substantial impact on health services for children, especially those with complex care needs. In addition, tying payment to value can increase use of ambulatory and preventive services and encourage creative outreach. However, abrupt changes can interrupt continuity and reduce access to care.
Allina Health used actionable data to identify potential areas of bias, then applied the right interventions to decrease implicit biases. For example, data revealed that the African American populations receiving care at Allina Health were not enrolling in hospice programs when they were eligible because the hospitalists weren’t referring African Americans at the same rate as other populations.
Vivian Anugwom, Health Equity Manager at Allina Health, shares how she led a team to implement new measures, including implicit bias trainings, to help address and overcome these biases to ensure health equity for all.
During this webinar, Vivian will help attendees:
- Understand how Allina Health uses data to identify disparities.
- Define bias and its impact on health disparities.
Improving the Health Outcomes of Both Patients AND PopulationsCHC Connecticut
NCA Clinical Workforce Development, Team-Based Care 2019 Webinar Series
Webinar broadcast on: May 23, 2019 | 2 p.m. EST
In this webinar experts will share their journey in planning, preparing and launching a population health initiative. With the goals of impacting population health outcomes while ensuring cost effectiveness, our experts designed interventions to eliminate gaps in care, particularly among special populations.
The “Project Maanasi” is a mission to deliver mental health and primary care services to poor rural women and children in southern India. The goal of the program has been to provide low cost or free care to villagers, sustained outreach to those who cannot access the clinic, and educate patients and others about seeking care to improve their lives.
Acting on Social Determinants and Health Equity: An Equity Toolkit for Public...Wellesley Institute
This presentation examines the relationship between the social determinants of health and health equity.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
Every two years, One Voice Texas membership participates in a survey to evaluate the degree of success of our work. In turn, these results are used by the Board and staff to guide growth of the organization. This survey is conducted by Gerald Goodman, PhD, Professor and Program Director, Health Care Administration, Texas Woman’s University.
Designing Coverage for All - Closing the Coverage Gaps - Joy Johnson WilsonOneVoiceTexas
Joy Johnson Wilson, Health Policy Director at the National Conference of State Legislatures, looks at the coverage gaps at the Designing Healthcare in Texas June 4, 2014 conference.
What Accounts for Health Disparities - Stephen Klineberg, Ph.D.OneVoiceTexas
Stephen Klineberg, Ph.D., Professor/Co-Director Rice University's Kinder Institute for Urban Research, shared the impact demographics have on access to healthcare. Presentation was made at the Designing Healthcare in Texas conference on June 4, 2014.
Expanding Access to Healthcare in Texas - Robert Greenwald, J.D.OneVoiceTexas
Robert Greenwald, J.D., Director of the Center for Health Law and Policy Innovation at Harvard Law School, looks at turning the Affordable Care Act challenges into Opportunities at the June 4, 2014 Designing Healthcare in Texas conference. (Hosts: One Voice Texas, Harris County Healthcare Alliance, Rice University Kinder Institute)
Carisa Magee, Manager, Medicaid/CHIP Program Policy Texas Health and Human Services Commission, presented an overview of Medicaid at the "Designing Healthcare in Texas" conference hosted by One Voice Texas, Harris County Healthcare Alliance and Kinder Institute on June 3, 2014.
Presentation by Marjorie McColl Petty, Regional Director of the Department of Health and Human Services, Region VI, at the Sept. 30, 2013 83rd Texas Post-Legislative Conference hosted by One Voice Texas, United Way of Greater Houston and the Harris County Healthcare Alliance.
Presentation by Mario Castillo, Regional Organizing Lead in the Houston-Gulf Coast region for Enroll America, at the Sept. 30, 2013 83rd Texas Post-Legislative Conference hosted by One Voice Texas, United Way of Greater Houston and the Harris County Healthcare Alliance.
Presentation by James Smith of the American Continental Group at the Sept. 30, 2013 83rd Texas Post-Legislative Conference hosted by One Voice Texas, United Way of Greater Houston and the Harris County Healthcare Alliance.
Harvard's Robert Greenwald on Texas MedicaidOneVoiceTexas
Robert Greenwald, JD, Clinical Professor of Law and Director of Center for Health Law and Policy Innovation at Harvard Law School, presented an in-depth analysis forum of the federal health reform Affordable Care Act and associated transformation of the Texas Medicaid system. On January 24 in Austin, he spoke to sever audiences on the challenges and opportunities specific to Texas including why the Affordable Care Act’s Medicaid expansion is so important to the provision of cost- effective, high quality care and treatment to low income uninsured Texans.
Professor Greenwald has over 20 years of experience in the fields of health law and policy. His Center is recognized as a national leader in Affordable Care Act implementation and in efforts to improve healthcare access and health outcomes for the uninsured and underinsured.
One Voice Texas and the Harris County Healthcare Alliance sponsored the event.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
4. Medicaid Opportunities
• Demonstrations - Money Follows the
Person Behavioral Health Pilot
• State Medicaid Plan Options – Home and
Community-based Services for People
with Severe Mental Illness
• Grant Opportunities – Incentives for
Prevention of Chronic Disease
4
5. Why focus on Mental Illness?
• Mental illness has costly human and financial consequences
• Texans with severe mental illness live 29 years less than other
Americans and have more health problems earlier in life.
• Mental health and substance abuse conditions comprise 9
percent of initial Texas Medicaid initial inpatient admissions
but represent 27 percent of potentially preventable
readmissions.
• Institutional care in state mental health hospitals costs the
state $500 or more dollars per day.
5
7. The Challenge
• National data indicated that large numbers of
nursing facility residents have a primary diagnosis
of mental illness, with a disproportionate number
being under the age of 65.
• In 2007, over 7,000 Texas nursing facility residents
were former clients of the mental health system.
• People with mental health and substance use
disorders experience special challenges in returning
to the community.
7
9. The Opportunity
• 2008- Texas awarded MFP demonstration
grant, funded by the Centers for Medicare
and Medicaid Services
• The grant allows Texas to test innovations,
including the Behavioral Health Pilot
9
10. MFP BH Pilot Goals
• Transition adults with severe mental illness
and/or substance abuse disorders from
nursing facilities to the community
• Help people be successful in the community
by integrating mental health and substance
abuse services with long term care services
and supports
• Result in positive, long-term changes to the
Medicaid system
10
11. BH Pilot Scope
• Includes adults with mental health or substance
use conditions and functional limitations who
have resided in a nursing facility for 3+ months.
• Two pilot sites in San Antonio (Bexar County) and
Austin areas.
• Partnership of State’s Medicaid, Mental Health
and Long Term Care systems.
11
12. BH Pilot Services
• Coordinated with other services provided
through Medicaid managed care
• Pre-Transition Services - up to six months
before discharge to help prepare for
community life.
• Post-Transition Services - up to one year of
Pilot services post-discharge
• Transition plan – to regular Medicaid
services and community resources
12
13. Cognitive Challenges
• Apathy
– A person does not start necessary activities on
their own or does not complete all the steps
• Disinhibition
– A person acts in a way that is not appropriate
to a situation, gets easily distracted, or
behaves very impulsively
• Mixed
– Both challenges present
13
14. Cognitive Adaptation Training
(CAT)
• Evidence-based psycho-social intervention
• Uses a motivational strengths perspective
to facilitate person’s initiative and
independence
• Provides environmental modifications
(e.g., calendars, clocks, signs, organizers)
to help people bypass cognitive challenges
and organize their environment and
function independently
14
15. Organizing Activities
Sam’s Daily Checklist
MON TUE WED THU FRI SAT SUN
Charge
phone
Use
Deodorant
Put on
shoes
Put on
clean shirt
15
20. Substance Use Services
• Assessment
• Individual &
Group Counseling
• Tobacco Cessation
Counseling
• Peer Support
• 24-hour On-Call
Support
• Motivational
Interviewing
• Harm Reduction
• Person-centered
care planning
• Interdisciplinary
team approach
20
21. Participant Characteristics
• Average Age was 59 (range 26-89)
• 54% are female
• 29% Hispanic, 17% African American,
52% Anglo
• 72% with serious mental illness (28% with
other mental illness or substance misuse)
• 5% with dementia
21
22. Functional Measures
• The Quality of Life Scale (QLS) (21 items) was developed to
evaluate deficit symptoms and impaired functioning in
people with schizophrenia.
• The Multnomah Community Ability Scale (MCAS) (17 items)
measures the functioning of chronically mentally ill persons
living in the community.
• The Social and Occupational Functioning Assessment Scale
(SOFAS) is a single item that measures an individual’s level of
social and occupational functioning resulting from mental
and physical health problems.
22
26. The Pilot Today
• Over 291 people have been served since 2008
• Approximately 70% of BHP participants served remain in the
community up to 5 years.
• Examples of increased independence include getting a paid job at
competitive wages, driving to work, volunteering, getting a GED,
teaching art classes, leading substance use peer support groups and
working toward a college degree.
• After initial relocation expenses, the Pilot annually saves Medicaid
money since community care costs about 40 percent less than nursing
facility care.
• Overall impact of program appears strong with additional data being
collected to expand analysis.
26
27. The Future
• Managed care organizations will provide Medicaid
rehabilitative and case management services for
people with severe mental illness. (They already
provide substance abuse and other mental health
services.)
• Texas could include the Pilot’s evidence-based
practices in its managed care system. Thousands of
Texans could benefit.
• Texas is sharing results nationally to inform federal
policy changes that support independence, recovery.
27
29. MFP-BH Return to NF Outcomes
• Medicaid data showing nursing facility stays were
obtained for 213 participants to determine whether they
were still in the community.
• 150 or 70% of participants remained in the community
o Median tenure was 24 months
o Longest tenure was 65 months
o Total community time in years for group is 314 years
• Over 50% of those who returned to nursing facility (n=63)
were in community for 24 months or longer; Total time in
community was 76 years
29
31. The Challenge
• Some adults who have severe mental illness
experience extended inpatient commitments –
sometimes lasting for years
• These individuals have very complex needs –
cognitive, physical, social
• They require individualized home and
community-based services (HCBS) to successfully
attain and maintain independence
• They could not get HCBS services through
existing waivers or Money Follows the Person
because of Medicaid regulations (IMD exclusion)
31
32. The Opportunity
• 1915(i) of SSA enables states to provide HCBS
under a Medicaid state plan amendment
• Can target a broad range of customized services
to populations such as adults with SMI, which
are not otherwise available under Medicaid (e.g.
residential supports, respite care, transition
assistance, specialized therapies, peer support)
• Rider 81: pursuing 1915(i) amendment for adults
with complex needs and very long, repeated
stays in psychiatric hospitals
• A complex, but worthwhile endeavor!
32
34. The Challenge
• The leading causes of death for people with severe mental
illness are chronic health conditions such as heart disease,
cancer and lung disease. Despite overall declines in cigarette
smoking, a high prevalence of smoking persists among
Americans with mental illness.
• Taking atypical antipsychotic medications puts an individual
at risk for developing type 2 diabetes.
• Alcohol misuse is one of the greatest risk factors for the
development of some cardiovascular diseases, cancer, chronic
lung diseases, and diabetes.
34
35. The Opportunity
• Texas awarded a Medicaid Incentives for Prevention of
Chronic Disease (MIPCD) Federal Grant
• Texas MIPCD study is known as WIN (Wellness
Incentives and Navigation)
• Large Randomized trial in Harris SDA (1250+ adult SSI
participants), operating through December 2015
• Provides evidence-based incentives to help Medicaid
clients adopt healthy behaviors, improve outcomes
• STAR+PLUS is Texas Medicaid’s dominant health care
delivery system for adults with disabilities. Potential for
large scale impact, if successful.
35
36. 36 36
WIN Interventions
• Person-centered wellness planning with professional
health navigators, who are trained in Motivational
Interviewing (MI) techniques.
• Flexible wellness account to support specific health goals
defined by the participant in the individual wellness
plan. ($1150 / yr., administered through the navigator)
• Wellness Recovery Action Planning training (WRAP) to
enable participants to better manage mental and
physical challenges.
37. WIN Features
• Rapid cycle improvement process
• Partnership: Stakeholder Advisory Group, Medicaid
Office, Medicaid MCOs
• Uses technology to collect data, reach participants and
manage workload
• Tracks outcomes including weight, BMI, clinical
indicators (e.g., HBa1c) health care utilization,
engagement in interventions, satisfaction, costs
37
38. The Goal
• People with mental illness less likely to
become or remain institutionalized
• People with behavioral health conditions
will be able to manage their physical and
mental health.
38
40. Contact Information
Dena Stoner, Senior Policy Advisor
Texas Department of State Health Services
dena.stoner@dshs.state.tx.us
40
Editor's Notes
Process Model
Set clear guidelines of performance expectations
2. Use fidelity monitoring to understand the effectiveness of intervention and retention
3. Identify gaps in progress and efficiency
4. Work with all team members to identify ways to close the gap
5. Test the new ideas on a small scale
UT-Austin clip 3:57-7:19
Dena
“AA is not the only way” – customized to people that have been institutionalized (going to someone’s home), w/c basketball group, going out into the community and supporting people as they engaging the community
We’ll see a video of Ron who went through the program and is now providing peer support
1. Scale of 1 to 5
1.5 Linear and curvilinear trends are present
2. Blue bars represent the 95% confidence about how future scores would likely look if this program were expanded throughout Texas
3. Non-overlap of Time 0 blue bar with other shows initial improvement has been maintained even if it fluctuates across time
4. Greater width of error bars represents greater fluctuation across time in outcomes, especially post-intervention
5. However, good news remains regarding improvement in functional outcomes
Linear and curvilinear trends are present
1.5 Scale of 1 to 5
2. Blue bars represent the 95% confidence about how future scores would likely look if this program were expanded throughout Texas
3. Non-overlap of Time 0 blue bar with other shows initial improvement has been maintained even if it fluctuates across time
4. Greater width of error bars represents greater fluctuation across time in outcomes, especially post-intervention
5. However, good news remains regarding improvement in functional outcomes
1. Linear and curvilinear trends are present
2. Blue bars represent the 95% confidence about how future scores would likely look if this program were expanded throughout Texas
3. Non-overlap of Time 0 blue bar with other shows initial improvement has been maintained even if it fluctuates across time
4. Greater width of error bars represents greater fluctuation across time in outcomes, especially post-intervention
5. However, good news remains regarding improvement in functional outcomes
Tom
For people with health needs that land them in a nursing facility level of care, the cost of living in the community under MFP is 61% of the cost of living in a nursing facility. This calculation is based on the following analysis which compares the monthly Medicaid reimbursable cost for a Texas nursing home resident with the cost of Medicaid recipients who participated in the Money Follows the Person program. The Texas Medicaid rates (http://www.hhsc.state.tx.us/rad/long-term-svcs/downloads/2014-nf-rates.pdf) assume that each nursing facility provides institutional care to Medicaid eligible recipients including the total medical, social and psychological needs of each client, including room and board, social services, over-the-counter drugs, medical supplies and equipment, and personal needs items. There are 36 unique, diagnosis related daily reimbursement rates. Additional daily reimbursable costs were added for patient liability (1.48), general liability (.13) and additional level of care (level 27=10.53). The average per diem rate was $131 and the average monthly reimbursement rate was $3,937 assuming 30 days in each month.
For MFP costs, Table 1 in Irvin et al. (2012) shows the costs for MFP participants in multiple categories. Excluding those with Intellectual Disabilities (n=1,466) and Unknown disabilities (n=269), the average, weighted cost per month was $2,407. This cost includes all Medicaid reimbursable costs. This figure represents 61% of the comparable Nursing home per person per month cost.
References
Irvin, C. V., Bohl, A., Peebles, V., & Bary , J. (2012), Post-Institutional Services of MFP Participants: Use and Costs of Community Services and Supports. THE NATIONAL EVALUATION OF THE MONEY FOLLOWS THE PERSON (MFP) DEMONSTRATION GRANT PROGRAM: R E P O R T S F R O M T H E F I E L D (Vol. 9). Mathematica Policy Research.
UT Austin video 10:10 - end
Some people have been out up to 6 years
Return to the NF is one factor, but not the only one. We do not express the outcome as an either/or but as days or years of institutionalization averted or reduced. Even if some people return over time that may not in itself always be a negative outcome. It could be a choice for some people, but at least a real and not a forced choice.