This document discusses structures and processes for quality improvement and waste reduction in Alberta Health Services. It outlines several key points:
1) Strategic Clinical Networks and Operational Clinical Networks are being implemented to drive clinically-led change, use best evidence to standardize practices, and improve outcomes across Alberta.
2) Clinical variance measurement is important to understand differences in care and outcomes across regions. Managing unjustified variance can improve patient care and reduce costs.
3) Health technology reassessment evaluates existing technologies to determine optimal use compared to alternatives, which could lead to reduced scope, decommissioning, or disinvestment. Several reassessment projects are proposed.
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In 2013, part of the Public Health system in England transferred out of the NHS into local government. Responsibility for the prevention and management of obesity in adults and children transferred with these teams, while parts of the NHS primary and secondary care system remained responsible for aspects of treatment, including bariatric surgery.
This workshop explores the challenges in commissioning a healthcare organization to provide an integrated service for obesity, weight management, and treatment in Nottinghamshire County, UK. These challenges include:
- Estimating the health needs of overweight and obese people across the County
- Taking into account the fact that needs will change over time
- The lack of available evidence
Learn how out how Scenario Generator, a population health modeling and simulation tool, was used to test assumptions and develop the evidence to procure an integrated service
Since the H1N1 influenza pandemic of 2009 there has been a dramatic increase in the number of patients receiving ECMO and in the number of hospitals that provide it. Data from the Extracorporeal Life Support Organisation (ELSO) suggests that over the last decade the number of adult patients receiving ECMO for respiratory support has increased at least 12-fold and the number of centres submitting data to the ELSO registry has tripled.
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Implementing American Heart Association Practice Standards for Inpatient ECG ...Allina Health
Implementing American Heart Association Practice Standards for Inpatient ECG Monitoring: An Interventional Study at Abbott Northwestern Hospital presented by Kristin Sandau, PhD, RN
SIMUL8 Director of Healthcare, Claire Cordeaux, discusses her experiences of developing and implementing population health strategies in the UK National Health Service, Canada, and Australia.
Evaluation of the Mother and Infant Health ProjectOlena Nizalova
This presentation is on the paper which exploits a unique opportunity to evaluate the impact of the quality change in the labor and delivery services brought about by the Mother and Infant Health Project in Ukraine. Employing program evaluation methods, we find that the administrative units participating in the Project have exhibited greater improvements in both maternal and infant health compared to the control ones. Among the infant health characteristics, the MIHP impact is most pronounced for infant mortality resulting from deviations in perinatal period. As for the maternal health, the MIHP is the most effective at combating anemia, blood circulation and urinary-genital system complications, and late toxicosis. The analysis suggests that the effects are due to early attendance of antenatal clinics, lower share of C-sections, and greater share of normal deliveries. Preliminary cost-effectiveness analysis shows enormous benefit per dollar spent on the project: the cost to benefit ratio is one to 97 taking into account both maternal and infant lives saved as well as cost savings due to the changes in labor and delivery practices.
Prioritisation in Public Health: Overview of Health Economics ApproachesOlena Nizalova
Overview of Health Economics Approaches Towards Prioritization based on the developments from the NIHR School of Public Health Research project led by Professor David Hunter.
Modeling an Integrated System for Obesity & Weight ManagementSIMUL8 Corporation
Worldwide obesity has more than doubled since 1980 (WHO; 2015). This is contributing to the growing number of patients living with chronic diseases and placing mounting pressure on health systems.
In 2013, part of the Public Health system in England transferred out of the NHS into local government. Responsibility for the prevention and management of obesity in adults and children transferred with these teams, while parts of the NHS primary and secondary care system remained responsible for aspects of treatment, including bariatric surgery.
This workshop explores the challenges in commissioning a healthcare organization to provide an integrated service for obesity, weight management, and treatment in Nottinghamshire County, UK. These challenges include:
- Estimating the health needs of overweight and obese people across the County
- Taking into account the fact that needs will change over time
- The lack of available evidence
Learn how out how Scenario Generator, a population health modeling and simulation tool, was used to test assumptions and develop the evidence to procure an integrated service
Since the H1N1 influenza pandemic of 2009 there has been a dramatic increase in the number of patients receiving ECMO and in the number of hospitals that provide it. Data from the Extracorporeal Life Support Organisation (ELSO) suggests that over the last decade the number of adult patients receiving ECMO for respiratory support has increased at least 12-fold and the number of centres submitting data to the ELSO registry has tripled.
The approach to the provision of ECMO in NZ and Australia has been very different, with Australia seeing a huge increase in the number of ECMO centres since 2009 (there are now at least 17 centres in Australia) whilst NZ has continued to have a single national service based in Auckland.
Multiple studies suggest a significant outcome benefit for patients treated at high-volume ECMO centres (defined as those with >30cases per year) compared with “occasional” users and guidelines from the UK, NZ and elsewhere recommend that its use be restricted to expert centres that integrate ECMO within a specialist service providing care for patients with severe acute lung disease that have the capacity to transport these patients safely on ECMO if required.
This session will discuss the evidence for the perceived “volume effect” and the challenges of providing a comprehensive retrieval service.
The impact of high-capability electronic health records on length of stay. Presented by Steven Shaha, Center for Policy & Public Administration, UK, at HINZ 2014, 12 November 2014, 11.15am, Marlborough Room 3
Barriers to access of quality renal replacement therapy in endstage renal dis...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care.
Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice.The journal publishes original papers, reviews, special and general articles, case management etc.
Associate Professor Ian Scott - Princess Alexandra Hospital; University of Qu...Informa Australia
Associate Professor Ian Scott
Director
Internal Medicine & Clinical Epidemiology; Associate Professor of Medicine
Princess Alexandra Hospital; University of Queensland
The result of the study revealed that there is significant difference understanding of the community, exposure and travel history which affect the quality perception and acceptance to tolerate quality health care service provision. Only 57.2% of the respondents were satisfied with quality of health care service provision. Waiting time is 0.072 negatively correlated with quality of health care service when P =<0.05. Besides this the study has drawn conclusions quality of health care is multifaceted and interlinked with different stakeholders, internal and external factors. The study shown ensuring quality of health care service is narrowing of the gap quality between the internal and external factors as well as strengthening health system and facility to increase community participation and ownership health care service provision through ensuring provider accountability and capacity building. Even though there is significant difference in health system complexity and technology quality is still remain same similarities
Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"
Ronald Paulus, MD, MBA
President & CEO
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Building a translational team for impacting public policyPre-Congress Worksh...OARSI
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
The impact of high-capability electronic health records on length of stay. Presented by Steven Shaha, Center for Policy & Public Administration, UK, at HINZ 2014, 12 November 2014, 11.15am, Marlborough Room 3
Barriers to access of quality renal replacement therapy in endstage renal dis...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care.
Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice.The journal publishes original papers, reviews, special and general articles, case management etc.
Associate Professor Ian Scott - Princess Alexandra Hospital; University of Qu...Informa Australia
Associate Professor Ian Scott
Director
Internal Medicine & Clinical Epidemiology; Associate Professor of Medicine
Princess Alexandra Hospital; University of Queensland
The result of the study revealed that there is significant difference understanding of the community, exposure and travel history which affect the quality perception and acceptance to tolerate quality health care service provision. Only 57.2% of the respondents were satisfied with quality of health care service provision. Waiting time is 0.072 negatively correlated with quality of health care service when P =<0.05. Besides this the study has drawn conclusions quality of health care is multifaceted and interlinked with different stakeholders, internal and external factors. The study shown ensuring quality of health care service is narrowing of the gap quality between the internal and external factors as well as strengthening health system and facility to increase community participation and ownership health care service provision through ensuring provider accountability and capacity building. Even though there is significant difference in health system complexity and technology quality is still remain same similarities
Opening Keynote"From Patient to Population: Providing Optimal Care - The Role for Technology"
Ronald Paulus, MD, MBA
President & CEO
Mission Health System
Building a translational team for impacting public policyPre-Congress Worksh...OARSI
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
Health IT Summit Denver 2014 - "Anatomy of a Health System"
This unique discussion series explores behind-the-scenes looks at the most progressive and high performing health systems in the country. Panelists will discuss critical areas such as go-live strategy, vendor management, patient engagement, IT governance and more. Attendees will walk away with a better understanding of how departments can effectively work together, tangible strategies for delivering high quality care while maintaining an efficient and secure health information system.
Moderator: Cynthia Burghard, Research Director, IDC Health Insights
Marc Lassaux, CTO, Technical Director Beacon Project, Quality Health Network
Justin Aubert, Chief Financial Officer, Quality Health Network
Kevin Fitzgerald, MD, CMO, Rocky Mountain Health
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Bea Brown | a locally tailored intervention to improve adherence to a clinica...Sax Institute
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Slides from the Strategic Clinical Network, Cardiovascular Disease Network meeting on 16 January 2015.
The event was run by the Living Longer Lives programme and covers the work we’re doing to implement the Department of Health’s CVD Outcomes strategy, including improving the physical health of people with serious mental illness, supporting the NHS Health Check programme and the GRASP suite of audit tools.
EuroBioForum 2013 - Day 2 | Mark PoznanskyEuroBioForum
EuroBioForum 2013 2nd Annual Conference
27-28 May 2013 - Hilton Munich City, Munich, Germany
http://www.eurobioforum.eu/2013
=======================================
# REGIONAL PERSPECTIVES #
Ontario Genomics Institute, Canada:
Innovative Research, Innovative Translation
Dr Mark Poznansky
President and CEO Ontario Genomics Institute
=======================================
http://www.eurobioforum.eu
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
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MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
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Temporomandibular Joint By RABIA INAM GANDAPORE.pptx
Présentation dr tom noseworthy
1. 11
Structures and Processes for
Creating & Managing Quality
Outcomes & Reducing Waste in
Alberta Health Services
GMF Symposium
April 19, 2013
Montreal, Quebec
Dr Tom Noseworthy
2. 22
Compared to other Provinces
Alberta is
• Not less expensive (highest per capita, higher
service intensity & higher unit costs)
• Not more accessible (maybe less)
• Not the country’s best quality for most
outcomes (with clear exceptions)
• Not the longest, or health-adjusted, length of life
5. 55
Alberta Health Services
• One health care delivery system for entire Province
• ‘Third way’- Canada (no regions, all regions, one)
• Largest health system in Canada- 3.7 million
• Budget $12B, 100,000 employees, 7500 doctors
• Formed 2008, 5 Zones in 2010, Networks in 2012
• Nine clinical networks launched to date
• Up to six more planned
6. 66
How will the Provincial Clinical Mandate of
AHS be Accomplished? Structures
• Strategic Clinical Networks
• Clinically-led change
• Performance measurement, research & best
evidence drive practice
• Clinical care pathways
• Clinical variance management & peer review
7. 77
Goals of Clinical Networks?
• Achieve the best outcomes
• Practice the highest quality of clinical care
• Seek the greatest value from resources used
• Engage clinicians in all aspects of this work
8. 88
Why Clinical Networks?
• Networks are positive ways for all partners
along a broad continuum to be involved in
planning & improving care & service delivery
• Networks have been shown to be an effective
mechanism to ensure collaboration, joint
decision-making and shared learning
• Networks are a sound model to promote the
use/uptake of clinical experience, knowledge
and evidence-based clinical pathways to
reduce clinical variation & improve care
10. 1010
What are Strategic Clinical Networks (SCNs)?
• Collaborative clinical teams with a provincial
strategic mandate to improve quality & outcomes
• Led by clinicians, driven by clinical needs,
focused on outcomes & based on best evidence
• Comprised of an all-inclusive membership, with
25 core members (community & specialty
clinicians, patients, policy-makers, researchers)
& leadership (0.5 Senior Medical Director, 0.5
Strategy Vice-President & 0.3 Scientific Director)
11. 1111
How do SCNs Work?
• Broad mandate:
– Specific populations: seniors, women's health, children
– High impact: cardiovascular disease & stroke
– High burden: diabetes, obesity & nutrition, amh
• Scope encompasses entire continuum of care
– From population health & prevention to primary care to
acute care to chronic disease management to palliation
• Projects & resources
– Driven by evidence and focused on improving outcomes
and eliminating waste
12. 1212
Planned Support & Resources for Each SCN
• Dedicated Business Intelligence Unit
– Project management, clinical analytics, case costing, quality
improvement, pathway development, patient safety,
knowledge management, health technology assessment
• Embedded research capability and expertise
• Education & skills development for leaders
• Funding including:
– Seed money for innovation, initiatives, and research
– Remuneration of core members
– Opportunities to retain savings that are realized
13. 1313
First Six SCNs (June 12/12)
• Addiction and Mental Health
• Bone and Joint Health
• Cancer Care
• Cardiovascular Health and Stroke
• Obesity, Diabetes and Nutrition
• Seniors’ Health
14. 1414
Three Operational Clinical Networks
Similar to SCNs
i. Provincial, clinically led teams
ii. Similar infrastructure & resources
Differ from SCNs
i. Responsible across populations
ii. Operationally focused
iii. Social determinants/ EOL agenda not
required in projects
16. 1616
Proposed SCNs (Fiscal 2013)
• Population Health and Health Promotion
• Primary Care & Chronic Disease Management
• Maternal Health
• Newborn, Child, and Youth Health
• Neurological Disease, ENT, and Vision
• Complex Medicine (GI, Kidney & Respiratory)
17. 1717
Proposed SCN & OCN Projects 2013
Obesity, Diabetes
& Nutrition
SCN
Bone & Joint
SCN
Surgery
OCN
Emergency
OCN
Addiction &
Mental Health
SCN
Cardiovascular
Health and Stroke
SCN
Insulin
Pump
criteria
Rural Stroke
Program
Vascular Risk
Reduction
C-CHANGE
Enhancing
recovery
after surgery
ART
E-referral
Fragility &
Stability -
Hip Fracture
Rx and
Prevention
Inappropriate
use of
antipsychotics
Cancer
SCN
Critical Care
OCN
Seniors’ Health
SCN
Depression
Pathway
Safe Surgery
Checklist
aCATS TBDTBD
Hip & Knee
5 year Plan
Lung
Cancer
Elder
Friendly
Care*
18. 1818
Project Scope:
• Create standards and clear definition of rural stroke
unit care
• Implement early supported discharge (ESD) &
enhanced stroke unit care in 5 small stroke centres
• Implement enhancements to stroke unit care for 10
rural primary stroke centres
System Impact:
• Acute care
• Transition management
• Long term care
Project Financials:
•Q4 (12/13): $ 141,964
•13/14: $1,745,950
• TOTAL Project: $2,873,594
Benefits to be Realized:
Short term – Jan 31/ 13 – Mar 31 /14
• ESD implemented in 5 small centres serving100
patients
• 26% reduction in length of stay; 3 persons avoid
nursing home care; 1 life saved
Long term– 1- 3 year window
• 214 new patients per year receive ESD and over 1000
new patients per year receiving full stroke unit services;
23 lives saved/year; 17 patients avoid nursing homes
after stroke/year
• Reduction in length of stay of over 20%
CV&S: Rural Stroke Action Plan
19. 1919
How Alberta Health Services Will Achieve its
Clinical Mandate (Processes)
• Strategic & Operational Clinical Networks
• Clinically-led change
• Performance measurement, research & best
evidence drive practice
• Clinical care pathways & models of care
• Clinical variance measurement & management
20. 2020
Variance Management
• Variance is everywhere you look for it
• Variation makes the world go around – but…
• How much variation is ‘good’
• Lessons from financial variances & management
• Variance points to a need to ask why & manage it
24. 2424
Clinical Variance Measurement
• Variance points to a need to ask why & manage it
• Variance measurement & management does this
• Small-areas clinical variation apparent for 30 years
• Multiple explanations for small-areas clinical variation
• Clinical variance management requires measurement
• Measurement necessitates sound health informatics
& clinical analytics
25. 2525
Clinical Variance Management
• Management requires measurement
• Compare to evidence, others & target best practice
• Some clinical variance is justified, some is not
• Unjustifiable variance is costly
• Unjustifiable variance adversely affects patients
• Managing clinical variance is sensitive & complex
• At some point, examines individual practices
26. 2626
Managing Individual Clinical Variance (1)
• The essence of professional self-regulation
• Comparative assessment of individual physician
performance may be required
• How is this best done & by whom
• What is the legal/moral mandate to protect identity
• Globe & Mail vs professional ‘privilege’
27. 2727
Managing Individual Clinical Variance (2)
• Understand the determinants of decision-making
• Lessons from behaviour modification
• Modification menu ( education, feedback,
participation, incentives, penalties & rules)
• Individual modalities do not work
• Habitual behaviours are hard to change
28. 2828
DEFINITION
Health Technology Reassessment (HTR) is a
structured, evidence-based assessment of the
clinical, social, ethical & economic effects of a
technology, currently used in the health care
system, to inform optimal use of that
technology in comparison to its alternatives.
Clement & Noseworthy IJTAHC 2011
30. 3030
Scope of Reassessment
• HTA focuses on introduction of new technologies
• HTR focuses on existing technologies:
– Obsolescence- when new supersedes old
– Waste (overuse, misuse)- scope of use
• Reassessment common in other fields
• Reassessment of health technologies is not
widely considered, practiced or standardized
• Reassessment may lead to no change; reduced
scope of use; decommissioning & disinvestment
31. 3131
Health Technology Reassessment is HTA +
• Clinical Synthesis
• Comparative effectiveness
• Economic evaluation of costs & benefits
+
• Impact analysis
• Intended consequences
• Unintended
• Social context
• Feasibility assessment
32. 3232
Proposed Reassessment Projects
• Knee MRI following injury
• Optimal cardiac imaging for cardiac conditions
• Antipsychotic use in elderly patients in LTC
• Nitrous Oxide use in Critical Care