The 10th Annual Utah Health Services Research Conference: Clinical and Economic Impact of a Pharmacist-Led Diabetes Collaborative Drug Therapy Management Program in a Medicaid ACO Setting. By: Eman Biltaji; C McAdam Marx; M. Yoo; B. Jennings; J. Leiser - University of Utah College of Pharmacy
Health Services Research Conference: March 16, 2015
Patient Centered Research Methods Core, University of Utah, CCTS
The 10th Annual Utah Health Services Research Conference: Clinical and Economic Impact of a Pharmacist-Led Diabetes Collaborative Drug Therapy Management Program in a Medicaid ACO Setting. By: Eman Biltaji; C McAdam Marx; M. Yoo; B. Jennings; J. Leiser - University of Utah College of Pharmacy
Health Services Research Conference: March 16, 2015
Patient Centered Research Methods Core, University of Utah, CCTS
Multispecialty Physician Networks: Improved Quality and Accountability - The ...EvidenceNetwork.ca
Multispecialty Physician Networks: Improved Quality and Accountability - The “Health Care Neighbourhood”
by Thérèse A. Stukel, Rick Glazier, Sue Schultz, Jun Guan Institute for Clinical Evaluative Sciences Toronto
Funded by: CIHR Emerging Team Grant in Applied Health Services and Policy Research
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This report is written for the Board of Directors of the Nazarene Community Health Clinic (NCHC). It outlines the importance and necessity of quality management as it pertains to the health care reform’s mandate that all Americans have access to quality, affordable health care.
Engaging Non-State Actors in Governing Health: Key to Improving Quality of Care?HFG Project
USAID’s Health Finance and Governance (HFG) and the Joint Learning Network hosted an hour-long webinar on engaging non-state actors in governing quality of care. The webinar presented in-country examples of private sector contributions in governing health quality — providing technical inputs on policy development, monitoring health service delivery, and promoting accountability in the health system.
This presentation explains the concept of the patient-centered medical home (PCMH), its function and its intended effects. A brief overview of the history of PCMH is also provided, as well as a discussion of its operational characteristics, its principles and outcomes, and what is expected in the future for the PCMH model.
Regulatory changes, plus advances in cloud computing and analytic technologies, are making it possible for U.S. healthcare providers, payers and patients to connect, commmunicate and collaborate seamlessly, and ensure that the right care is provided at the right place, at the right time.
The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Revie...CHC Connecticut
Dr. Nwando Olayiwola, Associate Director, Center for Excellence in Primary Care, Assistant Professor, University of California, San Francisco addresses the 2014 Weitzman Symposium on The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
CLICKNL Matchmaking event ''Opmaat naar Smart Energy Cities'' - 12 mei 2014CLICKNL
12 mei 2014 - Matchmaking Event georganiseerd door TKI Switch2SmartGrids (uit Topsector Energie) en CLICKNL (uit Topsector Creatieve Industrie).
De energiesector staat aan de vooravond van enorme veranderingen. Duurzamer, lokaler, innovatiever en met veel meer invloed vanuit de gebruikers. Het “Matchmaking Event, opmaat naar smart energy cities” wil de innovatiekracht van Nederland vergroten met creatieve oplossingen rondom slimme energie. We brengen daarom creatieve ondernemers, innovators en projecteigenaren en opdrachtgevers uit de energiewereld bij elkaar om nieuwe innovatieve energieprojecten naar ‘the next level’ te brengen.
Multispecialty Physician Networks: Improved Quality and Accountability - The ...EvidenceNetwork.ca
Multispecialty Physician Networks: Improved Quality and Accountability - The “Health Care Neighbourhood”
by Thérèse A. Stukel, Rick Glazier, Sue Schultz, Jun Guan Institute for Clinical Evaluative Sciences Toronto
Funded by: CIHR Emerging Team Grant in Applied Health Services and Policy Research
As part of the Strong Start for Mothers and Newborns effort, the CMS Innovation Center hosted a webinar to discuss why it is important to reduce early elective deliveries and share best practices on how reducing early elective deliveries improves the health of mothers and newborns across the country. Individuals representing the American College of Obstetricians and Gynecologists, the March of Dimes, providers and payers conveyed examples of successes and how reducing early elective deliveries can be accomplished. All interested parties were invited to attend this event.
- - -
CMS Innovations
http://innovations.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
This report is written for the Board of Directors of the Nazarene Community Health Clinic (NCHC). It outlines the importance and necessity of quality management as it pertains to the health care reform’s mandate that all Americans have access to quality, affordable health care.
Engaging Non-State Actors in Governing Health: Key to Improving Quality of Care?HFG Project
USAID’s Health Finance and Governance (HFG) and the Joint Learning Network hosted an hour-long webinar on engaging non-state actors in governing quality of care. The webinar presented in-country examples of private sector contributions in governing health quality — providing technical inputs on policy development, monitoring health service delivery, and promoting accountability in the health system.
This presentation explains the concept of the patient-centered medical home (PCMH), its function and its intended effects. A brief overview of the history of PCMH is also provided, as well as a discussion of its operational characteristics, its principles and outcomes, and what is expected in the future for the PCMH model.
Regulatory changes, plus advances in cloud computing and analytic technologies, are making it possible for U.S. healthcare providers, payers and patients to connect, commmunicate and collaborate seamlessly, and ensure that the right care is provided at the right place, at the right time.
The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Revie...CHC Connecticut
Dr. Nwando Olayiwola, Associate Director, Center for Excellence in Primary Care, Assistant Professor, University of California, San Francisco addresses the 2014 Weitzman Symposium on The Patient-Centered Medical Home Impact on Cost and Quality: An Annual Review of Evidence
Patient Centered Medical home talk at WVUPaul Grundy
To employers the cost of healthcare is now a business issue and this talk is about what one large buyer IBM did to drive transformation via broad coalition with other large employers to form the Patient Centered Medical Home movement and the covenant between buyer and provider away from the garbage we now buy episodic uncoordinated disintegrated care. In the change of convenient conversation we have worked with the Primary care providers to give us coordinated, integrated, accessible and compressive care with a set of principles know as the Patient centered medical home.
A Patient Centered Medical Home (PCMH) happens when primary care healers keeping that core healing relationship with their patients step up to become specialists in Family and Community Medicine. The move is to the discipline of leading a team that delivers population health management, patent centered prevention, care that is coordination, comprehensive accessible 24/7 and integrated across a deliver system. PCMH happens when the specialists in Family and Community Medicine wake up every morning and ask the question how will my team improve the health of my community today?
All over the world three huge factors are in play that is driving the concept of Patient Centered Medical Home. They are:
1) Cost and demography
2) Information technology and data (information that is actionable will equal a demand for accountability by the payer or buyer of the care)
3) Consumer demand to engage healthcare differently (at least as well as they can their bank- on line) have a question about lab results why not e-mail?
But at its core it is a move toward integration of a healing relationship in primary care and population management all at the point of care with the tools to do just that.
CLICKNL Matchmaking event ''Opmaat naar Smart Energy Cities'' - 12 mei 2014CLICKNL
12 mei 2014 - Matchmaking Event georganiseerd door TKI Switch2SmartGrids (uit Topsector Energie) en CLICKNL (uit Topsector Creatieve Industrie).
De energiesector staat aan de vooravond van enorme veranderingen. Duurzamer, lokaler, innovatiever en met veel meer invloed vanuit de gebruikers. Het “Matchmaking Event, opmaat naar smart energy cities” wil de innovatiekracht van Nederland vergroten met creatieve oplossingen rondom slimme energie. We brengen daarom creatieve ondernemers, innovators en projecteigenaren en opdrachtgevers uit de energiewereld bij elkaar om nieuwe innovatieve energieprojecten naar ‘the next level’ te brengen.
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
Standardized Bedside ReportingOne of the goals of h.docxwhitneyleman54422
Standardized Bedside Reporting
One of the goals of healthcare is to ensure that the patients get the best service possible while not compromising on the satisfaction and goodwill of the nurses and other healthcare professionals. A key aspect of ensuring quality healthcare is the consistent handling of patient information from nurse to nurse during shifts; information handled wrongly can jeopardize the patients’ health (Baker, 2010). It is important to implement procedures that ensure consistent and smooth handling of patient information from nurse to nurse to increase patient safety and improve nurse satisfaction. This paper will explore the merits of standardized bedside reporting as opposed to board reporting in ensuring a positive outcome and consistent quality healthcare.
Change model overview
A key aspect in determining whether bedside shift reporting has any merits over board reporting is the John Hopkins Nursing Evidence-Based Practice Process (JHNEBP). The John Hopkins Nursing Evidence-Based Practice Process is a framework for guiding the translation and synthesis of evidence into valid healthcare practice. JHNEBP has three cornerstones that include research, education, and practice; the framework ensures that research evidence is the basis of clinical decision-making. (Dearholt & Dang, 2012) The implementation of the John Hopkins Nursing Evidence-Based Practice Process has three key phases, the first phase is the identification of an important question, the second phase involves the systematic review of research evidence, and the third phase is translating the results into action. Nurses should use the JHNEBP process because it provides a clear way for healthcare professionals to translate research results into healthcare practice.
Practice Question
The team includes several key stakeholders who will benefit greatly from my research. Among the team members include myself as ER nurse, charge nurse, ERT ( Emergency room tech), nurse case manager, nurse supervisor, physician and hospital manager.
The evidence-based practice question that the team members will explore is "Does the use of a standardized bedside report versus board reporting help increase patient safety, nurse satisfaction, and positive outcome?" The evidence-based practice question assesses the ability of bedside shift reporting to improve healthcare provision. The practice area of the question is clinical. The practice issue came about because of assessing risk management concerns in ensuring good health practices. To answer the question, the team members gathered evidence from patient preferences, peer-reviewed journals, and clinical guidelines. The team members searched peer-reviewed journal databases to gather relevant information from previous research that could affect the results.
Understanding the merits of bedside shift reporting as opposed to board reporting is important as most healthcare organization use either strategy in collecting and passin.
Synopsis: Impact of Health Systems Strengthening on HealthHFG Project
Leaders in low- and middle-income countries (LMICs) require timely and compelling evidence about how to strengthen their health systems to improve the health and well-being of their citizens. Yet, evidence on how to strengthen health system performance to achieve sustainable health improvements at scale, particularly toward Ending Preventable Child and Maternal Deaths (EPCMD), fostering an AIDS-Free Generation (AFG), and Protecting Communities against Infectious Diseases (PCID) is limited. The evidence that does exist is scattered, insufficiently analyzed, and not widely disseminated. Without evidence, decision-makers lack a sound basis for investing scarce health funds in health systems strengthening (HSS) in an environment of competing investment options.
USAID is committed to advancing the evidence base on HSS and this commissioned report clearly demonstrates that HSS can improve health in LMICs.
This report, based on a review of systematic reviews of the effects on health of HSS, presents a significant body of evidence linking HSS interventions to measureable impact on health for vulnerable people in LMICs. Making decisions on who delivers health services and where and how these services are organized is important to achieve priority health goals such as EPCMD, AFG, and PCID. The findings of this report document the value of investing in HSS.
Edwina Rogers, executive director of Patient-Centered Primary Care Collaborative, began her presentation by highlighting the movement to advance medical homes.
With the U.S. being the number one in the world for the cost of healthcare and ranked number 37 in the quality category, something needs to change. Rogers discussed the broad stakeholder support and participation for the movement, as well as the incredible volunteer involvement. The four ‘centers’ include: the Center to Promote Public-Payer Implementation, the Center for Multi-Stakeholder Demonstration, the Center for eHealth Information Adoption and Exchange and the Center for Health Benefit Redesign and Implementation. Medical Homes will provide superb access to care, patient engagament in care, clinical information systems, care coordination, team care, patient feedback and publically available information.
Edwards explained that the Obama administration believes the medical homes concept is the best way to approach healthcare reform. The U.S. House of Representatives has showed great support for the movement and is helping develop and allocate funds for a five-year pilot program. She expressed her enthusiasm for the movement and her prediction that the medical home model is certainly the future of health care.
A complete version of Rogers’ presentation on the Patient-Centered Primary Care Collaborative is available online.
Low Functional health literacy is a problem affecting 90 million residents of the United States. Among the 90 million, 36% are adults who have “below basic” health literacy skills. Assessing health literacy is important in improving health behaviors, health outcomes, and perceived communication barriers related to health. The Patient Protection and Affordable Care Act enacted in 2010 brought about changes that demand a more coordinated approach to manage health care services. This research focused on the efforts being made to promote health literacy at Medicaid health homes such as Greater Buffalo United Accountable Healthcare Network (GBUAHN). This research consisted of observation of Patient Health Navigator interactions with patients in order to identify best practices of health literacy initiatives within GBUAHN. Results suggest best practices include promoting and establishing relationship to effectively enhance patients understanding of all their healthcare needs. This study suggests that GBUAHN should continue making use of recommendations related health literacy promotion while exploring areas of improvement as noted on scorecard. Patient Health Navigators are engaging patient in manner that will establish adherence within patients.
Presentation for UP MSHI HI201 Health Informatics class under Dr. Iris Tan and Dr. Mike Muin. Check out my blog - http://jdonsoriano.wordpress.com/2014/10/09/fitting-the-pi…making-it-work/
Similar to Improving Patient Health Outcomes with an EHR whitepaper (20)
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Improving Patient Health Outcomes with an EHR whitepaper
1. Improving Patient Health Outcomes
at Primary Care Systems in Clay, WV
Using an Electronic Health
Management System
Version 2.0: 2/11/2008
Prepared by: Sarah Chouinard, MD. and Jack L. Shaffer, Jr.
2. IMPROVING PATIENT CARE AT CLAY PRIMARY CARE CENTER USING AN EHR
Case Study for Primary Care Systems
Improving Patient Care Using an EHR
Background
A number of studies strongly suggest that health care services delivered in the United States
often do not meet patient needs. One of these studies indicates that only 50 percent of the
individuals studied received recommended preventive care and only 60 percent received
recommended chronic care. Equally troubling was the finding that, of those studied, twenty
percent received chronic care that was contraindicated. See: Mark A. Schuster, Elizabeth A.
McGlynn, Robert H. Brook (1998), “How Good Is the Quality of Health Care in the United States?”
The Milbank Quarterly 76 (4), 517–563.
These results were confirmed by a RAND Corporation study that found American adults received
only about half (54.9 percent) of recommended medical care in compliance with evidenced-based
guidelines. This study added to the mounting evidence of deficiencies in the U.S. health care
system, which was highlighted in a 2001 Institute of Medicine report, “Crossing the Quality
Chasm”, documenting the chasm between the care Americans receive and the care Americans
should expect.
There is emerging evidence that electronic health information systems (referred to generically
herein as “EHR” for “Electronic Health Record”) can have a profound impact on quality of service
and patient outcomes if implemented in concert with recommended health improvement
processes. The use of EHR systems permits participants to measure and report externally on a
number of quality indicators and more importantly, to use these results internally to continually
improve care delivery by more readily conforming to evidence-based clinical best practices.
Use of an EHR system facilitates measurement of outcomes and evaluation of interventions in
real-time rather than a retrospective environment, facilitating continuous improvement of the
workflow and processes of clinical activities. It also facilitates communication and coordination of
care among care team participants and allows tracking of patient health indicators over time
(facilitating health indicator trending through charts and graphs).
This case study reviews how the implementation of a population-based EHR along with the
chronic care model of care delivery and coordination (referred to herein as the “Care Model”
indicating a system of care for chronic conditions based upon a model developed by Ed Wagner,
MD, MPH, Director of the MacColl Institute for Healthcare Innovation and employed by
community health centers through the Health Disparities Collaborative efforts coordinated by
HRSA, see: http://www.improvingchroniccare.org/) is improving the health outcomes for patients
of Primary Care Systems in the rural community of Clay, West Virginia.
Primary Care Systems
Primary Care Systems, Inc., is a Federally Qualified community health center (FQHC) serving the
residents of Clay County, West Virginia, and surrounding areas. Primary Care Systems has two
primary clinical locations in Clay and Big Otter within Clay County, and three school-based health
centers at Clay Elementary, Clay Middle and Clay High Schools (with a fourth center planned for
the new Big Otter Elementary School in 2008). Primary Care Systems serves approximately
7,200 patients with approximately 30,000 patient encounters annually. Of the patients served,
over seventy percent are covered by Medicare or Medicaid or are uninsured. The staff of Primary
Care Systems currently includes 4 FTE physicians and 4 FTE mid-levels providing a range of
primary care services, including laboratory, radiology, behavioral health and maternity and well-
child services.
COMMUNITY HEALTH NETWORK OF WEST VIRGINIA PAGE 2
3. IMPROVING PATIENT CARE AT CLAY PRIMARY CARE CENTER USING AN EHR
(Note: FQHC is a federal designation from the Bureau of Primary Health Care (BPHC) within the
Health Resources and Services Administration (HRSA) of the US Department of Health and
Human Services and the Center for Medicare and Medicaid Services (CMS) that is assigned to
private non-profit or public health care organizations that serve predominantly uninsured or
medically underserved populations. FQHCs are located in or serve a Federally-designated
Medically Underserved Area/Population (MUA or MUP). FQHCs must operate under a consumer
Board of Directors governance structure, and provide comprehensive primary health, oral, and
mental health/substance abuse services to persons in all stages of the life cycle. FQHCs provide
their services to all persons regardless of ability to pay, and charge for services on a Board
approved sliding-fee scale that is based on patients’ family income and size. FQHCs must comply
with Section 330 (of the Public Health Service Act) program expectations/requirements and all
applicable federal and state regulations. FQHCs are also called Community/Migrant Health
Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics.)
In 2005, Primary Care Systems began to prepare for the implementation of an EHR system as a
member of the Community Health Network of West Virginia (the “Network’) and as a pilot site to
test concepts of personal health management and care coordination for the West Virginia
Medicaid program. This preparation involved implementation of the Care Model clinical
processes and realignment of clinicians within care teams. Care managers and coordinators
were trained on disease management processes and patient self-management techniques.
These processes were refined over a period of eighteen months and were used to guide the
configuration of the electronic health information system clinical reminders, health factor reports
and patient education material. In 2006, Primary Care Systems began implementation of an
electronic health management system, starting with care managers and clinical support team
members and then expanding to physicians. One of the aspects of the project that makes
Primary Care Systems truly unique is that it is the first community health center organization in
the country to successfully implement an adapted version of the Resource and Patient
Management System (“RPMS”) clinical information system developed and used by Indian Health
Service. This adapted version of RPMS has been branded as MedLynks™ by the Network.
The Medlynks system is a health centered configured version of the RPMS software platform (a
software platform that is largely in the public domain with a limited number of modules that are
proprietary) that has been used by the Indian Health Service to dramatically improve health
outcomes for tribal populations in a number of ambulatory care settings. MedLynks has
templates and tools adapted for use in community health centers and can serve as an alternative
to commercial applications to rapidly accelerate the adoption of population-based, patient-
centered electronic health information technology.
Clinical Outcome Measures
Primary Care System, like most FQHC grant recipients, is required to undergo periodic Office of
Performance Review (“OPR”, formerly called the Primary Care Effectiveness Reviews (“PCER”))
which may be combined with Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) reviews) to evaluate clinical outcomes and performance. The OPR process requires
that an FQHC select at least two quality measures from a list of fourteen possible measures and
perform a data analysis on those measures for the last three years. To prepare for its periodic
OPR evaluation, Primary Care Systems selected two measurements to analyze over the past
three years:
1. Diabetic patients whose HgBA1c lab results are “under control”. The accepted, standard
HgBA1c lab result of seven or less indicates that the patient has their condition under
control; anything above seven indicates that the diabetes condition is not being controlled
effectively.
2. The percentages of children and adolescents ages 2 thru 19 that have been identified as
clinically obese based upon their respective body mass index (BMI) score that have also
been referred to weight management counseling.
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4. IMPROVING PATIENT CARE AT CLAY PRIMARY CARE CENTER USING AN EHR
These two measures were selected because of some alarming statistics within West Virginia:
• West Virginia has historically ranked among the highest nationally for the prevalence of
diabetes. Over 10% of West Virginia adults identify themselves as having diabetes
(10.9% in 2004 and 10.4% in 2005).
• Among diabetic adults, 12% reported not having a recent HbA1c test, 30%-33% did not
have a dilated eye exam, and 30%-35% did not have a professional foot exam in the past
year. (BRFSS data 04-05). (Source: http://www.wvdhhr.org/bph/oehp/hsc/pubs
/BRFSS2004and2005/default.htm)
• According to the Robert Wood Johnson Foundation Report, childhood obesity rates have
more than tripled in WV from 1980 to 2004, from 5 to 17 percent.
The clinical teams of Primary Care Systems had a strong desire to help improve patient
outcomes for diabetics and to assure that children and adolescents with obesity received
appropriate weight management counseling.
Impact on Provider Productivity
In preparation for the OPR review, Primary Care Systems was required to produce the last three
years of metrics on both selected measures. In the production of these metrics, the clinical team
noted significant differences in the results during the period from 2005 to 2007. A careful analysis
of the data and clinical process changes suggested several factors influencing the favorable
trends in these outcomes.
The clinic characterized 2005 as a “normal” baseline year for them. During this period, Primary
Care Systems had a consistent number of providers; they were using paper charts, and were
operating primarily as they had in the past as the clinical team started to evaluate the impact
implementation of the Care Model would have on clinical practices.
In 2006, two disruptive events occurred within Primary Care Systems: 1) – The clinic lost two
physicians, and 2) – the clinicians began to implement MedLynks. With the loss of two
physicians, there was a productivity loss that occurred. With the implementation of MedLynks,
that productivity loss was amplified. As with any EHR implementation, there is an initial drop in
productivity due to the learning curve required to integrate the EHR into the patient treatment
process. Interestingly enough, studies tend to show that if a clinic or health center is not
operating properly, the health outcomes of chronically-ill patients do not improve and may even
decline. As Dr. Sarah Chouinard - the Medical Director of Primary Care Systems noted, “if you
have an unhealthy clinic, you will have unhealthy patients.”
In 2007, Primary Care Systems returned to a “normal” level of productivity. The clinic replaced
the two providers and completed full implementation of MedLynks.
Diabetic patients whose HgBA1c lab results indicate “control”
From a health outcome measurement standpoint, the HgBA1c is a very good measurement tool
since it is based upon an actual blood test. It is not a “soft measure” like counseling where the
meaning of the measure could be somewhat ambiguous. Although soft measures are valuable,
they are not as quantifiable in evaluating direct impact on patient health as these laboratory test
results.
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5. IMPROVING PATIENT CARE AT CLAY PRIMARY CARE CENTER USING AN EHR
After EHR Implementation
Diabetes HgBA1c
90.00%
79.30%
80.00%
68.50%
70.00%
Count:
59.30% 149
60.00%
Count:
98
50.00%
Count:
86 40.70%
40.00%
31.50%
30.00%
20.70%
20.00%
Count: Count:
45 59
Count:
10.00% 39
0.00%
2005 2006 2007
HGBA1C<7.0 Percentage Uncontrolled Percentage
In evaluating this specific measure, the 2005 number of 68.5% of the diabetic population of
Primary Care System patients whose condition is “controlled” (i.e., with a HgBA1c at or below 7)
was a good outcome - slightly above the West Virginia average. The national average is
somewhat higher at around 70%. For 2006, the lower numbers can be attributed to the
disruptions mentioned above that were occurring at the clinic. In 2007, Primary Care System
achieved an increase to nearly 80% in the number of patients whose diabetic condition was
controlled. The number of diabetic patients being evaluated also increased by 33% from 2005 to
2007. The patient population base increase was directly attributable to the use of the EHR in
more uniformly capturing these diabetic patients for care management.
The improvement in outcomes from 2006 to 2007 is directly related to the use of information from
the EHR and the implementation of the care model. In evaluating these outcomes, Dr. Chouinard
commented, “These increases are not because we suddenly got smarter or practiced medicine in
a different way – it’s not like we all of sudden learned how to use insulin. The increase was due
to the clinical staff being able to quickly run reports and following up with patients.”
By using MedLynks, the clinic was able to easily identify patients that were missing a recent
HgBA1c test. Without an EHR, tracking this information is difficult. This type of tracking in a
paper-based chart system requires using reports from a practice management or registry system
based upon ICD or CPT codes (that tend to reflect visit purpose more than overall prevalence of
chronic conditions and then having a staff member laboriously perform chart audits for the
specific lab. With the EHR, the clinic captures all meaningful patient clinical information, not just
a subset, and the capturing of the pertinent data is integrated within the patient treatment regime.
The EHR also allowed care managers to work with patients to establish self management goals
for diet and exercise, two important elements of therapeutic lifestyle change this have proven vital
in achieving and sustaining good control of blood sugar levels for diabetic patients.
Obese children and adolescents ages 2 – 19 referred to counseling
Another persuasive outcome improvement attributable to use of the EHR by Primary Care
Systems was the increase in the number of children and adolescents ages 2 thru 19 that have
been identified as clinically obese based upon their respective body mass index (BMI) score that
have also been referred to weight management counseling.
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6. IMPROVING PATIENT CARE AT CLAY PRIMARY CARE CENTER USING AN EHR
Obesity DX for Ages 2 – 19 (with and without counseling)
2005, 2006, and 2007
8
10 2 23
44.4%
55.6% 8.0% 92.0%
2005 2006
YES COUNT NO COUNT YES COUNT NO COUNT
After EHR Implementation
156 0
100% 0%
2007
YES COUNT NO COUNT
In 2005, Primary Care Systems only captured the BMI statistic on 18 patients that were children
or adolescents that met the targeted class (i.e., obese). Of those 18 patients, only 8 were
referred to weight management counseling. In 2006, the overall capture rate of BMI metrics
increased slightly, however, the referrals decreased to 8%. This percentage indicates that only 2
of the 25 obese adolescents or children identified in 2006 were referred to counseling. Upon
analyzing the reason for this decline between 2005 and 2006, it was discovered that much of the
decline could be attributed to the loss of one specific provider who practiced at one of the school
based centers with a particular interest in childhood and adolescent obesity.
In 2007, the numbers increased dramatically. The entire population in this category increased
nearly 10 fold, from 18 in 2005 to 156 in 2007. The percentage being referred went to 100%.
These increases – particularly the increase in the number of patients in the targeted class – can
be directly linked to use of the EHR within Primary Care Systems.
Before implementation of the EHR, a nurse or care manager had to perform a specific calculation
to determine and record a patient’s BMI. With the adoption of the EHR, the BMI on each patient
is calculated and stored automatically with every visit – it is not an extra step for someone to
perform. Once the data was captured within the EHR, it was a simple procedure to produce
reports showing the patients that fell into the specific categories and to use these reports for
follow up and referral to counseling. The EHR also allowed for the creation of clinical reminders
to aid the nurse or clinical coordinator to recommend counseling to these patients at the time of
care, during the patient visit rather than retrospectively based upon chart audits (as was the case
pre-EHR implementation).
The improvement reflected in this measure demonstrates how an EHR can aid in the quality
improvement process by helping to establish a standard of consistent care throughout an
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7. IMPROVING PATIENT CARE AT CLAY PRIMARY CARE CENTER USING AN EHR
organization. Without an EHR, these evidenced-based best practices are often only consistently
employed by specific providers with a particular passion for the issue or targeted condition.
EHR as a tool in a process
One inference that can be drawn from these outcome results is that improvements were not
occurring because the patients just weren’t coming to the clinic. The clinic would perform an
HgBA1c test on the patient and then perhaps would not see the patient again for a year (or
more). This was largely due to the reactive nature of most health care engagements and the
acute care nature of most health care delivery. Most encounters in the old delivery system of
Primary Care Systems, like much of primary care in general, was based upon a patient-initiated
interaction with a specific emergent condition necessitating care, relegating many unmet needs to
a “get to it when we can” approach based upon 15 to 20 minute clinical increments with
physicians or mid-level providers.
One of the enormous benefits of a population-based EHR is identifying those patients who are
not up-to-date on recommended or required care. The EHR allows the clinical care teams to be
proactive in engaging patients in preventive and chronic disease self management. As noted
above, this requires a two-fold approach utilizing care management teams empowered and
informed with health information from the EHR.
In the HgBA1c improvement process, Primary Care Systems generated periodic reports of
patients who had an HgBA1c or other diabetic-type lab result at anytime in the clinic. Once a
patient was on this list, the care teams began to contact those patients by generating letters and
making phone calls over several months. During the first month a person was listed on the
report, they were mailed a letter requesting that the patient come to the clinic for examination.
The second month that patient was listed on the report, the patient was sent a follow-up letter
asking that they schedule a visit. If a patient remained on the list after sixty days, they received a
phone call from the clinical coordinator. After ninety days, the attending doctor called the patient
requesting a follow-up visit. The process would have been too cumbersome prior to
implementation of MedLynks, because these lists had to be generated manually.
Primary Care Systems also implemented processes and work flow changes to bring negative
health factors to the patient’s attention during a visit. Prior to EHR implementation, in most visits,
the physician would only deal with the primary purpose of the visit (i.e., the immediate health
concern that triggered the visit). With the EHR and the clinical reminders integrated into
MedLynks, the triage nurses and care managers of Primary Care Systems could bring negative
health factors such as an adverse BMI (indicating obesity or an overweight condition) to the
attention of the patient. The experience at Primary Care Systems confirms studies that have
found that repeatedly addressing these chronic conditions during clinical encounters can
empower and motivate a patient to take charge of his or her health and make necessary lifestyle
changes.
Another example of the power of these clinical reminders in improving health outcomes is in the
area of tobacco cessation. Prior to implementation of the EHR, the rate of documented
counseling for tobacco cessation at Primary Care System was under 20%. During the first year,
by using the clinical reminder system, the care teams achieved a rate of documented counseling
for tobacco cessation of one hundred percent. The impact that these changes have on the
individual lives of the patients is best exemplified by a patient that had been a lifetime smoker, but
recently was successful in her quest to kick the habit through counseling and patient self-
management guided by the reminder system and the work of a dedicated care manager. What
were occasional successes, like that of the patient described above, now are more commonplace
through the use of MedLynks. It is said that information is power and applied clinical information
at the point of care is a powerful force for health improvement.
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8. IMPROVING PATIENT CARE AT CLAY PRIMARY CARE CENTER USING AN EHR
Next steps: Future Improvements
Now that Primary Care Systems is making significant progress in the delivery of quality health
care, the clinical teams plan to expand their efforts to more patients with chronic conditions.
The team intends to focus on gaps in care such as identifying asthma patients with persistent
asthma that are not using appropriate medications, such as an inhaled steroid. Having
adolescent asthmatic patients who need controlling medications on a steroid has been clinically
proven to save lives and the physicians at Primary Care Systems believe that they can
dramatically improve upon their outcomes in this category in much the same way they have in the
aforementioned measures.
They also plan on developing reports and metrics for all other standard nationally-recognized
clinical outcome measures. Dr. Chouinard has summarized the commitment of the clinical staff at
Primary Care Systems this way: “The more we can measure and evaluate, the more we can
improve the care for our patients. As we master the use of this system, we are excited about the
level of improvement we can achieve for our patients with these tools as we move forward.”
Summary
It is important to recognize that an EHR is only one component in the health improvement
process. This case study shows that an EHR is a tool that can produce dramatic health
improvements if properly applied. In this case study, the particular tool had clinical reminders and
a number of other care management applications integrated to enable the care teams at Primary
Care Systems to deliver better health care; however, much of the health improvement was
achieved by the care teams effectively using the tools and the information that an EHR provides.
A number of studies have shown that an EHR implementation will not alone produce substantially
better outcomes.
As shown by this case study, Primary Care Systems is making significant strides in improving the
quality of the care it is delivering to its patients through the effective use of an EHR and the
adoption of the clinical care model. Although the implementation of either singularly could have
some impact on improved health outcomes, the most significant gains are made when the care
process realignment and the information and management tools are integrated and implemented
together.
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