Why screeing cancer patients for distress will increase disparities in psycho...James Coyne
Keynote address
Implementing screening of cancer patients for distress will not improve patient outcomes and may aggravate existing biases in who get psychosocial services.
Scoring Suffering to Address Patient Needs in Palliative Care: The "Maslow Sc...Mike Aref
Introduction
Palliative care patients have been scored by their symptom burden and performance but there is little standardization of their multidimensional suffering, needs, and wants. Maslow’s Hierarchy of Needs is a model for describing these needs as physiological, safety, love/ belonging, esteem, and self-actualization. The functional pain score is a validated method of scoring pain based on patient report and provider assessment. Using these two frameworks, the “Maslow Score” seeks to use Maslow’s Hierarchy to score the current patient situation based on symptom burden, plan, network, and meaning.
Methods
The scores are four-digit codes describing the patient situation at a given time base on team consensus. Each digit is a score from most secure, 0, to most vulnerable, 5. Both written examples and an algorithmic approach have been provided to obtain each score.
Results
Morning huddle has been expedited by utilizing scores recorded the previous day. Also if sudden changes have been reported they can be compared rapidly against a team standard. This triaging helps direct team resources as to whether patients should be reassessed by the entire team or specific members. The discussion has improved assessment of patients from an interdisciplinary perspective. In general, patients cannot improve their network and meaning scores until symptom and planning scores have been optimized.
Discussion
The “Maslow Score” appears to have improved the quality of care that our service delivers by improving efficiency. Further development and study is needed to standardize and validate our method.
Why screeing cancer patients for distress will increase disparities in psycho...James Coyne
Keynote address
Implementing screening of cancer patients for distress will not improve patient outcomes and may aggravate existing biases in who get psychosocial services.
Scoring Suffering to Address Patient Needs in Palliative Care: The "Maslow Sc...Mike Aref
Introduction
Palliative care patients have been scored by their symptom burden and performance but there is little standardization of their multidimensional suffering, needs, and wants. Maslow’s Hierarchy of Needs is a model for describing these needs as physiological, safety, love/ belonging, esteem, and self-actualization. The functional pain score is a validated method of scoring pain based on patient report and provider assessment. Using these two frameworks, the “Maslow Score” seeks to use Maslow’s Hierarchy to score the current patient situation based on symptom burden, plan, network, and meaning.
Methods
The scores are four-digit codes describing the patient situation at a given time base on team consensus. Each digit is a score from most secure, 0, to most vulnerable, 5. Both written examples and an algorithmic approach have been provided to obtain each score.
Results
Morning huddle has been expedited by utilizing scores recorded the previous day. Also if sudden changes have been reported they can be compared rapidly against a team standard. This triaging helps direct team resources as to whether patients should be reassessed by the entire team or specific members. The discussion has improved assessment of patients from an interdisciplinary perspective. In general, patients cannot improve their network and meaning scores until symptom and planning scores have been optimized.
Discussion
The “Maslow Score” appears to have improved the quality of care that our service delivers by improving efficiency. Further development and study is needed to standardize and validate our method.
A wonderful lecture at Maine Quality Counts, 2015. For Dr. Montori's approach to this subject see http://www.epatientdave.com/2016/01/02/a-declaration-of-the-future-of-caring-careful-kind-minimally-disruptive/
Depression is a state of feeling sad, miserable and down in the dumps with loss of self-confidence. Depression despite being a serious condition in all age groups is more common and significant in the
geriatric population as it is associated with morbidity and mortality. The cause of depression is multifactorial. Various scales have been developed to assess depression of which the Geriatric Depression
Scale is most suited for elderly population and those with dementia. In our study, we aim to analyse the prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care hospital and determine the factors influencing depression in them. The study was an Observational study carried out on 51 elderly patients over the age of 60 years attending the outpatient departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the prevalence of depression. A
self-designed questionnaire considering various factors causing depression was administered to determine
the factors influencing depression. It was found that among 51 elders in the age group of 60 to 80 years,
58.8% were depressed of which 54% were males and 68% were females. Financial fears regarding future
and income insufficiency were the most important factors contributing to depression. This shows that
monetary fear is a major factor resulting in depression. The government and other organizations must
ensure that better support both financial and other services like healthcare are provided to the elderly in
order to prevent depressive illnesses.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Improving the Health of Adults with Limited Literacy: What's the Evidence?Health Evidence™
Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health (NCCDH), hosted a 60 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on interventions to improve the health of adults with limited literacy, presenting key messages, and implications for practice on Wednesday October 31, 2012 at 1:00 pm EST. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Karen Fish, Knowledge Translation Specialist, and Connie Clement, Scientific Director, both from the NCCDH.
This webinar focused on interpreting the evidence in the following review:
Clement, S., Ibrahim, S., Crichton, N., Wolf, M., Rowlands, G. (2009). Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Education & Counseling, 75(3): 340-351.
The goal of this webinar is to help hospice and healthcare professionals understand the history, philosophy, and practice of hospice and palliative care, including common misconceptions, typical diagnoses for hospice referrals, identification of hospice-eligible patients, reimbursement for hospice services, and the
benefits of advance care planning and early referrals.
2016 16th population health colloquium: summary of proceedings Innovations2Solutions
This paper will discuss the four key ideas discussed at the Colloquium that will have important ramifications as healthcare organizations seek to implement population health strategies:
1. understanding and alleviating Patient fear is Key to Patient experience
2. the Case for a new Population Health Protection agenda as a means to drive down Healthcare Costs
3. using data and technology to improve Healthcare for older adults
4. engage Consumers in Wellness-based Population Health and thrive financially
A wonderful lecture at Maine Quality Counts, 2015. For Dr. Montori's approach to this subject see http://www.epatientdave.com/2016/01/02/a-declaration-of-the-future-of-caring-careful-kind-minimally-disruptive/
Depression is a state of feeling sad, miserable and down in the dumps with loss of self-confidence. Depression despite being a serious condition in all age groups is more common and significant in the
geriatric population as it is associated with morbidity and mortality. The cause of depression is multifactorial. Various scales have been developed to assess depression of which the Geriatric Depression
Scale is most suited for elderly population and those with dementia. In our study, we aim to analyse the prevalence of depression among elderly patients visiting the outpatient departments of a tertiary care hospital and determine the factors influencing depression in them. The study was an Observational study carried out on 51 elderly patients over the age of 60 years attending the outpatient departments of PSG Hospital. The Geriatric Depression Scale Short form was used to determine the prevalence of depression. A
self-designed questionnaire considering various factors causing depression was administered to determine
the factors influencing depression. It was found that among 51 elders in the age group of 60 to 80 years,
58.8% were depressed of which 54% were males and 68% were females. Financial fears regarding future
and income insufficiency were the most important factors contributing to depression. This shows that
monetary fear is a major factor resulting in depression. The government and other organizations must
ensure that better support both financial and other services like healthcare are provided to the elderly in
order to prevent depressive illnesses.
Where’s the evidence that screening for distress benefits cancer patients?James Coyne
“The case against screening for distress.” A presentation delivered as part of an invited debate with Alex Mitchell at the International Psycho Oncology Conference, Rotterdam, November 7, 2013
Improving the Health of Adults with Limited Literacy: What's the Evidence?Health Evidence™
Health Evidence, in partnership with the National Collaborating Centre for Determinants of Health (NCCDH), hosted a 60 minute webinar, funded by the Canadian Institutes of Health Research (KTB-112487), on interventions to improve the health of adults with limited literacy, presenting key messages, and implications for practice on Wednesday October 31, 2012 at 1:00 pm EST. Maureen Dobbins, Scientific Director of Health Evidence, lead the webinar, which included interactive discussion with Karen Fish, Knowledge Translation Specialist, and Connie Clement, Scientific Director, both from the NCCDH.
This webinar focused on interpreting the evidence in the following review:
Clement, S., Ibrahim, S., Crichton, N., Wolf, M., Rowlands, G. (2009). Complex interventions to improve the health of people with limited literacy: A systematic review. Patient Education & Counseling, 75(3): 340-351.
The goal of this webinar is to help hospice and healthcare professionals understand the history, philosophy, and practice of hospice and palliative care, including common misconceptions, typical diagnoses for hospice referrals, identification of hospice-eligible patients, reimbursement for hospice services, and the
benefits of advance care planning and early referrals.
2016 16th population health colloquium: summary of proceedings Innovations2Solutions
This paper will discuss the four key ideas discussed at the Colloquium that will have important ramifications as healthcare organizations seek to implement population health strategies:
1. understanding and alleviating Patient fear is Key to Patient experience
2. the Case for a new Population Health Protection agenda as a means to drive down Healthcare Costs
3. using data and technology to improve Healthcare for older adults
4. engage Consumers in Wellness-based Population Health and thrive financially
Relazione al Convegno MediMORE. Prospettive di sostenibilità nello sviluppo della medicina di precisione e conciliazione con gli obiettivi di salute pubblica
Essay on Definitions of Health
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Going Beyond Genomics in Precision Medicine: What's NextHealth Catalyst
Precision medicine processes, while involving genomics, are not confined to working with data about an individual’s genes, environment, and lifestyle. Precision medicine also means putting patients on the right path of care, taking into consideration other individual tolerances, such as participation and cost. Precision medicine processes incorporate data beyond the individual, pulling in socio-economic data, as well as relevant internal and external data, to create an entire patient data ecosystem. With reusable data modules, this information is processed within a closed-loop analytics framework to facilitate clinical decision making at the point of care. This optimizes clinical workflow, thus leading to more precise medicine.
Provider Based Patient Engagement - An Essential Strategy for Population HealthPhytel
As the healthcare industry starts to re-engineer care delivery to accommodate new reimbursement models, providers on the front lines of change recognize the need for population health management and for increasing patients’ engagement in their own care. These two approaches are inextricably bound together, because it is impossible to manage the health of a population without getting patients more involved in self-management and the modification of their own risk factors. This paper discusses the fundamentals of patient engagement and shows how automation tools and web-based care management can facilitate this key process.
Integrating Behavioral Health into Primary Care – Thought Leaders in Populati...Epstein Becker Green
Although mental health and substance abuse (behavioral health) services have historically been segregated from traditional medical care, its impact on patients’ well-being, physical health and cost-of-care has become increasingly critical to improving clinical quality outcomes while significantly decreasing financial costs by tens of billions of dollars. Drs. Daviss and Coleman will discuss the advances in policy and practice regarding the integration of behavioral health with physical health, as well as some of the gaps in identifying, aggregating, and analyzing data critical to a more holistic and comprehensive view of the individual.
In addition, the speakers will:
* Identify the clinical, legal, social, and financial impacts of behavioral health disorders on chronic medical conditions.
* Describe the challenges involved in improving clinical and financial outcomes in patients with chronic medical conditions who also have behavioral health symptoms and/or conditions.
* Demonstrate the rewards for implementing new information technology applications and analysis for better clinical and financial outcomes for these specific populations.
Moderator
* Mark E. Lutes, Member of the Firm and Chair of Epstein Becker Green's Board of Directors
Speakers
* Charles A. Coleman, PhD, Senior Sponsor of IBM's Population Health Insights and Programs Management of IBM's Healthcare Solutions Board
* Steven R. Daviss, MD, DFAPA, Chief Medical Officer at M3 Information, LLC, a DC-based mobile mental health information technology company that developed the peer-reviewed multi-dimensional, patient-centered mental health screening tool, M3Clinician
Epstein Becker Green Webinar - Moderated by Mark E. Lutes - http://www.ebglaw.com/events/the-challenges-and-rewards-of-integrating-behavioral-health-into-primary-care-%E2%80%93-thought-leaders-in-population-health-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
Peer response’s # 2Rules Please try not to make the responses s.docxdanhaley45372
Peer response’s # 2
Rules: Please try not to make the responses super lengthy, contribute one fact AND include references
HMGT 420
· Wk#3
Talar posted Jun 4, 2016 11:57 PM
Patients who have complex health needs require not only medical. But also social services and support from a variety of caregivers and providers. Facility managers who are part of care coordination could assist patient in receiving optimal care by addressing the challenges in coordinating care for these patients, and offer programmatic changes and policies that help deliver the best services to all patients.
Facility managers can come up with strategic plans based on prior data and make necessary changes based on preexisting conditions. “Patient- centered, comprehensive, coordinated, and accessible care that continuously improved through a systems-based approach to quality and safety” (AHRQ, 2012) are what’s needed to achieve the highest quality care possible in any health care facility.
Patient centered care can’t be achieved with providers only. It requires team work and collaboration among all stakeholders. To improve the quality and safety of patients, health care facility managers can work hand and hand with the coordinated team to provide a system based approach by drawing on decision-support tools, taking into account patient experience, and using population health management approach. Patient preference and needs on what aspects of care to be improved.
Respond to Talar here:
· Vanscoy, Week 3
Sarah posted Jun 5, 2016 11:07 AM
As a facility manager, and part of the care coordination team, I would look into models of care that would assist our situation. With the Affordable Care Act in place, there are accountable care organizations (ACOs), which provide models of care (“Promise,” 2013). There are many different definitions and perspectives on care coordination, but all lead to the goal of meeting patient needs and providing adequate healthcare (“Care,” 2014).
Care coordination is essential because each patient can interact with a variety of professionals each visit. For example, for a routine physical appointment, the patient could meet with the scheduling staff, medical assistants, nurses, doctors, pharmacists, and the billing staff. If each one of these member fails to coordinate as a whole, the patient could be harmed or neglected. As a care coordinator, I would be responsible for discussing an individualized care plan with each patient and ensuring that they understand their responsibilities. All barriers should be identified, such as financial, social (language), psychological, and anything that would effect the patient from following their correct plan of care and interacting with the staff (“Promise,” 2013). Another key point is to ensure the medical staff has reviewed the patient’s medical records and ensure that everyone is on the same page. These are just a few examples, because each case is different and each patient will have different needs. .
Review the World Health Organization’s (WHO) definition of healt.docxashane2
Review the World Health Organization’s (WHO) definition of health in Chapter 7 of your textbook. Then, write a research paper fulfilling the following requirements.
Why is the definition of health important to health policy?
Define the term “target population” as it relates to health policy.
How do societal influences impact the identification and definition process of policy?
Research a healthcare organization and highlight how their policies align or misalign with the WHO’s definition of health.
The paper
Must be four to six double-spaced pages in length (not including title and reference pages) and formatted according to APA style as outlined in the Ashford Writing Center.
Must include a separate title page with the following:
Title of paper
Student’s name
Course name and number
Instructor’s name
Date submitted
Must use at least four scholarly sources in addition to the course text.
Must document all sources in APA style as outlined in the Ashford Writing Center.
Must include a separate reference page that is formatted according to APA style as outlined in the Ashford Writing Center.
Defining
Health
Table
7-1
presents the view of health and health care espoused in the constitution of the World Health Organization. Although the UnitedStates is a U.N. member state, one would be hard put to find consensus in the United States on a number of the points that it cites as basicprinciples.
Asking people in the United States if health is more than the absence of illness or infirmity could produce a host of different responses. Somerespondents might come down on the side of physical and mental well-being but have a problem with trying to address social well-beingunder the heading of health. Indeed, the fact that we have millions of uninsured and do not provide mental health care to a large proportion ofthe population would seem to indicate a lack of commitment to physical and mental well-being.
Those analyzing or deciding on a policy need to understand the differences in the operational definitions of health that are representedaround the table. In the best of all possible worlds, those seated at the table would agree on thatdefinition and move on, but sometimes theart of politics depends, in part, on knowing when to try to agree on principles, or on actions, or on both, and whether to use limited politicalcapital to try to bring them into alignment publicly.
Table
7-1
Excerpts from the Preamble of the Constitution of the World Health Organization
…
the
following
principles
are
basic
…
• Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
• The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction ofrace, religion, political belief, or economic or social condition.
• The health of all peoples is fundamental to the attainment of peace and security and is dep.
ADVANCED NURSING RESEARCH
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ADVANCED NURSING RESEARCH 2
Evidence Based Practice Grant Proposal
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Grant Proposal-Assessing the role of stigma towards mental health patients in help seeking
Study problem
There are several studies that have shown that stigmatization towards mental health patients have been present throughout history and even despite the evolution in modern medicine and advanced treatment. For example, Verhaeghe et al., (2014), captures in a publication in reference to a study that he conducted that stigmatization towards mental health patients has been there even as early is in the 18th Century. People were hesitant to interact with people termed or perceived to have mental health conditions.
Stigmatization has resulted from the belief that those with mental problem are aggressive and dangerous creating a social distance (Szeto et al., 2017). Also, mental health-related stigma has become of major concern as it creates crucial barriers to access treatment and quality care since it not only influences the behaviour of the patients but also the attitude of the providers hence impacting help-seeking. Timmermann, Uhrenfeldt and Birkelund (2014), have identified stigma as a barrier that is of significance to care or help seeking while the extent to which it still remains a barrier have not been reviewed deeply. Therefore, this study will assess the role contributed by stigma in help seeking in depth. 1. Purpose
The intention of the research study is to review the association between stigma, mental illness and help seeking in order to formulate ways in which the stigma that is around mental health is done away with to enable as many people suffering from mental health complications to seek medical help.2. Background
Mental health is crucial in every stage of life. It is defined as the state of psychological well-being whereby the individual realizes a satisfactory integration instinctual drive acceptable to both oneself and his or her social setting (Ritchie & Roser, 2018). The status of mental health influences physical health, relationships, and most importantly day-to-day life. Mental health problems arise when there is a disruption in mental well-being.
The risk factors to mental health problems are not limited and therefore everyone is entitled to the problem irrespective of gender, economic status, and ethnic group. For example, data shows that in America one out of five individuals experience mental health problems annually; with mental disorders being recognized as the leading cause of disability not only in the United States but also globally (Ritchie & Roser, 2018). Mental health disorders are seen to be complex and of many forms such as anxiety, mood, and schizophren.
The Patient-Centered Medical Home in the Transformation From Healthcare to He...Paul Grundy
Surgeon General of the Navy VADM Matthew L. Nathan, MC USN
Fortunately, we have a way to address this crisis—the
Patient-Centered Medical Home (PCMH) model launched at Naval Hospital Pensacola and Walter Reed National Military Medical Center, Bethesda, Maryland (formerly the National Naval Medical Center) in 2008. It is now being implemented throughout the Military Health System (MHS) and carries great promise. It provides the clinical framework we need to meet our strategic objectives in terms of quality of care, impact on costs, population health, and readiness. One of the most significant benefits of the team-based, collaborative approach is that it allows us to embed within a primary care environment the psychologists, nutritionists, tobacco cessation specialists, mind-body medicine therapists, and health educators our patients need in order to develop and maintain mindful, healthy behaviors—along with the “mental armor,” our active duty military personnel need to increase their operational effectiveness and their resiliency in bouncing back from stressful situations. As we move ahead with this more comprehensive approach to health, we can begin to better address so many of our patients for whom we can find no specific reason for pain and discomfort. The PCMH model also provides a positive impact on our costs. Early data reporting from the PCMH clinics at Bethesda show reduced visits to the emergency room, lowered pharmacy costs, and significant per beneficiary per year savings and improved Healthcare Effectiveness Data and Information Set metrics, access, and patient satisfaction and trust. These positive impacts on the bottom line can be applied directly to improved costs or toward the reallocation of resources from reimbursing those who are sick to the population health-based programs that can make and keep our patients healthy.More significant, however, the PCMH environment allows us to go beyond mere collaboration and to a much more proactive approach to managing our patient populations. It is within the context of the medical home that we can begin to surround our patients with the tools and resources they need to move them from health care to health.
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.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
1. Gordon K. Norman, MD, MBA
Chief Medical Officer
xG Health Solutions
Graphical Lessons in Population Health
2. Graphical Lessons in Population Health
As a physician dedicated to improving population health for several
decades, I have relished and often reused a number of graphs and
graphics that depict salient issues in population health far better than
words can convey, at least for me, an admitted visual learner.
The following dozen are from my “greatest hits” collection, and I invite
readers to reuse these as appropriate.
“One look is worth a thousand words.”
Frederick Barnard, Printer's Ink, December 1921
3. 1. Determinants of Health / Premature Death
The first of these are a pair of graphs that vividly demonstrate the dominant influence
of personal lifestyle and health behaviors on health and premature death. Whenever
I get too focused on EHRs, CINs, PCMHs, ACOs, etc., these data remind me that until
we impact health behaviors and lifestyles for a population, we will not optimize
health outcomes.
Schroeder S. N Engl J Med 2007;357:1221-1228
4. 2. Rule of Halves
The successive gaps in our case finding, diagnostic confirmation, evidence-based
treatment, persistent adherence to treatment all compound to yield a disappointing
net result in our population health management throughput. This is vividly
demonstrated by the “Rule of Halves” which applies to diabetes and some other
chronic conditions.
5. 2. Rule of Halves (cont.)
A different depiction of this phenomenon of successive shortfalls in diabetes control is
shown below. However illustrated, serial drop-offs in our ability to render high quality
care and optimal outcomes to all who need it are an indictment of the current system
which is often characterized by “compounded mediocrity”.
6. 3. Medication Adherence
A key part of the shortfall problem above is the challenge of long-term medication
adherence. As pithily noted by former U.S. Surgeon General, C. Everett Koop, “Drugs
don’t work in patients who don’t take them.”
No portrayal of this challenge is more dramatic to me than the following graphics that
show how quickly after hospitalization for a heart attack that many patients stop using
life-savings drugs. After escaping the grim reaper in a scary CCU attached to cardiac
monitors and IV drips while contemplating one’s mortality, one might think the
survivors of this experience would be devoutly committed to their physician’s care
plan, particularly prescribed medications.
Shockingly, almost one quarter of patients had not filled their cardiac prescriptions in
one week after discharge, one third of patients stopped at least one of 3 indicated
medications, while 12% stopped all 3 within one month of hospital discharge! The
data clearly demonstrate that in as little as one year later, those quitting all 3 meds
suffered a 10% survival disadvantage compared to those who remained adherent.
9. Clinical Inertia
4. Clinical inertia
Clinical inertia is defined as lack of treatment intensification in a patient not at
evidence-based goals for care, and it occurs commonly in clinical practice, exposing
patients to avoidable morbidity and mortality risk. Because of the multifactorial
nature of this problem, it is not a simple or easy one to tackle yet must be addressed
for optimal population health. Systems of care which embed workflows, reminders,
order sets, thresholds for action, etc. are key for treating to target reliably.
10. 5. Diffusion of new knowledge
From the work of Balas & Boren and Paul Glasziou come the following 2 graphics
showing how slow and inefficient we are in deploying new health science into routine
practice.
If it takes on average 17 years for new, proven knowledge to become adopted by more
than half of all practicing clinicians, yet the half-life of medical knowledge these days
is on the order of 10 years, what prognosis does this portend for the future?
Adoption Half-life = 17y
Knowledge Half-
life = 10y
%ofpopulation
11. 5. Diffusion of new knowledge (cont.)
While the leaks in translating new research into routine care are real and many, we
must find ways to leverage EHRs and clinical decision support technology to do
significantly better than this.
0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21
Aware Accept Apply Able Act Agree Adhere
Valid
Research
If leakage is only 20% at
each stage of pipeline
…patients get only ~1/5
of full potential benefit
We experience successive “leaks” between research &
clinical practice that significantly dilute clinical benefit
12. 6. Changing health behaviors
A large literature has been developed about
why we behave as we do and how to change
unhealthy lifestyles and behaviors, but no
single model has emerged as superior to
others for population health improvement.
One of the more useful and practical is the
Information-Motivation-Behavioral Skills
(“IMB”) model from Fisher & Fisher,
endorsed by WHO and shown to be effective
in changing sexual behavior in teenagers,
ART adherence in AIDS patients, and in
diabetic self-care in multiple cultures.
Sensibly, if you know what you should
change and why, decide you want to make
the change, and are equipped with the
necessary behavioral tactics to support the
change, then you are much more likely to be
successful with long term behavior change.
13. 7. Social contagion
Research from Christakis and Fowler has demonstrated that our social networks
influence our behavior is subtle ways that may not be obvious but can be measured in
many settings. Understanding these behavioral influences may give us another lever
to use in population health improvement.
14. 8. Health literacy
We have long known that variability in health literacy impacts one’s wellbeing and
may limit the effectiveness of many approaches to improving population health.
15. 8. Health literacy (cont.)
This is a multifactor societal challenge that the health professions or public health
alone cannot solve without broader, grassroots initiatives.
16. 9. Personal health ecosystems
Aside from our genetic
and familial heritage, our
health is influenced by a
complex combination of
forces, beliefs, habits, and
other environmental and
societal factors that are
portrayed in the following
graphic. These myriad
influences often work at a
subconscious rather than
conscious level, making it
challenging to even
identify what they are for
a given individual, much
less change them.
17. 10. Holistic health care
Our specialty-oriented,
high-tech medical care
today is often perceived
by patients as fragmented
and organ-centric. Many
believe that to help
patients convert unhealthy
behaviors into healthy
ones, change unhealthy
beliefs to healthier ones,
and to slow morbidity
while enhancing quality of
life, we need a more
holistic approach to health
care that takes a person-
centric perspective.
18. 11. Squaring the Morbidity Curve
Jim Fries, MD depicted lifetime morbidity in the graphic below showing how the
default curve should be “squared” to represent improved quality of life for a greater
percentage of our lifespan than currently - a worthy goal for population health
management that harmonizes well with the Triple Aim.
19. 12. Value Chain for Accountable Care
Clearly there is no single, unique
chain of interdependent steps that
all health care organizations must
follow in order to be successful in
accountable care, but the following
schematic is based on observing
several that have been able to
achieve Triple Aim outcomes while
remaining financially viable.
Working backward from the
desired health outcomes, the key is
determining the population health
behaviors that need to change and
all the necessary steps required to
produce those changes at scale and
with persistence.
Complete
Population
Health Data
Integration &
EBM Gap
Analyses
Impactful
Health
Decision
SupportShared
Care
Plans w/
Better Use
of What
Works
Information,
Motivation,
Behavioral
Skills
Better
Health
Behaviors
Improved
Health
Outcomes