Presentation at National Hospice and Palliative Care Organization's 26th Annual Management & Leadership Conference, April 2011. One of the presenters is Kyle R. Allen, DO, AGSF, Chief, Division of Geriatric Medicine and Medical Director of Post Acute & Senior Services for Summa Health System.
Although highly arguable, and patients being central to healthcare systems, patient engagement is one the most underutilized aspect of the healthcare industry. Patient engagement is a promise of better health outcomes as well as the increasing knowledge and skill of people to manage their and their family members’ health.
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
The 10th Annual Utah Health Services Research Conference: Data: What's available and how we are use it is changing. By: Danielle A. Lloyd, MPH - Premier
Health Services Research Conference: March 16, 2015
Patient Centered Research Methods Core, University of Utah, CCTS
Better care at less cost - a 'how to' for commissioners and providers, pop up...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
mHealth Israel_Top Health Industry Issues of 2021_Will a Shocked System Emerg...Levi Shapiro
Presentation by PwC Health Research Institute for mHealth Israel, February 17, 2021: Top Health Industry Issues of 2021...Will a Shocked System Emerge Stronger?
Key Sections:
1) Rightsizing after virtual visit explosion
2) Changing clinical trials
3) Easing physician burden with digital
4) Healthcare forecast for 2021
5) Reshaping health portfolios
6) Resilient and responsive supply chains
7) Inter-Operability
Although highly arguable, and patients being central to healthcare systems, patient engagement is one the most underutilized aspect of the healthcare industry. Patient engagement is a promise of better health outcomes as well as the increasing knowledge and skill of people to manage their and their family members’ health.
This infographic speaks to the challenges Emergency Departments face in caring and following up with the growing population of patients they see, and demonstrates how some EDs are seeing measurable improvements in care, patient satisfaction and efficiency.
The 10th Annual Utah Health Services Research Conference: Data: What's available and how we are use it is changing. By: Danielle A. Lloyd, MPH - Premier
Health Services Research Conference: March 16, 2015
Patient Centered Research Methods Core, University of Utah, CCTS
Better care at less cost - a 'how to' for commissioners and providers, pop up...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
mHealth Israel_Top Health Industry Issues of 2021_Will a Shocked System Emerg...Levi Shapiro
Presentation by PwC Health Research Institute for mHealth Israel, February 17, 2021: Top Health Industry Issues of 2021...Will a Shocked System Emerge Stronger?
Key Sections:
1) Rightsizing after virtual visit explosion
2) Changing clinical trials
3) Easing physician burden with digital
4) Healthcare forecast for 2021
5) Reshaping health portfolios
6) Resilient and responsive supply chains
7) Inter-Operability
Build Physician Relationships that Drive Business Results; Part 2Renown Health
Baystate Health has established a comprehensive, data-driven approach to cultivate new physician referrals, retain current business and earn trust. In this presentation, learn how market intelligence, business analytics and customer engagement are used to focus physician outreach efforts and drive bottom line results.
How Providers Can Reshape their Operations to Master Value-Based ReimbursementsCognizant
Healthcare providers must make sweeping system, process and operational changes to thrive under the inevitable move to value-based payments. Here are our recommendations on how to get started.
Creating a standard of care for patient and family engagementChristine Winters
Nationally-recognized governance expert Beth Daley Ullem addresses the state of patient engagement in heathcare and provides a vision for establishing a minimum standard of care for patient engagement programs.
Partnering with Patients, Families and Communities for Health: A Global Imper...EngagingPatients
Engagement is an essential tool to improving global health. This report introduces a new framework for engagement to help countries assess current programs and think strategically about future engagement opportunities. It spotlights barriers to engagement and offers concrete examples of effective engagement from around the globe.
Creating value through patient support programsSKIM
How do we become more patient-centered as an organization? How do we ensure the patient/caregiver experience is as optimal as possible?
These are the questions that are being poised to healthcare market researchers in today’s healthcare landscape. And typically healthcare market researchers are turning to methods like “patient journeys” and “patient personas” to help bring that patient-centered understanding to the organization. Problem is … in order to be truly patient-centered, you need to take this charge on from the inside out.
Experience, Design and Innovation departments are springing up in all kinds of healthcare organizations intent on facilitating the organizational shift towards patient-centricity. And, unfortunately, market researchers are intentionally not being invited to the table. If history repeats itself, that will soon change though. These Experience, Design and Innovation departments will need the rigor and breadth of method knowledge that market researchers have in order to succeed in the strategic agendas of their work.
This presentation will give market researcher pointers on which skills, methods and mindsets they’ll likely need to adopt if they are hoping to be perceived as a valued contributor to an Experience, Design or Innovation team. In essence, give attendees a blueprint for how to open up a whole new professional opportunity for themselves, with a simple reframe on whom they are and what they do.
Post-Acute Preferred Provider Arrangements – Strategies for Partnership: Post...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Clifford E. Barnes - Post-Acute Crash Course Webinar Series - November 28, 2017.
Discussion Points:
* Care coordination initiatives—an opportunity for more comprehensive care
* How Affordable Care Act demonstration projects, such as bundled payments, patient-centered medical homes, value-based purchasing, and accountable care organizations, promote preferred provider arrangements
* Opportunities for partnership, and how to approach them
* Balancing patient choice and preferred provider networks
* Why integration can be preferable to acquisition
Take a coffee break every Tuesday in November at 2 p.m. ET to join us for a series of four 15-minute webinars on "Transacting in the Post-Acute Care Space: Considerations, Red Flags, and Opportunities!"
https://www.ebglaw.com/events/post-acute-preferred-provider-arrangements-strategies-for-partnership-post-acute-crash-course-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.
Human Care Systems provides comprehensive patient and HCP support programs for biopharm and medtech companies and provider and payer organizations in the rare disease market. We help organizations reach patient and HCP initiation, adherence and retention goals by integrating a proprietary intelligent stakeholder algorithm. The result is Real World Outcomes: optimized patient quality of life, HCP brand preference and brand ROI
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.
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
Building Patient-Centeredness in the Real World: The Engaged Patient and the ...EngagingPatients
This paper examines the separate but intertwined ethical, economic and clinical concepts of patientcenteredness and how ACOs provide a structure for turning those concepts into a functioning reality.
140306 dr tim ferris healthcare cost challengeNuffield Trust
In this slideshow, Dr Tim Ferris, Vice President for Population Health Management, Partners HealthCare, and Medical Director of the Massachusetts General Physicians Organisation; explores a new approach to meeting the health care cost challenge.
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
Build Physician Relationships that Drive Business Results; Part 2Renown Health
Baystate Health has established a comprehensive, data-driven approach to cultivate new physician referrals, retain current business and earn trust. In this presentation, learn how market intelligence, business analytics and customer engagement are used to focus physician outreach efforts and drive bottom line results.
How Providers Can Reshape their Operations to Master Value-Based ReimbursementsCognizant
Healthcare providers must make sweeping system, process and operational changes to thrive under the inevitable move to value-based payments. Here are our recommendations on how to get started.
Creating a standard of care for patient and family engagementChristine Winters
Nationally-recognized governance expert Beth Daley Ullem addresses the state of patient engagement in heathcare and provides a vision for establishing a minimum standard of care for patient engagement programs.
Partnering with Patients, Families and Communities for Health: A Global Imper...EngagingPatients
Engagement is an essential tool to improving global health. This report introduces a new framework for engagement to help countries assess current programs and think strategically about future engagement opportunities. It spotlights barriers to engagement and offers concrete examples of effective engagement from around the globe.
Creating value through patient support programsSKIM
How do we become more patient-centered as an organization? How do we ensure the patient/caregiver experience is as optimal as possible?
These are the questions that are being poised to healthcare market researchers in today’s healthcare landscape. And typically healthcare market researchers are turning to methods like “patient journeys” and “patient personas” to help bring that patient-centered understanding to the organization. Problem is … in order to be truly patient-centered, you need to take this charge on from the inside out.
Experience, Design and Innovation departments are springing up in all kinds of healthcare organizations intent on facilitating the organizational shift towards patient-centricity. And, unfortunately, market researchers are intentionally not being invited to the table. If history repeats itself, that will soon change though. These Experience, Design and Innovation departments will need the rigor and breadth of method knowledge that market researchers have in order to succeed in the strategic agendas of their work.
This presentation will give market researcher pointers on which skills, methods and mindsets they’ll likely need to adopt if they are hoping to be perceived as a valued contributor to an Experience, Design or Innovation team. In essence, give attendees a blueprint for how to open up a whole new professional opportunity for themselves, with a simple reframe on whom they are and what they do.
Post-Acute Preferred Provider Arrangements – Strategies for Partnership: Post...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Clifford E. Barnes - Post-Acute Crash Course Webinar Series - November 28, 2017.
Discussion Points:
* Care coordination initiatives—an opportunity for more comprehensive care
* How Affordable Care Act demonstration projects, such as bundled payments, patient-centered medical homes, value-based purchasing, and accountable care organizations, promote preferred provider arrangements
* Opportunities for partnership, and how to approach them
* Balancing patient choice and preferred provider networks
* Why integration can be preferable to acquisition
Take a coffee break every Tuesday in November at 2 p.m. ET to join us for a series of four 15-minute webinars on "Transacting in the Post-Acute Care Space: Considerations, Red Flags, and Opportunities!"
https://www.ebglaw.com/events/post-acute-preferred-provider-arrangements-strategies-for-partnership-post-acute-crash-course-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.
Human Care Systems provides comprehensive patient and HCP support programs for biopharm and medtech companies and provider and payer organizations in the rare disease market. We help organizations reach patient and HCP initiation, adherence and retention goals by integrating a proprietary intelligent stakeholder algorithm. The result is Real World Outcomes: optimized patient quality of life, HCP brand preference and brand ROI
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.
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
Building Patient-Centeredness in the Real World: The Engaged Patient and the ...EngagingPatients
This paper examines the separate but intertwined ethical, economic and clinical concepts of patientcenteredness and how ACOs provide a structure for turning those concepts into a functioning reality.
140306 dr tim ferris healthcare cost challengeNuffield Trust
In this slideshow, Dr Tim Ferris, Vice President for Population Health Management, Partners HealthCare, and Medical Director of the Massachusetts General Physicians Organisation; explores a new approach to meeting the health care cost challenge.
National Conference on Health and Domestic Violence. Plenary talk Paul Grundy
explaining how the Patient Centered Medical Home (PCMH) platform for healthcare deliver is more likely to support domestic violence prevention and creat a safer environment than the FFS episode of care system we are in now. The medical Home is a home for the data where the all the data goes and is held accountable this idea was first articulated by Dr. Calvin C.J. Sia, a Honolulu-based pediatrician in 1967.
This concept of the medical home was integrated with Ed Wagners Chronic disease Model and Thomas Bodenheimer Kevin Grumbach advanced/proactive primary care at the request of the Patient Centered Primary care Collaborative into a set of principles Know as the Joint principles of the Patient centered medical home.
The patient-centered medical home (PCMH), is a team based health care delivery set of principles led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. It is "an approach to providing comprehensive primary care for children, youth and adults" The provision PCMH medical homes allow better access to health care, increase satisfaction with care, and improve health. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).[10] Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
6 Characteristics of a Successful ACO By Steven Lash San DiegoSteven Lash
Steven lash San Diego shows that an Accountable Care Organization (ACO) success can be linked to 6 key characteristics. The high performing ACO reported reduced costs, improved patient satisfaction, and advanced population health. These traits were leadership and culture, prior experience, health IT, care management strategies,organizational and environmental factors, and incentive and payer alignment.
The Design of Accountable Care OrganizationsCJ Fulton
Pillars for Accountable Care
PCMH versus ACOs
Core competencies
Six core structural components of successful ACO deployment
Pioneer ACO burn and learn lessons
Barriers & root cause analysis
Patient attribution
Five modes of Accountable Care
Early value-based adopters
Value discovery assessment
Modified Triple Aim
GPRO
Breakdown by 33 Measures
Accountable Care Organizations and Physician Joint Ventures .docxAMMY30
Accountable Care Organizations and Physician Joint Ventures
Jeffrey P. Harrison
Chapter 9
“I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.”
—from The Hippocratic Oath (modern version)
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
1
Learning Objectives
Demonstrate an understanding of the interparty relationships associated with healthcare joint ventures and accountable care organizations.
Understand some of the dynamics and controversies surrounding the concept of accountable care organizations as an alternative approach to the current marketplace.
Demonstrate a basic understanding of the patient-centered medical home with attention to how it supports network-based delivery systems.
Master the concept of physician–hospital alignment and health system integration including consumer, provider, and regulatory developments.
Assess the emerging role of medical groups and hospital-owned group practices across the continuum of healthcare services.
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
2
Key Terms and Concepts
Accountable care organization (ACO)
Clinical integration
Equity-based joint venture
Hospitalist model
Integrated physician model
Medical foundation
Patient-centered medical home (PCMH)
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
3
Introduction
A positive relationship between hospitals and physicians is important to the success of the US healthcare system, because hospitals and physicians can be both collaborators and competitors.
Many hospitals and healthcare systems have moved to various models of physician integration through which hospitals hope to capture market share and physicians seek financial security.
After the Affordable Care Act (ACA) was passed in 2010, physician–hospital alignment became driven by another factor: cost control and quality outcomes in the accountable care era (Reiboldt 2013).
Physicians work in a wide range of settings and serve in leadership positions that have significant responsibility for quality of care.
Copyright 2016 Foundation of the American College of Healthcare Executives. Not for sale.
4
Clinical Integration
What Is It?
Coordination of patient care between hospitals and physicians across the healthcare continuum— e.g., an accountable care organization (ACO).
Provides an opportunity to coordinate services through centralized scheduling, electronic health records, clinical pathways, management of chronic diseases, and innovative quality improvement programs.
Clinical integration is necessary to delivering high-quality, affordable care in the current environment (Jacquin 2014).
Clinical.
A Clinically Integrated Network (CIN) is a selective partnership of physicians collaborating with
hospital(s) and other providers to deliver evidence-based care, improve quality and efficiency,
manage populations and demonstrate value to the market. Once these objectives are met, the network may contract on behalf of participants
Rick MacCornack, PhD
Chief Systems Integration Officer
Northwest Physicians Network
CEO
Rainier Health Network
Closing Presentation "ACOs and Health IT: True Delivery System Reform or Another Round of Unintended Consequences?"
A fundamental component of the Affordable Care Act is support for the creation of so-called Accountable Care Organizations. Health care information technology will play a critical role in the reform process, perhaps in ways which are not yet well understood. Using the framework and early experience of a local CMS appointed ACO, this session is intended to ask questions and provide examples for how IT efforts might contribute to healthy, disruptive change in improving medical care delivery.
Learning Objectives:
∙ Consider the unintended consequences of the current IT trajectory in supporting medical care delivery in relation to the mandates of the
Affordable Care Act. Consider some opportunities for future IT contributions and what will need to occur for these opportunities to be tapped.
∙ Reflect on the historical contributions of IT in health and how there will necessarily be a shift in IT development in the future in support of
medical care delivery reform.
Imagine a healthcare system where people live long, healthy lives, receiving quality, affordable care, with clinicians nationwide collaborating to improve outcomes. That's Accountable Care! Learn the benefits of becoming an ACO in this insightful eBook.
Similar to Strategic Options for Hospice & Palliative Care in the Era of ACOs (20)
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.
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
Strategic Options for Hospice & Palliative Care in the Era of ACOs
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2. Strategic Options for Hospice and Palliative Care in the Era of Accountable Care Organizations NHPCO 26th Annual Management & Leadership Conference April 2011 1
3. Presenters Jade Gong, MBA, RN Vice President, Strategic Initiatives Health Dimensions Group 4012 Nelly Custis Drive, Arlington, VA 22207 703-243-7391; jadeg@hdgi1.com Kyle R. Allen, DO, AGSF Chief, Division of Geriatric Medicine Medical Director Post Acute & Senior Services Summa Health System 75 Arch Street, Ste G1, Akron, OH 44303 330-375-3747; allenk@summahealth.org Jane Gorwin, RN, BSN, LNC, MA Senior Home Health and Hospice Consultant Health Dimensions Group 4400 Baker Rd, Ste 100, Minneapolis, MN 55343 760-250-4558; janeg@hdgi1.com 2
4. Topics Health care reform and its impact on post-acute and aging services providers Strategies for hospice and palliative care providers PEACE model of care PACE as an accountable care organization (ACO) model 3
9. Post-Acute Payments by Venue and Condition 7 In ACO-land, expect greater use of subacute skilled nursing and home health Note: Data are preliminary and subject to change. Numbers reflect standardized payment rates and therefore do not reflect provider-specific adjustments such as the area wage index or DSH payment adjustments. Spending captures payments for all PAC services that occur within 30 days of discharge from the hospital. Source: MedPAC analysis of 5% Medicare claims files 2004 to 2006.
15. How ACOs Provide Accountable Care in a New Delivery System Capacity to deliver continuum of care, grounded in strong primary care and minimal use of high-cost institutional settings Payment rewards slower cost growth so long as combined with improvements in quality Reliable measures of a person’s health assure that savings are achievedthrough improvements in care 9
29. Medicare ACOs in 2012, But Many ACO Demonstrations Now 11 3 Medicare Pilot Sites Many Private Payer Pilots Roanoke, VA Medica and Insurers Louisville, KY Tucson, AZ Torrance, CA
41. New Payment Model for Medicare ACOs: Shared Savings Current per-capita spending for assigned patients determined from claims for past three years Spending target is determined (Medicare) If actual spending lower than target, savings are shared IF quality targets are also achieved 14 ACO Launched Projected Target Shared Savings Actual 14 Adapted from Brookings Institute
42. Sample ACO Calculation 15 An organization must meet quality standards AND achieve cost savings to earn bonus payments * Actual costs for “assigned” population are less than pre-set expected costs based on risk-adjusted trends ** PGP demonstration gave groups 80% of savings; actual split for ACOs to be determined
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44. Pendingre-admission penaltiesPartner with other providers to enhance yourpost-acute andhome care continuum Partner with like providers to create one-stop chronic care management Strategy includes care transitions management and electronic health record
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47. How Do Palliative and Hospice CareFit into an ACO Model? Laying the foundation for a palliative care framework first 19
48. How Do Palliative and Hospice CareFit into an ACO Model? (continued) 20
49. What Needs to Change? The basic way we work with patients, especially in one of these three categories: Chronic Disease Management Need to better identify where a patient is within this trajectory Enhance acute to community-based transitional care coordination Interventional Palliation Educate/enlighten patient and family earlier Provide options for patient/family choice Hospice Care Marketing strategy and partnerships with hospitals and PCP 21
50. What Do ACOs Want from Post-Acute and Aging Services Providers? Not likely to be a partner, with “skin in the game”, but rather a contractor ACOs will want few PAC provider-contractors who: √ Can demonstrate value (quality and cost reductions) with credible data Few 30-day hospital readmissions High volume of discharges to home √ Have evidence-based clinical programs for most common SNF-HHA discharges and a care transitions program between venues √Have facilities/services that are geographically convenient to primary care physicians and hospitals √ Already have positive relationship with hospitals and PCPs √ Willing and able to be part of health information exchange 22
51. Hospice: Well Positioned for the Future Aging demographics – baby boomers Chronic disease “explosion” Key offenders: Congestive Heart Failure Diabetes Chronic Obstructive Pulmonary Disorder Pneumonia Parkinson’s – ALS – Dementias Depression 23
52. Not-for-Profit Accountable Care Readiness Strategy: Aging Services Provider Partnerships 24 Create a not-for-profit consortium within a market that has more value than any organization individually Benefits: One-stop shopping for hospitals and ACOs Benchmarks for hospital readmissionsand ongoing comparison Post-acute provider partnerships in geographic areas creating care continuum with standardized protocols Care management projects Bundling experiments with Medicare Advantage Plans as we learn to take risks Apply for grants for demonstration projects
59. Define Your Services: What are You Providing Within the Continuum? Palliative Care: interventional and comfort care focus Palliative care in–patient hospital versus home health Hospice Care: comfort care and quality of life focus Routine hospice care Respite Continuous care General in patient 26
60. Overarching Strategy of Why You Will Benefit an ACO Ability to reduce 30-day (+) hospital readmissions Ability to reduce emergency/urgent care visits Reduce hospital length of stay Potentially decrease in-patient hospital mortality rates 27 KNOW YOUR DATA AND SHARE IT!
61. Critical Elements for a Successful Strategy Implementation Evidence-based practice (interventional PC and hospice) Use of aligned, care protocols Patient/family centered—self-care management driven Coaching: motivational interviewing skills Patient/Family self goal-setting Medication awareness (PHR) Self symptom management and interventions 28
62. Critical Elements for Successful Strategy An integrated care management and health system navigator approach Effective electronic information exchange From provider to provider Patient/family to provider (tele-health, bio-sensory technology, video-audio interface) Real-time data management decision-making 29
63. What are Some of the Current Challenges? Current fiscal realities (shrinking margins) Hospitals Home Health Hospice Regulations and future Medicare payment models are always “behind” Hospice: limited to 6-month end-of-life prognosis Palliative care: not officially recognized No specific reimbursement for care management models…..yet 30
64. More Challenges Need for highly sophisticated data management information systems that will: Enhance traditional quality care indicators (pain management, satisfaction surveys post-death) Provide predictive statistical modeling as relates to primary diagnoses and co-morbid conditions Help to identify patients’ clinical and social needs within their trajectory (chronic disease management, interventional palliation, hospice) 31
65. Next Steps to Move Your Strategy Forward Evaluate your current services Do you provide what your hospital(s) and PCP(s) need? Do you collect the right data? Research your most likely ACO partners What are their specific needs? Get their data: mortality rates, lengths of stay, top chronic diseases causing the readmissions 32
66. Moving Your Strategy Forward Develop your presentation to meet with potential ACO partners: hospitals and PCPs Be specific with your data to show how YOU will be essential to their accountable care organization Explore current funding opportunities: Shared risk ventures with Medicare Advantage plans Grants Demonstration projects Be proactive to get a “seat at thetable” and start now! 33
67. If everything seems under control, you're just not going fast enough 34 Mario Andretti.
68. PEACE TRIAL Promoting Effective Advanced Care for Elders Kyle R. Allen, DO* Steven Radwany, MD* Susan Hazelett, MS, RN* Denise Ertle, MSN, RN, CNS* * Susan Fosnight, RPh, CGP, BCPS* Pamela Moore, PharmD, BCPS* Patricia Purcell, MSN, RN, CNS* * * Barbara Palmisano, MA * * * * Ruth Ludwick, PhD, RN.C, CNS* * * * * * Summa Health System, Health Services Research and Education Institute * * Area Agency on Aging 10B, Inc.* * * The University of Akron * * * * Northeastern Ohio Universities Colleges of Medicine and Pharmacy * * * * * Summa Affiliate, Robinson Memorial Hospital The PEACE Trial is supported by The National Palliative Care Research Center & the Summa Foundation Area Agency on Aging, 10B, Inc. | Summa Health System | NEOUCOM Kent State University | The University of Akron
69. Key Points A National Palliative Care Research Center-funded trial ($154,000 over 2 years) Collaboration between The University of Akron, Kent State University, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, the Area Agency on Aging 10B Inc., and Summa Health System A randomized controlled pilot study A palliative care case management intervention for PASSPORT consumers Intervention involves collaborative care between a hospital-based interdisciplinary team, the Area Agency on Aging, and the consumer’s PCP 36
70. The S.A.G.E. Project(Summa Health System/Area Agency on Aging, 10B/Geriatric Evaluation Project: A Successful Health Collaborative(Est. 1995) Improving Care through Collaboration: Integration of the Aging Network and Acute and Post Acute Medical Care Services 37
73. The SAGE Project A 15-year collaboration partnership Multiple initiatives, a “cast of thousands”, well maybe 100s, but you get the point Common goal to improve the health, well being and functional status of Akron region frail older adult population Identified major gaps in the continuum and care processes from each partner Searched and defined mutual benefits Shared mutual threats and concerns Built trust Grew and multiplied to other regional systems Communication, communication, communication Vision, Vision, Vision, Vision 39
74. Area Agency on Aging Programs Mission: To provide older adults and their caregivers long-term care choices, consumer protection and education so they can achieve the highest possible quality of life. Aging Resource Center PASSPORT Home Care Medicaid Waiver Assisted Living Medicaid Waiver Community Services Division Care Coordination Alzheimer’s Respite Program Family Caregiver Support Elder Rights Division 40
75. Who were the partners?Summa Health System Geriatric Medicine Department Summa Akron City Hospital Summa St. Thomas Hospital 6 Hospital System 2,027 licensed beds 61,800 admissions Level 1 Trauma 113,059 ED visits Community Locations 4 outpatient health centers Wellness Institute – medically-based fitness Health Plan 110,000 Covered Lives 16,000 Medicare Risk HMO Major Teaching Residency and Fellowship Program Post Acute/Senior Service Line 10 Certified Geriatricians 12 Geriatric Certified APNs Continuum of Care Acute Care/Acute Rehab/ LTAC/ SNF Beds Home Care/ Hospice/ Home Infusion/ HME SummaCare, Inc. Summa Western Reserve Hospital 41
88. AD-LIFE trial is supported by the Agency for Healthcare Research and Quality Grant # R01 HS014539. PEACE is funded by the National Palliative Care Research Center. Both are supported by the Summa Foundation.
91. Health Care Utilization Experience for Patients with Chronic Conditions: Current Health Care System Community-dwelling chronically ill patient with poor symptom control and coordination of care whose advance care wishes are rarely documented Hospitalization prompting advance care decisions (often by the family) Exacerbation of chronic illness 45
92. Palliative Care and Advance Care Planning Independent Management Hospice Advance Care Planning Symptom Management Disease Management Death Diagnosis 46
93. Patient Centered Care 47 Well Older Adults Cancer AIDS Gait Disorders Cancer (<65) Stroke Preventive care Genetic/ Developmental Disorders Advanced Organ Failure Palliative Care Geriatrics Stable chronic dx Chronic Critical Illness Geriatric syndromes Pediatric Oncology Frailty Peri-operative care Cystic Fibrosis Dementia Osteoporosis TBI Morrison, S . National Palliative Care Research Center
94. Target Population for the PEACE Pilot Study New PASSPORT enrollees >60 years old with one of the following diseases and the corresponding level of severity will be eligible for inclusion: CHF and being actively treated (AHA class C) COPD and on home O2 or nebulizer treatments Diabetes with renal disease, neuropathy, visual problems, or CAD End-stage liver disease, cirrhosis Cancer (active, not history of) except skin cancer Renal disease on dialysis ALS with history of aspiration Pulmonary hypertension Parkinson’s disease (stages 3 and 4) 48
95. Enrollment RN assessors from the AAoA will screen consumers at the time of their initial PASSPORT assessment RN assessor will obtain HIPAA release Research nurse will obtain consent and obtain baseline measures Consumers will be randomized to usual care or the intervention group 49
96. Intervention Each Care Manager will have approximately 10 consumers Care Manager will make 2 home visits centered on symptom assessment & advance care planning Care Manager will take her assessment findings to an interdisciplinary team Team produces recommendations for consumer & PCP Care Manager accompanies consumer to 1 PCP visit to assist consumer in discussing advance care goals with PCP Care Manager & Palliative Care Nurse supervisor make another home visit to begin implementation of plan of care Care Manager follows-up with consumer monthly for 1 yr to assure team recommendations are implemented PEACE Intervention 50
98. Challenges Getting buy-in from case managers Education and knowledge gaps Changing culture of the AAA Needing to get more top-down support for the project so AAA CM supported for the project Not over “medicalizing” the care plans 52
99. Successes Strong working relationship and commitment by the AAoA A team that has gone from forming to storming, not yet norming Culture sensitivity and knowledge between aging network and acute care sector—“becoming bilingual” Outgrowths of other educational projects, additional funding for PC research, and bridging the community network and acute sector 53
100. Additional PEACE Related Projects A survey of knowledge and attitudes about ACP and PC sent to all area PCPs. Funded by the Summa Foundation. A statewide survey of all care managers at all AAoA that will examine knowledge and attitudes regarding ACP and PC. Funded by Northeastern Ohio Universities Colleges of Medicine and Pharmacy. An educational program to teach AAoA care managers how to bring PC upstream in the disease process. Funded by the First Merit Foundation. 54
101. PACE as an ACO Model of Care Jade Gong, MBA, RN Health Dimensions Group 55
102. Comprehensive Services Integrates preventive, acute, and long-term care services All Medicare and Medicaid services, plus community long-term care services No benefit limitations, co-payments,or deductibles PACE is the only fully capitated and integrated Medicare and Medicaid program to serve frail nursing home eligibles 56
103. PACE Eligibility Criteria 55 years of age or older Live in a PACE service area Be certified as eligible to receivea nursing home level of care Be able to live safely in thecommunity at point of enrollment 57
105. PACE Nationally 79 PACE organizations and growing 31 states 20,000 PACEparticipants 100 to 2,000participantsper program 59
106. Social Services Pharmacy Home Care Nutrition Activities Personal Care Primary Care Transportation OT/PT Well-functioning IDT Key to PACE Success 60
108. PACE Payment Sources Payment features are unique Capitated payment system—per member per month (PMPM) Combines funding from multiple payor sources to meet all participant needs 62
111. Survival in PACE South Carolina Two counties PACE group same baseline risk as NH group PACE group higher baseline risk than Waiver group 65
112. PACE Core Competencies Provider-based model Tightly controlled care management and utilization systems Serves a nursing home-eligible population in the community when enrolled Good health care outcomes, high enrollee satisfaction, and low disenrollment rates Established existing program with a proven track record 66
114. Exploring Common Ground:PACE and Hospice Patient centered Holistic approach to care Utilizes interdisciplinary teams Supports caregivers Utilizes managed care efficiency Receives capitated payment (per diem or per month) 68
115. Why Should Hospice Develop PACE Programs? Meet community needs with broader care options for frail seniors at the end of life Build upon community awareness of hospice Draw upon greater stability of multiple revenue streams Greater efficiency through shared allocation of administrative expenses 69
116. PACE with Hospice Opportunities for Collaboration Each provider can focus on providingpatient-centered care Some hospice referrals may be more appropriatefor PACE Some PACE referrals may be more appropriatefor hospice PACE can utilize hospice expertise through contracting: Pain and symptom consultation/pain management Use of hospice interdisciplinary team (IDT) Training in end-of-life care Inpatient hospice facility if needed by participant 70