Journal articles on the topic 'Patient care delivery system'
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Lanigan, Megan, Theresa M. Lee, Lisa Torp, Beth Rudge, and Kit Yu Lu. "Using electronic medical records system to advance cancer survivorship programs." Journal of Clinical Oncology 36, no. 7_suppl (March 1, 2018): 65. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.65.
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65 Background: Survivorship care is now being increasingly recognized as an important part of cancer care. The Commission on Cancer (CoC) Standard 3.3 now recommends 100% compliance in the delivery of Survivorship Care Plans (SCP) by 2019 to eligible survivors. However, there are no systematic ways of ensuring compliance of Care Plan delivery and assessing patient eligibility. There are also no standardized methods for documentation or data collection to ensure appropriate consolidation of information from the electronic medical record (EMR) to a SCP, to assess for patient eligibility for survivorship follow up, or to appropriately report on timely delivery and follow-up with Survivorship Programs. Methods: Our survivorship team worked closely with the Cancer Registry Program, nurse navigators, and Information Technology team to optimize our institution owned EPIC electronic medical records system to populate and consolidate information automatically into patient specific care plans. By having electronic care plans, we are able to deliver plans to all members of the care team and to the patients. We also created discrete methods of flagging eligible survivors and automated data reporting and collection to ensure compliance and timeliness of care plan delivery. Results: By optimizing our electronic medical records system and our workflow process for Care Plan delivery, we were able to increase our delivery compliance rate to 100%. We are able to track patients through their care delivery and appropriately refer to our survivorship program and track care plan delivery. Conclusions: The CoC has implemented new standards to encourage appropriate survivorship care delivery and proper communication for ongoing survivorship care and follow up. With these new standards comes the challenge of developing and implementing a system for creating, delivering and evaluating the delivery of SCP. For our team to provide quality survivorship care that is measurable, we have developed data analysis and reports through our EMR with assistance from our IT department. These improvements utilizing our IT and EMR more efficiently has provided us with the ability to achieve 100% care plan delivery compliance.
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Mohammed, Khaled, Margaret B. Nolan, Tamim Rajjo, Nilay D. Shah, Larry J. Prokop, Prathibha Varkey, and Mohammad H. Murad. "Creating a Patient-Centered Health Care Delivery System." American Journal of Medical Quality 31, no. 1 (July 31, 2014): 12–21. http://dx.doi.org/10.1177/1062860614545124.
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Okazaki, Karen M. "The Development of a Patient Care Plan Delivery System." Nursing Management (Springhouse) 18, no. 12 (December 1987): 64B. http://dx.doi.org/10.1097/00006247-198712000-00017.
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Denberg, Thomas D., Stephen E. Ross, and John F. Steiner. "Patient acceptance of a novel preventive care delivery system." Preventive Medicine 44, no. 6 (June 2007): 543–46. http://dx.doi.org/10.1016/j.ypmed.2007.01.010.
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Rabrenovich, Violeta, Ronald Loo, and Kirk Tamaddon. "Improving quality of prostate cancer care in an integrated care delivery system." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 147. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.147.
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147 Background: Kaiser Permanente (KP) is an integrated care delivery system that provides clinical services to over 9 million members in nine states and the District of Columbia with the goal of providing high-quality and affordable health care to our patients. Over the last decade, the rapid adoption of prostate cancer (Pca) screening practice and technology have resulted in increased detection of Pca and helped identify opportunities for care improvement. KP initiated improvements of continuum of services provided to Pca patients. Methods: Transforming the care provided to Pca patients evolved into the first population-based cancer program that manages the entire continuum of care by taking advantage of our integrated health delivery system. Major accomplishments include appropriate Pca screening to prevent over-diagnosis (Prostate Cancer Screening), improved patient safety and claims reduction to prevent missed abnormal cancer screening (PSA Safety Net), comparative effectiveness of cancer treatment choices to improve quality, and benchmark outcomes in efficiency and clinical quality utilizing a new technology (Robotic Surgery). In addition, the program has achieved superior outcomes and value through innovative chemotherapy management for advanced disease (Lupron Management). Evidence-based medicine, research, analytics and continuous quality improvementare cornerstones of the program, while the pinnacle is our patients, who receive informed, shared decision making and equitable unbiased care. Results: We strongly believe that measures of how well our patients are living with Pca are as important as the cancer-specific survival measures; because of this, we established a prospective registry to measure quality of life for every newly diagnosed patient and stratified by all treatment types. This practice is being disseminated across the Program. Conclusions: By systematically stratifying this diverse population, we have been able to achieve efficient reliable care, and spread each successful process to other regions through collaboration with KP’s Interregional Chiefs of Urology.
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Beiranvand, Samira, Maryam Rassouli, Maryam Hazrati, Shahram Molavynejad, Suzanne Hojjat, Hanna Tuvesson, and Kourosh Zarea. "Hospice care delivery system requirements." International Journal of Palliative Nursing 28, no. 12 (December 2, 2022): 562–74. http://dx.doi.org/10.12968/ijpn.2022.28.12.562.
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Background: Hospice care is a perceived need in the Iranian health system. Aim: This qualitative study is explaining the stakeholders’ perception of what is required to develop a hospice care system for patients living with cancer in Iran. Methods: A total of 21 participants (specialists, policymakers, healthcare providers, cancer patients and family caregivers) were selected through purposeful sampling and interviewed in-depth in 2020. Interviews were analysed through directed content analysis. Findings: A total of 1054 codes, 7 categories and 21 subcategories were extracted. The requirements include the need to provide: multiple settings and diverse services; participatory decision making; integration into the health system; specialised human resources; an organised system of accountability; the preparation of the existing health system; and wider capacity-building in existing Iranian society. Conclusion: It is essential that Iranian services create a participatory comprehensive care plan, utilise expert manpower, integrate hospice care into the existing health system and organise a system of accountability. Policymakers should focus on the preparation of the health system and capacity building in society.
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Black, Lesley-Ann, Conor Mcmeel, Michael Mctear, Norman Black, Roy Harper, and Michelle Lemon. "Implementing autonomy in a diabetes management system." Journal of Telemedicine and Telecare 11, no. 1_suppl (July 2005): 6–8. http://dx.doi.org/10.1258/1357633054461886.
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We have developed a speech-based telemedicine system which enables patients with hypertension and type 2 diabetes mellitus to send frequent, home-monitored health data via the telephone to the point of care. The decision support module in the system was tested using data from a cohort of 10 patients generated over a two-year period. Results from the tests indicate that the system is effective in providing personalized feedback to the patient and in generating alerts for the clinical user. The work suggests that this method of care delivery is practical, informative, and may improve the efficiency of chronic health-care delivery by reducing costs and improving patient-physician communication between hospital visits.
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Cardin, Suzette, Sandra Kane, and Kathleen Koch. "Use of Patient Care Extenders in Critical Care Nursing." AACN Advanced Critical Care 3, no. 4 (November 1, 1992): 789–96. http://dx.doi.org/10.4037/15597768-1992-4007.
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This article explores the implementation and use of patient care extenders in two critical care units. Experimentation and diversity in changing the care-delivery system were the forces motivating the management team to redesign the existing nursing care-delivery system. The impetuses for the change process were the use of the role of the registered nurse and cost containment. Two case studies will illustrate from a practical perspective how the change occurred. Although the same nurse manager was responsible administratively for the two units, the patient care extender models were implemented differently. This was based on the conviction that each unit is unique with regard to patients and staff needs. The first case study occurred in an 18-bed cardiac telemetry unit in which the patient extender care model was integrated with direct patient care activities of the unit. In the second case study, which occurred in a ten-bed cardiac care unit, the patient care extender was integrated with indirect patient care activities. The approach to this article is practical, and it is intended for units that may be dealing with these issues in these changing times in health care
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Hibbard, Judith H. "Moving Toward A More Patient-Centered Health Care Delivery System." Health Affairs 23, Suppl2 (January 2004): VAR—133—VAR—135. http://dx.doi.org/10.1377/hlthaff.var.133.
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Schaffner, Julie W., Scott Alleman, Patti Ludwig-Beymer, Janice Muzynski, Donna J. King, and Lori J. Pacura. "Developing a Patient Care Model for an Integrated Delivery System." JONA: The Journal of Nursing Administration 29, no. 9 (September 1999): 43–50. http://dx.doi.org/10.1097/00005110-199909000-00010.
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Ozkaynak, Mustafa, Sharon A. Johnson, Bengisu Tulu, Jennifer L. Donovan, Abir O. Kanaan, and Adam Rose. "Exploring the effect of complex patients on care delivery tasks." International Journal of Health Care Quality Assurance 28, no. 5 (June 8, 2015): 494–509. http://dx.doi.org/10.1108/ijhcqa-11-2014-0105.
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Purpose – The needs of complex patients with chronic conditions can be unpredictable and can strain resources. Exploring how tasks vary for different patients, particularly those with complex needs, can yield insights about designing better processes in healthcare. The purpose of this paper is to explore the tasks required to manage complex patients in an anticoagulation therapy context. Design/methodology/approach – The authors analyzed interviews with 55 staff in six anticoagulation clinics using the Systems Engineering Initiative for Patient Safety (SEIPS) work system framework. The authors qualitatively described complex patients and their effects on care delivery. Findings – Data analysis highlighted how identifying complex patients and their effect on tasks and organization, and the interactions between them was important. Managing complex patients required similar tasks as non-complex patients, but with greater frequency or more intensity and several additional tasks. After complex patients and associated patient interaction and care tasks were identified, a work system perspective was applied to explore how such tasks are integrated within clinics and the resulting implications for resource allocation. Practical implications – The authors present a complex patient management framework to guide workflow design in specialty clinics, to better support high quality, effective, efficient and safe healthcare. Originality/value – The complex patient framework presented here, based on the SEIPS framework, suggests a more formal and integrated analysis be completed to provide better support for appropriate resource allocation and care coordination.
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Mills, Ann E., and Mary V. Rorty. "Total Quality Management and the Silent Patient." Business Ethics Quarterly 12, no. 4 (October 2002): 481–504. http://dx.doi.org/10.2307/3857996.
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Abstract:This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total Quality Management, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system.
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Loughran, John, Tauqir Puthawala, Brad S. Sutton, Lorrel E. Brown, Peter J. Pronovost, and Andrew P. DeFilippis. "The Cardiovascular Intensive Care Unit—An Evolving Model for Health Care Delivery." Journal of Intensive Care Medicine 32, no. 2 (July 8, 2016): 116–23. http://dx.doi.org/10.1177/0885066615624664.
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Prior to the advent of the coronary care unit (CCU), patients having an acute myocardial infarction (AMI) were managed on the general medicine wards with reported mortality rates of greater than 30%. The first CCUs are believed to be responsible for reducing mortality attributed to AMI by as much as 40%. This drastic improvement can be attributed to both advances in medical technology and in the process of health care delivery. Evolving considerably since the 1960s, the CCU is now more appropriately labeled as a cardiac intensive care unit (CICU) and represents a comprehensive system designed for the care of patients with an array of advanced cardiovascular disease, an entity that reaches far beyond its early association with AMI. Grouping of patients by diagnosis to a common physical space, dedicated teams of health care providers, as well as the development and implementation of evidence-based treatment algorithms have resulted in the delivery of safer, more efficient care, and most importantly better patient outcomes. The CICU serves as a platform for an integrated, team-based patient care delivery system that addresses a broad spectrum of patient needs. Lessons learned from this model can be broadly applied to address the urgent need to improve outcomes and efficiency in a variety of health care settings.
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Henry, Elizabeth, Abigail Silva, Elizabeth Tarlov, Cheryl Czerlanis, Margie Bernard, Cynthia Chauhan, Denise Schalk, and Greg Stewart. "Delivering Coordinated Cancer Care by Building Transactive Memory in a Team of Teams." Journal of Oncology Practice 12, no. 11 (November 2016): 992–99. http://dx.doi.org/10.1200/jop.2016.013730.
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Cancer care delivery is highly complex. Treatment involves coordination within oncology health-care teams and across other teams of referring primary and specialty providers (a team of teams). Each team interfaces with patients and caregivers to offer component parts of comprehensive care. Because patients frequently obtain specialty care from divergent health-care systems resulting in cross-system health-care use, oncology teams need mechanisms to coordinate and collaborate within and across health-care systems to optimize clinical outcomes for all cancer patients. Transactive memory is one potential strategy that can help improve comprehensive patient care delivery. Transactive memory is a process by which two or more team professionals develop a shared system for encoding, storing, and retrieving information. Each professional is responsible for retaining only part of the total information. Applying this concept to a team of teams results in system benefits wherein all teams share an understanding of specialized knowledge held by each component team. The patient’s role as the unifying member of the team of teams is central to successful treatment delivery. This clinical case presents a patient who is receiving oral treatment for advanced prostate cancer within two health systems. The case emphasizes the potential for error when multiple teams function without a point team (the team coordinating efforts of all other primary and specialty teams) and when the specialty knowledge of providers and patients is not well integrated into all phases of the care delivery process.
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Cooper, Robert Michael, and Erin Elizabeth Hahn. "Timeliness of care delivery for lung cancer patients in a vertically integrated health care system." Journal of Clinical Oncology 34, no. 7_suppl (March 1, 2016): 127. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.127.
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127 Background: A Kaiser Permanente Southern California (KPSC) organizational goal is to achieve optimal timeliness of cancer care delivery. The purpose of this report is to present a process used for a multi-disciplinary physician led performance improvement exercise at the at the Los Angeles Medical Center and share initial learnings. Methods: A CME approved Performance Improvement (PI) program to examine timeliness of care delivery for newly diagnosed patients with lung cancer was created for physicians. The multi-disciplinary core group met for 6 three hour blocks of time to process map the patient centered flow. The physicians evaluated current practice, developed a future state and made structural changes. The group focused on two time intervals: time from suspicion of malignancy until pathology resulted, and time from pathology until the start of treatment. Results: Initial learnings included, that the work was meaningful as shown by physicians using their dedicated education time and consistency of participation; an electronic medical record was useful for the initial process mapping and ongoing monitoring; patient flow is complex and patients followed many different paths to diagnosis and treatment. Participating in this project benefitted team building, improved understanding of the challenges throughout the system, enhanced empathy for their colleagues and patients, and educated physicians about performance improvement methodology. Preliminary review of timeliness of care delivery shows improvements in timeliness at the two time points both during the year of instituting a PI program and with the first interventions. Conclusions: A physician led multi-disciplinary approach to review of timeliness of care delivery is feasible and productive.
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Siminerio, Linda M., Gretchen Piatt, and Janice C. Zgibor. "Implementing the Chronic Care Model for Improvements in Diabetes Care and Education in a Rural Primary Care Practice." Diabetes Educator 31, no. 2 (March 2005): 225–34. http://dx.doi.org/10.1177/0145721705275325.
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Purpose The purpose of this pilot study was to determine the impact of implementing elements of the chronic care model (CCM; decision support, self-management, and delivery system redesign) on providers' diabetes care practices and patient outcomes in a rural practice setting. Methods In this pilot study, 104 patients with type 2 diabetes and 6 providers in a rural primary care practice were involved in an intervention that included a certified diabetes educator (CDE) who educated and supported providers on diabetes management and adherence to the American Diabetes Association (ADA) Standards of Care over the year of the project. The CDE also provided diabetes self-management education (DSME) at the office site for 29 of the 104 patients who received their care in the practice. The following variables were evaluated: provider perceived barriers to care and adherence to ADA standards of care and patient A1C, blood pressure, cholesterol, knowledge, and empowerment levels. Results Provider adherence to ADA Standards of Care increased significantly across all process measures. Patients who received DSME at point of service in the primary care practice setting gained improvements in knowledge, empowerment, A1C, and high-density lipoprotein cholesterol levels. Conclusions Implementing systems to support decision support, selfmanagement education, and delivery system redesign has a positive influence on practices and patient outcomes in outlying rural communities.
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Slotkin, Jonathan R., Alfred S. Casale, Glenn D. Steele, and Steven A. Toms. "Reengineering acute episodic and chronic care delivery: the Geisinger Health System experience." Neurosurgical Focus 33, no. 1 (July 2012): E16. http://dx.doi.org/10.3171/2012.4.focus1293.
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Comparative effectiveness research (CER) represents an evolution in clinical decision-making research that allows for the study of heterogeneous groups of patients with complex diseases processes. It has foundations in decision science, reliability science, and health care policy research. Health care finance will increasingly rely on CER for guidance in the coming years. There is increasing awareness of the importance of decreasing unwarranted variation in health care delivery. In the past 7 years, Geisinger Health System has performed broad reengineering of its acute episodic and chronic care delivery models utilizing macrosystem-level application of CER principles. These provider-driven process initiatives have resulted in significant improvement across all segments of care delivery, improved patient outcomes, and notable cost containment. These programs have led to the creation of novel pricing models, and when “hardwired” throughout a care delivery system, they can lead to correct medical decision making by 100% of providers in all patient encounters. Neurosurgery as a specialty faces unique challenges and opportunities with respect to broad adoption and application of CER techniques.
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Hall, Louise H., Rachael Thorneloe, Rocio Rodriguez-Lopez, Adam Grice, Mangesh A. Thorat, Katherine Bradbury, Meghana Wadnerkar Kamble, Grace N. Okoli, Daniel Powell, and Rebecca J. Beeken. "Delivering brief physical activity interventions in primary care: a systematic review." British Journal of General Practice 72, no. 716 (September 20, 2021): e209-e216. http://dx.doi.org/10.3399/bjgp.2021.0312.
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BackgroundPhysical activity (PA) brief interventions (BIs) involving screening and/or advice are recommended in primary care but frequency of delivery is unknown.AimTo examine the extent to which PA BIs are delivered in primary care, and explore factors associated with delivery, receipt, and patient receptivity.Design and settingA mixed-methods systematic review of studies conducted worldwide, with a narrative synthesis of results.MethodCINAHL, EMBASE, MEDLINE, and APA PsycINFO index databases were searched for qualitative and quantitative studies, dating from January 2012 to June 2020, that reported the level of delivery and/or receipt of PA BIs in primary care, and/or factors affecting delivery, receipt, and patient receptivity. Quality was assessed using the Mixed Methods Appraisal Tool. Attitudes towards and barriers to delivery were coded into the Theoretical Domains Framework and the Capability, Opportunity, and Motivation Behaviour model.ResultsAfter screening a total of 13 066 records, 66 articles were included in the review. The extent of PA screening and advice in primary care varied widely (2.4%–100% and 0.6%–100%, respectively). PA advice was delivered more often to patients with a higher body mass index, lower PA levels, and/or more comorbidities. Barriers — including a lack of time and training/guidelines — remain, despite recommendations from the World Health Organization and National Institute for Health and Care Excellence that PA advice should be provided in primary care. Few studies explored patients’ receptivity to advice.ConclusionPA BIs are not delivered frequently or consistently in primary care. Addressing barriers to delivery through system-level changes and training programmes could improve and increase the advice given. Understanding when patients are receptive to PA interventions could enhance health professionals’ confidence in their delivery.
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Kaufmann, Tara L., Katharine A. Rendle, Erin Aakhus, Andrea Bilger, Peter Edward Gabriel, Vivek Nimgaonkar, Arnav Shah, Rebecca Trotta, Frances Barg, and Justin E. Bekelman. "Perspectives on cancer care delivery from oncology patients who experienced unplanned acute care events." Journal of Clinical Oncology 37, no. 27_suppl (September 20, 2019): 201. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.201.
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201 Background: Unplanned acute care is debilitating and burdensome for patients with advanced cancer and their caregivers. There is a pressing need to understand how available evidence-based practices (EBPs) to reduce acute care 1) align with the needs and priorities of patients and 2) are best implemented within large health systems. We are conducting a mixed methods study to assess patient- provider- and system-level factors that shape the decision to seek acute care during active cancer treatment in order to select and adapt EBPs for implementation. Here we present data from patients’ perspectives. Methods: Purposive sampling approach to identify solid tumor cancer patients on active treatment with unplanned acute care events at a large health system from Aug 2018-Jan 2019. We conducted semi-structured interviews to elicit patients’ perspectives on factors that shape their decision to seek acute care and to inform intervention strategies. Results: Forty-nine patients participated in this study. We identify several patient factors that intersect with the decision to seek care: self-management behaviors, guilt, negative ED perception, safety concerns, and trust. Patients attempt self-management prior to contacting their oncology team, which introduces variability in the duration and severity of reported symptoms. Delay is related to patients’ guilt for burdening their oncology team and to provider accessibility. Patients describe a high symptom threshold to seek care that is often coupled with a negative perception of the ED, but do prefer in-person evaluation for new and distressing symptoms for safety. They express a high level of trust in the oncology team and relative distrust of non-oncology providers. Conclusions: Our data suggest a conceptual model for patient factors that drive unplanned acute care. Patients identify three areas for improvement: 1) enhanced peer support and education to manage uncertainty about cancer treatment; 2) accessible portals for patient-clinician communication; and 3) home or clinic-based after-hours oncology symptom management. Interventions to target these needs should address patients’ emotional concerns and be well integrated within the oncology team.
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Klemp, Jennifer R., Heather Vanbebber, Tanya Folker, Lisa Serig, Tim Metcalf, Audrey Roberts, Meredith Cooper, and Debbie Fernandez. "A health system wide approach to the delivery of survivorship care plans." Journal of Clinical Oncology 36, no. 7_suppl (March 1, 2018): 42. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.42.
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42 Background: Survivorship care plans (SCPs) are recognized by organizations including the American Society of Clinical Oncology and the American College of Surgeons Commission on Cancer, as a best practice for improving survivor care. Little evidence supports this and hospitals and cancer centers are scrambling to meet deadlines for SCP development and delivery. The University of Kansas Cancer Center (KUCC) addressed this utilizing electronic health record (EHR) integration, developing a health system wide approach to education and delivery, and building referral workflows to primary care and specialists. We report on this approach to developing and growing a survivorship care program. Methods: KUCC is a NCI designated cancer center within an academic medical center and health system, with 11 outpatient locations across the Kansas City. Under the guidance of a multidisciplinary team: providers, health care informatics, administrators, nursing, tumor registry, quality improvement, and researchers, KUCC developed a step-wise process to deliver comprehensive survivorship care across the health system. This multi-year initiative aligned with institutional accreditation standards and an ongoing focus on expanding evidence based, comprehensive cancer and supportive care. Results: In 2014 a formal survivorship program plan was put into action: Support from leadership, providers, research priority; Staff and patient survivorship education & training; Integrated delivery of survivorship care at all locations with direct interaction and feedback from cancer care teams; Short & long-term programmatic goals; Management and referral of late effects of cancer; EPIC integrated SCP template: auto-populated, customized, personalized; treatment summary uses tools that pull in data stored discreetly in the patient "file"; SCP delivery targeting COC phase-in timeline: 2015: n= 539 (10% projection n= 434); 2016: n= 1,355 (25% projection n=1,253). Conclusions: This step-wise, integrated approach to survivorship care has resulted in a health system wide delivery of SCPs and meeting national accreditation standards. Next steps include the evaluation of cost and clinical/patient reported outcomes.
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Stuessy, Peter, Federico Augusto Sanchez, and Madeline Schober. "Retrospective review of pegfilgrastim on-body injector delivery rates in a large health system." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e18273-e18273. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e18273.
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e18273 Background: Pegfilgrastim is used in patients at significant risk for febrile neutropenia following myelosuppresive chemotherapy. Labeling for pegfilgrastim requires administration the day after administration of chemotherapy. The pegfilgrastim on-body injector allows for delivery at home, without having to return to the clinic. Rates of appropriate delivery of pegfilgrastim via the on-body injector have not been studied in large scale outside of controlled environments. This retrospective review investigates the rate of appropriate delivery of pegfilgrastim via the on-body injector in a large heath system. Methods: Reports were created listing monthly clinic administration of the pegfilgrastim on-body injector at nineteen outpatient cancer care clinics from July 1st, 2016 to December 31st, 2016. Patient charts were reviewed for reported non-delivery of the medication. Results: Three hundred eighty-nine injections from 149 patient charts were reviewed. Of these injections, eight were not delivered (non-delivered rate = 2.1%). Four other administrations resulted in only partial dose delivery or unknown if dose was delivered (partial/unknown rate = 1%), leading to a failure rate of 3.1 with an appropriate delivery rate of 96.9%. Conclusions: In one health system’s experience, 96.9% of pegfilgrastim on-body injector administrations were delivered as planned. A process for real time evaluation of delivery rates should be created to address the 3-4% non-delivered dosing.
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Arshad, Shumaila, Ali Aun, and Muhammad Uzair Yousaf. "Drug Delivery System in Pakistan: A Review." Research in Pharmacy and Health Sciences 2, no. 3 (August 15, 2016): 174–78. http://dx.doi.org/10.32463/rphs.2016.v02i03.35.
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Drug Delivery systems are the means by which drug molecules are delivered to sites of action within the body.There are several pharmaceutical dosage forms (delivery Systems) available in Pakistan that is being used in different health care centers. Both conventional and advance dosage forms are used now days depending upon the condition of the patient, the disease state and available resources. But unfortunately Pakistan is a way behind in the field of technology among the other developing and developed countries in the world. There are few private setups which are well equipped with high class technology that caters the need of advanced drug delivery system in Pakistan. Mostly advanced drug dosage forms are imported from the other countries, thus it costs Pakistan a lot. In the present study Drug Delivery Systems in Pakistan is thoroughly studied and represented according to the generations of drug delivery system.
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Biernat, Lisa, Carly E. Milliren, Jon Rauen, Bill Lindsay, Betsy Weaver, and Todd Smith. "Improving Orthopedic Care Delivery Through Digital Engagement." Iproceedings 5, no. 1 (October 2, 2019): e16305. http://dx.doi.org/10.2196/16305.
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Background Patient activation has been hypothesized to improve medical and surgical outcomes by increasing patient involvement in the care plan. We tested this hypothesis by utilizing a patient activation tool in a population of adults having total hip or total knee replacement. We hypothesized that patient activation would be associated with increased discharge to home as opposed to a skilled nursing facility, reduced hospital length of stay, decreased inpatient readmissions, and decreased emergency department (ED) visits. Objective Using an email patient activation tool, we sought to increase patients’ involvement in their care before and after total joint replacement. Outcomes examined included day of surgery cancellation, length of hospital stay, discharge to home vs discharge to a skilled nursing facility, any ED visit within 30 days of discharge, and any inpatient readmission within 30 days of discharge Methods This was a quasi-experimental design comparing Jan-Jun 2017 to Jan-Jun 2018. We instituted an email patient activation tool for all patients with total knee or total hip replacement surgery beginning in January 2018. This tool was integrated with the electronic medical record system during the six month study period and patients could opt out at anytime if they desired. The tool was designed to prepare patients both educationally and emotionally for their operation with multiple easy-to-read emails starting from the time they were scheduled for surgery through six months postop. Percent of emails opened and clicked were used as measures of engagement for the intervention participants. Results Of the 2,027 TJR patients included, 720 were hip patients and 1,307 were knee patients. Pre- and postintervention groups were similar in gender and age. For hip replacement patients, length of stay was nearly 1/4 day lower in the postintervention group (β=-0.23; P=.001) after adjusting for gender, age and insurance; ED visits were lower among the postintervention group (OR=0.45; P=.05) after adjusting for gender, age and insurance; and postintervention patients were less likely to have day of surgery cancellation, any revisit (ED or readmission), and were more likely to be discharged home. However, these associations did not reach statistical significance. Conclusions Among patients who received the intervention, higher engagement was significantly associated with positive changes in almost all outcomes. Use of the digital patient activation tool demonstrated significant savings in length of stay and reduced ED visits among hip replacement patients. Although just under 50% of patients in the intervention group were enrolled to use the tool, these findings were still significant even when non-participants were included in the postintervention group.
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Khayal, Inas S., and Amro M. Farid. "Architecting a System Model for Personalized Healthcare Delivery and Managed Individual Health Outcomes." Complexity 2018 (2018): 1–24. http://dx.doi.org/10.1155/2018/8457231.
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In recent years, healthcare needs have shifted from treating acute conditions to meeting an unprecedented chronic disease burden. The healthcare delivery system has structurally evolved to address two primary features of acute care: the relatively short time period, on the order of a patient encounter, and the siloed focus on organs or organ systems, thereby operationally fragmenting and providing care by organ specialty. Much more so than acute conditions, chronic disease involves multiple health factors with complex interactions between them over a prolonged period of time necessitating a healthcare delivery model that is personalized to achieve individual health outcomes. Using the current acute-based healthcare delivery system to address and provide care to patients with chronic disease has led to significant complexity in the healthcare delivery system. This presents a formidable systems’ challenge where the state of the healthcare delivery system must be coordinated over many years or decades with the health state of each individual that seeks care for their chronic conditions. This paper architects a system model for personalized healthcare delivery and managed individual health outcomes. To ground the discussion, the work builds upon recent structural analysis of mass-customized production systems as an analogous system and then highlights the stochastic evolution of an individual’s health state as a key distinguishing feature.
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Barnsteiner, Jane H., Anne Mohan, and Pam Milberger. "Implementing Managed Care in a Pediatric Setting." AACN Advanced Critical Care 3, no. 4 (November 1, 1992): 777–87. http://dx.doi.org/10.4037/15597768-1992-4006.
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A challenge in the current nursing environment is the ability to provide care cost-effectively and yet achieve desired patient outcomes. The managed care delivery system facilitates achievement of these goals. The system incorporates management of time, resources, and personnel so that patient outcomes are achieved within appropriate time frames. This article describes the design and implementation of a managed care delivery system in a children’s hospital
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Flynn, MB, and J. Luchsinger. "Trauma care strategies for changing economic forces." Critical Care Nurse 17, no. 6 (December 30, 1997): 81–89. http://dx.doi.org/10.4037/ccn1997.17.6.81.
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Nurses have expertise in wellness, health promotion, delivery of acute care, and rehabilitation. As the venture into healthcare reform deepens, nurses must take a more proactive role in redirecting the delivery of trauma care in such a way that optimal provision of healthcare services is maintained while costs of providing care are reduced across the continuum of care. Efforts must focus on preventing traumatic injuries, restructuring healthcare delivery systems to meet the needs of patients with traumatic injuries, and reducing healthcare expenditures. Table 3 outlines strategies used by our facility to decrease cost without compromising patients' care. The current era is fraught with rapid changes that necessitate a creative, rational, and organized approach to making decisions about the delivery system for patient-focused care. Nurses are in an optimal position to develop and implement interdisciplinary, creative strategies that will maximize the delivery of trauma care services to the community. Each institution must evaluate the processes involved in its delivery of trauma care services. Strategies to contain costs must focus on processes implemented to achieve optimal outcomes of patients' care. The economic marketplace will evaluate care on the basis of outcome statistics and cost analysis. Thus, nurses must continue to be critical evaluators of nursing practice, always striving for the best healthcare delivery system possible during these turbulent economic times.
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Morley, D., and C. M. Thorpe. "Apparatus for Emergency Transtracheal Ventilation." Anaesthesia and Intensive Care 25, no. 6 (December 1997): 675–78. http://dx.doi.org/10.1177/0310057x9702500615.
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Twenty anaesthetists were asked what equipment they would use to ventilate a patient after having performed an emergency cricothyroid puncture. Six systems were described and these were assessed for efficiency in delivery of oxygen through a 14 gauge cannula. Delivery of oxygen depended on the pressure achieved within the system. Apparatus utilizing a Bain circuit achieved volumes of around 200 ml for each double-handed squeeze of the reservoir bag. Use of a system taught on the Advanced Trauma and Life Support (ATLS) course resulted in higher system pressures and consequently greater volumes of oxygen delivered. Use of the oxygen flush with this system provides the highest flow rate and system pressure which results in 628 ml being delivered for a one second compression.
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Frankel, A. "Improving patient safety across a large integrated health care delivery system." International Journal for Quality in Health Care 15, no. 90001 (December 1, 2003): 31i—40. http://dx.doi.org/10.1093/intqhc/mzg075.
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Bartz-Smith, Shari D., and Amy Campbell. "An Interdisciplinary Approach to a Well-Rounded Campus Healthcare Delivery System." Kinesiology Review 6, no. 4 (November 2017): 375–79. http://dx.doi.org/10.1123/kr.2017-0038.
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An injury care clinic (ICC) as part of a comprehensive campus-wide healthcare system is a cost-effective way to optimize the flow of patient care utilizing a collaborative model of healthcare in a time of physician shortage. Services include: basic first aid, injury evaluation, acute injury care, basic rehabilitation, preventative techniques including taping and stretching, and professional referrals. The ICC provides care to previously underserved campus community members, focusing on: club sport and intramural athletes, recreation center users, and the general student body, in addition to faculty and staff, going beyond the varsity athlete. The ICC functions through the efforts of athletic trainers, physicians, fitness specialists, administrators, faculty, and students across disciplines. After 3 years, the clinic has serviced more than 2,500 unique patients exceeding 4,800 patient encounters, demonstrating outcomes that access to affordable healthcare options with a licensed healthcare provider are warranted and needed.
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Eberman, Lindsey E., Zachary K. Winkelmann, Jessica R. Edler, and Elizabeth R. Neil. "Athletic Trainers' Knowledge Regarding Health Care Delivery Systems and Administration in the American Health Care System." Athletic Training Education Journal 15, no. 4 (October 1, 2020): 295–307. http://dx.doi.org/10.4085/150119052.
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Context The American health care system is dynamic and ever evolving. As athletic training continues to advance, our understanding of and the ability to integrate best practices in policy construction and implementation, documentation, and basic business practices is critical to promoting optimal patient care. Objective To identify and compare knowledge gaps of clinicians and educators regarding health care delivery systems and administration. Design and Setting Cross-sectional, Web-based survey. Patients or Other Participants Athletic trainers (N = 485), representative of the national demographic of the profession (age = 37 ± 12 years, experience = 14 ± 11 years). Intervention(s) We used a multi-part assessment including a perceived knowledge questionnaire, validated knowledge assessment (21 items: knowledge retrieval [11 items], knowledge utilization [10 items]), and self-efficacy scales. Main Outcome Measure(s) We calculated the knowledge assessment total score and compared educators (n = 41) and clinicians (n = 444). We calculated the knowledge gap with a Spearman ρ correlation to determine the relationship between perceived knowledge mean and the knowledge retrieval subscore. We calculated the practice gap with a Spearman ρ correlation to determine the relationship between self-efficacy mean and the knowledge utilization subscore. Results Athletic trainers scored less than 50% on a knowledge assessment (mean = 10.27 ± 2.41 of 21) about health care delivery systems and administration. We identified that educators scored approximately 1 point higher (11.65 ± 0.4) than clinicians (10.14 ± 0.11), equivalent to 7% to 10% higher on the knowledge assessment. We identified, relative to health care delivery systems and administration, a knowledge gap (Spearman ρ = .161, P < .001) between perceived knowledge and knowledge retrieval and a practice gap (Spearman ρ = .095, P = .037) between self-efficacy and knowledge utilization. Conclusions Athletic trainers demonstrated knowledge and practice gaps related to health care delivery systems and administration. To meet the expectations of the practice analysis and the needs of patients in today's American health care system, we must engage in professional development in this domain of practice.
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Shah, Priti Prasad. "In patient satisfaction survey- how does it help our health care delivery system (the patient, the health care giver and the organization)?" International Surgery Journal 4, no. 10 (September 27, 2017): 3280. http://dx.doi.org/10.18203/2349-2902.isj20174140.
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Background: Patient satisfaction is a mean of measuring the effectiveness of health care delivery. It can suggest proportion to the problem areas and a reference point to take management decisions. It can serve as a mean of holding physician accountable. Patient satisfaction data can be used to document health care quality for accrediting organizations and consumer groups. They can also measure specific initiative or changes in service delivery. They can increase loyalty of patients by demonstrating you care their perceptions and looking for ways to improve. The purpose of our study is to carry out evaluation of hospital services by getting a patient satisfaction survey. Main aim is to identify potential problems in the services.Methods: A hospital based inpatient satisfaction survey study done on 200 patients. A Predesigned structured questionnaire was based on relevance of questions to healthcare services on various aspects of inpatient care. The interviewer based questionnaires were filled after obtaining verbal informed consent from all subjects. 200 valid responses were analyzed using MS office excel. Data analysis of study is done using the SPSS (Statistical Package for the Social Science) Version 17 for window.Results: Results of our study is very positive and suggest that patients were satisfied with the attitude of doctors, nurses and paramedical staff and it was appreciated. As in D Y Patil Medical College and Hospital most facilities are free for the patients, so we got better feedback for the facilities and satisfaction for this study. Satisfied patients are more likely to continue using the health care services and maintain their relationship with specific health care providers.Conclusions: Patient satisfaction survey can be a driving force for changes in health care delivery with institutions and individuals. These initiatives can promote improvement in practice and also respond to patient expressed needs.
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Ashdown, Lynn C. "PATIENT: A Tool to Assist in Creating a Patient-Centered Team Approach to Health-Care Delivery: Lessons From a Physician Patient." Journal of Patient Experience 7, no. 1 (November 14, 2018): 16–18. http://dx.doi.org/10.1177/2374373518812048.
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Working as a physician, I believed that health care was patient focused and that patients were active participants in their own care. A few years ago, I started a lengthy and complex journey of my own as a patient, whereby I was awakened to the fact that the health-care system does not value the patient voice nor are they included in their care. I found myself having a unique perspective, whereby I understood health-care delivery from my work as a physician; but I also understood now the patient’s perspective in great detail. I know that the patient’s voice is an invaluable asset in health care. Knowing what I now know, I have begun giving presentations about the patient experience to health-care professionals. I developed the acronym ‘PATIENT,’ to educate health-care professionals with the necessary tools to help evolve health-care delivery to the patient-centered team approach.
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Kapoor, Bhushan, and Martin Kleinbart. "Building an Integrated Patient Information System for a Healthcare Network." Journal of Cases on Information Technology 14, no. 2 (April 2012): 27–41. http://dx.doi.org/10.4018/jcit.2012040103.
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The recent healthcare reform act provides incentive payments to providers for their ‘meaningful use’ of electronic health records to achieve significant improvements in care. The HITECH Act 2009 provides incentives payments through Medicare and Medicaid to clinicians and hospitals when they achieve specified improvements in care delivery. Citrus Valley Health Partners’ (CVHP) goals are bigger than just to comply with the regulations or simply to qualify for incentives, but rather include transforming their business to the next level in care delivery. They are seeking cooperation from their affiliates to build a community health information exchange that will allow CVHP and the affiliates to share and integrate patient health related information between their medical centers and the private physicians in their community. The integrated system will help community healthcare providers to work as a single operating entity focused and aligned on improving patient care, operational efficiency and cost effectiveness.
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Herrel, Lindsey A., Ziwei Zhu, Jennifer J. Griggs, Deborah R. Kaye, James M. Dupree, Chandy S. Ellimoottil, and David C. Miller. "Association Between Delivery System Structure and Intensity of End-of-Life Cancer Care." JCO Oncology Practice 16, no. 7 (July 2020): e590-e600. http://dx.doi.org/10.1200/jop.19.00667.
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PURPOSE: To determine whether the type of delivery system is associated with intensity of care at the end of life for Medicare beneficiaries with cancer. PATIENTS AND METHODS: We used SEER registry data linked with Medicare claims to evaluate intensity of end-of-life care for patients who died of one of ten common cancers diagnosed from 2009 through 2014. Patients were categorized as receiving the majority of their care in an integrated delivery system, designated cancer center, health system that was both integrated and a certified cancer center, or health system that was neither. We evaluated adherence to seven nationally endorsed end-of-life quality measures using generalized linear models across four delivery system types. RESULTS: Among 100,549 beneficiaries who died of cancer during the study interval, we identified only modest differences in intensity of end-of-life care across delivery system structures. Health systems with no cancer center or integrated affiliation demonstrated higher proportions of patients with multiple hospitalizations in the last 30 days of life (11.3%), death in an acute care setting (25.9%), and lack of hospice use in the last year of life (31.6%; all P < .001). Patients enrolled in hospice had lower intensity care across multiple end-of-life quality measures. CONCLUSION: Intensity of care at the end of life for patients with cancer was higher at delivery systems with no integration or cancer focus. Maximal supportive care delivered through hospice may be one avenue to reduce high-intensity care at the end of life and may impact quality of care for patients dying from cancer.
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TONGES, MARY CRABTREE. "Work Designs: Sociotechnical Systems for Patient Care Delivery." Nursing Management (Springhouse) 23, no. 1 (January 1992): 27–32. http://dx.doi.org/10.1097/00006247-199201000-00012.
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Bendix Andersen, Anne, Kirsten Beedholm, Raymond Kolbæk, and Kirsten Frederiksen. "When Clock Time Governs Interaction: How Time Influences Health Professionals’ Intersectoral Collaboration." Qualitative Health Research 28, no. 13 (June 11, 2018): 2059–70. http://dx.doi.org/10.1177/1049732318779046.
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When setting up patient pathways that cross health care sectors, professionals in emergency units strive to fulfill system requirements by creating efficient patient pathways that comply with standards for length of stay. We conducted an ethnographic field study, focusing on health professionals’ collaboration, of 10 elderly patients with chronic illnesses, following them from discharge to their home or other places where they received health care services. We found that clock time not only governed the professionals’ ways of collaborating, but acceleration of patient pathways also became an overall goal in health care delivery. Professionals’ efforts to save time came to represent a “monetary value,” leading to speedier planning of patient pathways and consequent risks of disregarding important issues when treating and caring for elderly patients. We suggest that such issues are significant to the future planning and improvement of patient pathways that involve elderly citizens who are in need of intersectoral health care delivery.
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Momoh, Rabiu. "Dextrose-Containing Infusion Running in An Arterial Line System." European Journal of Medical and Health Sciences 4, no. 4 (August 11, 2022): 6–7. http://dx.doi.org/10.24018/ejmed.2022.4.4.1204.
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Processes and procedures in intensive care units and during anaesthetic delivery are centered around ensuring patient safety. This article aims to shed light on a rare possible mechanism for inadvertent iatrogenic hypoglycaemia as can affect critical care specialists or anaesthetists in the line of service delivery and recommendations have been suggested.
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Korda, Holly, and Gloria N. Eldridge. "Payment Incentives and Integrated Care Delivery: Levers for Health System Reform and Cost Containment." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 48, no. 4 (November 2011): 277–87. http://dx.doi.org/10.5034/inquiryjrnl_48.04.01.
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The Patient Protection and Affordable Care Act encourages use of payment methods and incentives to promote integrated care delivery models including patient-centered medical homes, accountable care organizations, and primary care and behavioral health integration. These models rely on interdisciplinary provider teams to coordinate patient care; health information and other technologies to assure, monitor, and assess quality; and payment and financial incentives such as bundling, pay-for-performance, and gain-sharing to encourage value-based health care. In this paper, we review evidence about integrated care delivery, payment methods, and financial incentives to improve value in health care purchasing, and address how these approaches can be used to advance health system change.
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Simon, Melissa A., Julia R. Trosman, Bruce Rapkin, Sarah S. Rittner, Elizabeth Adetoro, Marcie C. Kirschner, Catherine A. O’Brian, Laura S. Tom, and Christine B. Weldon. "Systematic Patient Navigation Strategies to Scale Breast Cancer Disparity Reduction by Improved Cancer Prevention and Care Delivery Processes." JCO Oncology Practice 16, no. 12 (December 2020): e1462-e1470. http://dx.doi.org/10.1200/jop.19.00314.
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PURPOSE: Patient navigation uses trained personnel to eliminate barriers to timely care across all phases of the health care continuum, thereby reducing health disparities. However, patient navigation has yet to be systematized in implementation models to improve processes of care at scale rather than remain a band-aid approach focused solely on improving care for the individual patient. The 4R systems engineering approach (right information and right treatment to the right patient at the right time) uses project management discipline principles to develop care sequence templates that serve as patient-centered project plans guiding patients and their care team. METHODS: A case-study approach focused on the underserved patient shows how facilitators to timely breast cancer screening and care pragmatically identified as emergent data by patient navigators can be actionized by iteratively revising 4R care sequence templates to incorporate new insights as they emerge. RESULTS: Using a case study of breast cancer screening of a low-income patient, we illustrate how 4R care sequence templates can be revised to incorporate emergent facilitators to care identified through patient navigation. CONCLUSION: Use of care sequence templates can inform the care team to optimize a particular patient’s care, while functioning as a learning health care system for process improvement of patient care and patient navigation scaling. A learning health care system approach that systematically integrates data patterns emerging from multiple patient navigation experiences through in-person navigators and 4R care sequence templates may improve processes of care and allow patient navigation scaling to reduce cancer disparities.
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Carryer, Jenny, Fiona Doolan-Noble, Robin Gauld, and Claire Budge. "New Zealand patients’ perceptions of chronic care delivery." Journal of Integrated Care 22, no. 2 (April 14, 2014): 71–80. http://dx.doi.org/10.1108/jica-12-2013-0048.
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Purpose – Care coordination for patients with chronic conditions is one aim of an integrated health care delivery system. The purpose of this paper is to compare findings from two separate New Zealand studies and discusses the implications of the results. Design/methodology/approach – The paper describes and discusses the use of Patient Assessment of Chronic Illness Care Measure in two different geographic areas of New Zealand and at different times. Findings – The studies suggest that, despite the time that has elapsed since government investment in care coordination for long-term conditions, there has been little change in the nature of service delivery from the patient perspective. Originality/value – The paper highlights the shortcomings of simply providing additional funding for care coordination, without built in accountabilities, no planned evaluation and no concerted focus on what the model of care should look like.
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McGrath, Elizabeth Boutin, Jennifer Willyard, Maya Langa, Sarah K. Walsh, and Andrea B. Buccellato. "Shift in survivorship care delivery." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 230. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.230.
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230 Background: Survivorship care often occurs within a single visit at the end of treatment to discuss a treatment summary and/or survivorship care plan with a patient. With increased understanding of both immediate and long-term effects of cancer and cancer treatment we need to consider support for the patient from the time of diagnosis through the end of the patient’s life. In this quality improvement (QI) initiative, a team of survivorship stakeholders utilized survey and focus group methodology to develop a set of recommendations to support a large, academic medical center in a rural setting to move toward this holistic notion of survivorship care. Methods: Surveys regarding experience with survivorship care were deployed to oncology providers, allied health providers, and patients and care partners. Surveys were deployed via a web-based survey tool using email groups and lists developed by the oncology department, as well as printed handouts with the survey URL and a QR code available to patients during clinic visits. A focus group was conducted with oncology APPs to discuss findings and to develop recommendations to support survivorship care delivery. Results: Responses received from 59 patients, 20 care partners, 24 allied health providers, and 19 providers. Over half (52.6%) of patients and care partners indicated that survivorship services were “very important” to their care, with less than 10 respondents (11.5%) indicating that they were “not at all important.” Providers indicated that they do discuss and/or provide survivorship support to their patients (84.2% of respondents), but almost 80% indicated that they were only somewhat knowledgeable (36.8%) or not knowledgeable at all (42.1%) about survivorship services available to patients and care partners. Both allied health and providers indicated that documenting survivorship care was complex. Only 12.5% of providers indicated that patients had a formal survivorship visit; instead, providers indicated that survivorship care is incorporated into routine follow-up visits (75%) and/or active treatment visits (50%). Both allied health (60.0%) and providers (69.2%) indicated that documentation, if done at all, was entered through a free text note. Many acknowledged that this made data tracking, whether for continuity of care or program analysis purposes, labor-intensive. Conclusions: This QI initiative revealed the need for two supportive mechanisms to facilitate the shift from survivorship care that’s limited to a dedicated visit type or tied to a specific document to survivorship care that is woven into all aspects of a patient’s treatment and life beyond treatment. The first mechanism is a robust set of informational resources to ensure providers are knowledgeable about the services that are available to their patients and the referral mechanisms for those services. The second is a mechanism within the EHR to allow survivorship notes to be entered into any visit type and be extracted easily from the system.
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Leggett, H., D. Duijster, G. V. A. Douglas, K. Eaton, G. J. M. G. van der Heijden, K. O’Hanlon, H. Whelton, and S. Listl. "Toward More Patient-Centered and Prevention-Oriented Oral Health Care." JDR Clinical & Translational Research 2, no. 1 (September 28, 2016): 5–9. http://dx.doi.org/10.1177/2380084416668167.
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ADVOCATE (Added Value for Oral Care) is a project funded by the European Commission’s Horizon 2020 program, which aims to develop strategies for a system transition toward more patient-centered and prevention-oriented oral health care delivery within health care systems. This system should balance the restorative and preventive approaches in dental and oral health care. ADVOCATE is a partnership among 6 European Union member states, which involves collaboration among universities, state-funded health care providers, and private insurance companies in Denmark, Germany, Hungary, Ireland, the Netherlands, the United Kingdom, and Aridhia, a biomedical informatics company based in Scotland. There are 6 interrelated work packages, which aim to address the following objectives: 1) in-depth evaluation of oral health care systems in European Union member states to identify best system designs for oral disease prevention, 2) development of a set of measures to provide information on oral care delivery and oral health outcomes, 3) evaluation of a feedback approach in dental practice that aims to facilitate a change toward preventive oral health care delivery, and 4) economic evaluation of strategies to promote preventive oral health care and development of policy recommendations for oral health care systems. The project is novel in its use of data that are routinely collected by health insurance organizations, as well as the engagement of key stakeholders from dental teams, insurers, patients, and policy makers in guiding the development and progress of the project. This article outlines in detail the objectives and research methodology of the ADVOCATE project and its anticipated impact. Knowledge Transfer Statement: This commentary describes the development of policy options to promote a greater focus on disease prevention in general dental practice. The approach builds on identifying the comparative effectiveness of alternative incentive schemes, as well as methods to monitor clinical and patient-derived measures of success in creating health for patients. The article describes the development and application of the measures and the evaluation of their success in orienting clinical practice more toward disease prevention.
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Pascual, Glenn D. "Nursing Communication Bundle: Behavior Standards Review Article Series: 1." International Journal of Nursing Sciences and Clinical Practices 2, no. 1 (November 11, 2021): 1–6. http://dx.doi.org/10.47890/ijnscp/glenndpascual/2021/10042116.
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Changing healthcare delivery systems demand greater accountability from hospital organizations and healthcare providers (Briggs et al., 2018). The radical restructuring of the healthcare system that is required to reduce spiraling healthcare costs and make healthcare accessible to all citizens will necessitate ongoing changes in healthcare organizations. The challenge for hospital organizations is to improve quality and service delivery through an ongoing process of innovation, restructuring of systems and processes, and implementation of aligned service behaviors to increase patient satisfaction and enhance clinical outcomes (Figure 1.0). Patient satisfaction scores serve as system indicators for financial reimbursement from government and private insurance agencies and as impetus for hospital organizations to choose the functional system of delivering care to improve quality, achieve desired outcomes, and enhance the patient care experience. Given the macroeconomic nature of the impact of patient satisfaction scores on hospital reimbursement, the challenge for healthcare organizations is to improve quality and service delivery through an ongoing process of innovation, restructuring systems and processes, and implementation of aligned standardized service behaviors to increase patient satisfaction and enhance clinical outcomes. Hospitals under the current healthcare landscape are rewarded for the quality of care provided; thus, better outcomes indicate hospitals’ financial viability (Centers for Medicare and Medicaid Services, 2018).Managing service delivery across a highly divergent and fast-paced healthcare system requires sharp focus on execution and standardized operational excellence. Continuous quality improvement (CQI) has been shown to be a powerful tool to help make health care organizations more effective. CQI is a structured system for creating organization-wide participation and partnership in planning and implementing continuous improvement methods to understand, meet, or exceed patient needs and expectations. Developing a culture of excellence and quality in care can create an enthusiasm for change, passion for results, and drive for innovation equating to better service to healthcare consumers and better patient satisfaction scores.
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Noyes, Katia, John R. T. Monson, Irfan Rizvi, Ann Savastano, James S. A. Green, and Nick Sevdalis. "Regional Multiteam Systems in Cancer Care Delivery." Journal of Oncology Practice 12, no. 11 (November 2016): 1059–66. http://dx.doi.org/10.1200/jop.2016.013896.
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Teamwork is essential for addressing many of the challenges that arise in the coordination and delivery of cancer care, especially for the problems that are presented by patients who cross geographic boundaries and enter and exit multiple health care systems at various times during their cancer care journeys. The problem of coordinating the care of patients with cancer is further complicated by the growing number of treatment options and modalities, incompatibilities among the vast variety of technology platforms that have recently been adopted by the health care industry, and competing and misaligned incentives for providers and systems. Here we examine the issue of regional care coordination in cancer through the prism of a real patient journey. This article will synthesize and elaborate on existing knowledge about coordination approaches for complex systems, in particular, in general and cancer care multidisciplinary teams; define elements of coordination derived from organizational psychology and human factors research that are applicable to team-based cancer care delivery; and suggest approaches for improving multidisciplinary team coordination in regional cancer care delivery and avenues for future research. The phenomenon of the mobile, multisystem patient represents a growing challenge in cancer care. Paradoxically, development of high-quality, high-volume centers of excellence and the ease of virtual communication and data sharing by using electronic medical records have introduced significant barriers to effective team-based cancer care. These challenges urgently require solutions.
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Poncelet, Ann, and J. Hudson. "Student Continuity with Patients: A System Delivery Innovation to Benefit Patient Care and Learning (Continuity Patient Benefit)." Healthcare 3, no. 3 (July 22, 2015): 607–18. http://dx.doi.org/10.3390/healthcare3030607.
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Gianchandani, Erwin P. "Toward Smarter Health and Well-Being: An Implicit Role for Networking and Information Technology." Journal of Information Technology 26, no. 2 (June 2011): 120–28. http://dx.doi.org/10.1057/jit.2011.5.
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The number of people afflicted with chronic illnesses such as obesity, cancer, and diabetes has soared in recent years, generating new kinds of disparate medical challenges. In turn, these challenges have resulted in skyrocketing costs, preventable deaths, and medical malpractice claims. For example, studies have found nearly half of all US patients receive inadequate care each year, over 2 million are harmed by hospital-acquired infections, and over 1 million suffer disabling complications during surgery – even though half of these are thought to be avoidable. These challenges have catalyzed the beginning of a transformation in care delivery, from a health-care system that focuses on disease to one that must look after patients – including individuals and communities. To provide proper treatment to those who are chronically ill, the health-care system has to support improved individuals’ health-related practices prior to the manifestation of disease; ensure that a range of practitioners can deliver quality clinical care during the onset of an illness; and facilitate patient-provider-family partnerships during post-disease wellness care. As we describe in this review, key advances in networking and information technologies – spanning patient monitoring, data visualization and decision making, robotics and computer vision for diagnosis and surgery, social networking for fostering community-based support systems, and so on – stand to drive forward these changes. Together with social scientists, systems engineers, medical practitioners, and computer scientists, information systems scholars can help alter the nature of care delivery well into the twenty-first century, ultimately contributing to a system that is much more safe, effective, reliable, and timely than it is today.
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Tenytska, Tetiana, Iuliia Myroshnychenko, and Ekaterine Lomia. "Conflict management system in health care." Health Economics and Management Review 1, no. 2 (2020): 61–69. http://dx.doi.org/10.21272/hem.2020.2-07.
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This article provides ways to improve the conflict management system in health care based on analyzing the causes of conflicts in a private medical institution. The authors considered the healthcare delivery process in the triad «health worker – patient – society». The study involved analyzing conflict causes in the health care system in the relationship between «health worker – patient» and «health worker – health worker». To determine the conflict causes in private medical institutions and ways to minimize them, the authors used questionnaire data collection, interviewing technique, data analysis, and graphic approach. The study object is medical staff and patients of SILMED Diagnostic Medical Center in Ukraine. The findings identified the main problems in the organization of the conflict management system. Therefore, the essence of conflict situations arising in a medical institution was determined. The obtained results allowed formulating proposals to improve the conflict management system of the private medical institution. Thus, the authors emphasized that the conflict management system in private medicine should minimize the probability of conflict, focus on the treatment quality and the service price. Besides, it should include the development of moral codes for doctors in private medical institutions. The authors noted that to reduce conflict in the relationship «medical worker – medical worker», conflict prevention is more effective than constructive resolution. Thus, conflict prevention requires less effort, resources, and time for a successful clinic operation. To decrease conflicts in the relationship «health worker – patient», it is essential to make a pact between the patient and private medical institution. It establishes the patient’s relationship with the clinic and is publicly available for customers. In the study, the authors concluded that during the consultation, the healthcare professional should persuade the patient to follow all recommendations for maintaining or improving the patient’s health, requiring, if necessary, evidence from the clinic’s patients to follow the treatment protocol.
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Tawfik, Bernard, Shoshana Adler Jaffe, Jamina Oomen-Hajagos, Lisa Mohler, Inigo San Gil, Miria Adler Kano, Shawnia R. Ryan, et al. "Streamlining survivorship care plan (SCP) creation and delivery to primary care providers in poor, rural, and minority patients." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e24181-e24181. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e24181.
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e24181 Background: The number of cancer survivors is rapidly climbing due to increased screening and improved treatment. Survivorship Care Plans (SCPS) summarize the patients’ treatment and is a communication tool between oncologists and primary care physicians (PCP)s. Creation and delivery of the SCPs has been labor intensive and costly for many healthcare systems and a previous paper based system at our institution was ineffective. The University of New Mexico Comprehensive Cancer Center (UNMCCC) treats a unique population of lower socioeconomic status (SES) (poverty rate 19.7%), rural (22.6%) and minority (Native Americans and Hispanics constitute 10.4% and 48% of the population respectively) patients in a large rural state. Methods: Beginning March 2019, UNMCCC initiated a process for creation and delivery of SCPs through the Electronic Medical Record (EMR). EMRs are not designed to delivery SCPs to patients and PCPs, so EMR functions were creatively repurposed. Upon identification of eligible patients, providers would place an electronic SCP order through the EMR. Designated staff then partially completes the SCPs based on medical record review while the EMR imports demographics, PCP, cancer and stage. Then the EMR flags SCPs ready for delivery and the provider edits, approves and prints the SCP for the patient at the next encounter. Once printed, the EMR alerts medical records to send the SCP to the PCP via mail or EMR routing. Results: 282 SCPs were ordered, 222 (78.7%) were created and 86 (38.7%) given to patients after definitive therapy of Breast (77.9%), Colorectal (7.0%), Gynecological (9.3%) and Prostate Cancer (5.8%). Of 72 SCPs eligible to be sent to PCPs, 48 (66.7%) were successfully mailed or sent via EMR, 13 (18.1%) had PCP discrepancies, 6 (8.3%) had no PCP and 5 (6.9%) had PCPs in systems which do not accept unsolicited records. Conclusions: The UNMCCC cares for low SES, rural and minority patients and was able to create and deliver SCPs to a significant number of patients and PCPs. Future process steps will involve creating tailored SCPs for other diagnoses, resolving PCP discrepancy issues and creating an EMR alert for PCPs when they receive an SCP. Additionally, assessment of both patient and PCP perceptions is ongoing.
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Ojesanmi, O. A., S. O. Ojesanmi, B. Akinnuwesi, and M. Odim. "A Framework for Deployment of 3g Wireless Network and Mobile Agent in Health Care Delivery System." International Journal of Agent Technologies and Systems 2, no. 4 (October 2010): 10–16. http://dx.doi.org/10.4018/jats.2010100102.
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The extent of the AIDS crisis is becoming clear in many African countries, as increasing numbers of people with HIV are becoming ill. The technology of mobile phones has brought ubiquitous access to information coupled with software agents and health care delivery systems in hospitals. It enables patient-physician contact to be more frequent. Such an environment can provide personalized monitoring services to patients and decision support to physicians, as well as maintenance for cost control. This paper proposes the deployment of 3G wireless technology with mobile agents for health care delivery to HIV/AIDS patients. Patient, nurse and physician are the agents in the proposed system. Each agent uses a mobile phone to communicate with the server anywhere at any time without restrictions. The system employs the mobility, flexibility and autonomous characteristics of mobile agents to monitor patients. The system has the ability to provide fast and reliable assistance to the patients.
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Kuperberg, Karen, Diana Mager, and Susan Dello. "Transformation to Room Service Food Delivery In a Pediatric Health Care Facility." Canadian Journal of Dietetic Practice and Research 70, no. 4 (December 2009): 200–203. http://dx.doi.org/10.3148/70.4.2009.200.
Full textAbstract:
Patient food service is an important component in the nutritional management of hospitalized children. The previous meal delivery system at The Hospital for Sick Children in Toronto was a cold-plating re-thermalized system. Issues related to this model included order lead time, the reheating process, menu selection, and service style. Research into other systems led us toward room service, an innovative and flexible mode of meal delivery. Transformation to room service occurred over one year, and included implementation of a new computer system, kitchen renovation, redesign of menus and a new meal delivery system called Meal Train, and changes to human resource allocations. Throughout the transformation, consultations were held with key stakeholders, including the children’s council, the family advisory, the nursing council, and a multidisciplinary committee involving nursing staff, dietitians, patient service aides, infection control personnel, occupational health employees, patient representatives, and food services staff. Now, Meal Train is running smoothly, and meal days and food costs have been reduced. Others considering a project like this must know their clients’ needs and be willing to think outside the box. They should familiarize themselves with current information on systems and equipment, consult with key stakeholders within their organization, and then create the system that will work for them.