10,449 research outputs found

    HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996: Health & Public Welfare

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    The Standards for Privacy of Individually Identifiable Health Information (“Privacy Rule”) establish a standard for the use and protection of individuals’ health information and apply to certain covered entities or their business associates. Covered entities may only disclose an individual’s protected health information in limited situations. Covered entities or individuals that fail to comply with the Privacy Rule standards may be subject to civil or criminal penalties

    Quality Improvement Initiative to Reduce Fall Risk in the SNF

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    Residents who fall in SNF either sustain significant decline to quality of life or die from their injuries. The average fall costs about $34,000 per incident. On average, 19.8% of residents fall at least once per month. The purpose of this project was to assess, identify, and advance nursing practice to decrease falls by evaluating current facility standard of practice, fall policy, procedures, and protocol. The objective was to create actions that would close the communication gap between clinicians and residents. This project encourages clinicians to intertwine resident feedback and strategies into the plan of care to help reduce fall risk. A focus group was conducted with 11 residents with previous fall experience. Through structured discussion, several important gaps in communication related to residents\u27 plan of care were identified. Examples identified include, 10 of 11 residents indicated they were never asked to participate in their plan of care, 10 of 11 residents indicated staff did not listen to them, and 11 of 11 stated they did not know they could change the plan of care that staff had put in place. Further feedback from the focus group demonstrated residents desire to be involved in their care however, they were largely excluded from this process in the past. This project contributes to positive social change by identifying ways to close the communication gaps and reduce risk for falls by intertwining clinician and resident fall practices. A highly recommended fall committee was established at the project facility to encourage staff buy in, advancement of nursing practice and resident involvement in reducing falls

    Healthcare Management Primer

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    This primer was written by students enrolled in HMP 721.01, Management of Health Care Organizations, in the Health Management & Policy Program, College of Health and Human Services, University of New Hampshire. This course was taught by Professor Mark Bonica in Fall 2017

    Evidence-Based Approaches to Lowering UTI Rates in Skilled Nursing Facilities: A Review of the Literature and Application to a Local Skilled Nursing Home

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    The purpose of this paper may be divided into two parts. The first part was a literature review that sought to determine the most common risk factors for developing a urinary tract infection in nursing homes, as well as to identify evidence-based practice interventions for decreasing UTI rates within that specific patient population. The second part consisted of a case study that sought to apply the principles gathered from the literature review to the UTI logs of a deidentified local nursing home. It was found that indwelling urinary catheters and age are the two most common precipitating risk factors for developing a UTI. In addition, prevalence of other risk factors is dependent on the specific qualities of each nursing home and their patients. Thus, initial interventions should begin with an extensive root cause analysis. Front-line staff should also be involved in the initiation and maintenance of any interventions. In terms of the case study, many of the principles identified in the literature review were found to be present in the participating nursing home. It was also found that the nursing home’s rehabilitation hall had a statistically significant higher mean number of UTI cases in comparison to the long-term hall. A root cause questionnaire was designed and provided to the nursing home in order to address this trend

    Transitional Care Medical House Call: A Pilot Project

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    Problem Description: Vulnerable, homebound older adults are highly susceptible to unplanned 30-day hospital readmissions, which is costly for the healthcare system. As a result, health care expenditures for this population continue to rise. Studies have shown that transition of care programs, when complemented with home-based primary care delivery, may improve health care outcomes for this population. Purpose: The purpose of this quality improvement pilot project was to implement medical house calls as a component of transitional care management (TCM) and measure patient outcomes such as unplanned 30-day readmission rates and correlate predictors of readmission. As a secondary outcome, the project explored, tracked, and later analyzed point-of-care concerns during medical house call visits, which were conducted by a provider with prescriptive authority, a nurse practitioner (NP). Interventions: Medicare beneficiaries, 65 years and older, who were discharged from skilled nursing facilities (SNFs) to home were identified by convenience sampling through referral and offered a home visit by an NP. Before discharge, patients’ acuity was assessed, and a LACE Index score was assigned. Unplanned 30-day readmissions to the hospital were measured and correlated to point-of-care conditions found during medical house call visits: number of days to see patients; common distribution of LACE Index scores; number of medications (polypharmacy) before and after visits; prescriptions required; comorbidities; and time to primary care provider (PCP) visits. Results: A total of 145 patients were seen by the NP. LACE Index scores ranged from 11-15 (M = 12.6; SD = 2.9). The readmission rate was 19.2%, which was higher than the benchmark, 18.5%; however, the patients’ LACE Index scores indicated high acuity. Most patients experienced two comorbidities, with hypertension being the most common. Regression analysis showed that heart failure was a significant predictor of unplanned 30-day hospital readmissions. Heart failure patients were 5 times more likely to be readmitted than patients with other comorbidities. Medications were reduced after medication reconciliation from 17 to 11, which was statistically significant (z = -7.497, p \u3c .001). Almost half of the patients required prescriptions during the visit, and more than half were unable to see their PCP for 14 days or more. Interpretation: This project has shown that older adults discharged from a higher level of care can benefit from TCM through medical house calls by an NP within 14 days after discharge. Visits significantly reduced polypharmacy, provided a way to get prescriptions that would otherwise be unobtainable from a PCP for 14 days or more after discharge, and managed high readmission risks. Conclusion: Further study of system redesign and policy change that affect care delivery by NPs in care transitions is highly recommended

    Meeting Joint Commission Compliance by Improving the Chart Audit Process

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    A hospice and home health care agency with an estimated 300 current patients looking to gain Joint Commission accreditation tasked its quality improvement department with identifying and improving deficiencies in the nursing documentation of patients’ charts. In order to do so, a redesign of their current chart auditing system needed to occur to take the process from pen and paper to an electronic database where the data gathered from the audit could be disseminated. The quality improvement team focused on ensuring that the new electronic process was user-friendly, encompassed all the quality areas needed, and allowed charts to be reviewed more quickly. Once the electronic audit was implemented, preliminary surveys showed that nurses were pleased with the new program and the time needed to complete the audit decreased from 45 minutes to 20 minutes. The hospice and home health care agency expects to gain Joint Commission accreditation once the changes are firmly in place

    Health departments : Interim guidance on developing a COVID-19 case Investigation & contact tracing plan

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    This interim guidance document is intended to assist state, local, territorial and tribal health departments develop jurisdictional plans for the implementation and enhancement of COVID-19 case investigation and contact tracing efforts.cdc.gov/coronavirusCS317074-A June 1, 2020 8:55 PMcase-investigation-contact-tracing.pdfI. Introduction-- II. Scaling up Staffing Roles Involved in Case Investigation & Contact Tracing-- III. When to Initiate Case Investigation & Contact Tracing Activities-- IV. Investigating a COVID-19 Case-- V. Contact Tracing for COVID-19-- VI. Outbreaks-- VII. Special Considerations .-- VIII. Building Community Support-- IX. Data Management-- X. Evaluating Success-- XI. Confidentiality and Consent-- XII. Support Services to Consider-- XIII. Digital Contact Tracing Tools-- XIV. Resources-- Appendix A\u2014Glossary of Key Terms . -- Appendix B\u2014Tips for Locating COVID-1 Cases and Contacts-- Appendix C\u2014Data Elements for Case Investigation and Contact Tracing Forms-- Appendix D\u2014Tool for Estimating the Number of Contact Tracers Needed -- Parameter values used for high and low estimates.2020775

    Value Based Healthcare: The Missing Formula for Quality Patient Care

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    Value Based Care is driving the need to balance value with cost. Health care organizations must address the value component as part of the patient care experience. Reimbursements to physicians and healthcare organizations are the focus on delivering value care to the patient while keeping costs down for the insurance company and overhead for the organizations. Health care providers face challenges on how to connect ethics, patient safety, and decision making to quality of care for each individual patient. Insurance companies are looking at the volume of people, how many episodes of care for each condition, how many providers for each separate condition, and finding the lowest cost for highest quality of care the patient can experience. Creating, testing and implementing new policies and procedures is what the leading insurance companies are currently doing to make Value Based Care a reality in the United States Healthcare System. This paper will focus on the integration of value, cost, and customer satisfaction with patient care delivery
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