How Registries Can Help Performance Measurement Improve Care

Suggests ways to better utilize databases of clinical information to evaluate care processes and outcomes and improve measurements of healthcare quality and costs, comparative clinical effectiveness research, and medical product safety surveillance

Practice transformations to optimize the delivery of HIV primary care in community healthcare settings in the United States: A program implementation study.

BackgroundThe United States HIV care workforce is shrinking, which could complicate service delivery to people living with HIV (PLWH). In this study, we examined the impact of practice transformations, defined as efficiencies in structures and delivery of care, on demonstration project sites within the Workforce Capacity Building Initiative, a Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program Special Projects of National Significance (SPNS).Methods and findingsData were collected at 14 demonstration project sites in 7 states and the District of Columbia. Organizational assessments were completed at sites once before and 4 times after implementation. They captured 3 transformation approaches: maximizing the HIV care workforce (efforts to increase the number of existing healthcare workforce members involved in the care of PLWH), share-the-care (team-based care giving more responsibility to midlevel providers and staff), and enhancing client engagement in primary HIV care to reduce emergency and inpatient care (e.g., care coordination). We also obtained Ryan White HIV/AIDS Program Services Reports (RSRs) from sites for calendar years (CYs) 2014-2016, corresponding to before, during, and after transformation. The RSR include data on client retention in HIV care, prescription of antiretroviral therapy (ART), and viral suppression. We used generalized estimating equation (GEE) models to analyze changes among sites implementing each practice transformation approach. The demonstration projects had a mean of 18.5 prescribing providers (SD = 23.5). They reported data on more than 13,500 clients per year (mean = 969/site, SD = 1,351). Demographic characteristics remained similar over time. In 2014, a majority of clients were male (71% versus 28% female and 0.2% transgender), with a mean age of 47 (interquartile range [IQR] 37-54). Racial/ethnic characteristics (48% African American, 31% Hispanic/Latino, 14% white) and HIV risk varied (31% men who have sex with men; 31% heterosexual men and women; 7% injection drug use). A substantial minority was on Medicaid (41%). Across sites, there was significant uptake in practices consistent with maximizing the HIV care workforce (18% increase, p < 0.001), share-the-care (25% increase, p < 0.001), and facilitating patient engagement in HIV primary care (13% increase, p < 0.001). There were also significant improvements over time in retention in HIV care (adjusted odds ratio [aOR] = 1.03; 95% confidence interval [CI] 1.02-1.04; p < 0.001), ART prescription levels (aOR = 1.01; 95% CI 1.00-1.01; p < 0.001), and viral suppression (aOR = 1.03; 95% CI 1.02-1.04; p < 0.001). All outcomes improved at sites that implemented transformations to maximize the HIV care workforce or improve client engagement. At sites that implemented share-the-care practices, only retention in care and viral suppression outcomes improved. Study limitations included use of demonstration project sites funded by the Ryan White HIV/AIDS Program (RWHAP), which tend to have better HIV outcomes than other US clinics; varying practice transformation designs; lack of a true control condition; and a potential Hawthorne effect because site teams were aware of the evaluation.ConclusionsIn this study, we found that practice transformations are a potential strategy for addressing anticipated workforce challenges among those providing care to PLWH. They hold the promise of optimizing the use of personnel and ensuring the delivery of care to all in need while potentially enhancing HIV care continuum outcomes

Developing a Functional Measure Across the Continuum of Post-Acute Care

This dissertation proposed to establish a post-acute care continuum measurement system by creating an item bank that linked existing instruments. We linked two instruments measuring physical activities of daily living in the Veterans healthcare system, Functional Independence Measure which is used in Inpatient Rehabilitation Facilities and the Minimum Data Set which is used in the Community Living Centers. The objectives included: (a) creating an IRT-based item bank, (b) creating IRT-based short forms from the item bank, (c) comparing measurement precision of converted scores from varied FIMTM and MDS forms, and (d) comparing accuracy of the varied forms in generating functional related groups (FRG). We found measurement precision and accuracy decreased as the number of item decreased. FIM short forms (SFs) had similar precision and better accuracy than MDS SFs. The MDS_13-item form had acceptable precision and accuracy for generating FRGs, supporting developing a continuity measurement by linking existing instruments

Private Enterprise for Public Health: Opportunities for Business to Improve Women's and Children's Health

This guide, developed by FSG and published by the Innovation Working Group in support of the global Every Woman, Every Child effort, explores how companies can create shared value in women's and children's health. The document sets out opportunities for multiple different industries to develop new product and services, improve delivery systems and strengthen health systems that can support global efforts to save 16 million women's and children's lives between now and 2015. It particularly notes that companies need not wait for health services to "catch up" with their economic model, but rather they can work proactively to help accelerate change, by partnering with other industries, civil society and the public sector to create collective impact in a specific location. The aim of the guide is to catalyze these transformative partnerships

Moving Care to the Community: An International Perspective

Medical treatments that were once provided in hospital are being increasingly administered in the community. Within health systems, there is a renewed focus on delivering general health care in the community, freeing hospitals to provide more complex, specialised and emergency care. As the drive to shift specialised and non-specialised care out of hospital gathers momentum, there is a greater demand for a skilled and competent community nursing workforce to facilitate this shift at a local level. Nurses are essential in the delivery of continuous care as they often serve as an interface between acute and community care, focusing on prevention, self- management and providing support to transition patients smoothly across the health and social care services.Moving care to the community has been a UK-wide health and social care policy priority for more than a decade. However, progress has been slow and in some cases fragmented. In order to address the issue, it is important to first review where this shift has been implemented and which lessons can be learned from international experiences. The RCN is committed to working closely with its equivalent nursing organisations overseas to learn from international best practices and incorporate some of this learning to shape health and social care policy in the UK, and more specifically promote good nursing practice. This report will focus on system-wide or sector specific reforms in Australia, Canada, Sweden, Norway and Denmark as these countries have at one point or another addressed the need todeliver care outside of hospitals, either in patients' homes, GP clinics, community-basedcentres or care home settings

Crafting a System of Profound Knowledge Management in Long-Term Care

The paradigm shift to a knowledge economy, predicted by Drucker, is currently reflected in a knowing-to-doing gap in healthcare, potentially threatening the lives of long-term care (LTC) residents and sustainability of LTC organizations. The purpose of this grounded theory study was to seek a substantive conceptual theory to explain how LTC uses knowledge management (KM) to improve performance by probing the a priori views and lived experiences of 11 LTC knowledge creators, managers, and users. Data were collected via semi structured interviews that were transcribed and coded. The research questions guided by the conceptual concentrated on how KM is used in LTC, what KM processes enhance or inhibit performance in LTC, the nature of knowledge in LTC, and the potential impact of Deming\u27s theory of profound knowledge on KM in LTC. Data analysis included coding, categorizing, constant comparison, conceptualizing, and theorizing to reveal a tentative unified theory of crafting a system of KM in LTC that theoretically extends Deming\u27s organizational theory of profound knowledge to integrate the individual knower within Deming\u27s organizational perspectives. Findings included participant use of sentinel data and bridging decisions in response to emergent knowledge needs, risk management versus quality management performance drivers, and participant perceptions of resource dependence in response to emergent knowledge needs. Findings also include social change implications for LTC facilities, residents, and staff driven by systematic KM to facilitate clinical best practices, lessons learned, and resourcing the use of knowledge to enhance LTC performance capabilities. Study conclusions include a call for future research related to study findings across the healthcare continuum

How to use the International Classification of Functioning, Disability and Health as a reference system for comparative evaluation and standardized reporting of rehabilitation interventions

Rehabilitation aims to optimize functioning of persons experiencing functioning limitations. As such the comparative evaluation of rehabilitation interventions relies on the analysis of the differences between the change in patient functioning after a specific rehabilitation intervention versus the change following another intervention. A robust health information reference system that can facilitate the comparative evaluation of changes in functioning in rehabilitation studies and the standardized reporting of rehabilitation interventions is the International Classification of Functioning, Disability and Health (ICF). The objective of this paper is to present recommendations that Cochrane Rehabilitation could adopt for using the ICF in rehabilitation studies by: 1) defining the functioning categories to be included in a rehabilitation study; 2) specifying selected functioning categories and selecting suitable data collection instruments; 3) examining aspects of functioning that have been documented in a study; 4) reporting functioning data collected with various data collection instruments; and 5) communicating results in an accessible, meaningful and easily understandable way. The authors provide examples of concrete studies that underscore these recommendations, whereby also em-phasizing the need for future research on the implementation of specific recommendations, e.g. in meta-analysis in systematic literature reviews. Furthermore, the paper outlines how the ICF can complement or be integrated in established Cochrane and rehabilitation research structures and methods, e.g. use of standard mean difference to compare cross-study data collected using different measures, in developing core outcome sets for rehabilitation, and the use of the PICO model. © 2019 EDIZIONI MINERVA MEDICA