Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

A case study in open source innovation: developing the Tidepool Platform for interoperability in type 1 diabetes management.

OBJECTIVE:Develop a device-agnostic cloud platform to host diabetes device data and catalyze an ecosystem of software innovation for type 1 diabetes (T1D) management. MATERIALS AND METHODS:An interdisciplinary team decided to establish a nonprofit company, Tidepool, and build open-source software. RESULTS:Through a user-centered design process, the authors created a software platform, the Tidepool Platform, to upload and host T1D device data in an integrated, device-agnostic fashion, as well as an application ("app"), Blip, to visualize the data. Tidepool's software utilizes the principles of modular components, modern web design including REST APIs and JavaScript, cloud computing, agile development methodology, and robust privacy and security. DISCUSSION:By consolidating the currently scattered and siloed T1D device data ecosystem into one open platform, Tidepool can improve access to the data and enable new possibilities and efficiencies in T1D clinical care and research. The Tidepool Platform decouples diabetes apps from diabetes devices, allowing software developers to build innovative apps without requiring them to design a unique back-end (e.g., database and security) or unique ways of ingesting device data. It allows people with T1D to choose to use any preferred app regardless of which device(s) they use. CONCLUSION:The authors believe that the Tidepool Platform can solve two current problems in the T1D device landscape: 1) limited access to T1D device data and 2) poor interoperability of data from different devices. If proven effective, Tidepool's open source, cloud model for health data interoperability is applicable to other healthcare use cases

State Strategies to Improve Quality and Efficiency: Making the Most of Opportunities in National Health Reform

Examines ten states' initiatives to address key components of quality and efficiency improvement, including data collection, aggregation, and standardization; public reporting; payment reform; consumer engagement; and provider engagement

Sharing Resources: Opportunities for Smaller Primary Care Practices to Increase Their Capacity for Patient Care

Outlines findings linking shared resources with use of health information technology, care coordination, self-management, and quality monitoring, and strategies to increase resources among small and midsize practices by expanding shared resource models

Realizing Health Reform's Potential: How the Affordable Care Act Will Strengthen Primary Care and Benefit Patients, Providers, and Payers

Examines issues in primary care and outlines the 2010 healthcare reform law's provisions to strengthen it, including temporary hikes in Medicare and Medicaid payments and support for innovations in care delivery and primary care workforce development

Pressure Ulcer Prevention System

Pressure ulcers, also known as bedsores, are a widespread but often understated problem. A pressure ulcer is an injury that develops with constant pressure on an area of skin for a long time. They range from bruises to open wounds to even exposed bone. These injuries especially impact bedridden and elderly hospital inpatients, since these people must depend on nursing staff for mobility. Pressure ulcers can seem to be a solved problem. Solutions that completely eliminate pressure ulcers do exist. These solutions, however, are too expensive for widespread use, at thousands of dollars per bed. Other solutions, such as relying on nursing staff to move all patients is not reliable, and nurses develop chronic back pain from the strain of moving so many patients so often. The Pressure Ulcer Prevention System is designed specifically to be an affordable solution for these injuries in a hospital or assisted living setting. The system collects data from a gyroscopic sensor and multiple pressure sensors mounted on the patient, and sends an alert to the nurses’ station if a patient is at risk of developing a pressure ulcer, and needs attending. The system does not replace nurse care, nor does it change the most common solution of manually moving patients, but it instead helps nursing staff be more efficient

Development of a Self‐Management Theory‐Guided Discharge Intervention for Parents of Hospitalized Children

Background Parents of hospitalized children, especially parents of children with complex and chronic health conditions, report not being adequately prepared for self‐management of their child\u27s care at home after discharge. Problem No theory‐based discharge intervention exists to guide pediatric nurses\u27 preparation of parents for discharge. Purpose To develop a theory‐based conversation guide to optimize nurses\u27 preparation of parents for discharge and self‐management of their child at home following hospitalization. Methods Two frameworks and one method influenced the development of the intervention: the Individual and Family Self‐Management Theory, Tanner\u27s Model of Clinical Judgment, and the Teach‐Back method. A team of nurse scientists, nursing leaders, nurse administrators, and clinical nurses developed and field tested the electronic version of a nine‐domain conversation guide for use in acute care pediatric hospitals. Conclusions The theory‐based intervention operationalized self‐management concepts, added components of nursing clinical judgment, and integrated the Teach‐Back method. Clinical Relevance Development of a theory‐based intervention, the translation of theoretical knowledge to clinical innovation, is an important step toward testing the effectiveness of the theory in guiding clinical practice. Clinical nurses will establish the practice relevance through future use and refinement of the intervention