Development of a Patient-Centered Medical Home Toolkit at an Integrated Primary Care Clinic

Health care spending in the United States far exceeds that of other high-income countries (Squires & Anderson, 2015). In 2013, the U.S. spent 17.1 percent of its gross domestic product (GDP) on healthcare, which was almost 50 percent more than the next highest spender noted as France (Squires & Anderson, 2015). While the U.S. spends more on healthcare than other countries, multiple other health outcome measures are worse including life expectancy, heart disease, diabetes, and chronic respiratory illnesses (Squires & Anderson, 2015). Today’s healthcare system is highly fragmented, lacking the necessary coordination within the primary care setting. Better care coordination may ultimately improve patient care, lower costs, and increase patient satisfaction in health care. In order to address the complex nature of health care there have been multiple models introduced. One model is the Patient-Centered Medical Home (PCMH) with the goal of reforming the healthcare system. For this scholarly project, a quality improvement project was implemented at an integrated primary care clinic currently PCMH recognized where the PCMH documentation practices of the staff have diminished putting the clinic’s re-recognition at risk. The purpose of this project was to develop a PCMH toolkit to improve the staff knowledge and documentation compliance regarding PCMH. To address the lack of documentation, a toolkit was developed. A survey consisting of 10 Likert-style items was given to all staff members prior to the development of the toolkit to evaluate the level of knowledge about PCMH and associated documentation. A chart audit was conducted to assess the current documentation compliance for PCMH prior to development of the toolkit to guide the focus of the toolkit and educational intervention. The PCMH toolkit was developed to include useful information for staff to utilize during documentation practices based on the results of the initial surveys and chart audit. ThePCMH toolkit also included information for the future PCMH standard requirements and the crosswalk between the current and future standards. Once the toolkit was assembled, the staff were then educated on its contents and how to utilize the toolkit. After a two-week period of time, the staff were given post-intervention questionnaires to assess for changes in knowledge and a post-intervention chart audit was performed to assess documentation compliance. Donabedian model served as a conceptual model to frame the formal quality improvement project exploring staff knowledge and practice about PCMH and required documentation. The Plan-Do-Study-Act model served as an implementation guide for educating staff about PCMH and required documentation as well as developing a PCMH toolkit. Findings suggested that education and training on PCMH and associated required documentation may increase the knowledge of staff members. This may contribute to an increase in successful Patient Centered Medical Home implementation. Limitations of the project included the brief evaluation period and a continued incomplete staffing structure. Recommendations for sustainability and future iterations of the toolkit involve further investigation of the documentation process and identification of effective staffing roles and responsibilities once the staff is up to full capacity with a nursing supervisor in place. The formalization of the quality improvement project in the integrated primary care clinic during the PDSA cycle provided a strong foundation from which to build subsequent PDSA cycles focusing on improved documentation practices

Shaping the future for primary care education & training project. Education and training needs analysis (ETNA) toolkit: a resource kit and users’ guide

The Education and Training Needs Analysis (ETNA) Toolkit that has been developed as part of an inter university collaboration in the North West of England entitled the ‘Shaping the Future for Primary Care Education and Training’ project. The tool has been developed by the University of Bolton and Lancaster University in collaboration with key stakeholders including representatives from Primary Care Trusts and Social Services across the North Wes

Development and formative evaluation of the e-Health implementation toolkit

<b>Background</b> The use of Information and Communication Technology (ICT) or e-Health is seen as essential for a modern, cost-effective health service. However, there are well documented problems with implementation of e-Health initiatives, despite the existence of a great deal of research into how best to implement e-Health (an example of the gap between research and practice). This paper reports on the development and formative evaluation of an e-Health Implementation Toolkit (e-HIT) which aims to summarise and synthesise new and existing research on implementation of e-Health initiatives, and present it to senior managers in a user-friendly format.<p></p> <b>Results</b> The content of the e-HIT was derived by combining data from a systematic review of reviews of barriers and facilitators to implementation of e-Health initiatives with qualitative data derived from interviews of "implementers", that is people who had been charged with implementing an e-Health initiative. These data were summarised, synthesised and combined with the constructs from the Normalisation Process Model. The software for the toolkit was developed by a commercial company (RocketScience). Formative evaluation was undertaken by obtaining user feedback. There are three components to the toolkit - a section on background and instructions for use aimed at novice users; the toolkit itself; and the report generated by completing the toolkit. It is available to download from http://www.ucl.ac.uk/pcph/research/ehealth/documents/e-HIT.xls<p></p> <b>Conclusions</b> The e-HIT shows potential as a tool for enhancing future e-Health implementations. Further work is needed to make it fully web-enabled, and to determine its predictive potential for future implementations

Use of Antipsychotic Medications in Individuals With Alzheimer\u27s Disease in Nursing Facilities

Patients with Alzheimer\u27s disease or other types of dementia often require long-term care in nursing facilities (NF) where they may display out-of-character behaviors complicating their care. While antipsychotic medications are sometimes prescribed for NF residents, their use is considered inappropriate for the control of dementia behaviors. The Centers for Medicare and Medicaid Services have rated Texas the worst state in the country for the inappropriate use of antipsychotic medications for NF residents with dementia. This project was guided by the star model of knowledge transformation with the goal to reduce inappropriate use of antipsychotic medications through NF staff education. The purpose of this project was to develop an educational program for nurses, direct care staff, pharmacists, and prescribers regarding appropriate use of antipsychotic medications, reduction efforts, alternative non pharmacological interventions, and an associated toolkit of educational resources. The program development was accomplished in conjunction with a team of local experts who provided process evaluation regarding their satisfaction with the planning process through the completion of an anonymous, 10-question, Likert-type survey. All participants scored their results with a (5) strongly agree or (4) agree. A descriptive analysis of the survey data provided information that positively supported the development of the project. At the end of the project, the education program and resources were delivered to the Texas Health and Human Services Commission, with a plan for later implementation and outcome evaluation. This project has the potential to achieve positive social change through reducing the numbers of Texan NF residents with dementia who are inappropriately prescribed antipsychotic medications, which will result in an increase in their quality of life

Globe: All Ireland Programme for Immigrant Parents: Final Evaluation Report

In 2007, the Child and Family Research Centre, NUI Galway, was commissioned by the PMC to evaluate Globe: All Ireland Programme for Immigrant Parents. From 2007 - 2009 a number of interim evaluation reports were submitted to the PMC on the development phase of the project and its resources. In 2009, following the extension of the project, the objectives of the evaluation were revised. These objectives, which underpin this final evaluation report, are as follows:Examine and assess the pilot phase;Examine and assess the uptake and use of the Information Packs by parents and practitioners;Examine and assess the partnership working and development on a multi-sectoral and crossborder basis of the PMC, and more generally in meeting the needs of immigrant parents;Examine and assess the mainstreaming of learning and good practice; andExamine and assess the training/awareness raising and support of practitioners in delivering the programme

Charting Complex Changes: Application of the eHealth Implementation Toolkit (e-HIT) in the Delivering Assisted Living Lifestyles at Scale (dallas) Programme

The 'dallas' (Delivering Assisted Living Lifestyles at Scale) programme is a UK-wide digital healthcare initiative that has been designed to support independent living, enhance preventative care, and improve lifestyles by harnessing the potential of e-health technologies and digital services. This short paper presents a brief update on one strand of the University of Glasgow evaluation of the dallas programme. We have used the e-Health Implementation Toolkit (e-HIT) to investigate processes involved in the implementation of e-health tools and digital services being developed and deployed across the dallas communities and to assess 'distance travelled' by communities from baseline to midpoint of a three year programme. Qualitative data analysis was guided by the Normalisation Process Theory (NPT) and Framework Analysis. The e-HIT scores indicated that the dallas communities had underestimated the amount of work involved in implementing at scale. Qualitative data analysis showed that communities have successfully navigated barriers in order to make significant progress in strategic areas, including the development of new models of partnership working resulting in brand recognition and agile service design. The dallas communities are now sharing lessons learned and generating new professional knowledge, skills and understanding across several key strategic areas required for operationalising the implementation of e-health technologies and digital services at scale. The new knowledge being generated through the dallas programme will contribute to the ongoing transformation of digitally enabled healthcare based on more personalised flexible models of provision which resonates with the current e-health policy environment

Design of MARQUIS2: study protocol for a mentored implementation study of an evidence-based toolkit to improve patient safety through medication reconciliation.

BackgroundThe first Multi-center Medication Reconciliation Quality Improvement Study (MARQUIS1) demonstrated that implementation of a medication reconciliation best practices toolkit decreased total unintentional medication discrepancies in five hospitals. We sought to implement the MARQUIS toolkit in more diverse hospitals, incorporating lessons learned from MARQUIS1.MethodsMARQUIS2 is a pragmatic, mentored implementation QI study which collected clinical and implementation outcomes. Sites implemented a revised toolkit, which included interventions from these domains: 1) best possible medication history (BPMH)-taking; 2) discharge medication reconciliation and patient/caregiver counseling; 3) identifying and defining clinician roles and responsibilities; 4) risk stratification; 5) health information technology improvements; 6) improved access to medication sources; 7) identification and correction of real-time discrepancies; and, 8) stakeholder engagement. Eight hospitalists mentored the sites via one site visit and monthly phone calls over the 18-month intervention period. Each site's local QI team assessed opportunities to improve, implemented at least one of the 17 toolkit components, and accessed a variety of resources (e.g. implementation manual, webinars, and workshops). Outcomes to be assessed will include unintentional medication discrepancies per patient.DiscussionA mentored multi-center medication reconciliation QI initiative using a best practices toolkit was successfully implemented across 18 medical centers. The 18 participating sites varied in size, teaching status, location, and electronic health record (EHR) platform. We introduce barriers to implementation and lessons learned from MARQUIS1, such as the importance of utilizing dedicated, trained medication history takers, simple EHR solutions, clarifying roles and responsibilities, and the input of patients and families when improving medication reconciliation

Consumer Voices for Coverage: Advocacy Evaluation Toolkit

Offers step-by-step guidance on evaluating advocacy projects, including developing a logic model, collecting evaluation data, and using focus groups and interviews to evaluate or inform program performance. Includes surveys on RWJF's advocacy initiative

Applying a Multidimensional Strategy to Mitigate Lateral Violence in a Small Rural Community Hospital in Western New York

Providing registered nurses with education and strategies to mitigate lateral violence is an evidenced-based method for creating a culture of civility. A descriptive pilot study with registered nurses was conducted on two medical/surgical units at a small rural community hospital. Strategies included a review of organizational policies, a one-day educational retreat for unit managers and registered nurse champions, and an online educational toolkit on lateral violence for the staff nurses on the pilot units

A Faculty Development Workshop for High-Value Care Education Across Clinical Settings.

IntroductionDespite rising health care costs, trainees frequently do not receive formal high-value care (HVC) training. As medical education often occurs through informal learning, it is imperative that medical educators be prepared to teach HVC concepts across clinical settings.MethodsThis workshop was created to provide frameworks for teaching HVC across four pediatric educational settings: (1) case-based conferences, (2) inpatient rounding, (3) ambulatory visits, and (4) conversations with patients and families. Frameworks were developed based on literature review, content experts' knowledge, and internal assessment and feedback. The workshop was divided into two sections: a didactic overview of HVC education and interactive small-group sessions to practice application of the Toolkit for Teaching High-Value Care. At the end of the workshop, participants completed the Prescription for High-Value Care to create a personal action plan.ResultsThis workshop has been presented at both national and local pediatric conferences. From over 89 evaluations (83% response rate), participants felt the workshop met objectives, served as a valuable use of their time, and provided useful resources. Evaluations elicited specific actions that participants gleaned from workshop content along with proposed behavior changes, such as creating HVC case-based conferences at their home institution and initiating more value-based discussions.DiscussionThis workshop has been successfully presented in both national and local settings and has been well received by participants. The workshop is targeted for clinical educators and aims to address the gap in faculty development for HVC education