Developing Targeted Interventions to Advance Maternal Health in a Geographic Medicaid Accountable Care Organization: Lessons From the Implementation of Camden Delivers

Through the design and launch of Camden Delivers the Coalition developed targeted interventions within an ACO infrastructure to advance maternal health in a Medicaid-covered population. Key insights from this process include the need to:* Utilize data to understand community need and design interventions around that need* Establish a population health surveillance system to produce actionable data to intervene with a complex population* Institute a tiered intervention system targeted to identified need, and* Leverage and coordinate across existing resources in the community to reduce duplication.Going forward, with the infrastructure developed by the Coalition to collect and review health data, along with the intricate web of community partners and resources, the next step in this program is to enhance feedback loops between partners and to help navigate patients seamlessly between partners during the highly fragmented experience of managing a pregnancy and healthcare during the interconception period. A formal network of communication between patients, case workers, care managers, providers and community resources through more sophisticated use of data and convening will allow us to support vulnerable patients in an even more effective manner. The Coalition looks forward to playing this convener role and working across groups to the end of better care management services and improved health for women of maternal age in Camden

The Medicare Physician Group Practice Demonstration: Lessons Learned on Improving Quality and Efficiency in Health Care

Discusses the experiences of ten large practices earning performance payments for improving the quality and cost-efficiency of health care delivered to Medicare fee-for-service beneficiaries

Advancing Aircraft Operations in a Net-Centric Environment with the Incorporation of Increasingly Autonomous Systems and Human Teaming

NextGen has begun the modernization of the nations air transportation system, with goals to improve system safety, increase operation efficiency and capacity, provide enhanced predictability, resilience and robustness. With these improvements, NextGen is poised to handle significant increases in air traffic operations, more than twice the number recorded in 2016, by 2025.1 NextGen is evolving toward collaborative decision-making across many agents, including automation, by use of a Net-Centric architecture, which in itself creates a very complex environment in which the navigation and operation of aircraft are to take place. An intricate environment such as this, coupled with the expected upsurge of air traffic operations generates concern respecting the ability of the human-agent to both fly and manage aircraft within. Therefore, it is both necessary and practical to begin the process of increasingly autonomous systems within the cockpit that will act independently to assist the human-agent achieve the overall goal of NextGen. However, the straightforward technological development and implementation of intelligent machines into the cockpit is only part of what is necessary to maintain, at minimum, or improve human-agent functionality, as desired, while operating in NextGen. The full integration of Increasingly Autonomous Systems (IAS) within the cockpit can only be accomplished when the IAS works in concert with the human, formulating trust between the two, thereby establishing a team atmosphere. Imperative to cockpit implementation is ensuring the proper performance of the IAS by the development team and the human-agent with which it will be paired when given a specific piloting, navigation, or observational task. Described in this paper are the steps taken, at NASA Langley Research Center, during the second and third phases of the development of an IAS, the Traffic Data Manager (TDM), its verification and validation by human-agents, and the foundational development of Human Autonomy Teaming (HAT) between the two

An Integrative Health Approach for Geriatrics With Neurocognitive Disorders Living in a Care Facility

Integrative health (IH) has been shown in the literature to decrease resistance to cares and behaviors and improve apathy levels, patient-staff relationships, and quality of life in patients with neurocognitive disorders (NCD), formerly known as dementia, yet there continues to be a lack of implementation of these modalities. Coinciding with this, many CNAs working in care facilities are faced with decreases in job satisfaction due to disconnect they experience with these patients. This project was designed for CNAs to pilot a soothing touch protocol to a Midwestern care facility’s residents to improve CNA’s job satisfaction; increase connectivity, peace, and closeness; and promote a higher quality of life in this vulnerable population. The Plan-Do-Study-Act (PDSA) model was used for implementing this piloted change. This project demonstrated that stakeholder support along with face-to-face experiential education of this complementary intentional soothing touch protocol led to a successful implementation with 100% of CNAs reporting it was a manageable, feasible, and effective way to calm residents and 100% of CNAs stating they would continue to implement the protocol into their cares after the completion of this project

Working with Legacy Media: A Lone Arranger\u27s First Steps

[Excerpt] In 2013, a naked hard drive from Fiji arriving in my small religious archives (an equivalent full-time staff of 2.5 – one archivist and two archives’ assistants) started me off on the path of digital preservation and, in particular, the digital forensics practices that are beneficial for archivists. With such a small staff, outsourced IT services, and no digital preservation policy in sight, it was time to start exploring how institutions of my size could manage legacy media and start planning for the born-digital archives that will continue to arrive. Since I hold a part-time position, I was able to undertake this exploration in my own time through the support provided by a scholarship from the Ian McLean Wards Memorial Trust in 2015

CASE STUDY 95-04: Operator Certification: A Case Study in Operator Self-Inspection

Operator certification is the process where production workers are trained, authorized, and given the necessary resources to inspect their own work. This case study evaluated operator certification systems in the manufacturing process at three major aerospace companies during the Spring of 1995. Within the manufacturing area, operator certification was observed in such operations as high volume machining operations, certain processing operations-such as leak testing, balancing, and painting-and production of high volume detail parts. This case study was initiated as a result of the data from the human resources focus group’s survey in 1994. Prof. Jan Klein found that the airframe sector had a significantly lower percentage of plants where production workers perform inspection tasks as compared to the engine and electronics sectors. While operator certification is not a new concept, it appeared to be a best practice within two of the three sectors of the aerospace industry. This case study was performed to investigate these high potential payoffs

Optimizing Medication Prior Authorization

Problem: Prior authorizations (PAs) play a pivotal role in ensuring patients’ access to prescription medications. However, this process often leads to delays in patient care and places increased burden on healthcare professionals. Aim of the Project: The aim of this project was to expedite the processing of medication PAs for adult patients with a target of reducing the processing time to less than 36 hours. This not only facilitates prompt medication initiation for patients but also reduces costs and time expended by the healthcare organization. Review of the Evidence: A comprehensive review of the literature indicates that suboptimal PA processes can result in patient care delays, elevated healthcare expenses, and added administrative burden. Evidence showed centralizing responsibilities and utilizing electronic prior authorization (ePA) systems simplified and expedited the process. Project Design: This quality improvement (QI) project design was based on Deming’s Model for Improvement principles used to enhance patient care by standardizing processes. An inter-professional team consisting of nurses, pharmacists, and administrative staff collaborated to develop and implement a new standard workflow. Using Plan-Do-Study-Act (PDSA) cycles, the team identified key drivers of delays, which included manual data entry, fragmented communication, and a lack of standardized workflows. The OhioHealth Change Management Model was used to support the development and execution of the project and to communicate the change effectively. Intervention: The pilot intervention centralized PA tasks with a dedicated coordinator at the FQHC, utilizing electronic tools to enhance communication among the providers, pharmacies, and payers. The team conducted PDSA cycles to refine workflow standardization, PA transaction routing, and the development of a workforce coverage plan. Significant Findings/Outcomes: The project yielded substantial results, in line with existing literature. In twelve weeks, 36 PAs were processed using the centralized workflow, reducing average processing time by 79% compared to previous months. While the average time didn’t dip below 36 hours, it improved patient and staff satisfaction, and PA processing costs dropped 78%. Implications for Nursing: Efficiencies in the medication PA process significantly enhance nursing practice by reducing administrative burden and streamlining patient care, in alignment with the IOM six domains of healthcare quality. Additionally, this QI project supports the Institute for Healthcare Improvement’s Triple Aim by enhancing patient experience as nurses can devote more time to patient care instead of navigating complex, manual authorization processes

Increasing Compliance of Bar Code Medication Administration in the Emergency Room

Purpose: To ensure quality healthcare, it is necessary to provide safe medication administration. The specific goal is the reduction of medication errors in the hospital setting with concentration in the emergency room (ER). Bar-code medication administration (BCMA) has proven to be effective on the in-patient units in the hospitals researched and visited as part of this project, but the issue still remains that the emergency rooms exhibit a decreased compliance rate. The purpose of this Doctor of Nursing Practice (DNP) project, is to reverse the situation in a local community hospital that has a 50 bed emergency room, promoting increased compliance to affect improved medication safety measures. This was done by educating the nursing staff in the emergency room regarding the addition of an application related to verbal orders which increases with high acuity levels. The application will automatically profile the verbal order so that the nurse can use the BCMA and therefore increase compliance. Significance of the Project: “Thirty-four percent of all medication errors in hospitals occur in the administrative phase of the medication process and less than 2 percent of these errors are intercepted before execution” (Voshall, Piscotty, Lawrence, & Targosz, 2013, p. 530). In addition to causing possible harm or even death to a patient when an adverse event occurs, it is also a devastating economic factor. This is a nurse-driven change and to make it a success the nursing staff must perceive that the goals are realistic and that this will improve their practice. To insure a positive outcome it is essential to establish systems standards which are compatible with nursing needs and expectations, and which facilitate development of Information Technology (IT) systems which are supportive of nursing practice (Zadvinskis, Chipps, & Yen, 2013). Methods: Four goals were established for this project that was named: The Medication Quality Initiative. The first was to improve the compliance of BCMA utilization in the ER since they were averaging 70.9% BCMA usage following implementation, and had recently declined to 41.1 percent (RWJUH, 2015). Through careful research of the daily ER patient logs and the weekly data utilization sheets for BCMA, it had been determined that verbal medication orders increase in relationship to the increased patient activity and acuity levels, decreasing compliance. Because of this occurrence medications cannot be profiled in a timely manner and the nurses use work-arounds. The second goal was to meet with the team that consisted of the Chief Nursing Officer (CNO), ER Medical Director, ER Nursing Director, IT, Executive Informatics Nurse, IT Pharmacist, Nursing Educator, and the project preceptor. It was unanimously approved to turn on the application called CARE ADMIN in the Medication Administration Record (MAR) portion of the Patient’s Electronic Health Records (EHR) System so that verbal orders can be immediately profiled. Figure E3, in Appendix E, shows the “Create Order and Document” button which is only available to ER Users of this system to allow the automatic profiling process to take place. For the third goal, this author conducted an in-service program for 52 ER nurses so that they had a proper understanding of this new application, as well as the importance of BCMA compliance. In addition, they were given a pre-survey to determine their overall perceptions and use of this technology. The fourth goal was instituting the project, which was on-going for eight weeks. During that period, the data utilization sheets were reviewed weekly to determine project success and sustainability. At the conclusion of the eight weeks, the staff completed a post-survey to determine their perceptions after having used the new verbal order process. This post survey looked at both pre and post education perceptions. Project Outcome: The overall response was positive. The five levels of nursing practice “From Novice to Expert” related to the core of the emergency room staffing matrix. This was an advantageous time for this project because the mentors were teaching medication administration via the BCMA to new graduates as well as incorporating how to use the verbal order application. The overall consensus was that it does improve nursing practice since it does rapidly profile the medications, thereby improving patient care. Additionally, it has been subsequently, observed that many of the physicians have become more time sensitive in transcribing their medication orders in the computer. Clinical Significance: As a result of this project, it was noted that the percentage of BCMA use has increased. The Director of the Emergency Room will continue to have the nurses utilize the application. The sustainability of this project enhances medication administration in the emergency room. This procedure has become an integral part of the ER orientation to new staff members given by the nurse educator and nurse preceptors

Improving Teledermatology Utilization in an Alaskan Health Care System

A Project Submitted in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF NURSING PRACTICE in Nursing ScienceThe consistent demand for dermatology services, within an Alaskan health care network, warrants an organized, collaborative approach to acquiring a higher capacity of teledermatology consultations. The lack of uniformity among providers for using telemedicine technology in dermatology can hinder cost-saving care. Understanding the obstacles and utilization practices surrounding teledermatology adoption is a crucial objective for a project conducted in an integrated health care system. Devising a protocol with supporting education may reinforce expectations for primary care providers and community health aides and practitioners to be consistent with the utilization of dermatology consultations. A Teledermatology Utilization Project was conducted in an Alaska urban facility to affect change throughout an integrated system. Results indicated a significant increase in teledermatology cases since implementing a protocol and supportive education.Title Page / Abstract / Table of Contents / List of Figures / List of Tables / List of Appendices / Nomenclature / Chapter 1: Overview of the Problem / Chapter 2: Review of the Literature / Chapter 3: Organizational Framework / Chapter 4: Project Design / Chapter 5: Implementation Process and Procedure / Chapter 6: Results and Outcomes / Chapter 7: Implications for Practice / Chapter 8: Summary and Conclusion / References / Appendi