Successes and Challenges of Optimal Trauma Care for Rural Family Physicians in Kansas

Introduction. Kansas has a regionalized trauma systemwith formal mechanisms for review, however, increasedcommunication with rural providers can uncover opportunitiesfor system process improvement. Therefore, thisqualitative study explored perceptions of family medicinephysicians staffing emergency departments (ED) in rural areas,specifically to determine what is going well and what areasneeded improvement in relation to the trauma system. Methods. A focus group included Kansas rural family physiciansrecruited from a local symposium for family medicinephysicians. Demographic information was collected via surveyprior to the focus group session, which was audiotaped.Research team members read the transcription, identifiedthemes, and grouped the findings into categories for analysis. Results. Seven rural family medicine physicians participated inthe focus group. The majority were male (71%) with the mean age46.71 years. All saw patients in the ED and had treated injuriesdue to agriculture, falls, and motor vehicle collisions. Participantsidentified successes in the adoption and enforcement of standardizedprocesses, specifically through level IV trauma centercertification and staff requirements for Advanced Trauma LifeSupport training. Communication breakdown during patient dischargeand skill maintenance were the most prevalent challenges. Conclusions. Even with an established regionalized traumasystem in the state of Kansas, there continues to be opportunitiesfor improvement. The challenges acknowledged byfocus group participants may not be identified through patientcase reviews (if conducted), therefore tertiary centersshould conduct system reviews with referring hospitals regularlyto improve systemic concerns. KS J Med 2017;10(1):12-16

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Increasing Specialty Care Availability

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.Part 2: "Increasing Specialty Care Availability"Solutions such as telemedicine, innovative partnerships between specialists and primary care physicians, and centralized local referral networks improve access to specialty care

Modeling And Optimization Of Non-Profit Hospital Call Centers With Service Blending

This dissertation focuses on the operations problems in non-profit hospital call centers with inbound and outbound calls service blending. First, the routing policy for inbound and outbound calls is considered. The objective is to improve the system utilization under constraints of service quality and operators\u27 quantity. A collection of practical staffing assignment methods, separating and mixing staffing policy are evaluated. Erlang C queuing model is used to decide the minimum number of operators required by inbound calls. Theoretical analysis and numerical experiments illustrate that through dynamically assigning the inbound and outbound calls to operators under optimal threshold policy, mixing staffing policy is efficient to balance the system utilization and service quality. Numerical experiments based on real-life data demonstrate how this method can be applied in practice. Second, we study the staffing shift planning problem based on the inbound and outbound calls routing policies. A mathematical programming model is developed, based on a hospital call center with one kind of inbound calls and multiple kinds of outbound calls. The objective is to minimize the staffing numbers, by deciding the shift setting and workload allocation. The inbound calls service level and staffing utilization are taken into consideration in the constraints. Numerical experiments based on actual operational data are included. Results show that the model is effective to optimize the shift planning and hence reduce the call centers\u27 cost. Third, we model the staffing shift planning problem for a hospital call center with two kinds of service lines. Each kind of service is delivered through both inbound calls and outbound calls. The inbound calls can be transferred between these two service lines. A mathematical programming model is developed. The objective is to minimize the staffing cost, by deciding the shift setting and workload allocation. The inbound calls service level and staffing utilization are taken into consideration in the constraints. Numerical experiments are carried out based on actual operational data. Results show that the model is effective to reduce the call centers\u27 labor cost

Optimization of Mental Health Appointment Mix: Telemental Health and In-person Appointment Model Maximizing Revenue and Mitigating No-shows

Mental Health care leaders are challenged with meeting revenue requirements while incorporating telemental health (TMH) to increase access. The objective of this project was to create a model to optimize revenue based on variables derived from the literature, notably no-shows, reimbursement, salary cost, and appointment type. The model was tested through sensitivity analysis. The order of sensitivity to net revenue based on a 10% variable increase was reimbursement rate (19% increase), appointment volume (10% increase), cost (8.5% decrease), and no-shows (1% decrease). 3 scenarios were run for large (10 providers), mid-sized (4 providers), and single provider facilities. In-person vs telemental health appointment mix for each scenario was set at 80%/20%, 50%/50%, and 20%/80%. Reimbursement rate for TMH was set at 70%, 80%, 90% and 100% (parity) of in-person recovery. Results showed 100% TMH reimbursement was the only scenario increased TMH appointments increased revenue. 90% reimbursement had minimal revenue loss with increased TMH (2-3%) and 70% or 80% had significant losses (9%-30%). Parity is vital to TMH revenue impact and adoption

A Working Lexicon for the Tele-Intensive Care Unit: We Need to Define Tele-Intensive Care Unit to Grow and Understand It

Telemedicine in the intensive care unit (Tele-ICU) has grown exponentially since the first formalized program in 2000. Initially, there was limited product choice, and certain capabilities have been engineered into the process with the implication of necessity. New technology is evolving, and new vendors are entering the market place, which should yield a multitude of technologies from which to select. To date, there has been no organized lexicon designed to facilitate communication, comparison, or evaluation. This article is designed as a starting point to develop a lexicon applicable to all technologies for the Tele-ICU with the goal of facilitating clinical comparisons and administrative choices.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90470/1/tmj-2E2011-2E0045.pd

The Current State of the Pediatric Emergency Medicine Workforce and Innovations to Improve Pediatric Care

Many hospitals and emergency departments lack resources to optimally care for ill and injured children, perpetuating risks of receiving fragmented and “uneven” care. In this article, we describe the present state of our pediatric emergency medicine workforce as well as the impact that different innovations could have on the future of pediatric emergency care. Many innovative initiatives, including physician and advanced practice provider education and training, pediatric readiness recognition programs, telemedicine and in-situ simulation outreach, and community paramedicine are being utilized to help bridge access gaps and augment the reach of the pediatric emergency medicine workforce. Advocacy for reimbursement for novel care delivery models, such as community paramedicine and telemedicine, and funding for outreach education programming is essential. Also, better understanding of our current training models for and utilization of advanced practice practitioners in pediatric emergency medicine is crucial to understanding the diversity of workforce growth and opportunity

Feasibility of using teleradiology to improve tuberculosis screening and case management in a district hospital in Malawi.

Malawi has one of the world's highest rates of human immunodeficiency virus (HIV) infection (10.6%), and southern Malawi, where Thyolo district is located, bears the highest burden in the country (14.5%). Tuberculosis, common among HIV-infected people, requires radiologic diagnosis, yet Malawi has no radiologists in public service. This hinders rapid and accurate diagnosis and increases morbidity and mortality

Models for providing improved care in residential care homes: a thematic literature review

This Annotated Bibliography is one output from a review of the available research evidence to support improved care in residential care homes as the needs of older people intensify. Key findings The review identified extremely little published evidence on residential care homes; the research base is almost exclusively related to provision of care in nursing homes. Much of this research is from the US or other non-UK sources. Although it could be argued that some findings are generalisable to the UK residential care context, a systematic process is required to identify which. The literature often makes no distinction between nursing and residential homes; use of generic terms such as ‘care home’ should be avoided. There is considerable international debate in the quality improvement literature about the relationship between quality of care and quality of life in nursing and residential homes. Measures of social care, as well as clinical care, are needed. The centrality of the resident’s voice in measuring quality of life must be recognised. Ethnic minority residents are almost entirely absent from the quality improvement literature. Some clinical areas, internationally identified as key in terms of quality e.g. palliative care, are absent in the general nursing and residential home quality improvement literature. Others such as mental health (dementia and depression), diabetes, and nutrition are present but not fully integrated. Considerable evidence points to a need for better management of medication in nursing homes. Pharmacist medication reviews have shown a positive effect in nursing homes. It is unclear how this evidence might relate to residential care. There is evidence that medical cover for nursing and residential care home residents is suboptimal. Care could be restructured to give a greater scope for proactive and preventive interventions. General practitioners' workload in care homes may be considered against quality-of-care measures. There is US literature on the relationship between nurse staffing and nursing care home quality, with quality measured through clinical-based outcomes for residents and organisational outcomes. Conclusions are difficult to draw however due to inconsistencies in the evidencebase. Hospital admission and early discharge to nursing homes research may not be generalisable to residential care. The quality of inter-institutional transfers and ensuring patient safety across settings is important. To date research has not considered transfer from residential to nursing home care. The literature on district nurse and therapist roles in care homes includes very little research on residential care. Partnership working between district nurses and care home staff appears largely to occur by default at present. There is even less research evidence on therapist input to care homes. Set against the context outlined above, the international literature provides evidence of a number of approaches to care improvement, primarily in nursing homes. These include little discussion of cost-effectiveness other than in telecare. Research is needed in the UK on care improvement in residential homes