The New York City Health and Hospitals Corporation: Transforming a Public Safety Net Delivery System to Achieve Higher Performance

Describes the results of the public benefit corporation's improvement initiatives -- a common clinical information system for continuity, coordination on chronic disease management, teamwork and continuous innovation, and access to appropriate care

Pilot Study: Avoiding Readmissions of Heart Failure Patients Across Transitions of Care

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed. Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence based interventions were Project RED (Re-Engineered Discharge) and the TC Advocacy Plan. Project RED has 12 elements to improve the hospital discharge process by reducing rehospitalization rates, promoting safety, and increasing patient satisfaction. The TC Advocacy Plan consisted of screening tools, HF education, teamwork, collaboration, and use of resources. It offered different strategies and interventions that strengthen the initiatives in avoiding readmissions. This initiative was supported by a collaborative team that included physicians, nurses, social workers, and pharmacists. Results: Project RED 12 elements and the TC Advocacy Plan were all implemented. The identified trends in data were presented to key stakeholders. This possibly led to an enhanced multidisciplinary collaboration creating continuity of care in patient\u27s seamless transition from inpatient to outpatient settings. Conclusion: An intervention that incorporates Project RED and the TC Advocacy Plan may be effective in preventing avoidable readmissions, but further investigation is needed

The childrens palliative care provider of the future: A blueprint to spark, scale and share innovation

This policy report sets out an optimistic vision of what a world-class provider of children's palliative care (CPC) could look like in the future. It proposes nine key features through which providers can innovate to improve access and quality over time, drawing on best practice and trends as described by 50 CPC service leaders in 27 countries, as well as insights from other healthcare sectors. Recognising that there is huge variation among CPC providers and the systems they work in, this 'blueprint' is intended for inspiration and challenge, not prescription. In addition to key areas for future innovation it also highlights many areas in which CPC providers are already exemplars within the healthcare sector. CPC leaders and other stakeholders are invited to reflect on the opportunities the blueprint describes and how their own organisations might benefit from pursuing these

The Development of a Patient Portal for Use During Hospitalization: Pediatric Registered Nurses' Perspectives

Patient portals are innovative digital health technologies that are impacting nursing practice. A patient portal is an electronic tool that allows patients and parents to access personal health information. There has been a recent focus to implement patient portal technology when children are hospitalized. This manuscript style thesis examines pediatric registered nurses (RNs) perspectives of new technology including patient portals and its impact on nursing care. The first manuscript is a thematic literature review that was conducted to determine pediatric health care providers perceptions of patient portal implementation. Five articles were included in the analysis and only two articles focused exclusively on health care providers views. Four themes summarize the pediatric practitioner’s experiences with a portal technology: The Benefits of the Patient Portal; Impact on Provider Workload; User-Friendliness of the Patient Portal; and Health Care Providers Needs with Portal Implementation. Pediatric RNs voices are limited in currently published research. Therefore, the second manuscript is an interpretive description study conducted to explore pediatric RNs perspectives of new technology, including a proposed patient portal, on patient care. A total of 10 nurses participated in a semi-structured individual interview. Six themes represent the RNs views of new technology, including a proposed patient portal, and the impact on nursing care during a child’s hospitalization. The first three themes: Standing in Both Worlds, Reshaping the Care Triad, and Needing Support embody the nurses’ views on the implementation of technology in the pediatric inpatient units they work. The RNs previous experience with health technology implementation informs their perspectives of a new portal technology and its potential impact on patient care. The last three themes encompass the RNs views on the development of a patient portal: Improving Family Centred Care, Connecting with Care, and Anticipating Nursing Implications. Overall, the RNs are anticipating a positive impact the portal can have on the hospital experience for children and their family members. Even though the nurses report a feeling of standing in both worlds in regards to technology and its varied implementation, they are still optimistic. The RNs are also bringing awareness to the impact of all the new technology, not just a single piece, on patient care and the art of nursing. The integrated discussion provides recommendations to a larger ongoing study and discusses the impact on nursing practice, education, and research. Recruiting and involving pediatric RNs can take considerable time and effort but they can provide valuable insight and feedback on new technology, including patient portals, which may result in more sustained use.

Providers' assessment of a novel interactive health information technology in a pediatric intensive care unit

Objective: To explore perceptions of critical care providers about a novel collaborative inpatient health information technology (HIT) in a pediatric intensive care unit (PICU) setting. Methods: This cross-sectional, concurrent mixed methods study was conducted in the PICU of a large midwestern children's hospital. The technology, the Large Customizable Interactive Monitor (LCIM), is a flat panel touch screen monitor that displays validated patient information from the electronic health record. It does not require a password to login and is available in each patient's room for viewing and interactive use by physicians, nurses, and families. Quantitative data were collected via self-administered, standardized surveys, and qualitative data via in-person, semistructured interviews between January and April 2015. Data were analyzed using descriptive statistics and inductive thematic analysis. Results: The qualitative analysis showed positive impacts of the LCIM on providers' workflow, team interactions, and interactions with families. Providers reported concerns regarding perceived patient information overload and associated anxiety and burden for families. Sixty percent of providers thought that LCIM was useful for their jobs at different levels, and almost 70% of providers reported that LCIM improved information sharing and communication with families. The average overall satisfaction score was 3.4 on a 0 to 6 scale, between "a moderate amount" and "pretty much." Discussion and Conclusion: This study provides new insight into collaborative HIT in the inpatient pediatric setting and demonstrates that using such technology has the potential to improve providers' experiences with families and just-in-time access to EHR information in a format more easily shared with families

EQUITABLE PHARMACOGENETIC TESTING IMPLEMENTATION FOR RURAL AND UNDERSERVED POPULATIONS

Pharmacogenetic testing has potential to transform healthcare, yet implementation strategies have been limited to major academic medical centers serving metropolitan communities and large health systems. In contrast, rural, community-based health systems are slow to implement these advances, threatening to exacerbate existing healthcare disparities for rural populations. A majority of Montanans live in rural areas, with unique challenges in providing access to pharmacogenetics. We have established partnerships with three clinical sites who serve rural, underserved populations including American Indian, pediatric, and low socioeconomic status patients. We conducted a needs assessment for pharmacogenetic testing implementation by interviewing 48 key stakeholders. Interview questions were centered around participants opinions regarding pharmacogenetics and their perceived barriers and facilitators for implementation of testing. A codebook was created by analysis and organization of common themes. Positive opinions on using pharmacogenetics to guide therapy were common. Perceived benefits included reduced time to symptom management, fewer adverse events, and improved adherence. Concerns expressed in similar studies based in larger medical centers were also present, including conflicts with reimbursement and test turnaround time. Unique concerns for vulnerable, underserved populations included equitable access based on socioeconomic status and sensitivity to culture and historical injustices, particularly for tribal people. Participants were enthusiastic about using telehealth to implement pharmacogenetics in these communities. This will provide an innovative strategy for pharmacogenetic testing and consultations. Participants were eager to implement testing in their facilities. Many concerns can be mitigated with a strategic implementation plan targeted for underserved patients. Our model will implement pharmacogenetics using a telehealth delivery model centered at the University of Montana with outreach to rural health systems and providers. This has the potential to expand as new health innovations are translated into practice. Future work in this area will involve assisting partner sites with implementation efforts and measuring clinical outcomes related to testing services. Our study will help overcome the unique challenges in delivering pharmacogenetics to rural and underserved communities and we aim to provide a model for states with similar patient populations. Our goal is to pave the way for equitable access to pharmacogenetics for all

Healthcare Management Primer

This primer was written by students enrolled in HMP 721.01, Management of Health Care Organizations, in the Health Management & Policy Program, College of Health and Human Services, University of New Hampshire. This course was taught by Professor Mark Bonica in Fall 2017

Genesys HealthWorks: Pursuing the Triple Aim Through a Primary Care-Based Delivery System, Integrated Self-Management Support, and Community Partnerships

Details Triple Aim pilot programs to engage primary care doctors in care coordination, prevention, and efficient use of specialty care through a physician-hospital organization; promote healthy behaviors; and extend access for the poor and uninsured