Evaluating diverse electronic consultation programs with a common framework.

BackgroundElectronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion.MethodsUsing a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems' end-users.ResultsOrganizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies.ConclusionA core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs

Core Principles to Improve Primary Care Quality Management

Quality management in American health care is in crisis. Performance measurement in its current form is costly, redundant, and labyrinthine. Increasingly, its contribution to achieving the Quadruple Aim is under close examination, especially in the domain of primary care services, where the burden of measurement is heaviest. This article assesses the state of quality management in primary care in the United States, particularly the 2015 Medicare Access and Children’s Health Insurance Program Reauthorization Act, in comparative perspective, drawing lessons from the Quality and Outcomes Framework in the United Kingdom. The health care delivery function specific to primary care is pivotal to crossing the quality chasm, yet prior efforts to improve the quality of this function have failed more often than succeeded. These failures are the result of quality programs unguided by core principles of primary care. Quality management in primary care requires a more disciplined approach, adherent to 4 foundational principles: optimizing holistic patient and population health; harnessing the Quadruple Aim as a dynamic whole; applying measurements as tools for quality, not outcomes of quality; and prioritizing therapeutic relationships. These principles serve as the foundation for a bridge to high-functioning primary care that will lead American health care closer to the Quadruple Aim

Demonstrating Occupational Therapy’s Distinct Value: Addressing the Quadruple Aim of Health Care Through Doctoral Capstone Projects

The quadruple aim of health care focuses on enhancing health care systems through improving quality patient care, improving the health of populations, providing care in cost-efficient ways, and improving the experience of providing health care by decreasing provider and caregiver stress and burnout. The purpose of this retrospective review is to share how the curricular design and doctoral capstone process from one postprofessional occupational therapy doctorate program have been designed to support students in recognizing occupational therapy’s distinct value in creating sustainable practice changes to move their respective health care systems forward. The postprofessional occupational therapy doctorate curriculum over 12 years has supported over 250 students in creating sustainable practice change projects in various work settings across the US. Doctoral capstone projects can be an effective platform for illustrating occupational therapy’s distinct value by showing how occupational therapy services are unique and valuable in health care institutions. A strong curricular design with supports related to focusing on all aspects of the quadruple aim is an effective mechanism for enhancing care

Care Coordination: Roles of Registered Nurses Across the Care Continuum

Lack of coordination leads to health care that is fragmented, inconsistent, and poorly planned. Conversely, effective care coordination supports achieving the Quadruple Aim. Care coordination, roles of RNs in care coordination, and implications for healthcare delivery are explored

Toward the Quadruple Aim: Impact of a Humanistic Mentoring Program to Reduce Burnout and Foster Resilience.

Objective:To assess the effect of a faculty development program (Mentoring and Professionalism in Training [MAP-IT]) that fosters humanism in medicine on elements of burnout and the development of resilience. Participants and Methods:The cohort of participants was drawn from a cross-section of disciplines and represented a diverse group of health professionals, including physicians, nurses, physician assistants, pharmacists, psychologists, social workers, and chaplains. The 106 participants were divided into 12 groups, each of which was facilitated by two or three leaders. Each group completed the MAP-IT curriculum from October 1, 2017, through July 31, 2018. All participants and leaders completed the Connor-Davidson Resilience Scale and the Maslach Burnout Inventory (assessing emotional exhaustion, depersonalization, and personal accomplishment) before and after completion of the program. Results:The participants\u27 scores for emotional exhaustion and depersonalization remained unchanged following the completion of the MAP-IT curriculum. However, their scores for personal accomplishment and resilience increased significantly and approximated those of the leaders. Conclusion:The MAP-IT program has shown effectiveness both in fostering resilience and a sense of personal accomplishment. The time is ripe for institutional programming to create and foster the personal tools needed to prevent burnout and its sequelae

Navigating the Tension between Being a Transformational Leader and an Efficient Leader?

Since its introduction in 2014, the quadruple aim of optimizing healthcare performance by reducing costs and improving population health, patient experience, and healthcare team well-being has not been realized. Lean, a formal quality improvement model aimed at eliminating waste, improving flow and quality of care, and increasing efficiency, has been inconsistently successful in healthcare due to poor implementation and organizational understanding. This discussion paper explores the potential for transformational leaders to support the use of lean through empowering clinical leaders. Transformational leadership is a relational style of leadership found to motivate followers by soliciting their perspectives on problem-solving while supporting each individual to reach their full potential. Although transformational leaders can foster the development of clinical leaders to influence and coordinate care, they must navigate the tension between supporting clinical leaders and the organizational demands for improved efficiency. The gains of supporting the use of lean by clinical leaders could be meaningful development of strategies aimed at the quadruple aim by supporting the daily efforts of front-line nurses and their leaders to improve the delivery of quality care

What Is the Effect of Telehealth and the Internet of Medical Things (IOMT) on Outcomes When Used in At-Risk Pregnancies: A Scoping Review of the Components of Remote Maternal Monitoring for Hypertensive Disorders that Can Successfully be Done Via Digital Technology?

IoMT (Internet of Medical Things) is an emerging technology that facilitates individualized remote e-health services to improve patient\u27s quality of life and satisfaction while decreasing healthcare expenditures. The objective of this scoping review is to explore the usage of IoMT and remote patient monitoring (RPM) in at-risk pregnancies for hypertensive disorders to mitigate pregnancy-related complications. IoMT and other devices in an intelligent health system can meaningfully ameliorate maternal care management in the United States (U.S.). Wearables and nearables, subcategories of IoMT, can be utilized to facilitate patient-centered care and promote excellence in health maintenance/management through a holistic continuum of care approach while decreasing maternal mortality and morbidity in the U.S., which currently has the highest maternal mortality ratio/rate (MMR) among all western nations. IoMT and RPM can leverage the Quadruple Aim framework, the current gold standard in U.S. healthcare service delivery, and exist at the convergence of the different dimensions of care. The four tenets of the Quadruple Aim in delivering high-quality healthcare are to (1) Improve population health, (2) Lower healthcare costs, (3) Enhance patient experience, and (4) Improve care team well-being

Coexisting Values in Healthcare and the Leadership Practices That Were Found to Inspire Followership Among Healthcare Practitioners

Healthcare delivery in the United States has a storied history that has led the American public to expect that their Health Care Practitioners (HCPs) will personally and professionally enact values such as altruism, benevolence, equality, and capability. A progressive set of events that involves the implementation of the market-based solution in the Patient Protection and Affordable Care Act has led healthcare organizations to become increasingly concerned with a conceptually different set of values. It has become more necessary for healthcare organizations to dedicate attention to market values (e.g., competition; productivity) as they operate in an environment that is commonly described as a $3.3T industry. There is significant concern that important care values are being sacrificed as the U.S. health system becomes increasingly commercialized. It is also believed that HCPs are experiencing increasing levels of demoralization and burnout as a result of their inability to realize their personal and professional care value preferences. A qualitative investigation into the experiences of a selection of HCPs served to reveal how the administration in a large health system fosters compatibility among personal, professional, and market value priorities via an application of the tenets of values-based leadership. Study outcomes also feature implications for both the servant leadership and transformational leadership constructs

Burnout in cardiac anesthesiologists. results from a national survey in italy

Objective: There is increasing burnout incidence among medical disciplines, and physicians working in emergency settings seem at higher risk. Cardiac anesthesiology is a stressful anesthesiology subspecialty dealing with high-risk patients. The authors hypothesized a high risk of burnout in cardiac anesthesiologists. Design: National survey conducted on burnout Setting: Italian cardiac centers. Participants: Cardiac anesthesiologists. Interventions: The authors administered via email an anonymous questionnaire divided into 3 parts. The first 2 parts evaluated workload and private life. The third part consisted of the Maslach Burnout Inventory test with its 3 constituents: high emotional exhaustion, high depersonalization, and low personal accomplishment. Measurements and Main Results: The authors measured the prevalence and risk of burnout through the Maslach Burnout Inventory questionnaire and analyzed factors influencing burnout. Among 670 contacts from 71 centers, 382 cardiac anesthesiologists completed the survey (57%). The authors found the following mean Maslach Burnout Inventory values: 14.5 ± 9.7 (emotional exhaustion), 9.1 ± 7.1 (depersonalization), and 33.7 ± 8.9 (personal accomplishment). A rate of 34%, 54%, and 66% of respondents scored in “high” or “moderate-high” risk of burnout (emotional exhaustion, depersonalization, and personal accomplishment, respectively). The authors found that, if offered to change subspecialty, 76% of respondents would prefer to remain in cardiac anesthesiology. This preference and parenthood were the only 2 investigated factors with a protective effect against all components of burnout. Significantly lower burnout scores were found in more experienced anesthesiologists. Conclusion: A relatively high incidence of burnout was found in cardiac anesthesiologists, especially regarding high depersonalization and low personal accomplishment. Nonetheless, most of the respondents would choose to remain in cardiac anesthesiology