28,397 research outputs found

    Technology Target Studies: Technology Solutions to Make Patient Care Safer and More Efficient

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    Presents findings on technologies that could enhance care delivery, including patient records and medication processes; features and functionality nurses require, including tracking, interoperability, and hand-held capability; and best practices

    The transformation of community hospitals through the transition to value-based care: Lessons from Massachusetts

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    Enabling community hospitals to provide efficient and effective care and maintain competition on par with their academic medical center (AMC) counterparts remain challenges for most states. Advancing accountable care readiness adds to the complexity of these challenges. Community hospitals experience narrower operating margins and more limited access to large populations than their AMC counterparts, making the shift to value-based care difficult. Massachusetts has taken legislative action to ensure a statewide focus on reducing healthcare costs, which includes a nearly $120-million grant program supporting community hospital and system transformation toward a value-based environment. The Massachusetts Health Policy Commission’s Community Hospital Acceleration, Revitalization and Transformation (CHART) investment program is the state’s largest effort to date aimed at readying community hospitals for value-based care. In doing so, Massachusetts has created the largest state-driven, all-payer (payer-blind) readmission reduction initiative in the country. n this paper, we examine the design and evolution of CHART Phases 1 and 2 and offer insights for other states contemplating innovative approaches to bolstering community hospital participation in value-based care models

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

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    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

    What You Need to Know about Bar-Code Medication Administration

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    Medication errors are the most common type of preventable error. Bar-code medication administration (BCMA) technology was designed to reduce medication administration errors. Poor system design, implementation and workarounds remain a cause of errors. This paper reviews the literature on BCMA, identifies a gap in the findings and identifies three evidence based practices that could be used to improve system implementation and reduce error. The literature review identified that Bar-code medication administration and system workarounds are well documented and affect patient safety. Based on the critical analysis of 10 studies, we identified gaps in the standardization of BCMA planning, implementation, and sustainability. The themes that emerged from the literature were poor BCMA design and implementation that resulted in workarounds.The three evidence based strategies proposed to address this gap are, evidence based standardization in planning and implementation, the identification and elimination of workarounds and hard wiring. An evidence based checklist evaluates compliance with standard procedures. The LEAN model of Jodoka is used to assure adaptation of the machine to human workflow. Direct observation provides valuable workflow assessment. An effective BCMA implementation involves careful system design, identification of workflow issues which cause workarounds, and adapting the machine to nursing needs

    A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

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    BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics

    Scott & White Healthcare: Opening Up and Embracing Change to Improve Performance

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    Offers a case study of a multispeciality system with the attributes of an ideal healthcare delivery system as defined by the Fund. Describes a culture of continuous improvement, collaboration and peer accountability, and a comprehensive approach to care

    Improving health and public safety through knowledge management

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    This paper reports on KM in public healthcare and public safety. It reflects the experiences of the author as a CIO (Chief Information Officer) in both industries in Australia and New Zealand. There are commonalities in goals and challenges in KM in both industries. In the case of public safety a goal of modern policing theory is to move more towards intelligence-driven practice. That means interventions based upon research and analysis of information. In healthcare the goals include investment in capacity based upon knowledge of healthcare needs, evidence-based service planning and care delivery, capture of information and provision of knowledge at the point-of-care and evaluation of outcomes. The issue of knowledge management is explored from the perspectives of the user of information and from the discipline of Information Technology and its application to healthcare and public safety. Case studies are discussed to illustrate knowledge management and limiting or enabling factors. These factors include strategy, architecture, standards, feed-back loops, training, quality processes, and social factors such as expectations, ownership of systems and politics

    Addressing the Quality and Safety Gap Part I: Case Studies in Transforming Hospital Nursing and Building Cultures of Safety

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    Presents case studies of strategies four healthcare systems and a state government are using to address underlying causes in flawed systems: strengthening care processes, optimizing staffing, and promoting safe work habits. Lists policy recommendations

    Nurses’ Perception of Discharging the Medically Complex Pediatric Patient

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    The purpose of this study is to query the nurses for their perceptions of the barriers and facilitators of discharging medically complex pediatric patients from a freestanding children’s hospital in central California. Using a mixed methods research design via an online survey, 90 nurses identified 3 distinct themes that act as barriers. Those barriers include: 1) knowing the plan of care, 2) time, and 3) disposition of the family. Several implications for improving the discharge process for medically complex patients and overcoming the identified barriers include strategies to improve multidisciplinary communication, implementation of a Family Learning Center, use of video interpreters when in-person interpreters are not available, and respect for discharge readiness. Recognizing and implementing the appropriate interventions based on nurses’ feedback have the potential to improve quality and patient safety

    Population Health Matters Fall 2012 Download Full Text PDF

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