Analyzing the current state of Oregon's skilled nursing facilities

The purpose of this project is to paint a picture of the state of Oregon’s Skilled Nursing Facilities for the 2015 state fiscal year. Skilled Nursing Facilities are an important part of Oregon’s Long Term care continuum that provides care to individuals needing post-acute or on-going care. The URAP student assisted Public Health faculty and PhD students in preparing a report for the Oregon Department of Human Services. The student extracted, managed, summarized, and performed quality control on data from Skilled Nursing Facility Cost Reports and Revenue Statements. This data was further analyzed by the PhD students. The student also created graphs and tables of these data as well as other data from the Skilled Nursing Facility Minimum Data Set (MDS). The student performed new analyses of quality measure data retrieved though Nursing Home Compare, which is managed by the Center for Medicare and Medicaid services (CMS). These analyses described the variation in performance across Oregon Skilled Nursing Facilities. For example, moderate to severe pain reported in short stays was 11% in the highest performing 25% of all facilities and 42% in the lowest performing 25% of facilities, which highlights differences between the highest and lowest performing facilities

Quality of care and health status in Ukraine

BACKGROUND: We conducted a national level assessment of the quality of clinical care practice in the Ukrainian healthcare system for two important causes of death and chronic disease conditions. We tested two hypotheses: a) quality of care is predicted by physician and facility characteristics and b) health status is predicted by quality of care. METHODS: During 2009–2010 in Ukraine, we collected nationally-representative data from clinical facilities, physicians, Clinical Performance and Value (CPV) vignettes, patient surveys from the facilities, and from the general population. Each physician completed a written CPV vignette—a simulated case scenario of a typical patient visit—for each of two clinical cases, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). CPV vignette scores, calculated as a percentage of all care criteria completed by the physician, were used as the measure of clinical quality of care. Self-reported health measures were collected from exit and household survey respondents. Regression models were developed to test the two study hypotheses. RESULTS: 136 hospitals and 125 polyclinics were surveyed; 1,044 physicians were interviewed and completed CPV vignettes. On average physicians scored 47.4% on the vignettes. Younger, female physicians provide a higher quality of care—as well as those that have had recent continuing medical education (CME) in chronic disease or health behaviors. Higher quality was associated with better health outcomes. CONCLUSIONS: As low- and middle-income countries around the world are challenged by non-communicable diseases, higher quality of care provided to these populations may result in better outcomes, such as improved health status and life expectancy, and overcome regional shortfalls. Policy efforts that serially evaluate quality may improve chronic disease care.Keywords: Ukraine, Health policy, Health care delivery, Eastern Europe, Non-communicable diseases, Quality of car

Multimethod Evaluation of the VA’s Peer-to-Peer Toolkit for Patient-Centered Medical Home Implementation

BACKGROUND: Effective implementation of the patient-centered medical home (PCMH) in primary care practices requires training and other resources, such as online toolkits, to share strategies and materials. The Veterans Health Administration (VA) developed an online Toolkit of user-sourced tools to support teams implementing its Patient Aligned Care Team (PACT) medical home model. OBJECTIVE: To present findings from an evaluation of the PACT Toolkit, including use, variation across facilities, effect of social marketing, and factors influencing use. INNOVATION: The Toolkit is an online repository of ready-to-use tools created by VA clinic staff that physicians, nurses, and other team members may share, download, and adopt in order to more effectively implement PCMH principles and improve local performance on VA metrics. DESIGN: Multimethod evaluation using: (1) website usage analytics, (2) an online survey of the PACT community of practice’s use of the Toolkit, and (3) key informant interviews. PARTICIPANTS: Survey respondents were PACT team members and coaches (n=544) at 136 VA facilities. Interview respondents were Toolkit users and nonusers (n=32). MEASURES: For survey data, multivariable logistic models were used to predict Toolkit awareness and use. Interviews and open-text survey comments were coded using a “common themes” framework. The Consolidated Framework for Implementation Research (CFIR) guided data collection and analyses. KEY RESULTS: The Toolkit was used by 6,745 staff in the first 19 months of availability. Among members of the target audience, 80% had heard of the Toolkit, and of those, 70% had visited the website. Tools had been implemented at 65% of facilities. Qualitative findings revealed a range of user perspectives from enthusiastic support to lack of sufficient time to browse the Toolkit. CONCLUSIONS: An online Toolkit to support PCMH implementation was used at VA facilities nationwide. Other complex health care organizations may benefit from adopting similar online peer-to-peer resource libraries.Keywords: evaluation, implementation research, primary care redesign, patient-centered care, quality improvemen

The most used and most helpful facilitators for patient-centered medical home implementation

Background: Like other transformative healthcare initiatives, patient-centered medical home (PCMH) implementation requires substantial investments of time and resources. Even though PCMH and PCMH-like models are being implemented by multiple provider practices and health systems, little is known about what facilitates their implementation. The purpose of this study was to assess which PCMH-implementation resources are most widely used, by whom, and which resources primary care personnel find most helpful. Methods: This study is an analysis of data from a cross-sectional survey of primary care personnel in the Veterans Health Administration in 2012, in which respondents were asked to rate whether they were aware of and accessed PCMH-implementation resources, and to rate their helpfulness. Logistic regression was used to produce odds ratios for the outcomes (1) resource use and (2) resource helpfulness. Respondents were nested within clinics, nested, in turn, within 135 parent hospitals. Results: Teamlet huddles were the most widely accessed (80.4% accessed) and most helpful (90.4% rated helpful) resource; quality-improvement methods to conduct small tests of change were the least frequently accessed (42.4% accessed) resource though two-thirds (66.7%) of users reported as helpful. Supervisors were significantly more likely (ORs, 1.46 to 1.86) to use resources than non-supervisors but were less likely to rate the majority (8 out of 10) of resources as "somewhat/very helpful" than non-supervisors (ORs, 0.72 to 0.84). Longer-tenured employees tended to rate resources as more helpful. Conclusions: These findings are the first in the PCMH literature that we are aware of that systematically assesses primary care staff's access to and the helpfulness of PCMH implementation resources. Supervisors generally reported greater access to resources, relative to non-supervisors, but rated resources as less helpful, suggesting that information about them may not have been optimally disseminated. Knowing what resources primary care staff use and find helpful can inform administrators' and policymakers' investments in PCMH-implementation resources. The implications of our model extend beyond just PCMH implementation but also to considerations when providing implementation resources for other complex quality-improvement initiatives.KEYWORDS: Provider self-efficacy, Patient-centered medical home, Implementation resourcesThis is the publisher’s final pdf. The published article is copyrighted by BioMed Central and can be found at: http://www.implementationscience.co

Design, Qualification, and On Orbit Performance of the CALIPSO Aerosol Lidar Transmitter

The laser transmitter for the CALIPSO aerosol lidar mission has been operating on orbit as planned since June 2006. This document discusses the optical and laser system design and qualification process that led to this success. Space-qualifiable laser design guidelines included the use of mature laser technologies, the use of alignment sensitive resonator designs, the development and practice of stringent contamination control procedures, the operation of all optical components at appropriately derated levels, and the proper budgeting for the space-qualification of the electronics and software

Big Data: Managing the Future\u27s Agriculture and Natural Resource Systems

Big Data: Managing the Future\u27s Agriculture and Natural Resource Systems Big data is the incredible flow of information that surrounds each of us, every day. Big data tools identify patterns and habits, not only in research, but in manufacturing, logistics–even ordering items online

Textile manufacturing in Georgia, 1890-1930 : a case study of economic development activity

M.S.Robert C. McMat

Peer-to-Peer Toolkits Enhance Sharing of Best Practices Across an Integrated Delivery System

Background/Aims: A peer-to-peer approach to develop and disseminate online packages (“toolkits”) of locally developed system improvement resources (“tools”) at Veterans Affairs (VA) medical centers across the country. Toolkits were launched between 2010 and 2015. Tools consisted of medical record-based templates, decision support resources, patient-tracking databases and service agreements intended to improve the quality and timeliness of care. Methods: Series of online questionnaires and semi-structured telephone interviews about tool use, targeting clinicians, quality managers and others involved in veteran care or quality improvement (QI). Results: We evaluated uptake and use of the cancer/palliative care, primary care, specialty care and emergency services for women toolkits. Since first toolkit launch in 2010, more than 30,000 unique individuals have visited with nearly 19,000 visitors to the primary care toolkit alone. We identified facilitators of toolkit awareness and use across all four titles, including: 1) presence of facility/workgroup-level champions, 2) participation in learning collaboratives and the presence of other social networks, 3) engagement in QI initiatives, and 4) awareness of the facility’s performance on quality metrics/reports. Among respondents to the cancer care toolkit questionnaire, those who were aware of their facility’s performance on a VA-sponsored lung cancer study were significantly more likely to have visited the toolkit (odds ratio: 3.10, 95% confidence interval: 1.91–5.01). Respondents to the emergency services for women toolkit questionnaire who were involved in other QI activities were more likely to report toolkit use (odds ratio: 0.312 for uninvolved in QI, 95% confidence interval: 0.14–0.69). Barriers to uptake included strained personnel and financial resources as well as complicated approval processes to support tool implementation. Conclusion: User-driven online toolkits have broad appeal to providers and staff. They are a low-cost complement to other QI approaches, including gold standard toolkits whereby organizations rigorously design, test and disseminate tools. Additional work is needed identifying “less engaged” facilities and promoting toolkit use to them and others less closely tied to existing social networks. Increased opportunities for participation in learning/QI collaboratives and local support for the use of new tools may enhance uptake. Additional research is needed to increase our understanding of the link between toolkit use and clinical outcomes