Strategies and Tactics for Successful Implementation of Bundled Payments: Bundled Payment for Care Improvement at a Large, Urban, Academic Medical Center

2015 ◽  
Vol 30 (3) ◽  
pp. 349-350 ◽  
Author(s):  
Richard Iorio
JAMIA Open ◽  
2019 ◽  
Vol 2 (4) ◽  
pp. 479-488
Author(s):  
Bryan D Steitz ◽  
Joseph Isaac S Wong ◽  
Jared G Cobb ◽  
Brian Carlson ◽  
Gaye Smith ◽  
...  

Abstract Background and Objective Patient portal use has increased over the last two decades in response to consumer demand and government regulation. Despite growing adoption, few guidelines exist to direct successful implementation and governance. We describe the policies and procedures that have governed over a decade of continuous My Health at Vanderbilt (MHAV) patient portal use. Methods We examined MHAV usage data between May 2007 and November 2017. We classified patient portal activity into eight functional categories: Appointment, Billing, Document Access, Genetics, Health Result, Immunization, Medication, and Messaging. We describe our operating policies and measure portal uptake, patient account activity, and function use over time. Results By the end of the study period, there were 375 517 registered accounts. Policies made MHAV available to competent adults and adolescents 13 and over. Patients signed up for a limited access account online, which could be upgraded to a full-access account after identity verification. Patients could assign proxy accounts to family and caregivers, which permitted nonpatient access to select MHAV functions. Laboratory and radiology results were accessible via MHAV. Results were classified into three groups based on sensitivity, which govern the length of delay before results appeared in MHAV. Discussion and Conclusion Patient portals offer significant opportunity to engage patients in their healthcare. However, there remains a need to understand how policies can promote uptake and use. We anticipate that other institutions can apply concepts from our policies to support meaningful patient portal engagement.


2017 ◽  
Vol 25 (9) ◽  
pp. 654-663 ◽  
Author(s):  
Lindsay E. Jubelt ◽  
Keith S. Goldfeld ◽  
Saul B. Blecker ◽  
Wei-Yi Chung ◽  
John A. Bendo ◽  
...  

2016 ◽  
Author(s):  
Ashlee Viveiros

<p>Nursing handoff is the important exchange of pertinent information between nurses that is critical to patient safety. The purpose of this quality improvement project was to explore progressive care nurses' perceptions of usefulness of a new electronic SBAR handoff tool on an inpatient adult acute care setting at an academic medical center. A 10 question survey including eight Likert response and two open-ended response questions was created from content areas of a survey designed to measure nurses' perceptions of usefulness of a computerized tool for shift handover report writing. The anonymous survey was completed by 16 of 24 eligible participants. Descriptive statistics were performed on the study variables and responses from open-ended questions were analyzed for themes. Survey results revealed that nurses perceive the new handoff summary tool to save time and improve consistency of information exchanged. Nurses stated that communication between departments was not improved and that the summary screen does not accurately represent the patient at the time of report. Open-ended question responses revealed that user error may be contributing to some of the dissatisfaction with the tool. Responses indicated that many nurses still prefer a narrative type of handoff and read physician and nursing assessments for this type of description. Further exploration is needed. Implications for practice include the APRN's important contribution to a successful implementation of electronic handoff. The APRN is essential to the success of such changes as they are uniquely prepared to plan, implement, and evaluate this change across the three spheres of influence.</p>


2018 ◽  
Vol 34 (9) ◽  
pp. 707-713 ◽  
Author(s):  
Alexander H. Flannery ◽  
Melissa L. Thompson Bastin ◽  
Ashley Montgomery-Yates ◽  
Corrine Hook ◽  
Evan Cassity ◽  
...  

Background: Evidence-based medicine often has many barriers to overcome prior to implementation in practice, hence the importance of continuous quality improvement. We report on a brief (≤10 minutes) multidisciplinary meeting prior to rounds to establish a dashboard for continuous quality improvement and studied the success of this meeting on a particular area of focus: continuous infusion benzodiazepine minimization. Methods: This was a prospective observational study of patients admitted to the medical intensive care unit (MICU) of a large academic medical center over a 4-month period. A morning multidisciplinary prerounding meeting was implemented to report on metrics required to establish a dashboard for MICU care for the previous 24 hours. Fellows and nurse practitioners on respective teams reported on key quality metrics and other important data related to patient census. Continuous benzodiazepines were tracked daily as the number of patients per team who had orders for a continuous benzodiazepine infusion. The aim of this report is to describe the development of the morning multidisciplinary prerounding meeting and its impact on continuous benzodiazepine use, along with associated clinical outcomes. Results: The median number of patients prescribed a continuous benzodiazepine daily decreased over this time period and demonstrated a sustained reduction at 1 year. Furthermore, sedation scores improved, corresponding to a reduction in median duration of mechanical ventilation. The effectiveness of this intervention was mapped post hoc to conceptual models used in implementation science. Conclusions: A brief multidisciplinary meeting to review select data points prior to morning rounds establishes mechanisms for continuous quality improvement and may serve as a mediating factor for successful implementation when initiating and monitoring practice change in the ICU.


2002 ◽  
Vol 2 (3) ◽  
pp. 95-104 ◽  
Author(s):  
JoAnn Manson ◽  
Beverly Rockhill ◽  
Margery Resnick ◽  
Eleanor Shore ◽  
Carol Nadelson ◽  
...  

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