Improving Diabetes Care in an Urban Aboriginal Medical Centre

2005 ◽  
Vol 11 (3) ◽  
pp. 25 ◽  
Author(s):  
Diane A Longstreet ◽  
Marlene M Griffiths ◽  
Deanne Heath ◽  
Gauwada Emily G Marshall ◽  
Paolo Morisco ◽  
...  
Keyword(s):  
Best Practice ◽  
Service Providers ◽  
Standard Of Care ◽  
Holistic Health ◽  
Medical Centre ◽  
Care Plan ◽  
Care Plans ◽  
Patients With Diabetes ◽  
Care Approach ◽  
Design And Methods

The aim of this project was to improve the detection, monitoring, and medical care of Indigenous patients with diabetes in an urban Aboriginal medical centre. The research design and methods entailed the diabetes register being cleaned and updated. A pre- and post-project non-random sample audit of medical records of patients diagnosed with diabetes evaluated the level of care received compared to best practice standard of care. A multi-disciplinary Diabetes Team established procedures to improve the patient care provided. Additional service providers, including a dietitian, podiatrist, ophthalmologist, and endocrinologist, joined the team. A holistic health care approach was implemented with an emphasis on opportunistic care. The percentage of patients having a care plan completed increased from 18% in the 2002 audit to 72% in the 2003 audit. There were significant trends between increased completion of all cycle of care activities and frequency of GP review. Doctors prepared care plans for 50% of patients who attended less than two review visits in 2003, but increased to 89% if receiving six visits or more (p = 0.000). No significant improvement in health outcome was noted. The project showed significantly improved care planning and medical management of urban Aboriginal and Torres Strait Islander patients with diabetes.

scholarly journals Accuracy and Thoroughness of Treatment Summaries Provided as Part of Survivorship Care Plans Prepared by Two Cancer Centers

2017 ◽  
Vol 13 (5) ◽  
pp. e486-e495 ◽  
Author(s):  
Amye J. Tevaarwerk ◽  
William G. Hocking ◽  
Jamie L. Zeal ◽  
Mindy Gribble ◽  
Lori Seaborne ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Data Entry ◽  
Standard Of Care ◽  
Care Plan ◽  
Institute Of Medicine ◽  
Survivorship Care ◽  
Cancer Centers ◽  
Treatment Summaries ◽  
Care Plans ◽  
Treatment Information

Purpose: Treatment summaries prepared as part of survivorship care planning should correctly and thoroughly report diagnosis and treatment information. Methods: As part of a clinical trial, summaries were prepared for patients with stage 0 to III breast cancer at two cancer centers. Summaries were prepared per the standard of care at each center via two methods: using the electronic health record (EHR) to create and facilitate autopopulation of content or using manual data entry into an external software program to create the summary. Each participant's clinical data were abstracted and cross-checked against each summary. Errors were defined as inaccurate information, and omissions were defined as missing information on the basis of the Institute of Medicine recommended elements. Results: One hundred twenty-one summaries were reviewed: 80 EHR based versus 41 software based. Twenty-four EHR-based summaries (30%) versus six software-based summaries (15%) contained one or more omissions. Omissions included failure to provide dates and specify all axillary surgeries for EHR-based summaries and failure to specify receptors for software-based summaries. Eight EHR-based summaries (10%) versus 19 software-based summaries (46%) contained one or more errors. Errors in EHR-based summaries were mostly discrepancies in dates, and errors in software-based summaries included incorrect stage, surgeries, chemotherapy, and receptors. Conclusion: A significant proportion of summaries contained at least one error or omission; some were potentially clinically significant. Mismatches between the clinical scenario and templates contributed to many of the errors and omissions. In an era of required care plan provision, quality measures should be considered and tracked to reduce rates, decrease inadvertent contributions from templates, and support audited data use.

scholarly journals Establishing Individual Care Plans for Rehabilitation Patients: Traces of Self-Targeting in the Norwegian Universal Welfare State

2019 ◽  
Vol 10 (1) ◽  
pp. 24-47 ◽  
Author(s):  
Ivan Harsløf ◽  
Mirela Slomic ◽  
Ole Kristian Sandnes Håvold
Keyword(s):  
Service Providers ◽  
Care Plan ◽  
Rehabilitation Process ◽  
Welfare Services ◽  
Care Plans ◽  
Individual Care ◽  
Local Labour ◽  
Care Health ◽  
Individual Care Plan ◽  
The Individual

Several countries have introduced devices for coordination of complicated individual cases across care, health and welfare services. This study examined one such device: the individual care plan (ICP), introduced in Norway in 2001 to enhance user involve­ment and coordination across sectors and service providers. Despite strong political imperatives, however, ICPs have remained significantly underused. To understand why, this study investigated the experiences with ICPs among staff in municipal coordinating units, tasked with organising rehabili­ta­tion efforts and case­workers in local labour and welfare services. In focus groups, participants discussed the fictitious vignette of a patient with traumatic brain injury, a person clearly within the ICP target group. They praised ICPs for advancing the rehabilitation process but acknowledged that they were applied too rarely. Through abductive-retroductive recontextualisation, this study identified a practice of de-facto self-targeting: in some municipalities, patients had to request ICPs themselves. We argue that this mechanism may have emerged from ambiguous propensities of rehabilitation, simultaneously emphasising needs and potentials, and ultimately from ambiguities in the Norwegian welfare model balancing universalism and local autonomy.

Preventing and managing device-related pressure ulcers in oncology

2021 ◽  
Vol 30 (1) ◽  
pp. 48-53
Author(s):  
Susy Pramod
Keyword(s):  
Case Studies ◽  
Medical Device ◽  
Best Practice ◽  
Pressure Ulcers ◽  
High Standard ◽  
Standard Of Care ◽  
Care Plan ◽  
Tissue Viability ◽  
Prophylactic Devices ◽  
Individualised Care

There is growing evidence that medical device-related pressure ulcers (MDRPUs) are an increasing healthcare concern in all aspects of care. It is especially important to develop an individualised care plan for people at the end of life to prevent pressure ulceration and to treat this if it occurs. Tissue viability nurses have a responsibility to review and assess new prophylactic devices and dressings, to ensure a high standard of care is provided. This article describes the use of a soft silicone dressing, Kliniderm foam silicone lite, in combination with best practice, to prevent MDRPUs in the oncology setting. Three case studies show that the dressing helped avoid the occurrence of ulceration on the ears and nose in patients receiving oxygen through a nasal cannula.

A model for survivorship care plans (SCP) at a large academic institution.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 35-35
Author(s):  
Andrew Joseph Ward ◽  
John Lawrence Bell ◽  
Lindsey Jerkins
Keyword(s):  
Best Practice ◽  
Medical Center ◽  
Academic Medical Center ◽  
Surgical Oncology ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Survivorship Care ◽  
Care Plans ◽  
Daunting Task ◽  
Minimum Requirements

35 Background: In 2014, the American College of Surgeons Commission on Cancer mandated in Standard 3.3 that SCP be provided for all patients at the completion of active treatment. Minimum requirements for what SCP should include were provided; however, no standardized model was proposed. We outline how a large academic medical center approached this as an opportunity instead of an obstacle. Methods: A pilot for developing SCP for the University of Tennessee Medical Center Cancer Institute (UTMC, CI), where 2700 new cancer cases per year are seen, was created. Initially approached by the Division of Surgical Oncology, SCPs were established for all patients. This approach allowed the UTMC, CI to determine all best practices for meeting Standard 3.3. This pilot identified all major stake holders including mid-level providers who see follow-up patients, a physician champion, and the survivorship care plan that best fit our organizational challenges and work flow. Results: The described approach allowed us to exceed our goal of providing SCP for 10% of patients seen in 2015 prior to the conclusion of the third-quarter. By keeping the pilot small, we were able to pinpoint the “best practice” for identifying patients, completing the SCP, delivery of the SCP, and providing care in an efficient way. By creating SCP that can be adapted by the entire UTMC, CI, we were able to ensure that we are meeting all of our stakeholder’s needs. Conclusions: Compliance with Standard 3.3 for SCP does not have to be a daunting task. The process can be adapted to be efficient while utilizing already stressed financial and personnel resources. A successful survivorship program can be developed as a pilot prior to being adapted by an entire organization. We recommend identifying the appropriate stake holders, defining a physician champion, and identifying SCP that best serve the mission of each organization while meeting all regulatory requirements.

Implementation of survivorship care plans in the pediatric oncology clinic.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 55-55 ◽  
Author(s):  
Christine Moore Smith ◽  
Barron L. Patterson ◽  
Debra L. Friedman
Keyword(s):  
Pediatric Oncology ◽  
Standard Of Care ◽  
Primary Care Providers ◽  
Care Plan ◽  
Survivorship Care Plan ◽  
Cancer Center ◽  
Survivorship Care ◽  
Care Providers ◽  
Care Plans

55 Background: Quality survivorship care and follow up have been well described in the pediatric oncology population to improve overall health of cancer survivors. Typically, a key component is the delivery of a survivorship care plan (SCP) in a dedicated survivorship program. Creation of an SCP in the immediate post-treatment period has not been commonly adopted. To address the Commission on Cancer's (CoC) requirement to provide SCPs within six months of ending therapy, our pediatric oncology clinic has used quality improvement (QI) methods to incorporate SCPs into clinic workflow with subsequent survivorship program referral. Our aim is to meet the CoC’s benchmark of 50% of eligible patients receiving SCPs by December 31, 2017. Our secondary goal is to improve the timeliness of delivery to patients, families, and primary care providers (PCP). Methods: Registry data from our cancer center was utilized to identify eligible patients. Upcoming appointments were then identified for a panel of eligible patients using the electronic medical record (EMR). Providers use a standardized SCP template which includes the components required by the CoC. The SCP is then reviewed with families, electronically sent to the PCP, and saved in the EMR. Evaluation of the process included subjective feedback from providers and Plan-Do-Study-Act cycles. Based on this feedback and cycles, iterations of the template have been progressively streamlined and the EMR panel has been updated. Results: Care plan creation and delivery is ongoing. At baseline, 28% of eligible patients had SCPs previously created in the survivorship program. After implementation of our QI methods, to date, we have increased the proportion of eligible patients with an SCP to 40.3%, approaching our goal of 50% by December 31, 2017. We have also decreased the time from end of therapy to delivery of a care plan from 22.9 months to 14 months. This is expected to further improve as the process continues. Conclusions: The QI process has been successful in implementing a new standard of care for delivery of SCPs. Ongoing use of QI methods will increase compliance with the CoC standards and result in improved survivorship care.

scholarly journals THE IMPACT OF AN EARLY-STAGE DYADIC CARE PLANNING INTERVENTION ON CAREGIVER BURDEN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S217-S218
Author(s):  
Silvia Orsulic-Jeras ◽  
Carol Whitlatch ◽  
Justin Johnson
Keyword(s):  
Service Providers ◽  
Early Stage ◽  
Care Plan ◽  
Care Plans ◽  
Paired Samples ◽  
Sources Of Support ◽  
Effective Decision ◽  
Effective Decision Making ◽  
The Impact

Abstract Evidence supports the development of proactive, dyadic interventions for used in early-stage dementia. This type of intervention leads to more effective decision making which can reduce subsequent caregiver stress and burden. SHARE (Support, Health, Activities, Resources, Education), a six-session counseling-based intervention, encourages and supports care dyads to have important discussions about health care preferences that are often delayed or avoided until later-stage dementia. Typically, both the PWD and caregiver assume that most of the help will be delivered by the caregiver. SHARE aims to expand the network of care by evenly distributing care task responsibilities from the caregiver alone to other potential sources of support: family/friends and paid service providers. Early-stage dyads (n=63) successfully created a balanced and manageable plan of care with the help of their SHARE Counselor over a 6-month period. Follow-up interviews assessed care dyads from 1.5 to 2 years after their participation in SHARE ended. Analyses determined change in PWD ADL needs from enrollment (T1) to two years later (T2) and impact on caregiver task burden. Paired samples t-tests indicated a significant increase in PWD need for assistance with 18 ADLs, from a T1 mean of 8.76 to a T2 mean of 11.34 (t=-6.72, p=.000). This paper examines: 1) the benefits and challenges of creating a Care Plan in the early stages of dementia, 2) how SHARE dyads utilized their Care Plans when PWDs needed assistance, and 3) if reliance on family/friend and paid service provider options were realistic over time.

scholarly journals Exploring the impact of pharmacist comprehensive annual care plans on perceived quality of chronic illness care by patients in Alberta, Canada

2021 ◽  
pp. 171516352110203
Author(s):  
Candace Necyk ◽  
Jeffrey A. Johnson ◽  
Ross T. Tsuyuki ◽  
Dean T. Eurich
Keyword(s):  
Quality Of Care ◽  
Chronic Illness ◽  
Care Plan ◽  
Short Version ◽  
Chronic Illness Care ◽  
Online Questionnaire ◽  
Care Plans ◽  
Funding Program ◽  
The Impact

Background: In 2012, the Government of Alberta introduced a funding program to remunerate pharmacists to develop a comprehensive annual care plan (CACP) for patients with complex needs. The objective of this study is to explore patients’ perceptions of the care they received through the pharmacist CACP program in Alberta. Methods: We invited 3442 patients who received a pharmacist-billed CACP within the previous 3 months and 6888 matched controls across Alberta to complete an online questionnaire. The questionnaire consisted of the short version Patient Assessment of Chronic Illness Care (PACIC-11), with 3 additional pharmacy-specific assessment questions added. Additional questions related to health status and demographics were also included. Results: Overall, most patients indicated a low level of chronic illness care by pharmacists, with few differences noted between CACP patients and non-CACP controls. Of note, controls reported higher quality of care for 5 domains within the adapted PACIC-like tool compared with CACP patients ( p < 0.05 for all). Interestingly, only 79 (44%) of CACP patients reported that they had received a CACP, whereas only 192 (66%) of control patients reported that they did not receive a care plan. In a sensitivity analysis including only these respondents, individuals who received a CACP perceived a significantly higher quality of chronic illness care across all PACIC domains. Conclusion: Overall, chronic illness care incentivized by the pharmacist CACP program in Alberta is perceived to be moderate to low. When limited to respondents who explicitly recognized receiving the service or not, the perceptions of quality of care were more positive. This suggests that better implementation of CACP by pharmacists may be associated with improved quality of care and that some redesign is needed to engage patients more. Can Pharm J (Ott) 2021;154:xx-xx.

scholarly journals A Multidisciplinary Approach to Implement Personalized Breast Cancer Treatment and Care Plans

2021 ◽  
Vol 28 (1) ◽  
pp. 767-782
Author(s):  
Rashida Haq ◽  
Amy Kong ◽  
Pauline Gulasingam
Keyword(s):  
Breast Cancer ◽  
Primary Care Physicians ◽  
Phase 1 ◽  
Data Entry ◽  
Implementation Process ◽  
Standard Of Care ◽  
Care Team ◽  
Quality Improvement Initiative ◽  
Team Members ◽  
Care Plans

Implementation of survivorship care plans remain a challenge. This quality improvement initiative aims to integrate personalized treatment plans (PTP) and care plans (PCP) into the existing workflow for breast cancer (BC) patients. Methods: Phase 1 was to identify multidisciplinary team members to generate and deliver PTP and PCP. Concurrently, Phase 2 was to deliver PTP and PCP to newly diagnosed invasive BC patients at chemotherapy initiation and completion, respectively. Iterative plan, do, study, act (PDSA) cycles were applied to refine the process. The proportion of information completed for PTP and PCP generation and its delivery by the care team were measured. Patient and provider satisfaction were also assessed. Implementation Process and Results: The care transfer facilitator (CTF) was identified to complete and deliver PTP, and their data entry increased from 0% to 76%, 80%, 92% consecutively during the last 4 PDSA cycles. PTP and PCP were provided to 85% of eligible BC patients. Patients agreed that PTP helped them to actively participate in their care (88%) and communicate with the oncology care team (86%). Primary care physicians agreed that PTP and PCP had the information needed to “stay in the loop” (80%), and oncologists agreed they should be incorporated into oncology clinics (100%). Conclusions: Integrating PTP and PCP generation and delivery into existing workflow has led to an increase in uptake, sustainability and provider buy-in. With limited resources, it remains difficult to find care team members to complete the forms. A dedicated personnel or survivorship clinic is required to successfully implement PTP and PCP as the standard of care.

scholarly journals Lack of association between either outpatient or inpatient glycemic control and COVID-19 illness severity or mortality in patients with diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002203
Author(s):  
Paras B Mehta ◽  
Michael A Kohn ◽  
Suneil K Koliwad ◽  
Robert J Rushakoff
Keyword(s):  
Glycemic Control ◽  
Insulin Treatment ◽  
Insulin Level ◽  
Illness Severity ◽  
Icu Admission ◽  
Patients With Diabetes ◽  
Design And Methods ◽  
Insulin Use ◽  
Average Glucose ◽  
Ventilator Requirement

IntroductionTo evaluate whether outpatient insulin treatment, hemoglobin A1c (HbA1c), glucose on admission, or glycemic control during hospitalization is associated with SARS-CoV-2 (COVID-19) illness severity or mortality in hospitalized patients with diabetes mellitus (DM) in a geographical region with low COVID-19 prevalence.Research design and methodsA single-center retrospective study of patients hospitalized with COVID-19 from January 1 through August 31, 2020 to evaluate whether outpatient insulin use, HbA1c, glucose on admission, or average glucose during admission was associated with intensive care unit (ICU) admission, mechanical ventilation (ventilator) requirement, or mortality.ResultsAmong 111 patients with DM, 48 (43.2%) were on outpatient insulin and the average HbA1c was 8.1% (65 mmol/mol). The average glucose on admission was 187.0±102.94 mg/dL and the average glucose during hospitalization was 173.4±39.8 mg/dL. Use of outpatient insulin, level of HbA1c, glucose on admission, or average glucose during hospitalization was not associated with ICU admission, ventilator requirement, or mortality among patients with COVID-19 and DM.ConclusionsOur findings in a region with relatively low COVID-19 prevalence suggest that neither outpatient glycemic control, glucose on admission, or inpatient glycemic control is predictive of illness severity or mortality in patients with DM hospitalized with COVID-19.

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