scholarly journals Challenges of Implementing the 4Ms in Federally Qualified Health Centers and Private Academic Medical Centers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 813-813
Author(s):  
Bonnie Olsen ◽  
Theresa Sivers-Teixeira ◽  
Kelly Sadamitsu
Keyword(s):  
Older Adults ◽  
Health System ◽  
Large Scale ◽  
Academic Health ◽  
Medical Centers ◽  
Strategic Approach ◽  
Academic Medical ◽  
Leadership Engagement ◽  
Trained Staff ◽  
Implementation Plans

Abstract As our country increases our capacity to provide quality interprofessional geriatric medical care to older adults, we find challenges that are unique to the setting. Many older adults receive care in Federally Qualified Healthcare Centers where implementing Age-Friendly Care is critical. Implementing the 4M’s in this setting has specific challenges including lack of geriatric trained staff, staff turnover, leadership engagement and financial sustainability. When implementing Age-Friendly Care within a large-scale complex academic health system, equally difficult challenges surface. With less nimble infrastructures, changes in one service area can have a domino effect and create larger barriers in other parts of the system. Instituting the 4M’s in an academic health system environment requires a careful strategic approach and support from many areas of organizational leadership. This talk will focus on strategies to anticipate and adapt implementation plans to best address barriers that are unique to the setting.

EVALUATION OF VENTILATOR BUNDLE COMPLIANCE AT ACADEMIC MEDICAL CENTERS: A UNIVERSITY HEALTH-SYSTEM CONSORTIUM (UHC) BENCHMARKING PROJECT.

2006 ◽  
Vol 34 ◽  
pp. A91
Author(s):  
Mark Sloane ◽  
Helga Brake ◽  
Judith Jacobi ◽  
Jeremy Kahn ◽  
Susan Pingleton ◽  
...  
Keyword(s):  
Health System ◽  
Academic Medical Centers ◽  
Medical Centers ◽  
Academic Medical ◽  
Bundle Compliance

scholarly journals Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme

2021 ◽  
Vol 10 (4) ◽  
pp. e001369
Author(s):  
Camille P Vaughan ◽  
Ula Hwang ◽  
Ann E Vandenberg ◽  
Traci Leong ◽  
Daniel Wu ◽  
...  
Keyword(s):  
Older Adults ◽  
Health System ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Health Systems ◽  
Medication Safety ◽  
Potentially Inappropriate Medications ◽  
Health Administration ◽  
Academic Health ◽  
The Impact

Enhancing quality of prescribing practices for older adults discharged from the Emergency Department (EQUIPPED) aims to reduce the monthly proportion of potentially inappropriate medications (PIMs) prescribed to older adults discharged from the ED to 5% or less. We describe prescribing outcomes at three academic health systems adapting and sequentially implementing the EQUIPPED medication safety programme.EQUIPPED was adapted from a model developed in the Veterans Health Administration (VA) and sequentially implemented in one academic health system per year over a 3-year period. The monthly proportion of PIMs, as defined by the 2015 American Geriatrics Beers Criteria, of all medications prescribed to adults aged 65 years and older at discharge was assessed for 6 months preimplementation until 12 months postimplementation using a generalised linear time series model with a Poisson distribution.The EQUIPPED programme was translated from the VA health system and its electronic medical record into three health systems each using a version of the Epic electronic medical record. Adaptation occurred through local modification of order sets and in the generation and delivery of provider prescribing reports by local champions. Baseline monthly PIM proportions 6 months prior to implementation at the three sites were 5.6% (95% CI 5.0% to 6.3%), 5.8% (95% CI 5.0% to 6.6%) and 7.3% (95% CI 6.4% to 9.2%), respectively. Evaluation of monthly prescribing including the twelve months post-EQUIPPED implementation demonstrated significant reduction in PIMs at one of the three sites. In exploratory analyses, the proportion of benzodiazepine prescriptions decreased across all sites from approximately 17% of PIMs at baseline to 9.5%–12% postimplementation, although not all reached statistical significance.EQUIPPED is feasible to implement outside the VA system. While the impact of the EQUIPPED model may vary across different health systems, results from this initial translation suggest significant reduction in specific high-risk drug classes may be an appropriate target for improvement at sites with relatively low baseline PIM prescribing rates.

Funds flow in academic neurology

Neurology ◽  
2020 ◽  
Vol 94 (18) ◽  
pp. 785-791
Author(s):  
S. Andrew Josephson ◽  
Ralph L. Sacco ◽  
Jane M. Czech ◽  
Rikki N. Maher ◽  
Claire S. Knutson ◽  
...  
Keyword(s):  
American Academy ◽  
Health System ◽  
Academic Departments ◽  
Academic Health ◽  
Flow Models ◽  
Advantages And Disadvantages ◽  
Medical Centers ◽  
Departmental Leadership ◽  
American Academy Of Neurology ◽  
Future Growth

Funds flow arrangements define the financial relationships between departments, medical centers, and university entities within a coordinated academic health system. Although these funds flow frameworks differ, common themes emerge including those that are unique in their influence on academic departments of neurology. Here, we review various funds flow models and their application. Four typical models are described, highlighting the advantages and disadvantages of each for neurology, keeping in mind that most academic health systems use a hybrid model. Several considerations are important when neurology departmental leadership participates in crafting or revising of these funds flow agreements, including choice of benchmarking targets, planning and funding for future growth, demonstrating value, and supporting nonclinical missions including education and research. The American Academy of Neurology Academic Initiative aims to continue to help academic departments nationally understand these issues and define funds flow arrangements that incorporate the unique characteristics of our specialty and allow us to provide outstanding care for patients while supporting the broad missions of neurology departments.

scholarly journals Low‐Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System

2019 ◽  
Vol 67 (12) ◽  
pp. 2600-2604 ◽  
Author(s):  
John N. Mafi ◽  
Folasade P. May ◽  
Katherine L. Kahn ◽  
Michelle Chong ◽  
Edgar Corona ◽  
...  
Keyword(s):  
Older Adults ◽  
Proton Pump Inhibitor ◽  
Health System ◽  
Proton Pump ◽  
Academic Health

Age Advantages of Emotional Experience during the COVID-19 Pandemic are Robust, but Diminished Compared to Pre-pandemic Conditions

2020 ◽  
Author(s):  
Rui Sun ◽  
Disa Sauter
Keyword(s):  
Older Adults ◽  
Large Scale ◽  
Negative Emotion ◽  
Emotional Experience ◽  
Negative Emotions ◽  
Older Individuals ◽  
Selection Strategies ◽  
Scale Test ◽  
Prolonged Stress

Getting old is generally seen as unappealing, yet aging confers considerable advantages in several psychological domains (North & Fiske, 2015). In particular, older adults are better off emotionally than younger adults, with aging associated with the so-called “age advantages,” that is, more positive and less negative emotional experiences (Carstensen et al., 2011). Although the age advantages are well established, it is less clear whether they occur under conditions of prolonged stress. In a recent study, Carstensen et al (2020) demonstrated that the age advantages persist during the COVID-19 pandemic, suggesting that older adults are able to utilise cognitive and behavioural strategies to ameliorate even sustained stress. Here, we build on Carstensen and colleagues’ work with two studies. In Study 1, we provide a large-scale test of the robustness of Carstensen and colleagues’ finding that older individuals experience more positive and less negative emotions during the COVID-19 pandemic. We measured positive and negative emotions along with age information in 23,629 participants in 63 countries in April-May 2020. In Study 2, we provide a comparison of the age advantages using representative samples collected before and during the COVID-19 pandemic. We demonstrate that older people experience less negative emotion than younger people during the prolonged stress of the COVID-19 pandemic. However, the advantage of older adults was diminished during the pandemic, pointing to a likely role of older adults use of situation selection strategies (Charles, 2010).

scholarly journals COVID-19 and doctor emigration: the case of Ireland

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Niamh Humphries ◽  
Jennifer Creese ◽  
John-Paul Byrne ◽  
John Connell
Keyword(s):  
Health System ◽  
Large Scale ◽  
Qualitative Interviews ◽  
Snowball Sampling ◽  
Contact Potential ◽  
Work From Home ◽  
Travel Restrictions ◽  
Hospital Doctors ◽  
June July ◽  
Global Travel

Abstract Background Since the 2008 recession, Ireland has experienced large-scale doctor emigration. This paper seeks to ascertain whether (and how) the COVID-19 pandemic might disrupt or reinforce existing patterns of doctor emigration. Method This paper draws on qualitative interviews with 31 hospital doctors in Ireland, undertaken in June–July 2020. As the researchers were subject to a government mandated work-from-home order at that time, they utilised Twitter™ to contact potential respondents (snowball sampling); and conducted interviews via Zoom™ or telephone. Findings Two cohorts of doctors were identified; COVID Returners (N = 12) and COVID Would-be Emigrants (N = 19). COVID Returners are Irish-trained emigrant doctors who returned to Ireland in March 2020, just as global travel ground to a halt. They returned to be closer to home and in response to a pandemic-related recruitment call issued by the Irish government. COVID Would-be Emigrants are hospital doctors considering emigration. Some had experienced pandemic-related disruptions to their emigration plans as a result of travel restrictions and border closures. However, most of the drivers of emigration mentioned by respondents related to underlying problems in the Irish health system rather than to the pandemic, i.e. a culture of medical emigration, poor working conditions and the limited availability of posts in the Irish health system. Discussion/conclusion This paper illustrates how the pandemic intensified and reinforced, rather than radically altered, the dynamics of doctor emigration from Ireland. Ireland must begin to prioritise doctor retention and return by developing a coherent policy response to the underlying drivers of doctor emigration.

scholarly journals Multicenter point prevalence evaluation of the utilization and safety of drug therapies for COVID-19 at the onset of the pandemic timeline in the United States

2021 ◽  
Author(s):  
Nathaniel J Rhodes ◽  
Atheer Dairem ◽  
William J Moore ◽  
Anooj Shah ◽  
Michael J Postelnick ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Drug Therapy ◽  
Supportive Care ◽  
The United States ◽  
Primary Objective ◽  
Point Prevalence ◽  
Medical Centers ◽  
Academic Medical ◽  
History Of ◽  
Secondary Objective

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose There are currently no FDA-approved medications for the treatment of coronavirus disease 2019 (COVID-19). At the onset of the pandemic, off-label medication use was supported by limited or no clinical data. We sought to characterize experimental COVID-19 therapies and identify safety signals during this period. Methods We conducted a non-interventional, multicenter, point prevalence study of patients hospitalized with suspected/confirmed COVID-19. Clinical and treatment characteristics within a 24-hour window were evaluated in a random sample of up to 30 patients per site. The primary objective was to describe COVID-19–targeted therapies. The secondary objective was to describe adverse drug reactions (ADRs). Results A total of 352 patients treated for COVID-19 at 15 US hospitals From April 18 to May 8, 2020, were included in the study. Most patients were treated at academic medical centers (53.4%) or community hospitals (42.6%). Sixty-seven patients (19%) were receiving drug therapy in addition to supportive care. Drug therapies used included hydroxychloroquine (69%), remdesivir (10%), and interleukin-6 antagonists (9%). Five patients (7.5%) were receiving combination therapy. The rate of use of COVID-19–directed drug therapy was higher in patients with vs patients without a history of asthma (14.9% vs 7%, P = 0.037) and in patients enrolled in clinical trials (26.9% vs 3.2%, P < 0.001). Among those receiving drug therapy, 8 patients (12%) experienced an ADR, and ADRs were recognized at a higher rate in patients enrolled in clinical trials (62.5% vs 22%; odds ratio, 5.9; P = 0.028). Conclusion While we observed high rates of supportive care for patients with COVID-19, we also found that ADRs were common among patients receiving drug therapy, including those enrolled in clinical trials. Comprehensive systems are needed to identify and mitigate ADRs associated with experimental COVID-19 treatments.

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