Telehealth Facilitates Value-Based Care in Emergency Department Settings

2021 ◽  
pp. 256-261
Author(s):  
Deborah Ann Mulligan ◽  
Krista Drobac ◽  
Robert Shesser
Keyword(s):  
Value Chain ◽  
Hospital Admissions ◽  
Leadership Role ◽  
Emergency Physicians ◽  
Coordinated Care ◽  
Care Needs ◽  
Unscheduled Care ◽  
Value Based Care

Spurred by the COVID-19 pandemic, the health care industry is increasingly aware of benefits emergency physicians could contribute to value-based care. The use of emergency telehealth—to reduce the number of hospital admissions, readmissions, and missed outpatient follow-up appointments—will play an increasing role in the shift to value-based care paradigms. Although certain legal, regulatory, and reimbursement challenges remain, the COVID-19 outbreak should stimulate lawmakers and regulatory agencies to promulgate further measures that facilitate widespread adoption of telemedicine, which will inevitably extend into emergency care. Emergency physicians should play a leadership role in the development and implementation of coordinated care before, during, and after acute unscheduled care needs of patients. Coordinated care is a recognized role of emergency telehealth in the value chain. For emergency telehealth to be effective, it must be appropriately integrated into standard practice of emergency medicine.

Family-Centered, Community-Based, Coordinated Care for Children With Special Needs

PEDIATRICS ◽  
1989 ◽  
Vol 83 (6) ◽  
pp. 1061-1061
Author(s):  
RICHARD M. NARKEWICZ
Keyword(s):  
Task Force ◽  
Case Manager ◽  
Community Services ◽  
Coordinated Care ◽  
Care Needs ◽  
Care Coordinator ◽  
Community Based ◽  
The Family ◽  
Family Centered

Assuring that all children with special health care needs have access to family-centered, community-based, coordinated care, as described by Brewer et al in this issue of Pediatrics, is a timely and commendable goal that the American Academy of Pediatrics (AAP) shares. Pediatricians have a major role to play in the shaping of these services and assuring their accessibility by the children who need them. Last winter, the AAP held three task force meetings to discuss the role of pediatricians vis-á-vis the case manager/care coordinator. A consensus emerged from these meetings that a variety of roles should be available to pediatricians, depending upon the child's diagnosis, the pediatrician's training and interest, the skills of the family, and the community services available.

Expansion of an oncology care coordination nurse model to reduce hospitalizations and emergency department utilization.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 82-82
Author(s):  
Georgina T. Rodgers ◽  
Michelle Brusio ◽  
Jacob Lindberg ◽  
Craig Savage ◽  
Joseph Hooley ◽  
...  
Keyword(s):  
Patient Education ◽  
Care Coordination ◽  
Hospital Admissions ◽  
Care Transitions ◽  
Phone Call ◽  
Emergency Department Utilization ◽  
Coordinated Care ◽  
Care Coordinator ◽  
Oncology Care

82 Background: Comprehensive, coordinated care is a key driver of care transformation within the Oncology Care Model. Care coordination provides deliberate, organized, patient centered care initiatives aimed to improve care transitions, patient education, patient engagement and quality of care throughout the care continuum. Methods: Specialty care coordinator nurses were a part of our heath system’s model of care but over the course of our participation in the OCM we have implemented care coordination in our regional locations across 15 additional sites of care. Standardized templates for initial and follow up education were created for oral and parenteral therapies with an emphasis on symptom management education. A patient education tool was developed through a partnership with nursing, pharmacy and physicians across disease groups to outline when a patient should contact their physician or RN care coordinator with symptom issues. Targeted outreach calls and associated documentation templates were created for symptom assessment and adequate follow up. Templates include a pre-chemo orientation call, post treatment follow up phone call within seven days, and post hospital discharge/ED treat and release follow up calls. A team based huddle guideline was developed to provide a means for interdisciplinary communication to assess patients for high risk based upon medical, functional, social, cognitive and behavioral factors that might lead to a hospitalization. Results: Our teams worked closely with EMR specialists and internal data analysts to build appropriate templates and subsequent reports to monitor compliance with documentation, evaluate the number of outreach touch points and effectiveness of interventions on a reduction of hospitalizations and ED utilization. We have noted an a modest decrease in hospitalizations and ED utilization through OCM feedback reports and reconciliation reports. Conclusions: We continue to monitor our monthly hospital admissions and ED utilization across the health system and drill down into the data to determine if there are any opportunities where care coordination outreach and incoming telephone triage could have prevented the admission.

Service Coordinators in the NECC Trial: An RDNS perspective

2000 ◽  
Vol 6 (4) ◽  
pp. 104
Author(s):  
Megan Kerr ◽  
Janine Cramond ◽  
Maggie Scott
Keyword(s):  
Complex Care ◽  
Coordinated Care ◽  
Care Needs ◽  
Nursing Service ◽  
The North ◽  
Improved Outcomes ◽  
Service Coordinators ◽  
North Eastern ◽  
Complex Care Needs

The Royal District Nursing Service (RDNS) became involved in the North-Eastern Coordinated Care Trial in October 1997. The purpose of this was to assist the trial in exploring the hypothesis, that for people with chronic or complex care needs, care coordination will provide improved outcomes at the same or a reduced cost. There are a number of areas, which help to clarify the process involved in the trial and the benefits for clients: how the coordinators were chosen; the role of the Care and Service Coordinators: benefits experienced by the professionals; benefits experienced by clients: and discussion points.

Telephone-supported care coordination in an Australian veterans population: a randomized controlled trial

2009 ◽  
Vol 16 (2) ◽  
pp. 57-62 ◽  
Author(s):  
Richard Wootton ◽  
Helen Gramotnev ◽  
David Hailey
Keyword(s):  
Randomized Controlled Trial ◽  
Care Coordination ◽  
Controlled Trial ◽  
Intervention Group ◽  
Multidisciplinary Care ◽  
Cost Of Care ◽  
Coordinated Care ◽  
Care Needs ◽  
Randomized Controlled

An evaluation was undertaken on the effectiveness and efficiency of care coordination in delivering health services to Australian veterans with chronic or complex medical conditions requiring multidisciplinary care and who had moderate to high care needs. The veterans participated in a randomized controlled trial (RCT) supported by the Department of Veterans' Affairs. For evaluation of the RCT, information on cost of care and quality of life (QOL) was collected before the commencement of coordinated care and at follow-up after 12 months. Of 525 veterans who were recruited, 481 were surveyed at baseline (243 in the intervention group and 238 controls). At follow-up, 421 were surveyed (213 intervention and 208 controls). There were no significant differences between the coordinated care and control groups of veterans in costs of care or in QOL measurements using the SF-12 Health Survey and the EuroQol Group EQ-5D. These findings are consistent with those reported in earlier studies which suggest that benefits from care coordination programmes may take some time to emerge.

scholarly journals General practice attendances among patients attending a post-COVID-19 clinic: A pilot study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0016
Author(s):  
John Michael Broughan ◽  
Geoff McCombe ◽  
Gordana Avramovic ◽  
Des Crowley ◽  
Cheyenne Downey ◽  
...  
Keyword(s):  
Older Adults ◽  
General Practice ◽  
Pilot Study ◽  
Hospital Discharge ◽  
Hospital Admissions ◽  
Clinic Visit ◽  
University Hospital ◽  
Care Needs ◽  
Medical Histories

BackgroundAbout 10-35% of people with COVID-19 merit medical care within three weeks of infection. However, the prevalence of ongoing care needs among those experiencing severe COVID-19 illness is unclear.AimThis pilot study aimed to address this knowledge gap by examining GP attendance trends among patients attending a post-COVID-19 hospital follow-up clinic, 3-6 months after an initial clinic visit.Design, and SettingData was collected from adult patients attending a post-COVID-19 follow-up clinic at the Mater Misericordiae University Hospital, Dublin, Ireland.MethodParticipants completed questionnaires outlining their demographics, medical histories, emergency hospital admissions/re-admissions where applicable, and where relevant, GP attendances following hospital discharge. Analyses were conducted using descriptive/inferential statistics.ResultsParticipants’ (n=153) median age =43.5 (IQR =30.9–52.1 years). There were 105 females (68.6%, 95% CI=61.3%–75.9%). Various medical histories were reported among participants. 67 (43.2%, 95% CI=35.9%–51.6%) received emergency COVID-19 hospital care. Older adults, males, ICU admissions, and re-admissions were common among hospital attendees. Of the hospital attendees, 16 (24%, 95% CI=13.7%–34.2%) and 26 (39%, 95% CI=27.3%–50.7%) attended GPs within seven and 30 days of hospital discharge. Older adults, people with pre-existing medical conditions, and individuals admitted to ICU/readmitted to hospital were common among general practice attendees.ConclusionPersistent health issues appear to be common among severe COVID-19 patients, particularly those who are older adults, have pre-existing health problems, and had been in ICU and/or re-admission care. Larger scale studies of ongoing COVID-19 care needs in general practice/primary care are required.

30 The Role of A Virtual Clinic in Reducing Waiting Times for Out-Patient Follow-Up

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
F Thomson ◽  
K Richards
Keyword(s):  
Hospital Admissions ◽  
Action Plan ◽  
Waiting Times ◽  
Effective Means ◽  
Safety Net ◽  
Test Results ◽  
Potential Harm ◽  
Virtual Clinic

Abstract Topic Hospital admissions for older people are increasing with subsequent pressure on out-patient (OP) clinics. By early 2018, 350 patients were waiting up to 6 months for follow-up, with limited capacity in existing clinics. There were concerns regarding potential harm to patients from delayed review of significant results. Intervention A working group considered options for managing the OP waiting list. We decided to pilot a fortnightly virtual clinic (VC) where cases were reviewed without the patient present. All patients awaiting results were listed for the VC rather than routine OP. Each VC had 50 patients listed. Patient’s GP received a clear action plan. Clinic rules were modified as issues were identified. Links with other specialities evolved reducing the number of missing results. Data was analysed for 50% of consultations between January 2018 and March 2019. Improvement 311 VC appointments were reviewed: 207 in 2018 and 104 up to March 2019. Maximum 25 cases could be completed per clinic, additional sessions cleared initial backlog within 3 months. Completion time/case ranged from 2-15 minutes depending on complexity. Main reason for VC was test results: 82% in 2018, increasing to 93% in 2019. 61% in 2018, 80% in 2019 were discharged directly from VC. 20% required a 2nd VC for outstanding results. OP review post-VC fell from 16% in 2018 to just 2% in 2019. General OP requirements fell from 24hrs to 10 hours/ week as a result of VCs, releasing consultants for other clinical areas. Discussion VCs are an effective means of reviewing outstanding results from recent admissions and OP consultations. Routine listing of patients with outstanding investigations provides a safety net. Most results are normal and do not require follow-up. Repeat CXRs at 6 weeks continue to be requested for severely frail people who are unlikely to benefit.

Health$en$eTM: Developing a Board Game on Value-based Healthcare Financing

2019 ◽  
Vol 51 (1) ◽  
pp. 87-105
Author(s):  
Harold Tan ◽  
Yap Chun Wei ◽  
Heng Wei Yun ◽  
Koh Eng Hui Joan ◽  
Ho Wai Yee ◽  
...  
Keyword(s):  
Value Chain ◽  
Healthcare Expenditure ◽  
Healthcare Providers ◽  
Board Game ◽  
Healthcare Financing ◽  
The Matrix ◽  
Potential Impact ◽  
Value Based Care ◽  
Game Elements

Background. With rising healthcare costs, there is a need to transform healthcare financing to provide better care value and sustainability. Healthcare providers and consumers need to be educated about value-based care and financing. This can be done through games. Intervention & Methods. We describe the design of our board game Health$en$eTM which aims to let players simulate the role of funding patients’ care as the patients move across the care value chain. In the game, players will learn how certain care funding innovations help to optimize healthcare expenditure for better value. Discussion & Conclusion. We envisage that some game elements of Health$en$eTM may motivate players to transform healthcare financing systems in the real world. We formulate a matrix to predict the possible associations between game elements and psychological core drives relevant to Health$en$eTM. Further analysis of the game’s potential impact and validation of the matrix could be conducted in due course after the game is launched in a workshop.

scholarly journals Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022377 ◽  
Author(s):  
Iñaki Martín Lesende ◽  
Luis Ignacio Mendibil Crespo ◽  
Sonia Castaño Manzanares ◽  
Anne-Sophie Denise Otter ◽  
Irati Garaizar Bilbao ◽  
...  
Keyword(s):  
Primary Care ◽  
Functional Status ◽  
Associated Factors ◽  
Hospital Admissions ◽  
Functional Decline ◽  
Care Needs ◽  
Prospective Multicentre Study ◽  
Referral Hospitals ◽  
Adjusted Clinical Groups

ObjectiveTo analyse short-term functional decline and associated factors in over 65-year-olds with multimorbidity.Design and settingProspective multicentre study conducted in three primary care centres, over an 8-month period. During this period, we also analysed admissions to two referral hospitals.ParticipantsOf the 241 patients ≥65 years included randomly in the study, 155 were already part of a multimorbidity programme (stratified by ‘Adjusted Clinical Groups’) and 86 were newly included (patients who met Ollero’s criteria and with ≥1 hospital admission the previous year). Patients who were institutionalised, unable to complete follow-up or receiving dialysis were excluded.Outcomes and variablesThe primary outcome was the decrease in functional status category (Barthel Index or Lawton Scale). Other variables considered were sociodemographic characteristics, comorbidity, medications, number of admissions and functional status on discharge.ResultsPatients had a median age of 82 years (P7586) and of five selected chronic conditions (IQR 4–6), and took 11 (IQR 9–14) regular medications; 46.9% were women; 38.2% had impaired function at baseline.Overall, 200 persons completed the follow-up; 10.4% (n=25) of the initial sample died within the 8 months. In 20.5% (95% CI 15.5% to 26.6%) of them we recorded a decrease in functionality, associated with older age (OR 1.1, 95% CI 1.0 to 1.2) and with having ≥1 admission during the follow-up (OR 3.6, 95% CI 1.6 to 7.7). There were 133 hospital admissions in total during the follow-up considering all the patients included, and a functional decline was observed in 35.5% (95% CI 25.7% to 46.7%) of the 76 discharges in which functional status was assessed.ConclusionsA fifth of patients showed functional decline or loss of independence in just 8 months. These findings are important as functional decline and the increasing care needs are potentially predictable and modifiable. Age and hospitalisation were closely associated with this decline

Facing Disaster During a COVID-19 Outbreak: What Emergency Medicine Experts Should Know?

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Meisam Moezzi ◽  
Kambiz Masoumi ◽  
Arash Forouzan ◽  
Manda Poladzadeh ◽  
Fakher Rahim
Keyword(s):  
Emergency Medicine ◽  
Virus Transmission ◽  
Emergency Physicians ◽  
Emergency Rooms ◽  
Supportive Services ◽  
Medical Centers ◽  
Nurses And Physicians ◽  
Shed Light

Context: Since December 2019, the new coronavirus (COVID-19) has been identified as one of the significant challenges in the health systems of countries. Recently, the development and equipping of hospitals and medical centers have been considered as a priority, providing a variety of advanced services in the areas of diagnostic, therapeutic, and supportive services to patients. The present review aimed to shed light on the importance and crucial role of knowledge in the field of emergency medicine during the COVID-19 pandemic and to compare the local and international guidelines. Finally, in addition to the workplace and emergency practitioners’ acts, alongside the especial need to frequently disinfect with appropriate antiseptic materials, negative pressure ventilation should also be in the triage and emergency rooms. Besides, personal protection requirements should be sufficiently accessible, and emergency physicians should be trained to use them properly while adhering to safety principles. It is also recommended to use a cap, gown, appropriate mask, shield, and gloves during treatment, diagnostic and supportive measures, and practice frequent hand washing with antiseptic materials like alcohol solutions, as it reduces the risk of infection transmission. Moreover, it is imperative that nurses and physicians working in emergencies follow all safety principles at the end of the shift before entering their homes. Conclusions: Ultimately, the final goal is to reduce the virus transmission through early detection, supportive, diagnostic, and therapeutic actions, and appropriate follow-up.

Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 130-139 ◽  
Author(s):  
Danica W. Y. Liu ◽  
A. Kate Fairweather-Schmidt ◽  
Richard Burns ◽  
Rachel M. Roberts ◽  
Kaarin J. Anstey
Keyword(s):  
Risk Factors ◽  
Well Being ◽  
Current Status ◽  
Psychological Resilience ◽  
Cross Sectional ◽  
Life Project ◽  
Resilience Factors ◽  
First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

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