Value-Based Care

2019 ◽  
pp. 690-696
Author(s):  
Finly Zachariah ◽  
William Dale
Keyword(s):  
Palliative Care ◽  
Healthcare Costs ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Healthcare Team ◽  
Institute Of Medicine ◽  
A Value ◽  
Care Delivery Model ◽  
Value Based Care ◽  
Evidence Based Care

The unsustainable growth of healthcare costs has precipitated the need for significant reforms in healthcare with a focus on shifting from volume to value. Value-based care is evidence-based care that helps patients improve their health, reduce the effects from chronic diseases, and live healthier lives. The Institute of Medicine (IOM) report, Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, detailed several recommendations to improve care through the provision of palliative care. Palliative care is conducted by an interdisciplinary team and, in addition to addressing bio-psycho-socio-spiritual concerns, facilitates the alignment of patient preferences with healthcare delivery and minimizes under- and overtreatment. This chapter explores key opportunities aligned with the IOM’s report that recommend nurses and the healthcare team facilitate the incorporation of palliative care and execution and the adoption of a value-based care delivery model.

scholarly journals An Opportunity for Diagonal Development in Global Surgery: Cleft Lip and Palate Care in Resource-Limited Settings

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Pratik B. Patel ◽  
Marguerite Hoyler ◽  
Rebecca Maine ◽  
Christopher D. Hughes ◽  
Lars Hagander ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Surgical Care ◽  
Surgical Capacity ◽  
Middle Income ◽  
Humanitarian Emergencies ◽  
Resource Limited ◽  
Care Delivery Model

Global cleft surgery missions have provided much-needed care to millions of poor patients worldwide. Still, surgical capacity in low- and middle-income countries is generally inadequate. Through surgical missions, global cleft care has largely ascribed to a vertical model of healthcare delivery, which is disease specific, and tends to deliver services parallel to, but not necessarily within, the local healthcare system. The vertical model has been used to address infectious diseases as well as humanitarian emergencies. By contrast, a horizontal model for healthcare delivery tends to focus on long-term investments in public health infrastructure and human capital and has less often been implemented by humanitarian groups for a variety of reasons. As surgical care is an integral component of basic healthcare, the plastic surgery community must challenge itself to address the burden of specific disease entities, such as cleft lip and palate, in a way that sustainably expands and enriches global surgical care as a whole. In this paper, we describe a diagonal care delivery model, whereby cleft missions can enrich surgical capacity through integration into sustainable, local care delivery systems. Furthermore, we examine the applications of diagonal development to cleft care specifically and global surgical care more broadly.

scholarly journals Barriers to and facilitators of implementation of the integration of oncology and palliative care in daily practice: a systematic review

2021 ◽  
Author(s):  
Yu Uneno ◽  
Yoshiki Horie ◽  
Yuki Kataoka ◽  
Masanori Mori ◽  
Mami Hirakawa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Care Delivery ◽  
Daily Practice ◽  
Individual Characteristics ◽  
Educational Opportunities ◽  
Eligibility Criteria ◽  
Ovid Medline ◽  
Care Delivery Model ◽  
The Government

Abstract Background: Palliative care (PC) is widely recognized as an essential part of oncology care, and multiple academic societies have developed strong recommendations regarding the implementation of the integration of oncology and PC (IOP) in daily practice. However, IOP implementation is a slow- evolving process, and its barriers and facilitators have not yet been comprehensively identified. This systematic review aimed to clarify the barriers to and facilitators of IOP in the context of treating patients with advanced cancer.Methods: We searched Ovid MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature until June 3, 2017. We included original articles, narrative and systematic reviews, guidelines, editorials, commentaries, and letters. After title and abstract screening by two of five independent reviewers, we analyzed the data qualitatively using inductive content analysis and a consolidated framework for implementation research. Results: We obtained 3,304 articles, of which 60 met the predefined eligibility criteria. The numbers and proportions of original and review articles, guidelines, and other article types were 21 (35%), 30 (50%), 3 (5%), and 7 (12%), respectively. Five categories emerged regarding both the barriers to and facilitators of IOP: intervention characteristics, outer settings, inner settings, individual characteristics, and process. The representative barriers were limited availability of and access to PC services, limited educational opportunities for PC providers, insufficient reimbursement and research funding toward PC services, focus on cure rather than care (patients and their caregivers), and insufficient communication between oncology and PC staff (n = 26, 16, 14, 13, and 7, respectively). The representative facilitators were improvement of the availability of and access to PC services, development of an optimal integrated care model, enrichment of educational opportunities regarding PC (healthcare professionals), and initiatives by government and academic societies (n = 24, 18, 25, and 7, respectively).Conclusions: This study clarified the multi-level barriers to and facilitators of the implementation of IOP. Educational and financial support from the government and academic societies appears essential, and further effort to develop and investigate the implementable care delivery model is warranted.Registration: PROSPERO:CRD42018069212

Perceptions of Palliative Care: Voices From Rural South Dakota

2020 ◽  
pp. 104990912095380
Author(s):  
Chamika Hawkins-Taylor ◽  
Sarah Mollman ◽  
Beth Walstrom ◽  
Jennifer Kerkvliet ◽  
Mary Minton ◽  
...  
Keyword(s):  
Palliative Care ◽  
South Dakota ◽  
Care Delivery ◽  
Family Members ◽  
Care Team ◽  
Healthcare Team ◽  
Rural South ◽  
Team Members ◽  
Care Services ◽  
Interprofessional Healthcare

Objectives: This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery. Methods: Six focus groups were conducted over two months. Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants. Results: Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged: Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results: Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents.

The oncology palliative care matrix: A community-derived evaluation tool for constructing oncology palliative care programs.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 253-253
Author(s):  
Lynne Padgett
Keyword(s):  
Palliative Care ◽  
Assessment Tool ◽  
Care Delivery ◽  
Care Staff ◽  
Institute Of Medicine ◽  
Patient Identification ◽  
Self Assessment ◽  
Cancer Centers ◽  
Care Working Group ◽  
The Future

253 Background: While the Institute of Medicine and the Center to Advance Palliative Care have provided the impetus for many cancer centers to build palliative care programs, guidance regarding the “nuts and bolts” of program development is lacking. The Oncology Palliative Care Matrix (OPCM) is a unique self-assessment tool designed to facilitate both program evaluation and planning for provision of oncology palliative care. Methods: The National Cancer Institute Community Cancer Centers Program (NCCCP) Palliative Care Working Group developed the OPCM to assess palliative care capacity. The tool covers 17 components associated with quality palliative care delivery (e.g., staff training, patient identification, advanced care planning, attention to spiritual care). All NCCCP sites (16 enrolled in 2007, 14 enrolled in 2010) completed the matrix in 2010 evaluating their capacity with respect to each of these domains at the following time points: baseline (entry to the NCCCP program), 2 years after NCCCP enrollment (2007 sites only), and the upcoming year (goals for the future). Results: At baseline, matrix responses reflected variability in service capacity across the 17 domains. Reported capacity for specific palliative care components improved for the 2007 sites after 2 years in NCCCP; all sites identified ‘reach’ goals for the coming year. For example, at baseline, 63% of 2007 sites and 50% of 2010 sites referred only patients at end-of-life or with advanced disease and severe symptoms for palliative care services. However, after 2 years in NCCCP, 44% of 2007 sites still referred only these patients, while 56% made referrals to palliative care for patients at all cancer stages and/or as needed during post-treatment. Further, 100% of 2007 sites and 86% of 2010 sites aspired to this expanded referral capacity in the future. Conclusions: The OPCM shows utility in the community setting for self-assessment of capacity and strategic planning to improve quality palliative care delivery. It also highlights that some components of quality care may be easier to achieve/improve (e.g., referral for palliative care) than others (e.g., regular symptom assessment, palliative care staff support).

New Payment Models and Big Data Analytics

2014 ◽  
pp. 1622-1636
Author(s):  
Avnish Rastogi
Keyword(s):  
Care Delivery ◽  
Healthcare Delivery ◽  
Big Data Analytics ◽  
National Research Council ◽  
International Perspective ◽  
Institute Of Medicine ◽  
Healthcare Delivery System ◽  
Quality Outcomes ◽  
Younger Age ◽  
Government Mandates

It has been fascinating to watch how American healthcare delivery system is going through a paradigm shift to meet new government mandates and bend the care delivery cost curve. For years, US health care system has been fragmented and falling short on quality, outcomes, costs, and lacking framework to support care continuum. According to the study conducted by National Research Council and the Institute of Medicine, for many years, US population has been dying at the younger age than population with similar characteristics in other countries such as Canada, Australia and Japan. When compared with the peer countries, US Population did worse in health areas such as drug related deaths, obesity, chronic diseases, disability, etc. (Institute of Medicine of the National Academics. 2013 in, U.S Health in International Perspective Shorter Lives, Poorer Health.)

scholarly journals ASKING THE PEOPLE WHO MATTER THE MOST: DESIGNING A VALUE-BASED DEMENTIA SPECIALTY CLINIC

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S118-S118
Author(s):  
Alyssa Aguirre ◽  
Christopher Ulack ◽  
Joel Suarez ◽  
Kathleen Carberry ◽  
Justin Rousseau ◽  
...  
Keyword(s):  
Qualitative Methodology ◽  
Early Stage ◽  
Care Delivery ◽  
Outcome Measurement ◽  
Memory Loss ◽  
Cognitive Disorders ◽  
The People ◽  
Care Delivery Model ◽  
Care Partners ◽  
Value Based Care

Abstract This presentation will highlight our research which uses a qualitative methodology to incorporate the voices and experiences of people impacted by dementia into the value-based health model. This model is characterized by a team-based approach as well as the measurement of outcomes. The aim of value-based care is to provide individuals meaningful and compassionate care that helps them achieve the health outcomes that matter most to them. Foundational to creating this person-centered model is the incorporation of the perspectives of individuals with dementia and their care partners. Experience Groups offer an opportunity for those affected by dementia to share their expertise and describe their daily challenges and successes so we are able to learn from their experiences and better understand unmet and unarticulated needs. The findings of this research—consisting of 41 patients and 11 care partners—enabled the development of outcome measurement tools implemented at the clinical level, and the design of a care delivery model that addresses unmet needs. Some of the key findings from the research that have been implemented at the Cognitive Disorders Clinic and that will be highlighted in this poster are: 1. Care partners would like more emotional support from their medical team; 2. Individuals want more information about the trajectory of the disease and an actionable “roadmap-of-care”; 3. Care partners and those with early stage memory loss desire counseling and team-based care versus strictly physician-provided care.

scholarly journals Lessons from the COVID-19 pandemic for improving outpatient neuropalliative care: A qualitative study of patient and caregiver perspectives

2021 ◽  
pp. 026921632110173
Author(s):  
Zachary A Macchi ◽  
Roman Ayele ◽  
Megan Dini ◽  
Jensine Lamira ◽  
Maya Katz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Psychosocial Needs ◽  
Structured Interviews ◽  
Supportive Services ◽  
Care Needs ◽  
Survey Responses ◽  
The Impact

Background: COVID-19 has impacted persons with serious illness, including those with chronic, neurodegenerative conditions. While there are several reports on COVID-19’s impact on inpatient palliative care, literature is limited about the impact on outpatient care which may be more relevant for these patients. Aim: To generate a person-centered description of the impact of COVID-19 from the perspectives of patients living with neurodegenerative disease and caregivers to improve outpatient palliative care delivery. Design: This qualitative study used rapid analysis via matrix design to identify emergent themes related to participant perspectives on the challenges of COVID-19. Data sources included semi-structured interviews, open-ended survey responses, medical record documentation and participant-researcher communications. Setting/Participants: Data was collected from 108 patients with Parkinson’s disease, Alzheimer’s disease or related disorders and 90 caregivers enrolled in a multicenter, clinical trial of community-based, outpatient palliative care between March 20, 2020 and August 8, 2020 (NCT03076671). Results: Four main themes emerged: (1) disruptions to delivery of healthcare and other supportive services; (2) increased symptomatic and psychosocial needs; (3) increased caregiver burden; (4) limitations of telecommunications when compared to in-person contact. We observed that these themes interacted and intersected. Conclusions: Patients and caregivers have unmet care needs because of the pandemic, exacerbated by social isolation. While telemedicine has helped improve access to healthcare, patients and caregivers perceive clear limitations compared to in-person services. Changes in society and healthcare delivery in response to COVID-19 highlight ongoing and novel gaps that must be addressed to optimize future outpatient palliative care for neurologic illness.

scholarly journals Fully Integrated Oncology and Palliative Care Services at a Local Hospital in Mid-Norway: Development and Operation of an Innovative Care Delivery Model

2020 ◽  
Vol 9 (1) ◽  
pp. 297-318 ◽  
Author(s):  
Anne-Tove Brenne ◽  
Anne Kari Knudsen ◽  
Sunil Xavier Raj ◽  
Laila Skjelvan ◽  
Jo-Åsmund Lund ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Delivery ◽  
Local Hospital ◽  
Fully Integrated ◽  
Delivery Model ◽  
Care Services ◽  
Care Delivery Model ◽  
Palliative Care Services

scholarly journals Reinventing Palliative Care Delivery in the Era of COVID-19: How Telemedicine Can Support End of Life Care

2020 ◽  
Vol 37 (11) ◽  
pp. 992-997 ◽  
Author(s):  
Katherine C. Ritchey ◽  
Alice Foy ◽  
Erin McArdel ◽  
David A. Gruenewald
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Standard Operating Procedure ◽  
Care Staff ◽  
Tablet Computers ◽  
Training And Education ◽  
Telemedicine Technology ◽  
And Training

Telemedicine technology has become essential to healthcare delivery in the COVID-19 era, but concerns remain regarding whether the intimacy and communication that is central to high-quality palliative care will be compromised by the use of this technology. We employed a business model approach to identify the need for system innovation in palliative care, and a quality improvement approach to structure the project. Products from this project included a standard operating procedure for safe use of tablet computers for inpatient palliative care consultations and family visitations; tablet procurement with installation of video telehealth software; and training and education for clinical staff and other stakeholders. We describe a case illustrating the successful use of palliative care telehealth in the care of a COVID-19-positive patient at the end of life. Successful use of video telehealth for palliative care involved overcoming inertia to the development of telehealth infrastructure and learning clinical video telehealth skills; and engaging front-line care staff and family members who were open to a trial of telehealth for communication. Information gleaned from family about the patient as a person helped bedside staff to tailor care toward aspects meaningful to the patient and family and informed best practices to incorporate intimacy into future palliative video consultations and family visit.

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