Regional critical care delivery systems

2016 ◽  
Author(s):  
Theodore J. Iwashyna ◽  
Colin R. Cooke
Keyword(s):  
Critical Care ◽  
Systems Of Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Cost Effective ◽  
Design Decisions ◽  
Regional Systems ◽  
Regional System ◽  
Care Systems ◽  
Regionalization Of Care

A regional system of critical care is one in which hospitals are acknowledged to vary in their care of critically-ill patients, and procedures exist to systematically refer patients to a subset of those hospitals. Given scarcity in health care systems, regional systems of care are an attempt to rationalize differentiation among hospitals. There are several examples that suggest regionalization of care can result in cost-effective improvements in patient outcomes. Yet there are also numerous examples of regional systems of care that offer few benefits to patients, or that fail to actually concentrate patients despite the grand plans of their designers. This chapter suggests several key design decisions that can be used to help improve the effectiveness of regional system of care. Addressing all these issues may offer dramatic benefits for patients.

Abstract WP3: EMS Routing for Endovascular Patients- One Health Care Systems Successful Model

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Coleman O Martin ◽  
Angela M Hawkins ◽  
Karin Olds ◽  
Naveed Akhtar ◽  
William Holloway ◽  
...  
Keyword(s):  
Health System ◽  
Routing Protocol ◽  
Systems Of Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Stroke Care ◽  
Stroke Work ◽  
Stroke Patients ◽  
Successful Model ◽  
Care Systems

Background: Annually, over 1500 stroke patients are seen within a large metropolitan health system. The health system encompasses a designated comprehensive (CSC) and multiple primary (PSC) stroke hospitals with varying capabilities to manage stroke patients, resulting in varied care delivery. While CSCs mitigate inconsistencies by establishing a standard of stroke care, one shortcoming of the CSC model is lack of regulation in transfer of patients between centers within a health system containing multiple stroke designations. Purpose: The purpose of the project was to create a streamlined, emergency stroke work-up process across the various levels of stroke hospitals and to apply rapid routing practices for EMS when transferring stroke patients between facilities. These changes could reduce treatment times and optimize resources to facilitate transportation of stroke patients to the appropriate center. Methods: The system stroke steering team, in collaboration with regional EMS directors initiated 5 primary processes to reduce delays. These included 1) door in to door out times of 60 minutes, 2) loading radiology images into a cloud environment, 3) development of EMS algorithms, 4) prompt follow-up reports on stroke transfers, and 5) rapid loop-closure on gaps in the process. A reduction in door-to-therapy time and measures of patient outcome were used as indicators for effectiveness. Results: Implementation of a streamlined ED process and new routing protocol was associated with improved door-to-door times, door-to-treatment times and EMS transport times. Additionally, risk-adjusted mortality decreased from 0.7 in 2012 to 0.3 in 2014. Similarly, thrombolytic complications in intravenous and endovascular patients decreased from 7.5% in 2012 to 1.7% in 2014, while treatment rates in both increased. Conclusion: Within a large health system, utilizing a consistent ED process and new EMS routing protocol could contribute to improved outcomes. This raises the possibility that implementing system routing practices may improve collaboration within stroke systems of care and advance the CSC model.

The Future of Health Care in South Korea and the UK

2006 ◽  
Vol 5 (3) ◽  
pp. 375-385 ◽  
Author(s):  
Bob Matthews ◽  
Yoonsoon Jung
Keyword(s):  
Health Care ◽  
South Korea ◽  
Care Delivery ◽  
Health Care Systems ◽  
Public Provision ◽  
Capitalist System ◽  
Private Provision ◽  
Care Systems ◽  
Health Care Delivery Systems ◽  
The Uk

This paper discusses and compares the origin and development of the health care systems of South Korea and the UK from the end of WW2 and endeavours to compare outcomes. The paper emphasises the importance of war as a stimulus to the development of national health services in both countries and argues that there is convergence between the UK's nationalised NHS and South Korea's US-modelled capitalist system. Overall, we conclude that there is a possibility not only that the financing and nature of the Korean and UK health care delivery systems may show convergence, but it is not impossible that they will ‘change places’ with the UK system dominated by private provision and South Korea's by public provision.

scholarly journals Identification and management of prediabetes: results of the Latin America Strategic Prediabetes Meeting

2017 ◽  
Vol 41 ◽  
pp. 1 ◽  
Author(s):  
Patricio López-Jaramillo ◽  
Ramfis E. Nieto-Martínez ◽  
Gestne Aure-Fariñez ◽  
Carlos O. Mendivil ◽  
Rodolfo A. Lahsen ◽  
...  
Keyword(s):  
Latin America ◽  
Health Care Systems ◽  
Public Health Problem ◽  
Preventive Treatment ◽  
Cost Effective ◽  
Lifestyle Changes ◽  
Diagnosis And Treatment ◽  
Effective Interventions ◽  
The Status ◽  
Care Systems

To understand the status of prediabetes diagnosis and treatment in Latin America and to evaluate the use of metformin for diabetes prevention in this context. A panel of 15 diabetes experts from seven countries in Latin America met on 14 – 15 August 2014 in Lima, Peru, to review the available literature, discuss the role of prediabetes in type 2 diabetes mellitus and cardiovascular disease, analyze collected information, and make conclusions for prediabetes diagnosis and treatment in Latin America. Prediabetes diagnosis, screening, and treatment, including lifestyle changes, pharmacological treatment, and cost-effectiveness were discussed. Five resulting statements were issued for Latin America: prediabetes is a clinical and public health problem; health care systems do not currently diagnose/treat prediabetes; use of prediabetes risk detection tools are needed region-wide; treatment includes lifestyle changes, multidisciplinary education, and metformin; and registries of patient records and further studies should be supported. The expert panel concluded that in Latin America, preventive treatment through lifestyle changes and metformin are cost-effective interventions. It is important to improve prediabetes identification and management at the primary care level.

scholarly journals A 2019. évi ARIA kezelési irányelvek magyar adaptációja és a hazai alkalmazás lehetőségei allergiás rhinitisben

2020 ◽  
Vol 161 (49) ◽  
pp. 2059-2071
Author(s):  
Helga Kraxner ◽  
Andor Hirschberg ◽  
Kristóf Nékám
Keyword(s):  
Health Care ◽  
Allergic Rhinitis ◽  
Mobile Health ◽  
Health Care Systems ◽  
Cost Effective ◽  
Allergic Diseases ◽  
The European Union ◽  
Sentinel Network ◽  
Intranasal Corticosteroids ◽  
Care Systems

Összefoglaló. Az allergiás betegségekben szenvedő emberek száma világszerte, köztük Magyarországon is növekszik. Az egészségügyi ellátórendszerek azon dolgoznak, hogy minél hatékonyabban tudják felhasználni a rendelkezésre álló forrásokat. Az Allergic Rhinitis and its Impact on Asthma (ARIA) szervezet célja az allergiás náthában szenvedő betegek ellátásának javítása, szakmai ajánlások készítése, aktualizálása. Ennek egyik módja integrált betegellátási utak kidolgozása. Célunk ezek hazai elérhetővé tétele, az ajánlások széles körű elterjesztése az Európai Unió (EU) többi tagállamához hasonlóan Magyarországon is. Az ARIA más nemzetközi innovatív szervezetek bevonásával olyan integrált betegellátási utakat fejlesztett ki, amelyek allergiás nátha, esetleg társbetegsége, az asztma esetén támogatják a kezelést. Ezeket újgenerációs irányelvek kidolgozása útján alkották, amelyekhez felhasználták a mobiltechnológiából és pollenkamra-vizsgálatokból származó valós evidenciákat is. A gyógyszeres terápia optimalizálásához a vizuális analóg skálán alapuló, úgynevezett Mobil Légúti Figyelő Hálózat algoritmusát digitalizálták, és valós evidenciák felhasználásával tovább finomították. Allergén immunterápiára az ARIA a világon elsőként dolgozott ki integrált betegellátási utakat 2019-ben. A kezelési irányelvekhez való adherenciaszint alacsony, a betegek a tüneteik erőssége alapján módosítják a kezelést. A flutikazon-propionát–azelasztin kombináció hatása erősebb az intranasalis kortikoszteroidokénál, míg az utóbbi hatásosabb az oralis H1-antihisztaminoknál. A mobiltelefonokban tárolt elektronikus napló vagy más ’mobile health’ (mHealth) eszközök használata segíti a betegek kiválasztását allergén immunterápiára. Az ARIA által javasolt algoritmus megfelelőnek mutatkozott az allergiás rhinitis kezelésére, ezért ezek az irányelvek bekerülnek integrált betegellátási utakba, és részét fogják képezni az EU Egészségügyi és Élelmiszer-biztonsági Főigazgatósága digitalizált, személyközpontú gondozási anyagainak. Az allergén immunterápia hatékony az inhalatív allergének által okozott allergiás betegségekben, alkalmazását azonban korlátozni kell gondosan válogatott betegekre. Orv Hetil. 2020; 161(49): 2059–2071. Summary. The number of allergic patients is increasing all over the world, also in Hungary. Delivering effective and cost-effective health care is essential for all health care systems. ARIA (Allergic Rhinitis and its Impact on Asthma) aims to improve the care of patients who suffer from allergic rhinitis by setting up guidelines and updating them. Development of ICPs (integrated care pathways) can play an essential role in attaining this goal. Our aim is to make ICP-s developed by ARIA available also in Hungary, as is already the case in other countries of the European Union (EU). Together with other international initiatives, ARIA has worked out digitally-enabled ICPs to support care in allergic rhinitis and comorbid asthma. ICPs are based on new-generation guidelines using RWE (real-world evidence) from chamber studies and mobile technology. The MASK (Mobile Airways Sentinel NetworK) algorithm – based on visual analogue scale – was digitalized to support pharmacotherapy, and was refined by using RWE. ARIA was the first to develop ICPs for allergen immunotherapy (AIT) in 2019. Based on MASK data, patients did not follow guidelines and their adherence to treatment was poor. Patients would modify their treatments, depending on the disease control. The effect of fluticasone propionate–azelastine combination is superior to intranasal corticosteroids which are superior to oral H1-antihistamines. Electronic diaries obtained from cell phones and other ’mobile health’ (mHealth) devices help select patients for AIT. The ARIA algorithm for AR was found appropriate and no change is necessary. These guidelines will inform ICPs and will be included in the DG Santé digitally-enabled, person-centred care system. AIT is an effective treatment for allergic diseases caused by inhaled allergens. Its use should, however, be restricted to carefully selected patients. Orv Hetil. 2020; 161(49): 2059–2071.

A Comparison of Organized and Traditional Health Care

2005 ◽  
Vol 44 (02) ◽  
pp. 273-277
Author(s):  
D. M. Lawrence
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Health Care Systems ◽  
Delivery Systems ◽  
Traditional Health ◽  
Traditional Health Care ◽  
Care Systems ◽  
Health Care Delivery Systems

Summary Purpose: To compare organized and traditional health care delivery systems and their ability to meet several major challenges facing health care in the next 25 years. Approach: Analysis of traditional and organized health care systems based on a career spent in organized health care systems. Conclusions: The traditional health care system based on independent autonomous physicians is not able to meet the challenges of current healthcare. Stronger integration and coordination, i.e., organized health care delivery systems are required.

Abstract 45: Global Impact of the Covid-19 Pandemic on Stroke Hospitalizations and Mechanical Thrombectomy Volumes: A Society of Vascular and Interventional Neurology Covid-19 International Collaboration

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Raul Nogueira ◽  
Mohamad AbdalKader ◽  
Muhammad Mustafa Qureshi ◽  
Michael R Frankel ◽  
Diogo Haussen ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Systems Of Care ◽  
Health Care Systems ◽  
Control Period ◽  
International Study ◽  
High Volume ◽  
Geographic Variations ◽  
Global Impact ◽  
Care Systems ◽  
Low Volume

Introduction: The COVID-19 pandemic led to profound changes in both the organization of health care systems and the psychosocial behavior of the population worldwide. The extent to which the COVID-19 outbreak disrupted stroke systems of care merits study from a global lens. Methods: We conducted a retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The study objectives were to measure the global impact of the pandemic on the volumes for mechanical thrombectomy (MT), stroke and intracranial hemorrhage (ICH) hospitalizations over a 3-month period at the height of the pandemic (March 1 to May 31, 2020) compared with two control 3-month periods prior (immediately preceding and one year prior). A secondary objective was to examine whether these changes in volume were impacted by COVID-19 and baseline hospital center stroke volumes. Third, we evaluated the relationships between stroke and COVID-19 diagnoses. Results: There were 26,699 stroke admissions in the 3 months immediately before compared to 21,576 admissions during the pandemic months, representing a 19.2% (95%CI,-19.7 to -18.7) decline. There were 5,191 MT procedures in the 3 months preceding compared to 4,533 procedures during the pandemic, representing a 12.7% (95%CI,-13.6 to -11.8) drop. Significant reductions were also seen in relation to the prior year control period. The decreases were noted across centers with high, intermediate, and low COVID-19 hospitalization burden, and also across high, intermediate, and low volume stroke centers. High-volume COVID-19 centers (-20.5%) had greater declines in MT volumes than mid- (-10.1%) and low-volume (-8.7%) centers. There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, MT procedures, ischemic stroke/TIA and ICH admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke and MT volumes. Centers with higher COVID-19 inpatient volumes experienced steeper declines.

Developing and Measuring the Business Case for Health Information Technology

2017 ◽  
pp. 262-290 ◽  
Author(s):  
Duncan Wade Unwin ◽  
Louis Sanzogni ◽  
Kuldeep Sandhu
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Information Systems ◽  
Care Delivery ◽  
Health Care Systems ◽  
Business Case ◽  
It Adoption ◽  
Health It ◽  
Adoption Of Technology ◽  
Care Systems

This chapter examines the adoption of information technology and information systems to support the clinical process. It explores popular models of information systems adoption and success, and relates these to the health it context. The end result of successful adoption of technology should be the improvement in performance of health care delivery, yet measurement of performance is complex. The various approaches to performance measurement are discussed. As one of the challenges in predicting the outcomes of adoption is the lack of consistent taxonomy, a solution to which is proposed. The chapter then looks at evaluation of it projects and considers what special factors may affect health it adoption and benefits in developing health care systems.

Emergency Telehealth Services in the Correctional Setting

2021 ◽  
pp. 210-221
Author(s):  
Newton E. Kendig ◽  
David G. Ellis ◽  
Renoj Varughese ◽  
Obinna M. Ome Irondi
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Emergency Services ◽  
Point Of Care ◽  
Health Care Systems ◽  
Cost Effective ◽  
Correctional Setting ◽  
Correctional Health Care ◽  
Correctional Health ◽  
Care Systems

Millions of patients receive their primary health care in U.S. jails and prisons each year. Correctional health care systems frequently lack round-the-clock onsite physician services, and access to local hospital-based emergency services may be limited. Increasingly, correctional health care systems are relying on telehealth capabilities to improve their access to subspecialty services. Emergency telehealth services, however, are largely underutilized. Available reports suggest that emergency telehealth services can reduce outside medical trips and prove cost-effective in certain settings. Successful emergency telehealth programs emphasize the importance of a thorough diagnostic evaluation, effective communication with local correctional health care providers, and strategic use of point-of-care testing. This chapter provides practical recommendations for the telehealth evaluation and management of commonly occurring medical emergencies in the correctional setting.

Organizing a diabetes service

2011 ◽  
pp. 2005-2011
Author(s):  
Stephen C. L. Gough
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Cost Effective ◽  
Health Care Need ◽  
Delivery Of Care ◽  
Strategic Approach ◽  
Effective Manner ◽  
Care Systems ◽  
The Individual ◽  
The Uk

The increasing worldwide incidence and prevalence of diabetes is placing substantial pressures on health care systems and economies. As a consequence individuals involved in the care of people with diabetes are looking at services currently being provided and examining ways in which care can be organized in the most cost-effective manner. Whilst the degree to which diabetes care is delivered differs from country to country, similar fundamental questions are being asked by those involved in the delivery of care, including: What are we currently providing? What do we need to provide? What are we able to provide? Although the answers to these questions are quite different not just between countries but often within specific localities within a country, the ultimate aim is the same: to provide the best possible care to as many people with diabetes as possible. The global diversity of diabetes health care need is enormous and while the solutions will be equally diverse, the approach to the development of a diabetes service will, for many organizations, be similar. The main focus of this chapter is based upon the model or the strategic approach developed in the UK, but many of the individual component parts are present in most health care settings.

Tele-ICU “Myth Busters”

2012 ◽  
Vol 23 (3) ◽  
pp. 302-311
Author(s):  
Angelo Venditti ◽  
Chanda Ronk ◽  
Tracey Kopenhaver ◽  
Susan Fetterman
Keyword(s):  
Crisis Intervention ◽  
Health Care Systems ◽  
Quality Care ◽  
Cost Effective ◽  
Profound Impact ◽  
Telemetry Unit ◽  
Improved Outcomes ◽  
Growing Body ◽  
Care Systems ◽  
Service Expectations

Tele–intensive care unit (ICU) technology has been proven to bridge the gap between available resources and quality care for many health care systems across the country. Tele-ICUs allow the standardization of care and provide a second set of eyes traditionally not available in the ICU. A growing body of literature supports the use of tele-ICUs based on improved outcomes and reduction in errors. To date, the literature has not effectively outlined the limitations of this technology related to response to changes in patient care, interventions, and interaction with the care team. This information can potentially have a profound impact on service expectations. Some misconceptions about tele-ICU technology include the following: tele-ICU is “watching” 24 hours a day, 7 days a week; tele-ICU is a telemetry unit; tele-ICU is a stand-alone crisis intervention tool; tele-ICU decreases staffing at the bedside; tele-ICU clinical roles are clearly defined and understood; and tele-ICUs are not cost-effective to operate. This article outlines the purpose of tele-ICU technology, reviews outcomes, and “busts” myths about tele-ICU technology.

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