Moving toward patient-based funding through quality-based procedures (QBPs) for GI endoscopy and colposcopy.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 43-43
Author(s):  
Nabeela Ratansi ◽  
Aimee Langan ◽  
Irene Blais ◽  
Erin Svara ◽  
Karla Houser ◽  
...  
Keyword(s):  
Best Practices ◽  
Performance Management ◽  
Capacity Planning ◽  
Best Practice ◽  
Care Delivery ◽  
Clinical Pathways ◽  
Quality Care ◽  
Practice Variation ◽  
Evidence Based ◽  
Gi Endoscopy

43 Background: As part of the Ministry’s Health System Funding Reform initiative, Cancer Care Ontario is tasked to develop and implement Quality-Based Procedures (QBPs) for programs such as GI Endoscopy and Colposcopy. QBPs are clusters of patients with clinically related diagnoses or treatments that have been identified by an evidence-based framework as providing opportunity for improving quality outcomes and reducing costs. As stated by the Ministry, the goal is to reimburse providers for the types and numbers of patients treated, using evidence-informed rates associated with the quality of care delivered. Methods: QBPs are multiyear and have four key deliverables: Clinical: developing clinical best practices. Funding: tying best practices to pricing. Capacity Planning: understanding procedure types/volumes for capacity management. Monitoring/Evaluation: measuring the QBP’s impact. Developing the QBPs has involved: Creating Clinical Expert Advisory Groups (CEAG) of clinicians who are recognized for their knowledge and expertise. Tasking the CEAG to define quality and develop best practices informed by literature reviews, jurisdictional scans, and guidelines. Documenting these standards and clinical pathways in a clinical handbook, providing information on the practices that should be implemented to ensure consistent care delivery. The development of best practices is imperative to the foundation of the QBP and spans multiple years. Once best practice development is complete, it will be tied to pricing, where the procedure will be micro-costed based on workload, equipment, supplies, and other administrative costs. Results: The QBPs continue to evolve and aim to: Reduce practice variation. Improve patient outcomes. Improve system accountability. Improve cost-effectiveness of services. Effectiveness will be measured through a performance management framework, including an integrated QBP scorecard measuring appropriateness, access, and efficiency. Conclusions: The underpinning for moving towards an evidence-based, patient-based funding model involves defining quality standards and clincal best practices, and applying these guidelines to determine the cost of quality care.

scholarly journals Engaging Multidisciplinary Stakeholders to Drive Shared Decision-Making in Oncology

2018 ◽  
Vol 34 (1) ◽  
pp. 29-31 ◽  
Author(s):  
Gabrielle Rocque ◽  
Ellen Miller-Sonnet ◽  
Alan Balch ◽  
Carrie Stricker ◽  
Josh Seidman ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Best Practices ◽  
Shared Decision Making ◽  
Best Practice ◽  
Care Delivery ◽  
Evidence Based ◽  
Shared Decision ◽  
Oncology Practice ◽  
Development And Validation

Although recognized as best practice, regular integration of shared decision-making (SDM) approaches between patients and oncologists remains an elusive goal. It is clear that usable, feasible, and practical tools are needed to drive increased SDM in oncology. To address this goal, we convened a multidisciplinary collaborative inclusive of experts across the health-care delivery ecosystem to identify key principles in designing and testing processes to promote SDM in routine oncology practice. In this commentary, we describe 3 best practices for addressing challenges associated with implementing SDM that emerged from a multidisciplinary collaborative: (1) engagement of diverse stakeholders who have interest in SDM, (2) development and validation of an evidence-based SDM tool grounded within an established conceptual framework, and (3) development of the necessary roadmap and consideration of the infrastructure needed for engendering patient engagement in decision-making. We believe these 3 principles are critical to the success of creating SDM tools to be utilized both within and outside of clinical practice. We are optimistic that shared use across settings will support adoption of this tool and overcome barriers to implementing SDM within busy clinical workflows. Ultimately, we hope that this work will offer new perspectives on what is important to patients and provide an important impetus for leveraging patient preferences and values in decision-making.

American Academy of Otolaryngology–Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities

2021 ◽  
pp. 019459982098413
Author(s):  
Cecelia E. Schmalbach ◽  
Jean Brereton ◽  
Cathlin Bowman ◽  
James C. Denneny
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Best Practice ◽  
Medical Center ◽  
Quality Care ◽  
Academic Medical Center ◽  
Neck Surgery ◽  
Performance Measure ◽  
Head And Neck Surgery ◽  
Evidence Based

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

AN INTERNATIONAL POSITION STATEMENT ON THE MANAGEMENT OF FRAILTY IN DIABETES MELLITUS: SUMMARY OF RECOMMENDATIONS 2017

2017 ◽  
pp. 1-11
Author(s):  
A.J. SINCLAIR ◽  
A. ABDELHAFIZ ◽  
T. DUNNING ◽  
M. IZQUIERDO ◽  
L. RODRIGUEZ MANAS ◽  
...  
Keyword(s):  
New England ◽  
American Medical ◽  
Best Practice ◽  
English Language ◽  
Quality Care ◽  
Position Statement ◽  
Evidence Based ◽  
Medicine Journal ◽  
Wide Range ◽  
International Experts

Aim: the the International Position Statement provides the opportunity to summarise all existing clinical trial and best practice evidence for older people with frailty and diabetes. It is the first document of its kind and is intended to support clinical decisions that will enhance safety in management and promote high quality care. Methods: the Review Group sought evidence from a wide range of studies that provide sufficient confidence (in the absence of grading) for the basis of each recommendation. This was supported by a given rationale and key references for our recommendations in each section, all of which have been reviewed by leading international experts. Searches for any relevant clinical evidence were generally limited to English language citations over the previous 15 years. The following databases were examined: Embase, Medline/PubMed, Cochrane Trials Register, Cinahl, and Science Citation. Hand searching of 16 key major peer-reviewed journals was undertaken by two reviewers (AJS and AA) and these included Lancet, Diabetes, Diabetologia, Diabetes Care, British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Journal of Frailty & Aging, Journal of the American Medical Directors Association, and Journals of Gerontology – Series A Biological Sciences and Medical Sciences. Results: two scientific supporting statements have been provided that relate to the area of frailty and diabetes; this is accompanied by evidence-based decisions in 9 clinical domains. The Summary has been supported by diagrammatic figures and a table relating to the inter-relations between frailty and diabetes, a frailty assessment pathway, an exercise-based programme of intervention, a glucose-lowering algorithm with a description of available therapies. Conclusions: we have provided an up to date evidence-based approach to practical decision-making for older adults with frailty and diabetes. This Summary document includes a user-friendly set of recommendations that should be considered for implementation in primary, community-based and secondary care settings.

Evidence-Based Best Practices Collections

2011 ◽  
pp. 280-287 ◽  
Author(s):  
Forrest Shull ◽  
Raimund Feldmann ◽  
Michelle Shaw ◽  
Michelle Lambert
Keyword(s):  
Knowledge Management ◽  
Best Practices ◽  
Competitive Advantage ◽  
Driving Force ◽  
Best Practice ◽  
General Concept ◽  
Lessons Learned ◽  
Evidence Based ◽  
Specific Knowledge ◽  
White Board

For capturing and transferring knowledge between different projects and organizations, the concept of a Best Practice is commonly used. A similar but more general concept for knowledge capturing is often referred to as a Lesson Learned. Both best practices and lessons learned are frequently organized in the form of knowledge collections. Such collections exist in many forms and flavours: From simple notes on a white board, to paper file collections on a shelf, to electronic versions filed in a common folder or shared drive, to systematically archived and standardized versions in experience and databases, or even specific knowledge management systems. In the past few decades, many organizations have invested much time and effort in such specific knowledge collections (e.g., databases, experience repositories) for best practices and/ or lessons learned. The driving force behind all these activities is to disseminate knowledge about proven solutions to their workforce. Ultimately, the goal is to avoid mistakes and improve the overall workflow and processes to possibly save money and gain a competitive advantage.

Tele-ICU Partners Enhance Evidence-Based Practice

2012 ◽  
Vol 23 (3) ◽  
pp. 312-322 ◽  
Author(s):  
Carol Olff ◽  
Cynthia Clark-Wadkins
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Best Practice ◽  
Evidence Based Practice ◽  
Care Delivery ◽  
Health Care Team ◽  
Evidence Based ◽  
New Members ◽  
Management Protocol ◽  
Information Research

Evidence-based practice (EBP) has become more than just a trendy buzzword in health care; EBP validates care delivery methods and grants satisfaction to nurses in knowing the care they provide is based on valid, current information. Research-based enhancements are paramount to the advancement of nursing practice and prompt the implementation of creative methods to improve care. The advent of the tele–intensive care unit (ICU) introduces new members of the health care team to assist with implementation of EBP initiatives. This new partnership results in improved length of stay, mortality rates, and ventilator times for critical care patients. Current literature suggests that a clinician-driven, standardized ventilator management protocol is of significant benefit. Tele-ICU clinicians provide an interactive element to coordinate interdisciplinary team efforts. Enhanced communication, data evaluation, and timely intervention expedite the weaning process and reduce ventilator length of stay. Consistent collaboration between tele-ICU and bedside clinicians successfully improves patient outcomes through standardized adherence to best-practice initiatives.

Preparing for an Epidemic: Cancer Care in an Aging Population

2014 ◽  
pp. 133-137 ◽  
Author(s):  
Ya-Chen Tina Shih ◽  
Arti Hurria
Keyword(s):  
Older Adults ◽  
Cancer Care ◽  
Care Delivery ◽  
Quality Care ◽  
Aging Population ◽  
Population Based ◽  
Cancer Drug ◽  
Evidence Based ◽  
Evidence Based Care

The Institute of Medicine's (IOM) Committee on Improving the Quality of Cancer Care: Addressing the Challenges of an Aging Population was charged with evaluating and proposing recommendations on how to improve the quality of cancer care, with a specific focus on the aging population. Based on their findings, the IOM committee recently released a report highlighting their 10 recommendations for improving the quality of cancer care. Based on those recommendations, this article highlights ways to improve evidence-based care and addresses rising costs in health care for older adults with cancer. The IOM highlighted three recommendations to address the current research gaps in providing evidence-based care in older adults with cancer, which included (1) studying populations which match the age and health-risk profile of the population with the disease, (2) legislative incentives for companies to include patients that are older or with multiple morbidities in new cancer drug trials, and (3) expansion of research that contributes to the depth and breadth of data available for assessing interventions. The recommendations also highlighted the need to maintain affordable and accessible care for older adults with cancer, with an emphasis on finding creative solutions within both the care delivery system and payment models in order to balance costs while preserving quality of care. The implementation of the IOM's recommendations will be a key step in moving closer to the goal of providing accessible, affordable, evidence-based, high-quality care to all patients with cancer.

Health professionals' perspectives on delivering patient-focused wound management: a qualitative study

2019 ◽  
Vol 28 (Sup7) ◽  
pp. S4-S13 ◽  
Author(s):  
Janet L. Kuhnke ◽  
David Keast ◽  
Sue Rosenthal ◽  
Robyn Jones Evans
Keyword(s):  
Health Care ◽  
Health Professionals ◽  
Best Practice ◽  
Care Delivery ◽  
Wound Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Wound Management ◽  
Evidence Based ◽  
Venous Leg Ulcer

Objective: This study examined the perspectives of health professionals on the barriers and solutions to delivery of patient-focused wound management and outcomes. Methods: A qualitative, descriptive study design was used. Participants were health-care managers, clinical leaders, nurses and allied health members who are part of wound care services. Open-ended surveys were distributed to participants in a series of learning workshops, and data analysed to identify leading themes. Results: A total of 261 participants took part and 194 surveys were returned (response rate: 74%). From the analysis five themes emerged: patient/family wound-related education; health professional wound-related education; implementation of evidence-based wound care and dissemination of evidence-based wound information across professions and contexts; teamwork and respectful communication within teams; and a higher value and priority placed on wound care through collaborative teams by managers, leaders and policymakers. Conclusion: Findings suggest that ongoing, system-wide education is needed to improve prevention, assessment, treatment and management of four wound types: venous leg ulcer (VLU), diabetic foot ulcer (DFU), pressure ulcer (PU) and surgical wounds. Health professionals are committed to delivering best practice in wound care. Participants identified that effective patient-focused, evidence-based wound care involves having a health-care system with a clear mandate to ensure wound care is a priority. A high value placed on wound care by managers and clinical leadership could transform the present systems. Additionally, effective and widespread dissemination of evidenced-informed practice information is crucial to positive patient outcomes. Education and team commitment for consistent and respectful communication would improve care delivery.

scholarly journals Best Practice Elements of Multilevel Suicide Prevention Strategies

Crisis ◽  
2011 ◽  
Vol 32 (6) ◽  
pp. 319-333 ◽  
Author(s):  
Christina M. van der Feltz-Cornelis ◽  
Marco Sarchiapone ◽  
Vita Postuvan ◽  
Daniëlle Volker ◽  
Saska Roskar ◽  
...  
Keyword(s):  
Best Practices ◽  
Suicide Prevention ◽  
Systematic Reviews ◽  
Best Practice ◽  
Suicide Attempts ◽  
Synergistic Effects ◽  
Data Extraction ◽  
Evidence Based ◽  
Practice Elements ◽  
Multilevel Interventions

Background: Evidence-based best practices for incorporation into an optimal multilevel intervention for suicide prevention should be identifiable in the literature. Aims: To identify effective interventions for the prevention of suicidal behavior. Methods: Review of systematic reviews found in the Pubmed, Cochrane, and DARE databases. Steps include risk-of-bias assessment, data extraction, summarization of best practices, and identification of synergistic potentials of such practices in multilevel approaches. Results: Six relevant systematic reviews were found. Best practices identified as effective were as follows: training general practitioners (GPs) to recognize and treat depression and suicidality, improving accessibility of care for at-risk people, and restricting access to means of suicide. Although no outcomes were reported for multilevel interventions or for synergistic effects of multiple interventions applied together, indirect support was found for possible synergies in particular combinations of interventions within multilevel strategies. Conclusions: A number of evidence-based best practices for the prevention of suicide and suicide attempts were identified. Research is needed on the nature and extent of potential synergistic effects of various preventive activities within multilevel interventions.

scholarly journals The Use of Prophylactic Anticonvulsants in Patients with Brain Tumours—A Systematic Review

2006 ◽  
Vol 13 (6) ◽  
pp. 222-229 ◽  
Author(s):  
J. Perry ◽  
L. Zinman ◽  
A. Chambers ◽  
K. Spithoff ◽  
N. Lloyd ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Brain Tumours ◽  
Best Practice ◽  
Meta Analysis ◽  
Significant Risk ◽  
Practice Variation ◽  
Cochrane Library ◽  
Evidence Based ◽  
Newly Diagnosed

Questions: Should patients with newly diagnosed brain tumours receive prophylactic anticonvulsants to reduce seizure risk? What is the best practice for patients with brain tumours who are taking anticonvulsant medications but who have never had a seizure? Perspectives: Patients with primary or metastatic brain tumours who have never had a seizure still have a 20% risk of experiencing a seizure over the course of their disease. Because considerable practice variation exists in regard to the management of patients with brain tumours who have never had a seizure, and because conflicting evidence has been reported, the Neuro-oncology Disease Site Group (DSG) of Cancer Care Ontario’s Program in Evidence-based Care felt that a systematic review of the evidence was warranted. Outcomes: Outcomes of interest were incidence of seizures and adverse effects of prophylactic anticonvulsant therapy. Methodology: The MEDLINE and Cochrane Library databases were systematically searched for relevant evidence. The review included fully published reports or abstracts of randomized controlled trials (RCTs), systematic reviews, meta-analyses, and practice guidelines. The present systematic review was reviewed and approved by the Neuro-oncology DSG, which comprises medical and radiation oncologists, surgeons, neurologists, a nurse, and a patient representative. Results: Quality of Evidence: The literature search located one evidence-based practice guideline, one systematic review, and five RCTs that addressed prophylactic anticonvulsants for patients with brain tumours. Evidence for the best management of seizure-naïve patients who are already taking anticonvulsants was limited to one retrospective study and exploratory analyses within several RCTs. Benefits and Harms: Pooled results of the five RCTs suggest that the incidence of seizures in patients who receive prophylactic anticonvulsants is not significantly different from that in patients who do not receive anticonvulsants (relative risk: 1.04; 95% confidence interval: 0.70 to 1.54; p = 0.84). This analysis accords with results from a published meta-analysis. Evidence is insufficient to determine whether patients who are currently taking anticonvulsants but who have never had a seizure should taper the anticonvulsants. Patients who received anticonvulsants reported adverse effects, including rash, nausea, and hypotension, but whether these effects are a result of the anticonvulsants or of other treatments could not be determined. Conclusions: Based on the available evidence, the routine use of postoperative anticonvulsants is not recommended in seizure-naïve patients with newly diagnosed primary or secondary brain tumours, especially in light of a significant risk of serious adverse effects and problematic drug interactions. Because data are insufficient to recommend whether anticonvulsants should be tapered in patients who are already taking anticonvulsants but who have never had a seizure, treatment must be individualized.

The cost per patient of deviations from evidence-based standards of oncology care.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6515-6515
Author(s):  
Arlene A. Forastiere ◽  
William A. Flood ◽  
Erik Yedwab ◽  
Vlad Kozlovsky ◽  
Elaine Whyler ◽  
...  
Keyword(s):  
Lower Cost ◽  
Quality Care ◽  
Practice Variation ◽  
National Standards ◽  
Evidence Based ◽  
First Order ◽  
Inappropriate Treatment ◽  
Oncology Care ◽  
Treatment Intent ◽  
The Cost

6515 Background: Practice variation contributes to the high cost of healthcare and wasteful spending; by contrast, adherence to evidence-based (EB) clinical guidelines is advocated to improve quality and potentially lower cost. We sought to estimate the average cost per patient associated with unjustified deviations from EB national standards for use of chemotherapy, supportive drugs, and radiotherapy. Methods: The ITA Partners/eviti, Inc. database of oncology treatment plans (TPs) reviewed for payers for adherence to national guideline recommendations (e.g. ASCO, ASTRO, NCI, NCCN Compendium, FDA) was used to calculate the variance in cost between submitted TPs with unwarranted deviations from EB standards and EB care. For prospective reviews, the final EB treatment given was known and for retrospective reviews, the variance was estimated based on the EB alternative with the lowest cost. AWP pricing was used to calculate chemotherapy and supportive drug costs, and Medicare pricing for radiotherapy. First order savings were calculated. An annual trend of 8% was applied from the mid-data period to 2013 (Milliman Client Report 2010). Results: From March 2009 to March 2012, a total of 2775 consecutive patients had TPs submitted and of these, 730 patients had unjustified, non-EB TPs. All cancer types, stage and treatment intent (curative, non-curative) were included. The cost of EB treatment was less than the submitted TP for 622 (85%) patients, more for 9 (1%), and zero (could not be taken due to payer plan definitions) for 99 (14%). Descriptive statistics for the cost per patient of non-EB TPs trended to 2013 showed: mean $25,579, median $13,882, standard deviation $40,958. Conclusions: In this unselected population comprising all cancers, 26% had TPs that did not conform to EB standards or could not be medically justified. Our conservative estimate of the average per patient overspend (first order) on inappropriate treatment validates the potential for quality care to lower cost and deliver huge value to patients, physicians, and payers. [Table: see text]

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