scholarly journals A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals to coproduce health

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 1140
Author(s):  
Peter Lachman ◽  
Paul Batalden ◽  
Kris Vanhaecht
Keyword(s):  
Healthcare Providers ◽  
Institute Of Medicine ◽  
Quality Model ◽  
The People ◽  
The Us ◽  
Quality Movement ◽  
Service Oriented ◽  
Shared Humanity ◽  
Effectiveness Of Care ◽  
Quality In Healthcare

Background: It is twenty years since the US Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of “service-oriented” systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or “kin-centred care” to emphasise the shared humanity of people involved in the interdependent work. This is a more expansive view of what “person-centredness” began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.

scholarly journals A multidimensional quality model: an opportunity for patients, their kin, healthcare providers and professionals in the new COVID-19 period

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1140
Author(s):  
Peter Lachman ◽  
Paul Batalden ◽  
Kris Vanhaecht
Keyword(s):  
Healthcare Providers ◽  
Complexity Science ◽  
Institute Of Medicine ◽  
Quality Model ◽  
The People ◽  
Quality Movement ◽  
Service Oriented ◽  
Shared Humanity ◽  
Effectiveness Of Care ◽  
Quality In Healthcare

Background: It is twenty years since the Institute of Medicine (IOM) defined quality in healthcare, as comprising six domains: person-centredness, timeliness, efficiency, effectiveness, safety and equity. Since then, a new quality movement has emerged, with the development of numerous interventions aimed at improving quality, with a focus on accessibility, safety and effectiveness of care. Further gains in equity and timeliness have proven even more challenging. The challenge: With the emergence of “service-oriented” systems, complexity science, the challenges of climate change, the growth of social media and the internet and the new reality of COVID-19, the original domains proposed by the IOM invite reflection on their relevance and possibility for improvement. The possible solution: In this paper we propose a revised model of quality that is built on never-ending learning and includes new domains, such as Ecology and Transparency, which reflect the changing worldview of healthcare. We also introduce the concept of person- or “kin-centred care” to emphasise the shared humanity of people involved in the interdependent work. This is a more expansive view of what “person-centredness” began. The delivery of health and healthcare requires people working in differing roles, with explicit attention to the lived realities of the people in the roles of professional and patient. The new model will provide a construct that may make the attainment of equity in healthcare more possible with a focus on kindness for all.

Research and the Doctor of Nursing Practice

2009 ◽  
Vol 23 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Kristine L. Florczak
Keyword(s):  
Nursing Practice ◽  
American Association ◽  
Healthcare Providers ◽  
Position Statement ◽  
Nursing Research ◽  
Institute Of Medicine ◽  
Doctor Of Nursing Practice ◽  
Quality In Healthcare ◽  
The Impact ◽  
Educating Nurses

This column concerns itself with the issue of research and the doctor of nursing practice. The reports of the Institute of Medicine about patient safety, quality in healthcare, and the restructuring of education of healthcare providers are reviewed. The reasons for the creation of the doctor of nursing practice are illuminated along with the essentials of educating nurses for the role and the position statement on nursing research by the American Association of Colleges of Nursing. Finally, the impact that those with a doctor of nursing practice who conduct nursing research may have on the discipline of nursing is considered.

The Crisis of the Ryukyus (1877–82)

2018 ◽  
Author(s):  
Patrick Sze-lok Leung ◽  
Anthony Carty
Keyword(s):  
International Law ◽  
Colonial Power ◽  
Independent State ◽  
The People ◽  
The Us ◽  
The Status ◽  
Historical Viewpoint

Okinawa is now considered as Japanese territory, without challenge from most world powers. However, this is debatable from a historical viewpoint. The Ryukyu Kingdom which dominated the islands was integrated into Japan in 1879. The transformation is seen by Wang Hui as a process of modernization. This chapter argues the issue from an international law perspective. It shows that Ryukyu was an independent State as demonstrated by the 1854 Ryukyu–US Treaty, although it sent regular tributes to China. The Japanese integration by coercion is not justifiable. The people of Ryukyu were willing to continue being a tributary State rather than part of Japan. Britain, as the greatest colonial power, did not object. China and the US attempted to intervene in this affair, but no treaty has so far been concluded. Therefore, the status of Ryukyu/Okinawa remains unresolved and may need to be revisited, while putting the history context into consideration.

scholarly journals Perceived Barriers to COVID-19 Testing

2021 ◽  
Vol 18 (5) ◽  
pp. 2278
Author(s):  
Pearl A. McElfish ◽  
Rachel Purvis ◽  
Laura P. James ◽  
Don E. Willis ◽  
Jennifer A. Andersen
Keyword(s):  
Analytical Approach ◽  
Nasal Swab ◽  
Healthcare Providers ◽  
Research Participant ◽  
Perceived Barriers ◽  
Lower Income ◽  
The Us ◽  
Qualitative Descriptive ◽  
Descriptive Method ◽  
Background Prior

(1) Background: Prior studies have documented that access to testing has not been equitable across all communities in the US, with less testing availability and lower testing rates documented in rural counties and lower income communities. However, there is limited understanding of the perceived barriers to coronavirus disease 2019 (COVID-19) testing. The purpose of this study was to document the perceived barriers to COVID-19 testing. (2) Methods: Arkansas residents were recruited using a volunteer research participant registry. Participants were asked an open-ended question regarding their perceived barriers to testing. A qualitative descriptive analytical approach was used. (3) Results: Overall, 1221 people responded to the open-ended question. The primary barriers to testing described by participants were confusion and uncertainty regarding testing guidelines and where to go for testing, lack of accessible testing locations, perceptions that the nasal swab method was too painful, and long wait times for testing results. (4) Conclusions: This study documents participant reported barriers to COVID-19 testing. Through the use of a qualitative descriptive method, participants were able to discuss their concerns in their own words. This work provides important insights that can help public health leaders and healthcare providers with understanding and mitigating barriers to COVID-19 testing.

scholarly journals Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines

2021 ◽  
pp. 1-3
Author(s):  
Sarathi Kalra ◽  
Alpesh Amin ◽  
Nancy Albert ◽  
Cindy Cadwell ◽  
Cole Edmonson ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Acoustic Properties ◽  
Patient Encounter ◽  
Call To Action ◽  
The Us ◽  
Cdc Guidelines ◽  
Control And Prevention ◽  
Healthcare Acquired Infections ◽  
Current Guidance ◽  
Tremendous Challenge

Abstract Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers. When cultured, even after disinfection, stethoscopes have high rates of pathogen contamination, identical to that of unwashed hands. The consequence of these practices may bode poorly in the coronavirus 2019 disease (COVID-19) pandemic. Alternatively, the CDC recommends the use of disposable stethoscopes. However, these instruments have poor acoustic properties, and misdiagnoses have been documented. They may also serve as pathogen vectors among staff sharing them. Disposable aseptic stethoscope diaphragm barriers can provide increased safety without sacrificing stethoscope function. We recommend that the CDC consider the research regarding stethoscope hygiene and effective solutions to contemporize this guidance and elevate stethoscope hygiene to that of the hands, by requiring stethoscope disinfection or change of disposable barrier between every patient encounter.

Abstract 220: Early Assessment of Real-world Utilization and Dosing of Sacubitril/Valsartan in the US

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Chun-Lan Chang ◽  
Xue Song ◽  
Tina Willson ◽  
Carol Duffy
Keyword(s):  
Real World ◽  
Maintenance Dose ◽  
Healthcare Providers ◽  
Dose Titration ◽  
Dose Increase ◽  
Early Assessment ◽  
Reduced Ejection Fraction ◽  
Starting Dose ◽  
The Us ◽  
Medicare Patients

Background: Based on the PARADIGM-HF trial, sacubitril/valsartan was approved for the treatment of patients with heart failure and reduced ejection fraction. This study provides an early view of its real-world utilization and dosing in the US before recent guideline updates. Methods: Adult patients with >=1 sacubitril/valsartan claim in 7/7/2015 - 3/31/2016 were selected from a large national claims dataset; their 1st sacubitril/valsartan claim was the index date. Data was required for >=24 months pre-index and >=3 months post-index. Dose at index and the maximum dose achieved post-index were obtained. Dose up-titration, defined as 1st appearance of a sacubitril/valsartan claim with a dose increase from the index strength, and the time to 1st dose increase were reported. Results: Among 981 qualified patients with a mean follow-up of 185 (SD ±81) days, 25% commenced sacubitril/valsartan on the suggested prescribing information (PI) starting dose of 49/51 mg b.i.d.; 58% started on 24/26 mg b.i.d.; 4% started on an even lower dose, and 13% indexed at the target maintenance dose of 97/103 b.i.d.. The target maintenance dose of 97/103 mg b.i.d. was achieved in 30% of patients. For those 856 patients indexing on <=49/51/ mg b.i.d., 58% had no dose up-titration post-index; 31% took >4 weeks to have up-titration initiated and 11% initiated up-titration within 4 weeks. Only 25% of Medicare patients compared to 35% of Commercial patients achieved the target dose of 97/103mg b.i.d.. (Table 1) Conclusion: Most patients commenced sacubitril/valsartan at lower doses than recommended in the PI and were poorly optimized, with the majority of patients having no upward dose titration. Approximately 13% actually indexed at the target maintenance dose. The reasons for these findings need further exploration. Healthcare providers should consider following the appropriate starting doses, with timely dose adjustment of sacubitril/valsartan as recommended in the PI to ensure patients receive the full clinical benefit of this medication as demonstrated in the PARADIGM-HF trial.

Valuing Diversity and Inclusion in Healthcare: Pathways to Equip Workforces in the Post-COVID-19 New Normal (Preprint)

2021 ◽  
Author(s):  
Jiban Khuntia ◽  
Xue Ning ◽  
Wayne Cascio ◽  
Rulon Stacey
Keyword(s):  
United States ◽  
Health System ◽  
Health Systems ◽  
The United States ◽  
Mediating Effect ◽  
New Normal ◽  
Diversity And Inclusion ◽  
Healthcare Workforce ◽  
The Us ◽  
Service Oriented

BACKGROUND The COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. The healthcare workforce remains relatively homogenous, even though they are caring for a highly diverse array of patients (6-12). It is a perennial problem in the US healthcare workforce that has only been accentuated during the COVID-19 pandemic. Medical workers should reflect the variety of patients they care for and strive to understand their mindsets within the larger contexts of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities. Along with talent and skills, diversity and inclusion (D&I) are essential for maintaining a workforce that can treat the myriad needs and populations that health systems serve. Developing hiring strategies in a post-COVID-19 “new normal” that will help achieve greater workforce diversity remains a challenge for health system leaders. OBJECTIVE Our primary objectives are (1) to explore the characteristics and perceived benefits of US health systems that value D&I; (2) to examine the influence of a workforce strategy designed to balance talent and D&I; and (3) to explore three pathways to better equip workforces and their relative influences on business- and service-oriented benefits: (a) improving D&I among existing employees (IMPROVE), (b) using multiple channels to find and recruit a workforce (RECRUIT), and (c) collaborating with universities to find new talent and establish plans to train students (COLLABORATE). METHODS During February–March 2021, we surveyed 625 health system chief executive officers, in the United States, 135 (22%) of whom responded. We assessed workforce talent and diversity-relevant factors. We collected secondary data from the Agency for Healthcare Research and Quality’s (AHRQ) Compendium of the US. Health Systems, leading to a matched data set of 124 health systems for analysis. We first explored differences in talent and diversity benefits across the health systems. Then, we examined the relationship between IMPROVE, RECRUIT, and COLLABORATE pathways to equip the workforce. RESULTS Health system characteristics, such as size, location, ownership, teaching, and revenue, have varying influences on D&I and business and service outcomes. RECRUIT has the most substantial mediating effect on diversity-enabled business- and service-oriented outcomes of the three pathways. This is also true of talent-based workforce acquisitions. CONCLUSIONS Diversity and talent plans can be aligned to realize multiple desired benefits for health systems. However, a one-size-fits-all approach is not a viable strategy for improving D&I. Health systems need to follow a multipronged approach based on their characteristics. To get D&I right, proactive plans and genuine efforts are essential.

A HIPAA Security and Privacy Compliance Audit and Risk Assessment Mitigation Approach

2021 ◽  
Vol 3 (2) ◽  
pp. 28-45
Author(s):  
Young B. Choi ◽  
Christopher E. Williams
Keyword(s):  
Healthcare System ◽  
Information Assurance ◽  
Healthcare Providers ◽  
Security And Privacy ◽  
Privacy Requirements ◽  
Security Controls ◽  
The Us ◽  
Compliance Audit ◽  
And Control ◽  
Health Laws

Data breaches have a profound effect on businesses associated with industries like the US healthcare system. This task extends more pressure on healthcare providers as they continue to gain unprecedented access to patient data, as the US healthcare system integrates further into the digital realm. Pressure has also led to the creation of the Health Insurance Portability and Accountability Act, Omnibus Rule, and Health Information Technology for Economic and Clinical Health laws. The Defense Information Systems Agency also develops and maintains security technical implementation guides that are consistent with DoD cybersecurity policies, standards, architectures, security controls, and validation procedures. The objective is to design a network (physician's office) in order to meet the complexity standards and unpredictable measures posed by attackers. Additionally, the network must adhere to HIPAA security and privacy requirements required by law. Successful implantation of network design will articulate comprehension requirements of information assurance security and control.

scholarly journals Evaluation of a regional air-quality model with bidirectional NH<sub>3</sub> exchange coupled to an agroecosystem model

2013 ◽  
Vol 10 (3) ◽  
pp. 1635-1645 ◽  
Author(s):  
J. O. Bash ◽  
E. J. Cooter ◽  
R. L. Dennis ◽  
J. T. Walker ◽  
J. E. Pleim
Keyword(s):  
Air Quality ◽  
The United States ◽  
United States Department ◽  
Air Quality Model ◽  
Quality Model ◽  
Coupled Modeling ◽  
Surface Exchange ◽  
Agroecosystem Model ◽  
The Us ◽  
Bidirectional Exchange

Abstract. Atmospheric ammonia (NH3) is the primary atmospheric base and an important precursor for inorganic particulate matter and when deposited NH3 contributes to surface water eutrophication, soil acidification and decline in species biodiversity. Flux measurements indicate that the air–surface exchange of NH3 is bidirectional. However, the effects of bidirectional exchange, soil biogeochemistry and human activity are not parameterized in air quality models. The US Environmental Protection Agency's (EPA) Community Multiscale Air-Quality (CMAQ) model with bidirectional NH3 exchange has been coupled with the United States Department of Agriculture's (USDA) Environmental Policy Integrated Climate (EPIC) agroecosystem model. The coupled CMAQ-EPIC model relies on EPIC fertilization timing, rate and composition while CMAQ models the soil ammonium (NH4&amp;plus;) pool by conserving the ammonium mass due to fertilization, evasion, deposition, and nitrification processes. This mechanistically coupled modeling system reduced the biases and error in NHx (NH3 &amp;plus; NH4&amp;plus;) wet deposition and in ambient aerosol concentrations in an annual 2002 Continental US (CONUS) domain simulation when compared to a 2002 annual simulation of CMAQ without bidirectional exchange. Fertilizer emissions estimated in CMAQ 5.0 with bidirectional exchange exhibits markedly different seasonal dynamics than the US EPA's National Emissions Inventory (NEI), with lower emissions in the spring and fall and higher emissions in July.

scholarly journals Stroke Rehabilitation - An Overview of Existing Guidelines and Standards of Care

2011 ◽  
Vol 6 (3) ◽  
pp. 170 ◽  
Author(s):  
Richard D Zorowitz ◽  
Keyword(s):  
Stroke Rehabilitation ◽  
Healthcare Providers ◽  
Standards Of Care ◽  
Interdisciplinary Management ◽  
Stroke Survivors ◽  
Level Of Evidence ◽  
The Us ◽  
Guidelines And Standards ◽  
Complications Of Stroke ◽  
The Uk

Over seven million stroke survivors live in the US today. Despite the publication of the first post-stroke rehabilitation clinical practice guideline in 1995, many healthcare providers are unaware not only of stroke survivors’ potential for functional recovery, but also common secondary complications of stroke. This article summarises the best available evidence-based recommendations for the interdisciplinary management of stroke survivors and caregivers from five sources: two in the US, one in Canada, and two in the UK. Unique characteristics of each guideline are described, followed by a list of common clinical recommendations found in most, if not all, of the guidelines. Despite the advances in stroke rehabilitation over the past 16 years, much research still needs to be done to improve the level of evidence in stroke rehabilitation.

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