A patient-centered digital cost simulator based on Time-Driven Based-Activity Costing: a proof-of-concept study of knee replacement in two private Portuguese hospitals (Preprint)

2021 ◽  
Author(s):  
Salomé Azevedo ◽  
Francisco von Hafe ◽  
Carolina Ramos ◽  
João Leal ◽  
Ana Rita Londral
Keyword(s):  
Knee Replacement ◽  
Care Delivery ◽  
Unit Cost ◽  
Cost Of Care ◽  
Lessons Learned ◽  
Accurate Information ◽  
Proof Of Concept ◽  
Patient Centered ◽  
Patient Journey ◽  
Concept Study

BACKGROUND The number of knee replacement surgeries in OECD countries will continue rising due to the prevalence of osteoarthritis caused by aging and obesity. It is a cost-effective but expensive procedure. Consequently, decision-makers need accurate information on intervention outcomes and costs to manage the healthcare system efficiently. Literature proposed Time-Driven Based-Activity Costing (TDABC) as a cost measurement model that accounts for care cycle complexity, such as patient diversity and treatment variation. However, few studies show how to apply the TDABC model in a real context, considering the existing hospitals' information systems (IS). OBJECTIVE Our primary goal was to design a patient-centered digital cost simulator for assessing the provider's cost of care delivery that complemented the outcomes analysis in Knee Surgery. The secondary goal was to synthesize the learning experience of implementing the method in two Portuguese private hospitals of the same provider. METHODS The proof-of-concept study was designed based on the TDABC model. As the two hospitals had different care delivery chains for the same procedure, each hospital's study was independent. The unit cost of supplying capacity was calculated using data collected from interviews, literature reviews, and general ledger accounts. Both care delivery chains were defined using information from interviews with hospital staff and mapped using Visual Paradigm©. Time estimations were based on direct observation and data exported from hospitals' IS. The patient-centered digital cost simulator was created using Google Sheets. Through a focus group, the multidisciplinary team evaluated the model feasibility and generalisability. RESULTS A patient-centered digital cost simulator and the data structure that allows collecting the most relevant cost analysis data are presented. The main lessons learned are described through this paper and are based on practical application: (1) the patient journey must drive data collection, organization, and analysis for the TDABC implementation; (2) the implementation of TDABC in healthcare involves the commitment and dedication of the healthcare provider's teams; (3) breaking the activities into operations helps to obtain time estimations and allocate resources in the patient care pathway; (4) the listing of the used resources should follow the financial IS classification. CONCLUSIONS The simulator that was developed is still a proof-of-concept, but it enlightened the healthcare provider of future improvements in the existing IS infrastructure. The TDABC implementation requires that the hospitals' IS collect and interoperate different data sources (clinical, financial, and logistics) along the patient pathway. Therefore, future research should focus on developing effective and efficient interfaces to allow importing process, activity, resources, and time information from the existing IS and calculate the total costs of care per patient. Such data needs to be integrated with health outcomes measures in order to monitor healthcare interventions' value.

A Blueprint for the Conduct of Large, Multi-Site Trials in Telemedicine (Preprint)

2021 ◽  
Author(s):  
Patricia Commiskey ◽  
April W Armstrong ◽  
Tumaini Rucker Coker ◽  
Earl Ray Dorsey ◽  
John Fortney ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Care Delivery ◽  
Mental Healthcare ◽  
Stroke Care ◽  
Lessons Learned ◽  
Patient Centered ◽  
Implementation Challenges ◽  
Home Based ◽  
Family Based ◽  
Key Aspects

BACKGROUND Recent literature supports the efficacy and efficiency of telemedicine in improving various health outcomes, despite the wide variability in results. OBJECTIVE Understanding site-specific issues in the implementation of telemedicine trials for broader replication and generalizability of results is needed. Lessons can be learned from existing trials, and a blueprint can guide researchers to conduct these challenging studies using telemedicine more efficiently and effectively. METHODS This viewpoint presents relevant challenges and solutions for conducting multi-site telemedicine trials using seven ongoing and completed studies funded by the Patient Centered Outcomes Research Institute (PCORI) portfolio of large multi-site trials to highlight the challenges in implementing telemedicine trials. RESULTS Implementation challenges related to clinical, informatics, regulatory, legal, quality and billing were identified and described. CONCLUSIONS Lessons learned from these studies were used to create a blueprint of key aspects to consider for the design and implementation of multi-site telemedicine trials. CLINICALTRIAL NCT02358135: Improving Specialty-Care Delivery in Chronic Skin Diseases (PI: AWArmstrong) NCT02396576: Using Telehealth to Deliver Developmental, Behavioral, and Mental Health Services in Primary Care Settings for Children in Underserved Areas (PI: TRCoker) NCT02038959: Connect.Parkinson (PI: RDorsey) NCT04000971: C3FIT (Coordinated, Collaborative, Comprehensive, Family-based, Integrated, Technology-enabled Care) Stroke Care Trial (PI: KGaines) NCT03694431: Noninferiority Comparative Effectiveness Trial of Home-Based Palliative Care (HomePal) Trial (PI: HNguyen, KMularski) NCT04153864: SUMMIT (Scaling Up Maternal Mental healthcare by Increasing access to Treatments) Trial (PI: DRSingla) NCT03985800: Specialty Medical Homes to Improve Outcomes for Patients with Inflammatory Bowel Disease (IBD) and Behavioral Health Conditions Trial (PI: ESzigethy)

scholarly journals Patient-centered care pathways: what does it mean? An integrative conceptual framework to meet the need of an international consensus: a qualitative systematic review protocol

2021 ◽  
Author(s):  
Jean-Baptiste Gartner ◽  
Kassim Said Abasse ◽  
Ghita Ben Zagguou ◽  
Frédéric Bergeron ◽  
Paolo Landa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Care Delivery ◽  
Care Pathway ◽  
Patient Centered Care ◽  
Patient Centered ◽  
International Consensus ◽  
Patient Journey ◽  
Centered Care ◽  
Health Care Delivery Systems

Background: Faced with increased expectations regarding the quality and safety of health care delivery systems, a number of stakeholders are increasingly looking for more qualitative and efficient ways to deliver care. This study is conducted to provide a clear definition of the patient-centered care pathway and its characteristics to meet the need for an international consensus. Methods: This qualitative systematic review aims to perform a systematic synthesis of published evidence concerning (1) the definition of the patient trajectory, patient pathway or patient journey and (2) their characteristics. With a consulting librarian, a comprehensive and systematic search in three databases was conducted (PUBMED, Embase, ABI/Inform), from 1995 to 2020 without language criteria. Eligibility criteria guiding data selection will follow the PICo mnemonic criteria consisting of (1) Population : all types of patients managed by health care delivery systems for an acute or chronic condition regardless of age or condition, (2) Phenomena : studies that contribute to the definition and conceptualization of the concepts of care trajectory, care pathway and patient journey resulting in a theoretical and conceptual contribution, and (3) Context : health care providers include all providers of primary, secondary, tertiary, and quaternary care in any geographic area. Two reviewers will independently screen, select, extract data and make a critical assessment of the methodology used with the JBI Qualitative Assessment and Review Instrument (JBI QARI).Discussion: This systematic review will provide much-needed knowledge regarding patient-centered pathways. The results will benefit clinicians, decision makers, and researchers by giving them a clear and integrated definition and understanding of the patient-centered care pathways and their characteristics to finally meet the need for an international consensus.

scholarly journals Total Knee Replacement and the Effect of Technology on Cocreation for Improved Outcomes and Delivery: Qualitative Multi-Stakeholder Study (Preprint)

2017 ◽  
Author(s):  
Yasmin van Kasteren ◽  
Jill Freyne ◽  
M Sazzad Hussain
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Digital Technology ◽  
Care Delivery ◽  
Health Care Service ◽  
Hospital Length Of Stay ◽  
Patient Centered ◽  
Total Knee

BACKGROUND The growth in patient-centered care delivery combined with the rising costs of health care have perhaps not unsurprisingly been matched by a proliferation of patient-centered technology. This paper takes a multistakeholder approach to explore how digital technology can support the cocreation of value between patients and their care teams in the delivery of total knee replacement (TKR) surgery, an increasingly common procedure to return mobility and relieve pain for people suffering from osteoarthritis. OBJECTIVE The aim of this study was to investigate communications and interactions between patients and care teams in the delivery of TKR to identify opportunities for digital technology to add value to TKR health care service by enhancing the cocreation of value. METHODS A multistakeholder qualitative study of user needs was conducted with Australian stakeholders (N=34): surgeons (n=12), physiotherapists (n=3), patients (n=11), and general practitioners (n=8). Data from focus groups and interviews were recorded, transcribed, and analyzed using thematic analysis. RESULTS Encounters between patients and their care teams are information-rich but time-poor. Results showed seven different stages of the TKR journey that starts with referral to a surgeon and ends with a postoperative review at 12 months. Each stage of the journey has different information and communication challenges that can be enhanced by digital technology. Opportunities for digital technology include improved waiting list management, supporting and reinforcing patient retention and recall of information, motivating and supporting rehabilitation, improving patient preparation for hospital stay, and reducing risks and anxiety associated with postoperative wound care. CONCLUSIONS Digital technology can add value to patients’ care team communications by enhancing information flow, assisting patient recall and retention of information, improving accessibility and portability of information, tailoring information to individual needs, and by providing patients with tools to engage in their own health care management. For care teams, digital technology can add value through early detection of postoperative complications, proactive surveillance of health data for postoperative patients and patients on waiting lists, higher compliance with rehabilitation programs, and reduced length of stay. Digital technology has the potential to improve patient satisfaction and outcomes, as well as potentially reduce hospital length of stay and the burden of disease associated with postoperative morbidity.

The SAFEDC Model for Improving Transitions of Care: Lessons Learned from a Participatory Design Workshop (Preprint)

2021 ◽  
Author(s):  
Ji Youn Shin ◽  
Nkiru Okammor ◽  
Karly Hendee ◽  
Amber Pawlikowski ◽  
Grace Jenq ◽  
...  
Keyword(s):  
Participatory Design ◽  
Transitional Care ◽  
Care Transitions ◽  
Patient Discharge ◽  
Lessons Learned ◽  
Transitions Of Care ◽  
Care Transition ◽  
Patient Centered ◽  
Patient Journey ◽  
Design Workshop

BACKGROUND Transition home after hospitalization involves the potential risk of adverse patient events, such as knowledge deficits related to self-care, medication errors, and readmissions. Despite broad organizational efforts to provide better care transitions for patients, there are challenges in implementing interventions that effectively improve care transition outcomes, as evidenced by readmission rates. Collaborative efforts that require healthcare professionals, patients, and caregivers to work together are necessary to identify gaps associated with transitions of care and generate effective transitional care interventions. OBJECTIVE This study aims to understand the effectiveness of the Integrated Michigan Patient-Centered Alliance in Care Transitions (I-MPACT) design model of bringing together stakeholders of the healthcare system and providing them with a novel tool that captures the patient perspective (patient journey map). METHODS We chose a mixed method of direct patient observations and a participatory design workshop to develop transitional care interventions that serve each hospital’s unique situation and contexts. By applying thematic analysis methods, we analyzed problem statements and proposed interventions collected from the participatory design workshops. Findings showed the patterns of major discussion during the workshop. RESULTS Based on workshop results, we formalized the I-MPACT transition of care model, SAFEDC (socioeconomic, active engagement, follow-up, education, discharge readiness tool, consistency), which other organizations can apply to improve patient experiences in care transition. CONCLUSIONS Our study demonstrates the benefits of the participatory design approach in defining challenges associated with transitions of care related to patient discharge and generating sustainable interventions to improve care transitions.

scholarly journals A Cloud-Based Virtual Outpatient Clinic for Patient-Centered Care: Proof-of-Concept Study

10.2196/10135 ◽  
2018 ◽  
Vol 20 (9) ◽  
pp. e10135 ◽  
Author(s):  
Jelske Marije de Jong ◽  
Paula AM Ogink ◽  
Carin GM van Bunningen ◽  
Rieke JB Driessen ◽  
Lucien JLPG Engelen ◽  
...  
Keyword(s):  
Outpatient Clinic ◽  
Patient Centered Care ◽  
Proof Of Concept ◽  
Patient Centered ◽  
Concept Study ◽  
Centered Care

Updates to the ASCO Patient-Centered Oncology Payment Model

2020 ◽  
Vol 16 (5) ◽  
pp. 263-269 ◽  
Author(s):  
Jeffrey C. Ward ◽  
Brian Bourbeau ◽  
Alexander L. Chin ◽  
Ray D. Page ◽  
Stephen S. Grubbs ◽  
...  
Keyword(s):  
Medical Home ◽  
Care Delivery ◽  
Clinical Pathways ◽  
Quality Measurement ◽  
Lessons Learned ◽  
Multiple Sources ◽  
Patient Centered ◽  
Delivery Of Care ◽  
The Past ◽  
Oncology Care

The past decade has seen considerable innovation in the delivery of care and payment in oncology. Key initiatives have included the development of oncology medical home care delivery standards, the Medicare Oncology Care Model, and multiple commercial payer initiatives. Looking forward, our next challenge is to reflect on lessons learned from these limited-scale demonstration projects and work toward models that are scalable and sustainable and reflect true collaboration between payers and providers sharing common objectives and methods to advance cancer care delivery. To this end, ASCO continues its work on care delivery standards, quality measurement, and alternative payment models. Over the past year, ASCO has received input from physicians, administrators, payers, and employers to update its Patient-Centered Oncology Payment (PCOP) model. PCOP incorporates current work on provider-payer collaboration, the oncology medical home, and the value of clinical pathways and recognizes the need for common quality measurement, performance methodology, and payment structure across multiple sources of payment. The following represents a summary of the entire model. The model includes chapters on PCOP communities, clinical practice transformation, payment methodology, consolidated payments for oncology care, performance methodology, and implementation considerations. In future work, ASCO will continue its support of the PCOP model, including further development of care delivery standards, quality measures, and technology solutions (eg, CancerLinQ).

scholarly journals A Census of Actively Licensed Physicians in the United States, 2014

2015 ◽  
Vol 101 (2) ◽  
pp. 7-22 ◽  
Author(s):  
Aaron Young ◽  
Humayun J. Chaudhry ◽  
Xiaomei Pei ◽  
Katie Halbesleben ◽  
Donald H. Polk ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Census Data ◽  
Care Delivery ◽  
The United States ◽  
Physician Workforce ◽  
Accurate Information ◽  
Patient Centered ◽  
Starting Point ◽  
Medical License

Marked changes have occurred in health care delivery in the United States with the implementation of the Affordable Care Act (ACA), including the advancement of integrated health systems, the introduction of patient centered medical homes and the creation of accountable care organizations. With millions of Americans newly insured, never has there been a more pressing need for accurate physician workforce information and planning. Opinions vary about the nature and degree of anticipated physician shortages, and health care workforce determinations are fraught with variables and uncertainties that are challenging to address definitively. Identifying accurate information about the nation's currently licensed physician workforce, however, is an important starting point. This article reviews data received in 2014 by the Federation of State Medical Boards from the nation's state medical and osteopathic boards about the current supply of actively licensed physicians in the United States and the District of Columbia. Our census data demonstrates the total population of licensed physicians (916,264) has increased by 4% since 2012, and the nation, on average, added 12,168 more licensed physicians annually than it lost. The average physician is now older (by a year), predominantly male (but increasingly female at entry level) and increasingly a graduate of a medical school in the Caribbean. Meanwhile, the percentage of physicians with a single state medical license has remained constant at 79%.

Building an oncology community of practice.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 47-47
Author(s):  
Anne Willis ◽  
Deena R. Loeffler ◽  
Mandi Pratt-Chapman
Keyword(s):  
Care Delivery ◽  
Lessons Learned ◽  
Special Interest Groups ◽  
Management Approach ◽  
Dissemination And Implementation ◽  
Evidence Based ◽  
Patient Centered ◽  
Oncology Patient ◽  
Research Dissemination ◽  
Research Findings

47 Background: Oncology patient-centered outcomes research (PCOR) helps stakeholders, including patients, clinicians and policymakers, make decisions about care; yet, research findings may take years to be put into practice. With the increasing availability of survivorship PCOR, better methods are needed to disseminate and implement findings quickly and effectively. Engaging multiple stakeholders is essential to meet this need, and Communities of Practice (CoP) are effective in increasing collaboration across organizations and stakeholders. Methods: The George Washington University (GW) Cancer Institute created a CoP as a knowledge management approach to break down professional and organizational barriers, support learning for people new to the field and facilitate collaboration within and across organizations. The goal of the CoP is to create stronger links across researchers, healthcare professionals and patients by facilitating the sharing of survivorship information and resources. These linkages will result in enhanced dissemination of evidence-based practices. Results: The CoP is housed within the Generation and Translation of Evidence (GATE) website. The site features user-generated content, including descriptions of research findings and evidence-based interventions to succinctly provide information for a variety of stakeholders to guide decision-making as well as descriptions of best practices and lessons learned to capture practice-based efforts that can drive research. GATE features a question-and-answer bank with evidence-based responses by survivorship experts. The CoP includes Ask the Expert sessions to provide researchers an opportunity to interact with clinicians and patients to guide research dissemination. It also includes Special Interest Groups for researchers to create collaborations and advance research agendas. An e-newsletter highlights new GATE content and opportunities to collaborate. Conclusions: There is a clear need to better disseminate and implement survivorship PCOR evidence to improve cancer care delivery. The GATE website will aid in more rapid implementation of survivorship PCOR evidence into clinical practice and foster collaborative dissemination and implementation efforts.

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