Hospital Systems and Healthcare Reform

2014 ◽  
pp. 201-225
Keyword(s):  
Urgent Care ◽  
Easy Access ◽  
Emergency Rooms ◽  
Value Based Purchasing ◽  
Large Hospital ◽  
Bundled Payments ◽  
Patient Protection ◽  
Retail Clinics ◽  
Care Models ◽  
Hospital Systems

In this chapter, the author addresses the degree of involvement of large hospital systems in convenient care models. These systems are not known for being nimble and innovative, as many are inhibited by fixed budgets and low tolerance for risk. However, they have recently joined the trends and developed their own retail clinics, urgent care centers, and online clinics. In fact, several hospital systems now have a “convenient care strategy” to reduce demand on their overwhelmed emergency rooms and better serve their patients. These strategies also help the systems better position themselves to deal with recent regulatory provisions. Implications of the Patient Protection and Affordable Care Act (PPACA), such as value-based purchasing and bundled payments are discussed in depth. The authors propose that hospital-based convenient care models that are appropriately aligned and integrated with the new arrangements will embody excellent opportunities for hospital systems to provide easy-access entry-points for new patients, to substitute expensive traditional care settings with less costly alternatives, and to deliver high quality and expedient care that will keep patients in their network.

The Future

2014 ◽  
pp. 226-234
Keyword(s):  
Primary Care ◽  
Underserved Populations ◽  
Care Physician ◽  
Tipping Point ◽  
Emergency Rooms ◽  
Care Models ◽  
Hospital Systems ◽  
Access And Quality ◽  
Preventative Services ◽  
Fragmentation Of Care

In this chapter, the author evaluates the convenient care models on convenience, costs, access, and quality. The models studied receive high scores on convenience, costs, and quality when compared to hospital emergency rooms and primary care physician offices, despite issues related to possible fragmentation of care. However, improving access to care, especially among uninsured and underserved populations, does not seem to be an advantage offered by convenient care. The author posits that the American healthcare system appears to be at a tipping point, with rising consumerism, demands for price and quality transparency, and regulatory forces that are forcing providers to focus on value over quantity. He envisages that the race between hospital systems under legislative pressures and giant retailers spotting strategic opportunities will accelerate innovations and enable convenient care models to move from the margins to become the mainstream way of providing preventative services, treating minor conditions, and managing some chronic conditions.

The American Healthcare System

2014 ◽  
pp. 1-9
Keyword(s):  
Healthcare System ◽  
Primary Care Providers ◽  
Mortality Rates ◽  
Cost Of Care ◽  
Emergency Rooms ◽  
Uninsured Patients ◽  
Developed Country ◽  
Patient Protection ◽  
Life Expectancy At Birth ◽  
Shortage Of Physicians

This chapter provides an overview of the American healthcare system in terms of cost, quality, access, and convenience. Problems that have resulted in an unsustainable, inefficient, oversized, fragmented, and provider-centric system are discussed. While cost of care per capita and as a percentage of the Gross Domestic Product is much higher than in other countries, quality of care measured in terms of life expectancy at birth, infant mortality rates, and preventable mortality rates is questionable. The U.S. is the only developed country that does not provide coverage to 99.9% of its citizens. A large number of uninsured patients are expected to receive coverage under various provisions of the Patient Protection and Affordable Care (PPACA), but many others will remain uninsured or underinsured. Moreover, problems in hospital emergency rooms such as overcrowding, long wait times, ambulance diversions, patient boarding, and patients leaving without being seen by a provider are addressed. The author predicts that these problems will only be exacerbated by the expected shortage of physicians and other primary care providers.

Consensus Statement on Urgent Care Centers and Retail Clinics in Acute Care of Children

2019 ◽  
Vol 35 (2) ◽  
pp. 138-142 ◽  
Author(s):  
Mohsen Saidinejad ◽  
Audrey Paul ◽  
Marianne Gausche-Hill ◽  
Dale Woolridge ◽  
Alan Heins ◽  
...  
Keyword(s):  
Acute Care ◽  
Consensus Statement ◽  
Urgent Care ◽  
Retail Clinics ◽  
Urgent Care Centers

The Process of Oncology Nurse Practitioner Patient Navigation: A Gounded Theory Approach: Key Factors for a Structural Assessment Utilizing an Oncology NP Navigator Care Model

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Johnson FM
Keyword(s):  
Nurse Practitioner ◽  
Advanced Practice ◽  
Theory Approach ◽  
Emergency Rooms ◽  
Key Factors ◽  
Practice Nurses ◽  
Oncology Nurse ◽  
Care Models ◽  
Evidenced Based

Nurse practitioner care led models care models are evolving. A literature review by [1] emphasizes the utilization of advanced practice nurses and nurses in the geriatric setting based on the utilization of evidenced-based nursing practices incorporating interprofessional novel approaches across settings ranging from the community, long-term, and acute care. Likewise, nurse practitioner led models are emerging in the forefront to deliver care to cancer patients across all care settings such as emergency rooms [2], survivorship [3], treatment both home [4], in-house [5], as well as for palliative care [6].

Assessment of medical devices: How to conduct comparative technology evaluations of product performance

2007 ◽  
Vol 23 (4) ◽  
pp. 455-463 ◽  
Author(s):  
Lawton R. Burns ◽  
Eric T. Bradlow ◽  
J. Andrew Lee ◽  
Anthony C. Antonacci
Keyword(s):  
Medical Devices ◽  
Hospital Costs ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Evidence Base ◽  
Product Performance ◽  
Value Based Purchasing ◽  
Large Hospital ◽  
Study Results ◽  
Performance Dimensions

Objectives: U.S. expenditures on medical devices ($70 billion in 2003) are one of the fastest growing components of hospital costs. Physicians’ selection of medical devices lacks an evidence base on the comparative clinical effectiveness of these products. Comparative studies (e.g., vendor 1 versus vendor 2, technology A versus technology B) are increasingly promoted in the public sector as a means of cost containment, value-based purchasing, and quality improvement. This study illustrates how hospitals and physicians can conduct comparative technology assessments of product performance.Methods: Surgeons evaluated comparable medical devices manufactured by eight different vendors in standardized surgical procedures. Devices included sutures and endomechanical products, which account for $2.5 billion of total device spending. Evaluations covered multiple performance dimensions, including ergonomics, functionality, clinical acceptability, and vendor preference.Results: One vendor's products garnered consistently high ratings from surgeons, while two other vendors garnered consistently low ratings. Differences in ratings were statistically significant and persist when controlling for physician background characteristics and prior experience. Study results were used by a large hospital group purchasing organization to select which vendors to contract with for these products.Conclusions: Comparative technology evaluations assist physicians and hospitals in making cost-effective purchases of devices. These evaluations provide robust information on the performance of products routinely used by clinicians. Such evaluations can be carefully designed to have scientific rigor and clinical credibility.

scholarly journals A Case of Novel Coronavirus Disease 19 in a Chronic Hemodialysis Patient Presenting with Gastroenteritis and Developing Severe Pulmonary Disease

2020 ◽  
Vol 51 (5) ◽  
pp. 337-342 ◽  
Author(s):  
Antoney J. Ferrey ◽  
Grace Choi ◽  
Ramy M. Hanna ◽  
Yongen Chang ◽  
Ekamol Tantisattamo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Case Fatality ◽  
Disease Status ◽  
Viral Disease ◽  
Chronic Hemodialysis ◽  
Urgent Care ◽  
Maintenance Hemodialysis ◽  
Low Grade ◽  
Emergency Rooms ◽  
Novel Coronavirus

Novel coronavirus disease 2019 (COVID-19) is a highly infectious, rapidly spreading viral disease with an alarming case fatality rate up to 5%. The risk factors for severe presentations are concentrated in patients with chronic kidney disease, particularly patients with end-stage renal disease (ESRD) who are dialysis dependent. We report the first US case of a 56-year-old nondiabetic male with ESRD secondary to IgA nephropathy undergoing thrice-weekly maintenance hemodialysis for 3 years, who developed COVID-19 infection. He has hypertension controlled with angiotensin receptor blocker losartan 100 mg/day and coronary artery disease status-post stent placement. During the first 5 days of his febrile disease, he presented to an urgent care, 3 emergency rooms, 1 cardiology clinic, and 2 dialysis centers in California and Utah. During this interval, he reported nausea, vomiting, diarrhea, and low-grade fevers but was not suspected of COVID-19 infection until he developed respiratory symptoms and was admitted to the hospital. Imaging studies upon admission were consistent with bilateral interstitial pneumonia. He was placed in droplet-eye precautions while awaiting COVID-19 test results. Within the first 24 h, he deteriorated quickly and developed acute respiratory distress syndrome (ARDS), requiring intubation and increasing respiratory support. Losartan was withheld due to hypotension and septic shock. COVID-19 was reported positive on hospital day 3. He remained in critical condition being treated with hydroxychloroquine and tocilizumab in addition to the standard medical management for septic shock and ARDS. Our case is unique in its atypical initial presentation and highlights the importance of early testing.

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