scholarly journals Patient needs and resource intensity weighting in the ambulatory care unit

2021 ◽  
pp. 476-482
Author(s):  
Andrea Knox ◽  
John Larmet
Keyword(s):  
Ambulatory Care ◽  
Current Model ◽  
Patient Needs ◽  
Role Clarity ◽  
Model Of Care ◽  
Improvement Project ◽  
Nursing Role ◽  
Practice Elements ◽  
Resource Intensity ◽  
Staffing Requirements

Across British Columbia Cancer (BC Cancer), oncology nurses work as part of an interdisciplinary team in the outpatient ambulatory care unit (ACU) and support patients across the trajectory of their cancer journey. Previous initiatives, which focused on identifying patient needs and nursing role optimization work, have enhanced role clarity, enabling nurses to articulate their scope of practice and specialty competencies required to best meet the needs of patients and families. However, while the patient needs and fundamental practice elements have been identified to optimize the ACU nursing role, a gap still exists in quantifying the staffing resources required to operationalize the current model of care. To address this gap, a quality improvement project was initiated to develop an internally validated ACU Nursing Resource Intensity Weighting (RIW) tool for projecting baseline staffing requirements. The tool can be utilized to inform strategic and operational planning discussions focused on improving the outpatient model of care in oncology.

scholarly journals Taking advantage of Covid-19 to improve hospital models of care: are we moving in the right direction?

2021 ◽  
pp. 1-7
Author(s):  
Raffaella Gualandi ◽  
Anna De Benedictis
Keyword(s):  
Hospital Management ◽  
Models Of Care ◽  
Patient Needs ◽  
Model Of Care ◽  
Letter To The Editor ◽  
Rapid Changes ◽  
Improve Hospital ◽  
The Right ◽  
Shed Light

Abstract In this letter to the Editor, we shed light on the rapid changes the Covid-19 virus has generated in hospital management. Recent experiences in the field aim to reorganizing hospital processes and policies. In this new scenario, new patient needs emerge, and a change in the hospital model of care should include them.

Cost Improvement Programme: Is it or isn’t it a utilitarian act?

2016 ◽  
Vol 7 (4) ◽  
pp. 176-179
Author(s):  
Sangeeta Misra ◽  
Professor Jonathan Sandler ◽  
David Waring ◽  
Ovais Malik
Keyword(s):  
Gross Domestic Product ◽  
Current Model ◽  
Internal Market ◽  
Domestic Product ◽  
Model Of Care ◽  
District Health ◽  
Health Authorities ◽  
Improvement Programme ◽  
Funding Gap

The King’s Fund published a report called Efficiency in the NHS: A Study of Cost Improvement Programmes in 1989. 1 It was based on cost improvement programmes (CIP) of three district health authorities and questions were raised about how CIPs could be used, valued and audited within the NHS. This led to a new internal market within the NHS, where prices were negotiated and the successful organisations were likely to be the ones keeping the costs down.2 The NHS spending in England has exceeded more than double that of 2010/2011. 2 The NHS spending as a percentage of gross domestic product (GDP) has also risen from 5.2 to 8%. 2 It was predicted that increasing population needs and the current model of care 2 would contribute to a funding gap of £30bn between 2013–2021. To tackle this predicted productivity challenge and financial gap, CIPs and income-generating CIPs were launched. 2

scholarly journals Cost-Effectiveness Analysis of A Quality Improvement Program to Reduce Cesarean Sections in Brazilian Private Hospitals: A Case Study

2020 ◽  
Author(s):  
Rosa Maria Soares Madeira Domingues ◽  
Paula Mendes Luz ◽  
Bárbara Vasques da Silva Ayres ◽  
Jacqueline Alves Torres ◽  
Maria do Carmo Leal
Keyword(s):  
Quality Improvement ◽  
Cost Effectiveness ◽  
Cesarean Section ◽  
Cesarean Sections ◽  
Model Of Care ◽  
Private Hospitals ◽  
Improvement Project ◽  
Term Births ◽  
The Cost ◽  
Childbirth Care

Abstract Background: In 2015, a quality improvement project of childbirth care called Adequate Birth Project (“Projeto Parto Adequado”- PPA) was implemented in Brazilian public and private hospitals, aiming to improve the quality of childbirth care and to reduce cesarean sections without clinical indications. The objective of this study is to conduct an economic analysis of two models of care existing in a private Brazilian hospital - the model following the recommendations of the PPA and the standard of care model - in reducing the proportion of cesarean sections. Methods: We conducted a case study in one of the private hospitals included in the PPA project. The main outcome was the proportion of cesarean section. We used total cost of hospitalization for women and newborns, from the perspective of the health care provider, during the length of the observed hospital stay. We did not apply discount rates and inflation rate adjustments due to the short time horizon. We conducted univariate sensitivity analysis using the minimum and maximum costs observed in hospitalizations and variation in the probabilities of cesarean section and of maternal and neonatal complications. Results: 238 puerperal women were included in this analysis. The PPA model of care resulted in a 56.9 percentage point reduction in the cesarean section probability (88.6% vs 31.7%, p <0.001) and an increase in the total cost of US$ 67,346.25, which an incremental cost-effectiveness ratio of US$ 1,183.59 per avoided cesarean section. Women in the PPA model of care also had a higher proportion of spontaneous and induced labor and a lower proportion of early term births. There were no maternal, fetal or neonatal deaths and no significant differences in cases of maternal and neonatal nearmiss. The cost of uncomplicated vaginal births and cesarean sections was the parameter with the greatest impact on the cost-effectiveness ratio of the PPA model of care. Conclusion: The quality improvement project of childbirth care “PPA” was cost-effective in reducing cesarean sections in women assisted in a Brazilian private hospital, without increasing severe negative maternal and neonatal outcomes and reducing the frequency of early term births.

scholarly journals The role of patient portals in enhancing self-care in patients with renal conditions

2019 ◽  
Vol 13 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Adil M Hazara ◽  
Katherine Durrans ◽  
Sunil Bhandari
Keyword(s):  
Current Model ◽  
Patient Empowerment ◽  
Home Blood Pressure ◽  
Test Results ◽  
Model Of Care ◽  
Patient Portals ◽  
Web Based ◽  
The Uk ◽  
The Impact

Abstract Web-based portals enable patients to access their electronic health records, including test results and clinical documents, from anywhere with Internet access. Some portals also serve as a means of two-way communication between patients and healthcare professionals and provide a platform for the recording of patient-entered data such as home blood pressure readings. Such systems are designed to encourage patient participation in the management of their condition, and ultimately to increase patient empowerment and self-management, which are associated with improved clinical outcomes. As an example of portal use in patients with renal conditions, we discuss the PatientView portal, which is offered free of cost to patients under the care of renal physicians in the UK. We present an account of its various features and briefly describe the user experience. Previous studies examining the impact of this portal on patient care have been very positive; it appears to be popular among users and overall levels of satisfaction with the service are high. As the use of patient portals increases, we discuss barriers to the more widespread use of portals. We offer suggestions on how the care of patients with renal conditions can be enhanced in the future by further developing the existing features, learning from experiences of other patient portals and providing better integration of portal use into the current model of care.

Patient-Centered Medical Home Capacity and Ambulatory Care Utilization

2016 ◽  
Vol 32 (5) ◽  
pp. 508-517
Author(s):  
Larry R. Hearld ◽  
Kristine R. Hearld ◽  
Claudia Guerrazzi
Keyword(s):  
Ambulatory Care ◽  
Medical Home ◽  
Emergency Department Utilization ◽  
Care Utilization ◽  
Patient Centered Medical Home ◽  
Model Of Care ◽  
Patient Centered ◽  
Physician Practices ◽  
The Us ◽  
The Cost

The patient-centered medical home (PCMH) has increasingly received attention as a model of care to potentially remedy the cost and quality problems that confront the US health care system, including and especially ambulatory care–related issues. This study examined the association between physician practices’ PCMH capacity and 3 indicators of ambulatory care utilization: (1) emergency department utilization, (2) ambulatory care sensitive hospitalization rate, and (3) 30-day all-cause readmission rate. Results show that overall PCMH capacity is associated with lower rates, and technical aspects of the PCMH in particular were associated with lower utilization rates while interpersonal capabilities were not.

Using the PEPPA framework to develop the nurse practitioner role in emergency care: Critical reflections

2021 ◽  
pp. 205715852098847
Author(s):  
Erika Boman ◽  
Kim Gaarde ◽  
Rika Levy-Malmberg ◽  
Frances Kam Yuet Wong ◽  
Lisbeth Fagerström
Keyword(s):  
Emergency Department ◽  
Nurse Practitioner ◽  
Current Model ◽  
Models Of Care ◽  
Advanced Practice Nursing ◽  
Model Of Care ◽  
New Model ◽  
New Models ◽  
Nursing Roles ◽  
Practitioner Role

In this article, we describe and critically reflect on how the PEPPA framework, a Participatory Evidence-based Patient-focused Process for Advanced Practice Nursing, was used to develop a new model of care including the nurse practitioner (NP) role in an emergency department in Norway, where the role is in its infancy. While there is limited earlier research on the applicability of the PEPPA framework, it was here found to be useful. Supported by the framework, we mapped the current model of care, identified stakeholders and participants, determined the need for a new model of care, identified priority problems and goals, and defined the new model of care and the NP role. The PEPPA framework is recommended to develop new models of care including the NP role. Nonetheless, the process has not been straightforward. It is noted that to communicate and establish the new role in a setting as demanding as an emergency department takes time. Support from the management team is essential to succeed in developing and establishing new models of care and new nursing roles, such as the nurse practitioner role.

scholarly journals An Ambulatory Care Clinic and Community Pharmacy Collaboration to Address Prescription Abandonment

2019 ◽  
Vol 10 (1) ◽  
pp. 14
Author(s):  
Joshua W Gaborcik ◽  
Brigid K Groves ◽  
Aaron Clark ◽  
Marilly Palettas ◽  
Alexa Sevin Valentino
Keyword(s):  
Health System ◽  
Community Pharmacy ◽  
Ambulatory Care ◽  
Grocery Store ◽  
Improvement Project ◽  
Care Clinic ◽  
Pharmacy Technician ◽  
Phone Calls ◽  
Article Type ◽  
Ambulatory Care Clinic

Purpose: The purpose of this research is to evaluate a collaborative workflow aimed at decreasing prescription abandonment. Setting: A federally qualified health center and a 340B contracted grocery store-based community pharmacy. Practice Workflow:  An ambulatory care clinic with an established partnership with a community pharmacy chain identified a need to decrease prescription abandonment rates. A process was developed whereby an ambulatory care pharmacy technician received a report from the pharmacy of prescriptions filled for at least 7 days since the initial fill date and at risk for abandonment at the community pharmacy. The pharmacy technician identified health-system barriers, attempted to remedy any identified barriers, and conducted patient reminder phone calls. Health-system barriers were classified by the following categories: incorrect contact information at the community pharmacy, incorrect 340B copayment, incorrect insurance information at the community pharmacy, and need for prior authorization. Evaluation: A prospective cohort study was conducted from February 2016 to April 2016 in order to evaluate the effectiveness of this workflow. Results: 551 prescriptions and 350 patients were included in this cohort.  Of the 551 prescriptions, 362 had at least one identified barrier that may have led to prescription abandonment. There were 111 health-system identified barriers, and 96 of these barriers were acted upon. Additionally, there were 459 patient identified barriers, and 179 of these barriers were acted upon. When a pharmacy technician was able to identify and act upon at least one barrier, 106 prescriptions (46.9%) were picked-up from the pharmacy. Conclusion: From the information gathered in this quality improvement project, operational changes have been implemented at the ambulatory care clinic and community pharmacy as a means to further decrease modifiable health-system barriers that may lead to prescription abandonment.    Article Type: Clinical Experience  

Sign in / Sign up

Export Citation Format

Share Document