...as a state where three or more chronic illness conditions prevail in a patient either centrally or dependant upon one or more central condition (Fortin et al., 2007). This clinical condition is characterised by overlapping pathophysiology, synergetic disease intensity and intersection of individual illnesses management (Boyd et al., 2010). Few examples of the composing illnesses include coronary heart diseases, dyspepsia, migraines, sleep disturbances, bowel imbalance and Sarcopenia ( Fortin et al., 2007) Prevalence of multi morbidity varies across different parts of the world depending upon variance of population sample, age group of the society, advancement of health care monitoring systems and ethnic conditions. In developing countries like most of the Asian countries, rates of life expectancy are reported to increase due to advances is environmental and working conditions of the population. With the increase in life expectancy rates, the prevalence of coexistence of these diseases also steeply increases and is directly proportional (Akker et al., 1998). Further more, the prevalence of this clinical condition is more in developing countries when compared to that of developed countries due to increased percentage of vulnerable groups like young children, diseased and unattended patients and poor economical conditions (Valderas et al., 2009). The government of UK launched a initiative in collaboration with the NHS to effectively manage care for patients with long term conditions...
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...Health Belief Model The HBM was adopted from the behavioral sciences to predict health behaviors by focusing on attitude and health behaviors of individuals (McEwen and Wills, 2014). It application into research is to help improve preventive interventions based on fear of disease and benefits obtained. The constructs utilized to explain this assumption are: perceive benefits, perceived barriers, and, cues to action (McEwen and Wills, 2014). It provides the APRN with strategies to make people aware of health problems, and implement programs to change modifiable risk factors and behaviors to health ones (McEwen and Wills, 2014). Self-management is a basis of diabetes care, and it is believed that improving patient self-efficacy is a crucial...
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...about. Primary care is one of the biggest transformations currently taking place in healthcare. Helping to direct this transformation is a team of researchers lead by Dr. Edward H. Wagner, who have proposed a model for transforming primary care as well as improving efficiency and effectiveness in the health care system. This model, referred to as the Patient-Centered Medical Home (PCMH), embraces practice principles taken from the Chronic Care Model and the Pediatric Model (Wagner, 2012). PCMH model contains what is referred to as eight key “change concepts” that are essential for transforming a medical practice into a medical home. These change concepts are first introduced in the article “Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes” written by Edward H. Wagner, Katie Coleman, Robert J. Reid, Kathryn Phillips, and Jonathan R. Sugarman. Accordingly, I will be providing a critique of this article, as well as providing an assessment of the change concepts underlying PCMH. The article’s review of literature highlights the need for a robust primary care sector that can reduce health care costs and significantly improve care. In light of the Affordable Care Act, which emphasizes improved access to care while keeping costs low (Sultz, 2014, p.54), the challenge of balancing cost and quality service at the primary care level is a growing concern. In fact, the Affordable Care Act has a direct impact on the delivery of primary care, since an increasing...
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...self-management goals, provide peer support and to improve access and quality of care to meet current ADA guidelines (2014). The initial project extended over 6 months with a midterm, 4 month and 6 month process evaluation. The overarching goals of this project were to: 1.) Improve the quality of care offered to Veteran patients using U-500 insulin within the context of the Madison VHA Outpatient Diabetes Clinic so that it aligned with current best-practice guidelines. 2.) Evaluate the feasibility, as defined...
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...THE CASE FOR A MODEL OF CARE Contemporary health care systems are constantly challenged to revise traditional methods of health care delivery. These challenges are multifaceted and stem from: 1. novel pharmacological and non-pharmacological treatments; 2. changes in consumer demands and expectations; 3. fiscal and resource constraints; 4. changes in societal demographics in particular the ageing of society; 5. an increasing burden of chronic disease; 6. documentation of limitations in traditional health care delivery; 7. an increasing emphasis on transparency and accountability, 8. evidence based practice (EBP) and clinical governance structures; and 9. the increasing cultural diversity of the community. These challenges provoke discussion of the necessity of developing services around a model of care. What do we mean by a model of care? Ambiguity exists in the literature, with the terms, model of care, nursing model, philosophy, paradigm, framework and theory often used interchangeably, despite referring to diverse, yet parallel concepts (Tierney 1998). In their recent review of the literature, the Queensland Government (Australia) reported that they found no consistent definition of ‘model of care’ (Queensland Health 2000). They concluded that a model of care is a multidimensional concept that defines the way in which health care services are delivered (Queensland Health 2000). More specifically, Davidson and Elliott...
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...Jenifer S McFarlane Grand Canyon University: NRS-430V June 10, 2012 In 2008, the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) came together to collaborate and develop a constructive plan for the nursing profession moving forward in the coming age of affordable care for all U.S. citizens. Both parties agreed that available, excellent care could not be attained without exceptional nursing practice and leadership. The report establishes that achieving a successful health care system in the future rests on the future of the nursing profession. The IOM and RWJF (2011) stated, “We believe that preparation of an expanded workforce, necessary to serve the millions who will now have access to health insurance for the first time, will require changes in nursing scopes of practice, advances in the education of nurses across all levels, improvements in the practice of nursing across the continuum of care, transformation in the utilization of nurses across settings, and leadership at all levels so nurses can be deployed effectively and appropriately as partners in the health care team.” In order to make the required advancements to the health care system in the coming years, it will be necessary to make changes to the variety of nursing degree programs presently available. Increasing the capacity of nursing schools is necessary in order to expand the nursing workforce overall. Nursing curriculum needs to be redesigned to ensure that graduating...
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...Change Project NUR 492 November 10, 2014 Dr. Christine Markut Change Project Today’s healthcare providers are struggling more than ever to provide high quality care while controlling the costs of healthcare. The demands of an aging population and shortage of medical personnel have brought challenges to the medical office and physicians somehow need to improve their access. Instead of limiting the time patients are able to spend with their physician discussing their medical concerns, why not increase the time and make it more effective for both the patient and the physician. Incorporating GMA’s may allow our physicians to see more patients, provide more care, and increase practice revenue. The patient benefits with increased access to the provider as well as receiving significant education with their peers that suffer from the same medical conditions (Rhee, 2013). This is a win – win situation for the organization and patients. Patients are typically allotted 15 to 30 minutes to discuss their concerns with the physician but with group medical appointments (GMA), patients are actually able to spend up to 90 minutes with their provider. GMA’s offer an alternative structure in the way effective and efficient care is delivered to chronically ill patients (Schmucker, 2006) and it allows greater interaction time with the provider. A GMA will typically involve approximately 8-12 patients while all of the components of individual appointments can be delivered to include: one-on-one...
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...Memorandum To: Dr. Robert I. Grossman, CEO NYU Langone Date: November 7, 2012 Re: Restructuring Health Care Payment and Improving Quality The U.S. devotes a much larger share of its national income to health care than any other country in the world. However, the gross over-spending has not yielded the healthiest population (OECD Health data, 2009). Our economy is continually growing at a lesser rate than healthcare spending. The need to restrain this unsustainable growth in health care costs is often overlooked in favor of reform focused on expanding access to care. Attention must be focused on restructuring the payment process with the goal of reducing costs without sacrificing quality. With an aging population comes chronic conditions that require efficiently coordinated care. About 10 million Americans require long term care, 42% of which are under 65 with disabilities or chronic illness (Rowland, 2009). It is also not uncommon for chronic patients to receive duplicate testing, conflicting treatment advice, and expensive prescriptions from multiple practitioners. The Medicare system was a fee-for service payment plan, until a prospective payment was introduced. A contributing factor to the problem has been the trending of hospitals and insurers to better cover acute episodes rather than preventative or ongoing care. For example, the average length of stay is down from less than 8 days in the 1970s to 4.6 days in late 2000’s. In a similar trend, gross outpatient...
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...Jean Watsons: Daily goals for Intensive Care Unit Ventilated patients Brea Blais Southern New Hampshire University Advanced Nursing Concepts Dr. Bladen May 13, 2015 Jean Watsons: Daily goals for ICU Ventilated patients An estimated 85% of errors occur in care when communication is not clear (Pronovost et al., 2003). When Nurses or doctors do not know how to properly care for their patients, then these patients cannot recover in an appropriate time frame (Pronovost et al., 2003). “At baseline less then ten percent of nurses and residents understand the goals of care for the day”(Pronovost et al., 2003, para. 2). After the implementation of a daily goals worksheet 95% of nurses and residents understood the goals of care for the day, length of stay was decreased, and other critical care patient problems were decreased. (Pronovost et al., 2003). Jean Watson’s human caring theory was the foundation of the daily goals, created in Johns Hopkins Hospital, in 2003. The daily goals sheet was developed in a 16 bed surgical oncology ICU to improve patient outcomes by improving communication between the members of the healthcare team (Pronovost et al., 2003). Transpersonal relationships and a caring relationship were used when creating the Daily goals sheet (Fawcett & DeSanto Madeya 2013). Daily goals were used in the ICU setting, with any patient population that may present to the ICU with an acute or chronic problem (Fawcett & DeSanto Madeya 2013). Content and format of...
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...Health Care Coordination Models: Benefits and Challenges Traci L French Salem International University Abstract: Care coordination refers to several forms of patient care management that is patient- rather than provider-focused and has the end goal of the “Triple Aim”-improved patient experience, improved population health and decreased per capita costs. These goals are achieved by developing healthcare models which promote collaborative care between providers, increase communication between health care entities, actively engage patients in health care and lifestyle choices and rely heavily on health technology to extend provider services, personalize care and monitor quality improvement efforts. The main barriers to care coordination implementation include poor reimbursement for services, difficulties with provider network communications, shortages of trained care coordination personnel and ambiguity in provider roles and responsibility, which can lead to provider accountability issues. When well-established, care coordination models allow patients to form substantive, long-term personal relationships with providers and increase personal accountability for health care choices. These relationships increase compliance with care regimens in the ambulatory setting and decrease costs with overall improvement in patient quality of life. Care coordination refers to several forms of patient care management which is patient- rather than provider-focused and has the end goal of...
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...Health Care Information Systems Evolution of Health Care Information Systems HCS 533 Health Information Systems Tana M. Daniel Steven Fowler January 31, 2011 Evolution of Health Care Information Systems Bridging the gap in health care information technology will promote safe, proficient, patient-focused, and effective patient care in a timely manner. In this paper the subject is to examine two contemporary health care organizations and compare and contrast several features that will include the type of information systems currently in use, analyze the transmission of data 20 years ago and how the exchange of data today. In addition, this paper will cover two major events and technology advances that have influenced current HCIS practices. Five information systems seen in health care organizations are (Wagner, 2009) 1) computerized provider order entry 2) medication administration 3) telemedicine 4) telehealth, and 5) personal health records (p. 121). Each system can provide quality improvement, improve patient safety, and be cost effective. Skilled Nursing Facilities have made significant changes over the last 20 years, in comparison to now. Looking at a skilled nursing facility present time versus a skilled nursing facility operation of Dunseith Community Nursing Home in North Dakota 20 years ago. With the implementation of new rules and regulations, this requires skilled nursing facilities to focus on quality patient care and...
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........................................................ 4 Healthcare emotional intelligence ......................................................................... 4 Training implications .............................................................................................. 5 Training and Health Care ....................................................................................... 6 The physician and emotional intelligence .............................................................. 7 Conclusion ............................................................................................................. 8 Introduction There is a renewed interest in healthcare, in the role of Emotional Intelligence — a set of behavioral competencies, distinct from traditional IQ, that impact performance. There is also a growing body of evidence that individual behaviors, including EQ, influence patient outcomes and organizational success. What is EQ? How does it apply to healthcare? How do we use it to improve performance? Everyone is striving to provide patient-centered care. Operational strategies like Lean or Six-Sigma help in designing new, patient-centered care models. Information systems make clinical and financial data more useful and enhance efficiency. These strategies and technologies are widely available, but not every organization is successful....
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...OF HOME HEALTH The Future of Home Health Mary C. Reed The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of N5311 Nursing Management in Health Care Stephanee Thurman, MSN, RN August 1, 2012 2 THE FUTURE OF HOME HEALTH The Future of Home Health Home health has been the topic of several news discussions lately. Doctors and nurses are afraid that since Medicare fraud has taken place in so many home health agencies, that Medicare is going to start shutting down a lot of home health agencies so that they have less fraud to watch out for. The studies I have chosen discuss positive outcomes that are related to providing care in the patient’s home. I have worked in home health for four years. In those four years, home health services have been through many changes. After obtaining my Masters of Science in Nursing I plan on continuing to work in home health. I would like to move up to a management position after graduation. Home health is interesting to me and I enjoy working with patients in their home environment. Patients seem to be more motivated in their home setting instead of being in a rehabilitation center or hospital. “In home nursing care, patient care activities focus on enabling patients to assume responsibility for self-monitoring and self-management through teaching, supporting, goal setting, and modeling decision-making” (Or, Valdez, Casper, Carayone, Burke, Brennan &...
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...improving Quality and Value in the U.S. Health Care System August 2009 Preamble The Bipartisan Policy Center (BPC) is a public policy advocacy organization founded by former U.S. Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchell. Its mission is to develop and promote solutions that can attract the public support and political momentum to achieve real progress. The BPC acts as an incubator for policy efforts that engage top political figures, advocates, academics, and business leaders in the art of principled compromise. This report is part of a series commissioned by the BPC to advance the substantive work of the Leaders’ Project on the State of American Health Care. It is intended to explore policy trade-offs and analyze the major decisions involved in improving health care delivery, and discuss them in the broader context of health reform. It does not necessarily reflect the views or opinions of Senators Baker, Daschle, and Dole or the BPC’s Board of Directors. The Leaders’ Project was launched in March 2008. Co-Directed by Mark B. McClellan and Chris Jennings, its mission is (1) to create a bipartisan plan for health reform that can be used to transform the U.S. health care system, and (2) to demonstrate that health reform is an achievable political reality. Over the course of the project, Senators Baker, Daschle, and Dole hosted public policy forums across the country, and orchestrated a targeted outreach campaign to...
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...Chronic Critical Illness Judith E. Nelson1, Christopher E. Cox2, Aluko A. Hope1,3 and Shannon S. Carson4 + Author Affiliations 1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, and Hertzberg Palliative Care Institute, Mount Sinai School of Medicine, New York, New York; 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina; 3Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York; 4Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, School of Medicine, Chapel Hill, North Carolina Correspondence and requests for reprints should be addressed to Judith E. Nelson, M.D., J.D., Box 1232, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029. E-mail: Judith.nelson@mssm.edu Next SectionAbstract Although advances in intensive care have enabled more patients to survive an acute critical illness, they also have created a large and growing population of chronically critically ill patients with prolonged dependence on mechanical ventilation and other intensive care therapies. Chronic critical illness is a devastating condition: mortality exceeds that for most malignancies, and functional dependence persists for most survivors. Costs of treating the chronically critically ill in the United States already exceed $20 billion and are increasing. In...
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