...Annotated Bibliographies Lisa Stevens Kaplan University Annotated Bibliographies Au, A., McAlister, F., Bakal, J., Ezekowitz, J., Kaul, P., & vanWalraven, C. (2012). Predicting the risk of unplanned readmission or death within 30 days of discharge after a heart failure hospitalization. American Heart Journal, 164(3). 365-372. Retrieved from: http://www.medscape.com/viewarticle/771215_print This article sought to find an appropriate model to predict the risk of unplanned heart failure readmissions. The primary outcome from chart reviews also included death of heart failure patients within 30 days of discharge. The study looked at Centers for Medicaid and Medicare Services (CMS) models and the LACE+ index, to mention two of many that looked at prediction ability. The LACE+ index is a model that looks at length of stay, acuity, the Charlson comorbidity score and age, to predict readmissions. They found that no one model was appropriate in predicting the 30-day readmission rates, although using a combination of the models was an improvement to that predictor. The authors are all physicians, PhDs, or have a Master’s degree- helping to establish credibility. The authors also make a statement as to the funding of the project and that they (the authors) were solely responsible for all data collection, design and submission approval writing for the project, also lending credibility to the study. The references used for this study were appropriate in age, of the 28; 13 were...
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...older, who have been diagnosed with CHF and teach them about heart failure management and how to prevent hospital readmissions. Congestive heart failure is an illness that effects millions each year and with proper management, individuals can still lead a productive life. Prior to the teaching presentation, a community teaching work plan proposal was developed which helped create an outline for the teaching lesson. This paper will review the teaching plan, the epidemiological rational related to CHF, evaluate the teaching experience, how the community responded, and what the strengths of the teaching plan were and areas that need improvement. Summary of teaching plan Teaching about congestive heart failure management and how to prevent returning to the hospital for complications related to CHF, is an important topic to discuss and educate the community about, especially the elderly. The teaching plan developed by this writer estimated the teaching time to last 30 minutes and would take place at Victory Home Care. Between the cost of paper and ink to make the pamphlet for educational handout and cookies, juice, and coffee for refreshments, the estimated cost was $30.00. The community this writer chose was a home health center, who assisted this writer in identifying and gathering a group of patients diagnosed with CHF, to come in and allow this writer to teach them about CHF management and hospital readmission....
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...patient outcomes. Hospitals are under tremendous pressure to reduce their avoidable rehospitalization rates. In October 2012, hospitals started being penalized for having higher readmission rates. Jenks estimates that readmissions within thirty days of discharge cost Medicare more than seventeen billion dollars annually (Jenks, Williams, and Coleman, 2009). There is no doubt that readmissions following a hospitalization are very costly. This issue is critical in nursing today because skyrocketing costs can affect salaries and poor outcomes can be blamed on poor care. The quest for better outcomes proves to be a collaborative effort between hospitals, physicians, case managers, therapists, social workers and caregivers. In May of 2008 St Luke’s Hospital in Cedar Rapids, Iowa implemented a transitions in care program. They understood that the hand off from hospital to home was not working effectively. They focused on being sure that the patient as well as the care givers understood the patients diagnosis, plan of care and plan for follow up care with their doctors. They used the “teach back” method, by having the patients teach the nurses it allowed them to verbalize what they know and engage them in their own learning. The focus was on their heart failure patients and their readmission rate started at twelve percent. After education and discharging to home care, who was able to reinforce and continue to reteach and assist patients to monitor for symptoms and change...
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...Memo #1: Potential challenges on ACA Readmission Patient Safety Organization (PSO) was designated by the Affordable Care Act to assist Hospitals with relatively high readmission rates to reduce the number. Readmission is defined as an admission of a patient to the hospital within 30 days of the date of discharge. According to the Centers for Medicare & Medicaid Services (CMS), University Hospitals was on the list of high readmission rates, with an AMI of 21.8, HF of 26.6, and a total of 1328 of discharges. There are many resources available on reducing unnecessary hospital readmissions, for example, the ProjectRED, which “can reduce readmissions by integrating better communication among clinicians and patients and by instituting follow-ups after discharge” (CMS). However, one important approach was to improve the transition process in inpatient and outpatient care for UH. By setting up a detailed and enforceable action plan to improve continuity of care, UH should focus on the following aspects: the compliance of national safety goals and regulations, the quality of transition approaches, the follow-up of regular reexamine, etc. These are not only methods to avoid high readmission rates, but also techniques to improve patient satisfaction and to reduce unnecessary administrative costs. Furthermore, another plausible approach is to bring closer relationship between hospitals and patient families, since they are an important part of patient satisfaction. Pay-for-performance ...
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...1. Does the ACO experiment achieve the dual objectives of cost savings and coordination of care? Why or why not? Identify three reasons supporting your position, grounded in the literature. I believe that the ACO experiment has the potential to provide cost saving methods and coordination of care because of the structured care patient will receive from one managed group of physicians, who can collaborate and share data, the incentives the facilities will be offered for efficient and effective care, and the quality measures that will be in place for the organization to follow. According to NPR.ORG, HHS estimates that ACOs could save Medicare up to 960 million dollars within the first three years of implementation. Also Kaiser Health News stated that all 32 Pioneer ACOs succeeded in improving quality and performed better than Medicare fee for service in 15 quality measures. In 2012, they also generated 87.6 million in the first year of the program (Kaiser). The three ways I feel ACOs will achieve cost savings and coordination of care are by: Cohesive and organized patient care: ACOs will provide better communication in order to streamline procedures and processes across the different HC settings, so the patient can obtain more education and information. These organizations will be able to keep costs down because they can monitor and share information responsibility between one another to ensure the patient is receiving the appropriate care. Healthcare will be more of a unit...
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...include only ‘burn’, ‘coronary’ and ‘respiratory’ care units. The CINAHL and Cochrane Database search failed to reveal any relevant results. Results: My search generated 33 articles and their review shed light on a few recurrent themes identified as being the reason for early re-admissions. Premature discharge, time gaps between reaching the wards and being seen, lack of attention by ward nurses, lack of experience of medical staff in the wards were some of the themes identified. Conclusions: For a patient, coming back to the ICU is always a cause of concern for physicians, patients as well as their families. After reviewing a significant number of studies, we can see how certain factors have linear and non-linear relationships with readmissions to...
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...Health Law and Regulations Federal regulations play a major role in the health care industry. Federal laws and regulations protect the American public from a number of health risks and administer programs for public welfare. Federal regulations also regulate the health insurance industry by implementing cost-containment measures. Through various regulatory bodies, Department of Health and Human Services (HHS) protects and regulates public health at every level. HHS is the United States principal federal agency for protecting the health of Americans and providing essential human services. HHS administers more grant dollars than all other federal agencies combined. Medicare program administered by HHS is nation’s largest health care insurance. HHS governs more than 300 programs administered by its 11 operating divisions (Department of Health & Human Services, 2011). In addition, Office of the Inspector General (OIG) is also part of the HHS. Description of each 300 programs is beyond the scope of this paper. However, it is imperative to understand the role of each operating agency and how it affects the health care industry. Role of Federal Regulatory Agencies Each operating division consists of sub-divisions making health care system a complex maze. Main 11 operating agencies are: Administration for Children and Families (ACF) The ACF provides funding for family assistance, child support, and childcare. The state, county, and city governments provide these services (Department...
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...Heart Failure Western Governors University Pathopharmacological Foundations for Advanced Nursing Practice Heart Failure It is estimated that about five million people in the United States are living with heart failure with an overwhelming number of 550,000 newly diagnosed cases each year, costing the nation roughly $32 billion dollars per year (Centers for Disease Control and Prevention, 2016). Heart failure is a complex, pathophysiological condition in which the ventricles of the heart is weakened and unable to pump effectively to meet the body’s needs for nutrients or has lost adequate filling capacity. Clinical presentations of heart failure depends on which ventricles have failed to pump blood adequately; left ventricular failure, also known as congestive heart failure (CHF) is more common than right ventricular failure (McCance & Huether, 2014). The most common symptoms of heart failure are shortness of breath, fatigue, and peripheral edema. HF is not a disease, but rather a manifestation of a diseased heart. Large number of disorders can lead to heart failure, and with the aging population and many surviving primary cardiac events, it is no surprise that the most common reason for hospitalization in patients older than 65 years old is heart failure (McClintock, Mose, & Smith, 2014). Heart failure has become a major public health problem because it is the only cardiac condition that continues to increase in prevalence (McClintock, Mose, & Smith, 2014)...
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...Congestive Heart Failure Armi Gonzales Western Governors University Congestive Heart Failure A. Investigated Disease Process Congestive Heart Failure is a condition in which the heart is unable to pump a sufficient amount of blood for the body to function. If the heart’s ability to pump blood decreases, blood and fluids may start to pool into the lungs and accumulate in the legs, ankles, and feet causing an edema, shortness of breath, and fatigue. (Heart Failure, 2015, para. 2) The American Heart Association and American College of Cardiology defines heart failure as “a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricles to fill with or eject blood” (King, Kingery, & Casey, 2012, p. 1). Heart failure can be seen as a widespread disease, affecting around five million Americans. (Titler et al. n.d.) It is a chronic condition that is disabling and costly and common to our aging population. With the advancement in therapy and early diagnosis, survival increases from previously fatal acute cardiac events to patients feeling better and living longer. Millions of Americans living with heart failure are 65 years of age or older. (Roger et al, 2004) A1. Pathophysiology The Circulatory system focuses on the heart, a muscular organ that pumps blood through a complex network of blood vessels throughout the body. Blood that is pumped from the heart carries oxygen and nutrients that fuel...
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...in diverse settings such as, in critical nursing, psychiatric nursing, gerontological nursing, and for teaching purposes. In the United States, “the model is used to guide practice with clients with acute and chronic health problems” (Parker &ump; Smith, 2010, p. 192). As further explained by Parker and Smith (2010), the client system is the core: a person, individual, or community and the core interact with the flexible lines of defense, the normal lines of defense, and the lines of resistance. The client system is constantly affected by internal and external stressors. The goal of nurses in applying the Neuman System Model is, “to maximizing the quality of life lived, maintaining the highest level of independence possible, and preventing exacerbations of the on-going illness” (Ebersole, Hess, Touhy, Jett, and Luggen, 2008, p. 258). Mrs. J is a 79-year-old African-American female client, who lives with her husband in a wheelchair accessible home. She has always been a home maker, enjoys cooking the family meals, and raising the grandchildren. Mrs. J is a mother of three children with great family support and loves the outdoors. She has multiple medical conditions: adult onset diabetes, moderate obesity, indigestion, hypertension,...
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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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...per the article by JAMA, the minimum believed to be spent on wasteful spending is $558 billion per year, and a midpoint of $910 billion per year. Eliminating that alone is enough to make a change in our healthcare system. In order to elaborate on the topic, this project identifies one of the waste wedges I decided to write about, tells why I chose the particular one that I did, what exactly the wedge is and how it produces waste while affecting healthcare, and then finally what we can do to lessen the waste, as well as a proposition to eliminate waste in said category while looking at a proposal to better the organization and population. II. Selection of Topic For this project I chose Failures of Care Delivery as my waste wedge to explore. A. What is Failures of Care Delivery Failures of Care Delivery as defined in the JAMA article is:" the waste that comes with poor execution or lack of widespread adoption of known best care processes, including, for example, patient safety systems and preventative care practices that have been shown to be effective. The results are patient injuries and worse clinical outcomes. Better care can save money. We estimate that this category...
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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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...The Economics of Health Care Quality and Medical Errors Charles Andel, Stephen L. Davidow, Mark Hollander, and David A. Moreno Charles Andel, MBA, BSRT, is Manager of Radiology Quality and Compliance at Loyola University Medical Center and a graduate of Loyola University Chicago’s Quinlan School of Business MBA in Healthcare Management program. He may be reached at cjandel@lumc.edu. Stephen L. Davidow, MBA, APR, is a health care marketing and communications professional with a strong focus on quality and patient safety. He is a graduate of Loyola University Chicago’s Quinlan School of Business MBA in Healthcare Management program. He may be reached at stephen@davidowcommunciations.com or 708-284-2300. Mark Hollander, MBA, is a financial manager at the Department of Veterans Affairs and graduate of Loyola University Chicago ’s Quinlan School of Business MBA in Healthcare Management program. David A. Moreno, MBA, is a biotechnology business analyst and graduate of the Loyola University Chicago’s Quinlan School of Business MBA in Healthcare Management program. He may be reached at dmoreno1@gmail.com. Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical...
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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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