84 results for “Hospital Readmission”.
One of the key reasons that was found to be a factor in readmissions is that insurance companies continue to push for shorter hospital stays. They have reduced the number of days that they will pay for certain conditions. This was found to be a key factor in releasing patients early, when they might have benefited from a longer hospital stay (Bueno, oss, & Wang et al., 2010; Capelastegui, A,, Espana, P., & Quintana, J. et al., 2008), This factor will have to be considered as a potential barrier to the study. It may be that insurance companies and Medicaid/Medicare reimbursements are a factor in early release of patients rather than hospital practices.
Factors that were identified in other studies of hospital 30-day readmissions included the presence of deep vein thrombosis and pulmonary embolism (Spencer, Gore, & Lessard et al., 2008). Severity scores such as those for community-acquired pneumonia were…
Bueno, H., Ross, J. & Wang, Y. et al. (2010). Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006. JAMA.
Capelastegui, A,, Espana, P., & Quintana, J. et al. (2008), Declining length of hospital stay for pneumonia and post discharge outcomes. Am J. Med. 121(10):845-52.
Capelastegui, A., Espana, P, & Chest.Quintana, J.
causes for Medicare and Medicaid patients to be readmitted to hospitals within thirty days of a prior discharge. This is a fairly pervasive and major problem and it is one that demands solutions. As part of this capstone, there will be a number of facets and tools used. There will be a problem description that identifies what the problem is and why it is important. There will be a solution description that broadly asserts what is needed to address and resolve the problem identified. There will be an implementation plan that will lay out how the program will be rolled out to the locations and the people that work therein. There will also be an evaluation plan that will be used to monitor and assess performance so that any deficiencies can be spotted and addressed before they become full-on conflagrations that can sap the performance and outcomes of the project.…
Challen, L., Kelso, C., & Gandi, B. (2014, May). Association between prescription drug benefit and hospital readmission rates. Hospital Pharmacy, 49, 449-454.
Hospitals with more elderly, poor patients likely to face readmission penalties" by Katie Sullivan (January 8, 2014)
Are some hospitals discharging patients before they are ready, causing them to be subsequently readmitted? This would seem to be the issue involved in the recent decision by the federal government to assess penalties if hospitals treat so-called "dual-eligible seniors," or those eligible for medical care under both Medicare and Medicaid, because these patients are at higher risk of readmission within 30 days of discharge. According to an article by Sullivan (2014), the reality of the situation is that the majority of the hospitals that will be adversely affecting by this decision are those whose treatment area contains inordinately higher percentages of senior citizens who require a greater share of healthcare resources compared to their younger counterparts. Moreover, the quality of care being provided in these hospitals is not generally at issue. In…
Sullivan, K. (2014, January 8). Hospitals with more elderly, poor patients likely to face readmission penalties. FierceHealthcare. Retrieved from http://www.fiercehealthcare.
Amin, B et al. (2013). Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets. Journal of Neurosurgery: Spine, 18(2): 134-138.
This study examines the University of California's Medical Center in San Francisco in order to determine if its all-cause readmission rates accurately reflect the readmission rates for spine injury patients. The secondary purpose of the study is to identify readmission predictors. The researchers collected data from 5780 consecutive patient visits. 5% of the visitors were readmitted within a month of their discharge. The researchers examined variables that led to their readmission and regression analysis was conducted in order to spot predictors. A t-test was also used to see if there was any difference in admission vs. non-readmission incidents. The researchers found that infection was the number one variable leading to readmission, inoperable management the second most common variable, and planned surgery the third most common variable for…
Kachalia, A. (2013). Improving patient safety through transparency. New England
Journal of Medicine, 369: 1677-1679.
This study provides a qualitative review of why transparency is helpful in health care. The researcher shows that openness with patients and clinical health care providers is essential to maintaining a relationship of trust, accountability, and of improving patient safety. The more forthcoming with information that health care providers are with patients, the more forthcoming patients are likely to be with their providers. The research indicates that many health care organizations are still behind the curve when it comes to developing a workplace culture that actively promotes and facilitates transparency. The study indicates that a principled and formal approach to addressing errors in disclosure would go a long way in supporting a culture of transparency. This study is helpful in identifying an issue in nursing that requires attention for the good of both patient and practitioner.
eadmission of patients with diabetes is a problem that warrants consideration of the contributing factors. eadmission of patients within 30 days of discharge is considered to be an indicator of healthcare quality -- along with other circumstances, such as patient lifestyle -- that needs to be addressed from a patient care perspective and from a cost of care perspective (Dungan, 2012). A dismal statistic starkly represents the problem: oughly 8% of the U.S. population is represented by patients with diabetes, yet this group accounts for 23% of the hospitalizations in the nation (Dungan, 2012). On top of this figure, between 14.4% to 21% of diabetic patients are readmitted, compared to 8.5% and 13.5% of U.S. hospital patients overall (Dungan, 2012). The problem is exacerbated by the rise in national rates of diabetes means that more patients will present from the general population and, accordingly, more patients with diabetes will experience…
Donnell-Jackson, K., Ram M. Jhingan, R.M. And Rubin, D.J. (2013). Early Readmissions among hospitalized patients with diabetes: A qualitative assessment of contributing factors. Paper presented at Diabetes: Diagnosis, Complications & Outcomes, The Endocrine Society's 95th Annual Meeting and Expo, from June 15 -- 18, 2013, in San Francisco, California.
Dungan, K.M. (2012, September). The effect of diabetes on hospital readmissions. Journal of Diabetes Science Technology, 6(5), 1045-1052. Retreived from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570838/
Dye, J. G, Schatz, I.M., Rosenberg, B.A., and Coleman, S.T. (2000, January). Constant comparison method: A kaleidoscope of data. The Qualitative Report, 4(1/2).
Hellman, R. (2014, October). An individualized inpatient diabetes education and hospital transition program for poorly controlled hospitalized patients with diabetes. Endocrine Practice, 20(10), 1097-1099.
Implementation of Strategies to educe Psychiatric eadmission
To this end, it is clear that hospital readmission remains a prevalent phenomenon in adult psychiatric patients, placing a huge morbidity and economic burden on individuals, families, and healthcare organizations (Burton, 2012; Machado et al., 2012). Addressing psychiatric readmission, therefore, is an important priority for healthcare providers. Evidence demonstrates that psychiatric readmission is mainly caused by ineffective transition of care from the inpatient to the outpatient setting (Kalseth et al., 2016). In essence, reducing psychiatric readmission requires effective care transition interventions. The purpose of this EBP project is to reduce readmissions in an adult psychiatric hospital by 10% over a three-month period.
There are several models that provide guidelines for the implementation of practice change. In this case, however, given the nature of the clinical setting and resource availability, osswurm & Larrabee's (1999) is deemed an appropriate model. The…
Burton, R. (2012). Improving care transitions. Health Policy Brief. Health Affairs.
Chugh, A., Williams, M., Grigsby, J., & Coleman, E. (2009). Better transitions: improving comprehension of discharge instructions. Frontiers of Health Services Management, 25(3), 11-32.
Coleman, E., Roman, S., Hall, K., & Min, S. (2015). Enhancing the care transitions intervention protocol to better address the needs of family caregivers. Journal of Healthcare Quality, 37(1), 2-11.
Eassom, E., Giacco, D., Dirik, A., & Priebe, S. (2014). Implementing family involvement in the treatment of patients with psychosis: a systematic review of facilitating and hindering factors. BMJ Open, 4, e006108.
Quality Improvement Project
Diabetes -- Chronic Condition Background
Type 1 and Type 2 Diabetes
isk factors for type 1 diabetes
isk factors for prediabetes and type 2 diabetes
isk factors for gestational diabetes
The ationale for Selection
The Target Population
It has been estimated that in New York there is roughly two million people, or over twelve percent of the population, that have diabetes; furthermore, of this population, over half a million people have the condition but are not aware that they have it (American Diabetes Association, N.d.). It is further estimated that nearly five and a half million people, or over a third of the population, have prediabetes. Diabetes and diabetes-associated cardiovascular diseases have become the leading cause of death in the region accounting for roughly two-thirds of the deaths and the rates of diabetes has lead this trend to be referred to as the…
American Diabetes Association. (N.d.). Health Disparities. Retrieved from American Diabetes Association: http://www.diabetes.org/advocacy/advocacy-priorities/health-disparities.html
American Diabetes Association. (N.d.). New York, New York. Retrieved from American Diabetes Association: http://www.diabetes.org/in-my-community/local-offices/new-york-new-york/
CDC. (2013). Diagnosed Diabetes, Age Adjusted Rate (per 100) Adults - Total 2013. Retrieved from Center for Disease Control: http://gis.cdc.gov/grasp/diabetes/DiabetesAtlas.html
Department of Health. (N.d.). Diabetes. Retrieved from New York State: https://www.health.ny.gov/diseases/conditions/diabetes/
Arnold Palmer Hospital
Managing Service, Processes and Supply Chains
Hospitals and Supply Chains - Overview
Hospital Supply Chains - Advancements
Standard Supply Chain
Vendor Managed Inventory
Automated Point of Use Systems
The Next Step in Supply Chain Evolution
Arnold Palmer Hospital Supply Chain
The Arnold Palmer Hospital is one of the country's leading hospitals for women and children. It is located in Orlando, Florida and is currently a part of a national purchasing group in which it utilizes to provide supply chain purchases. Even though being a part of the purchasing group has some cost advantages stemming from the collective bargaining power, there are also many disadvantages that are not entirely consistent with the organizations priorities. These disadvantages can be mitigated by equipping the hospital with more modern supply chain technology. Therefore, an investigation was conducted that identified the supply chain options available for the…
Alverson, C., 2003. Beyond purchasing -- Managing hospital inventory. [Online]
Available at: http://managedhealthcareexecutive.modernmedicine.com/mhe/article/articleDetail.jsp?id=75802
[Accessed 23 September 2011].
Berling, R. & Geppi, J., 1989. Hospitals can cut materials costs by managing supply pipeline. [Online]
Healthcare Quality Indicators
ith the adoption of the Affordable Care Act, also now commonly referred to as Obamacare, the array of quality indicators used to assess healthcare facility performance has expanded. The addition of a number of quality indicators with direct connections to penalties and other punitive measures has created a great deal of pressure for hospitals and other healthcare facilities. Many of these quality indicators are designed to heighten accountability among hospitals and other acute healthcare treatment cites or systems. Among them, penalties for preventable readmissions has become an exceptionally prominent indicator of performance quality.
According to Brink (2013), the quality indicator of readmission rates has become an important issue for healthcare leaders and hospital administrators. Brink reports that roughly 12% of all Medicare patients will be readmitted to the hospital within the first 30 days of discharge for recurrent conditions that could be prevented…
Brink, S. (2013). Hospitals Seek to Avoid Penalties by Minimizing Readmissions. U.S. News and World Report.
Johnson, M. (2013). For Hospitals, Obamacare Rollout Makes Readmission Penalties a Top-of-Mind Priority. NJ Biz.
Rau, J. (2013). Medicare Revises Readmissions Penalties -- Again. Kaiser Health News.
Patient eduation an be desribed as a proess by whih majorly health professionals and other related stakeholders impart information to patients together with their aregivers so that there an be improvement of health status and also alter health behavior of patients. Those who may be involved in health eduation may inlude physiians, pharmaists, registered nurses, psyhologists, speial interest groups, and pharmaeutial ompanies. Health eduation an also be used as a tool by managed are plans in general preventative eduation and health promotion. Some of the important elements that are supposed to be onsidered when dealing with patient eduation are skill building and responsibility. It is neessary for patients to know why, when and how they are required to make their lifestyle hange. This proess of patient eduation is apable of reduing healthare osts.
Looking at studies pertaining ost ontainment, it shows that patient eduation results to…
c) Having the ability to carry out normal roles and activities
According to a prospective random control study by Department of Child Health, 25% are re-admitted to hospital within a year, (Madge P, McColl J, Paton J. 1997). There was asthma home management training programme using children aged two years or over. About two hundred and one children became randomized to intervention group (n=96) that was receiving the teaching or control group (n=105). The study found out that there was a very significant-admission and significant lowered the intervention group that was made up of 25% to 8. Such reduction was never accompanied through any increase within subsequent emergency room attendance. Another area of intervention indicated reductions in a day as well as night mobility three to four weeks after hospital administration.
There are theoretical models where principles of self-management have been developed, mainly from the fields of behavioral and psychology science. Among the models, the one that is mostly referred to is Bandura's self-efficacy theory. Self-efficacy includes persons' believing in their capacity to fruitfully learn and carry out a specific behavior. When a patient feels a strong sense of self-efficacy, they feel they are in control and have the urge of continuing with new and complicated tasks, (Warsi A et al., 2004). Meaning that patients are empowered and motivated to have the courage to manage their health problems when they gain a feeling of confidence regarding their ability to
If a hospital has a poor record of infections and patient falls, those patients who have a choice will avoid the hospital. So, as the hospitals begin recording and tracking the information, those that do not choose to improve lose patients (HQA 2011). Contrary wise, those hospitals that remain on the cutting edge of improving the quality of care for patients are hospitals that will be sought after by patients who have an option.
Another possible reason for the desire to improve conditions is for the sake of attracting better physicians. Many physicians are selective as to the hospitals they serve with. For instance, most Catholic physicians tend to only seek admission to Catholic hospitals.
It is possible that hospitals may seek reimbursement as a means of dealing with quality issues with patients. Currently, when a hospital makes a mistake the patient is still expected to pay the full amount…
Hospital Quality Alliance (2011). Quality Measures. Extracted February 4, 2012. http://www.hospitalqualityalliance.org/hospitalqualityalliance/qualitymeasures/qualitymeasures.html
Washington State Hospital Association (2011). Quality Indicators Search Page. Extracted February 4, 2012. http://www.wahospitalquality.org/index.php
Evidence-Based Practice Project: educing ate of Psychiatric eadmission
The purpose of the evidence-based practice project is to examine ways to eliminate psychiatric readmissions. More specifically, literature is reviewed to examine evidence supporting the effectiveness of care transition interventions in preventing re-hospitalization amongst adult patients with severe mental illness. In this chapter, the search process is first described. Next, the identified literature is summarized and synthesized, clearly evaluating the relevance of the literature to the specified PICOT question.
Literature for the review was searched in CINAHL, PubMed, EBSCO, ProQuest, and Google Scholar databases using the following phrases: psychiatric readmission, re-hospitalization, care transition interventions, transitional care interventions, and reducing readmission in adults with mental illness. Focus was particularly on literature published in English. From the first round of search, it was quite evident that not much scholarly attention has been given to the topic as the search returned less than…
Allen, J., Hutchinson, A., Brown, R., & Livingston, P. (2014). Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Services, 14: 346.
Gaynes, B., Brown, C., Lux, L., et al. (2015). Management strategies to reduce psychiatric readmissions. Technical Brief No. 21. Rockville, Maryland: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.
Kalseth, J., Lassemo, E., Wahlbeck, K., Haaramo, P., & Magnussen, J. (2016). Psychiatric readmissions and their association with environmental and health system characteristics. BMC Psychiatry, 16: 376.
Pincus, H. (2015). Care transition interventions to reduce psychiatric re-hospitalizations. Technical Brief. Alexandria, Virginia: National Association of State Mental Health Program Directors (NASMHPD).
Myocardial Infarction Minimizing Hospital Readmission
Phase 1: EBP for Effective Patient Care Transition
Donald, an acute myocardial infarction (MI) patient, has undergone angioplasty, a procedure in which a catheter is inserted into clogged arteries in a patient’s heart to widen them and improve blood flow. To supplement the angioplasty, Donald has had cardiac stents placed to prop the affected arteries open and reduce their risk of narrowing again. Studies have shown that several complications could result from angioplasty procedures and the insertion of stents as in Donald’s case. The most common complications include bleeding or vascular complications (6 percent of patients), acute renal failure (5 percent of patients), and stroke (0.3 percent of patients) (Dunlay et al., 2012). A study analyzing readmission rates among MI patients in Minnesota found that bleeding was the most common complication after angioplasty, affecting 6 percent of patients (Dunlay et al., 2012). The most common…
Lagoe, R.J., et. al. (13 Aug 1999) "Analyzing hospital readmissions using statewide discharge databases." Nursing Care Quarterly 13(6): 57-67.
Why did the authors select hospital readmissions as a way to evaluate the quality of care for these DRGs?
In contrast to simply measuring the patient's lengths of stay, the swiftness or slowness of patient discharge rates, lengths of patient occupancy, or patient mortality, measuring hospital readmissions rates were through to be an effective means of evaluating quality of care. The readmissions rate specifically measures treatment efficiency, namely that readmission often occurs when a condition that was not likely to have been treated during the patient's first stay of occupancy. In other words, length of stay by definition is affected by the patient's severity of illness -- the fact that a hospital might treat more children with broken legs (necessitating overnight stay) than chicken pox (not necessitating overnight stay) is not…
The results of this analysis highlight the need for hospitals to fine-tune their discharge process to reduce readmissions, and support the expenditure of additional resources for this purpose as a cost-effective intervention; as an example, author cites a hospital in Iowa that implemented a rigorous post-discharge planning process for patients with heart failure and 30-day readmission rates were reduced by 3-9% during the 3-month period following implementation.
The research showed that many elderly patients who suffer from congestive heart failure also suffer from a wide range of comorbid conditions, including diabetes and hypertension. These patients can be reasonably expected to require periodic or even frequent treatment in emergency departments and/or hospitalizations for these conditions, making the need for effective and seamless post-discharge planning especially important. In this regard, the research also showed that there are some valuable evidence-based practice guidelines available, though, that can help clinicians better coordinate post-discharge…
On March 23, 2010 the Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barack Obama. Along with the Health Care Reconciliation Act of 2010, the PPACA became part of the overall Health Care Reform concept of 2010. The health care reform process was promoted as a way to completely transform the health care industry and ensure that all Americans received affordable health care. hile supporters praise the legislation as a revolutionary law which will benefit ordinary Americans, critics claim that the Obama Administration used the health care reform process as a means of gaining control over the entire health care system. In an attempt to compare and contrast the provisions of this new law, this essay will discuss several provisions of the new health care legislation and compare the benefits as well as the criticisms of them.
Section 5501 of the PPACA provides for…
Appleby, Julie. (2011, Jan. 10). Effort To Reward Medicare Advantage Plans Draws Criticism. Kaiser Health News. Retrieved from http://www.kaiserhealthnews.org/Stories/2011/January/10/Medpac-on-Medicare-Advantage-bonuses.aspx
"Side Effects: Obamacare Could Punish Docs for Better Quality Care." (2010, July 16). The Heritage Foundation. Retrieved from http://fixhealthcarepolicy.com/health-care-news/side-effects-obamacare-could-punish-docs-for-better-quality-care/
Gold, Jenny. (2011, Jam. 18). "Accountable Care Organizations, Explained." NPR. Retrieved from http://www.npr.org/2011/04/01/132937232/accountable-care-organizations-explained
"Health Care Reform: Annual Fee on Prescription Drug Manufacturers and Excise Tax on Medical Devise Manufacturers." (2010, Apr.). Covington & Burling LLP Retrieved from http://www.cov.com
Transitional Care of Older Adults Hospitalized with Heart Failure Experiment
Naylor, M.D., Brooten, D., Campbell, R.L., Maislan, G.,, McCauley, K.M. Schuartz, J. Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized Trial.
This article has an interesting approach to summarizing the experiment that was conducted. Instead of a formal abstract, the article instead summarizes the design and outline in several sections. These sections include objectives, design, setting, participants, intervention, measurements, results, and conclusions. The sections that are listed replace the standard format for an abstract that condenses the design and the findings into one formal section. Personally, I prefer the organization of this format better as it more clearly illustrates all of the factors in the research in a clear and easily identifiable format.
Analysis of the Introduction
The authors of this research do state the problem that they are researching in a clear and coherent manner. The…
EBP is to facilitate strategy to eradicate short cycle return to second readmission of psychiatric patients on hospital beds. Doing so will assist health care providers in addressing the issue of bed shortage. eduction of readmission rates allows more space to be available for other patients and helps to cut costs as well as bring about better conformity with governmental regulations.
The search process used in this literature review began with searching key words in online databases such as Cochran eview, CINAHL, and other nursing research journal databases. Google Scholar was used as the primary search engine, with filters set to permit results from these particular databases. Key words used included "reducing readmission rates," "readmission psych," "causes of readmission psych hospital," "psych hospital readmission," "reduction of psych readmission," and other combinations of key words identified by relevant articles found after conducting these searches. More than a thousand articles…
Healthcare Administration -- New York State Care Act
The New York State Care (Caregiver Advise, ecord and Enable) Act was implemented into law in April this year. The development and enactment of this law is geared toward having a positive effect on caregivers who assist patients and family members recover in the aftermath of hospital admission. The legislation ensures patients in healthcare facilities can assign a family caregiver and the facility provides the designated caregiver instruction and illustrations of medical tasks they are likely to offer their loved ones at home. However, the implementation of this initiative across hospitals such as Winthrop Hospital has been characterized by several challenges that could hinder its effectiveness if not addressed.
New York State Care Act and its Importance/Benefit
There are approximately 2.8 million New Yorkers who offer unpaid care to their loved ones at any given time as well as nearly 1.6 million…
Dianoski, T. (2014, November 18). How the New Caregiver Advise, Record, Enable (CARE) Act Affects Hospitals and Health Plans. Retrieved August 11, 2016, from https://gomohealth.com/2014/care-act-hospitals-health-plans/
Kansas Department for Aging and Disability Services. (2015). The Kansas Caregiver Advise, Record, Enable (CARE) Act (HB 2058 and SB 265). Retrieved from Kansas Government website: https://www.kdads.ks.gov/docs/default-source/CSP/HCBS/HCBS-2015-Spring-Summit/Presentations/the-kansas-caregiver-advise-record-enable -(care)-act-presentation.pdf?sfvrsn=0
Kriss, E. (2015, June 1). AARP: Millions of NY Family Caregivers in Line for Help as Lawmakers Pass CARE Act. Retrieved August 11, 2016, from http://states.aarp.org/aarp-millions-of-ny-family-caregivers-in-line-for-help-as-lawmakers-pass-care-act/
Mitchell, G. (2013, April). Selecting the Best Theory to Implement Planned Change. Nursing Management, 20(1), 32-37.
home health care services in extending care delivery to the home setting is increasing in contemporary times. Home health care aims to shorten hospitalization and reduce the frequency of visits to the hospital for patients recuperating from a surgical operation or disease, or living with a chronic illness such as cancer, heart disease, and diabetes (Centres for Medicare and Medicaid Services [CMS], n.d.). It enables patients to have more independent living and a better quality of life. The author's organisation specialises in home health care. In conjunction with hospitals and physicians, the organisation delivers a wide range of individualised care services to patients at their own homes. Whereas the organisation has performed impressively in terms of patient satisfaction, there is still room for improvement. In cognizance of increased demand for home health care due to the underlying greater demand for healthcare in general, it is imperative for the organisation to…
Centres for Medicare and Medicaid Services (CMS) (n.d.). What is home health care? Retrieved from: https://www.medicare.gov/what-medicare-covers/home-health- care/home-health-care-what-is-it-what-to-expect.html
Ellenbecker, C., Samia, L., Cushman, M., & Alster, K. (2008). Chapter 13: Patient safety and quality in home health care. In R. Hughes (ed.), Patient safety and quality: an evidence-based handbook for nurses. Rockville: Agency for Healthcare Research and Quality.
Health Care Improvements
The health care industry is one that is much criticized in the United States. Many consumers look at this industry as one big giant industry that is only concerned about profitability, not about the health and safety of its customers. The health care industry must make many changes to change their image and provide better service to its customers. Medicare is a government health care insurance that covers 80% of the medical cost for individuals over the age of 65 years. Medicare currently has a bad reputation with its customers and with doctors. It is important for Medicare to change its reputation and build better relationship with customers and with doctors. By changing their image, Medicare will attract more doctors to become participants and this will be a better service for the customers. In this paper I will address some important steps that Medicare could take to…
Bebell et. al. (2010). Concerns, Considerations and New Ideas for Data Collection and Research in Education Technology Studies. Journal of Research on Technology in Education. 43 (1) 29-52
GAO Reports. (2001). Higher Expected Spending and Call for New Benefit Underscore Need for Meaningful Reform.GAO Reports. 1-19
Morgan, D.L. & Spanish, M.T. (1984). Focus Groups: A New Tool for Qualitative Research. Qualitative Sociology. 7 (3) 253-271
Newswire. (2010). Medicare Policy Changes Will Make it More Difficult for Nevada Beneficiaries to Obtain Power Wheelchairs. Newswire Phelan, J.L. & Jones, P. (2010). Heath Insurers Need to Quickly Assess Operational Costs for Medical Services Under Healthcare Reform. Healthcare Reform Briefing Paper.
Furthermore, one of the pillars of collaborative care that will need to be firmly established is the fostering of clear dialogue and a means for strong communication within the care management planning. For instance, there needs to be a clear decision and communication of all tests ordered and when the test results will be available. One of the most important aspects of this collaborative care will be the nursing interventions which can have significant impact on the patient's health and stabilization (Allen, 2010). In fact, strategic nursing care can even minimize readmission rates of Margaret and other patients with comparable conditions (Chen et al., 2012).
Prioritize the Nursing Care Needs of Margaret
The prioritization of nursing interventions is essential, and the way in which a nurse determines this priority is going to be something unique and distinct. "Trials reviewed demonstrated a beneficial impact of nursing interventions for secondary prevention in…
Adler, H.M. (n.d.). Toward a biopsychosocial understanding of the patient -- physician relationship: An emerging dialogue. (2007). J Gen Intern Med,22(2), 280 -- 285.
Afilala, J. (n.d.). Frailty in patients with cardiovascular disease: Why, when, and how to measure. (2011). Curr Cardiovasc Risk Rep, 5(5), 467 -- 472.
Allen, J.K. (2010). Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: Systematic review.
Journal of Cardiovascular Nursing,25(3), 207-220.
download Chamberlain Library) the articles uploaded, upload the articles required reading
This is for the "Telemonitoring…" article
The purpose of this research is to determine if it is advantageous to employ electronic home monitoring (EHM) for heart failure patients. Advantageous is determined by whether or not additional costs and hospital visits could be reduced with this technology, and if it could increase the length of time between hospital visits.
The research questions in this study were implicit and stated in the form of three hypotheses. The first questioned whether or not lower costs, emergency room and hospital visits could be achieved with EHM, the second was whether or not quality of life and caregiver mastery could improve while lowering rates of depressive symptoms, and the final one wondered whether or not, the combination of EHM, caregiver mastery and informal social support could decrease the risk of readmission to hospitals.
Sanford, J., Townsend-Rocchicciolli, J., Horigan, A., & Hall, P. (2011). A process of decision making by caregivers of family members with heart failure. Research & Theory for Nursing Practice, 25(1), 55-70.
Describe the data collection procedure.
This was a QUALITATIVE grounded theory study. Unstructured open-ended interviews were conducted in private mutually agreed on locations. Interviewers took notes and interviews were audiotaped. Interviews lasted from 45 minutes to 2 hours
what did the authors say about the reliability and validity of their data collection and analysis?
The authors did not address this point. On the contrary, they point out how their study contributes to previous studies on the topic.
What demographic information was reported?
The caregiver had to be related to the patient with heart failure, provide one activity of daily living, and/or assist the care recipient with two instrumental activities of daily living and not be paid for services. Demographic…
EClinicaWorks at ikers Island
ikers Island is a correctional facility that currently utilizes eClinicalWorks, which has emerged as a leader in medical software solutions. This paper examines the use of this electronic health records software at this correctional facility in relation to hospitalized inmates. The author includes an overview of how this software is run by Corizon Health and how the correctional facility works with Bellevue Hospital, which also has eClinicalWorks. The discussion includes an evaluation of how this software has been characterized by a workflow challenge that hinders effective workflows. The use of paper documentation by hospital staff because of inability of this software to visualize findings, discharge instructions or recommendations is discussed. This is followed by discussion of a proposed innovation and how it can be implemented using a project management approach. The final sections discuss strategies for going live and ongoing maintenance of the proposed innovation.
Corizon Health Website. (2015). About Corizon Health. Retrieved 26 November, 2015 from: http://www.corizonhealth.com/S=0/About-Corizon/Who-We-Are-History-and-Today
Miller, R.H. (2012, March). Satisfying Patient-Consumer Principles for Health Information Exchange: Evidence From California Case Studies. Health Affairs, 31(3), 537-547.
Pantaleoni et al. (2015, February 11). Successful Physician Training Program for Large Scale EMR Implementation. Applied Clinical Informatics, 2015(6), 80-95.
Stazesky, R., Hughes, J. & Venters, H. (2012, April). Implementation of an Electronic Health Record in the New York City Jail System. Retrieved April 18, 2016, from http://www.cochs.org/files/hieconf/implementation-ecw-new-york.pdf
Planned change in the eldercare advocacy organization
In the coming years, many countries will experience a dramatic shift in healthcare infrastructure due to an expanding elderly population size. However, the changes may vary across countries depending on many factors such as the kind of social welfare available in each country, the political environment which determine policies, the level of healthcare available and individual expectations in each country. Due to this wide variance, the innovations within this space will also vary greatly. What this means to the healthcare manager is that managing innovations becomes very hard (Shlutz, Andre & Sjovold, 2015 p 42). This also impacts on performance management which is fast gaining popularity in the public sector as a means to improve on accountability. Unfortunately, it has been cumbered by a series of challenges in its implementation; this is in spite of the frameworks developed over the last couple of…
Discharge Education to Promote Patient Self-Efficacy
Care and concern for the patient's health and well-being after being discharged from the hospital or clinic does not end for healthcare providers. Particularly for chronically ill patients, post-discharge care is more critical to ensure that in the course of the patient's daily routine and activities, all medical requirements are adhered to and all medications needed are complied with. This is why more often than not, patients receive discharge education as the healthcare provider's continuing effort to ensure that the patient and his/her family members or caregivers will be well-capacitated to continue care and treatment at home.
However, the above-mentioned scenario is the ideal rather than the actual. In real life, healthcare providers are often fraught with the dilemma of patients who are constantly hospitalized or have witnessed the worsening of their patient's condition as a result of non-compliance to their medications and other…
Baker, D., D. DeWalt, D. Schillinger, V. Hawk and B. Ruo. (2011). "The effect of progressive, reinforcing telephone education and counseling vs. brief educational intervention on knowledge, self-care behaviors and heart failure symptoms." Journal of Cardiac Failure, Vol. 17, No. 10.
Barnason, S., L. Zimmerman and L. Young. (2011). "An integrative review of interventions promoting self-care of patients with heart failure." Journal of Clinical Nursing, Vol. 21.
Castelnuovo, G. (2010). "TECNOB: study design of a randomized controlled trial of a multidisciplinary telecare intervention for obese patients with type 2 diabetes." BMC Public Health, Vol. 10.
Conn, V., A. Hafdahl, S. Brown and L. Brown. (2008). "Meta-analysis of patient education interventions to increase physical activity among chronically ill adults." Patient Education Counseling, Vol. 70, No. 2.
auspices and with a variety of purposes; this particular study described its secondary purpose as a method for describing decision making and the decision making process undertaken by patients with Heart Failure (HF). Even more importantly for this study was that the study's primary purpose was to determine and describe the process exhibited by the HF patient(s) care givers.
The specific question the study sought to answer was "How do caregivers of family members with HF make decisions" (p. 56).
The study was conducted using a "qualitative design" (p. 58). A qualitative design is normally conducted to gather data on perceptions, thoughts and beliefs concerning any number of subjects. This study was set up to determine the process of making decisions (regarding HF patients) by caregivers and why they made the decisions that they made. Since perceptions, beliefs and thoughts all play a significant role in medical treatment(s), the design…
PCVN; (2012) Progress in Cardiovascular Nursing, accessed on May 18, 2012 at http://www.blackwellpublishing.com/journal.asp?ref=0889-7204
Healthcare Data Compare Healthcare Grade of Maryland to Florida
Healthcare grades: The Commonwealth Fund
The Commonwealth Fund grades all states on access to healthcare, avoidable hospital use and costs, healthy lives, and prevention and treatment. For example, Pennsylvania ranks 12 on access: nearly
percent of nonelderly adult patients are insured and 92% of children. Florida has around 74% and Maryland around 83% of adults insured and 82 and 91% of children, approximately. In Pennsylvania, 86% of at-risk adults have had a checkup within two years versus 87 and 88% in Florida and Maryland respectively; 90% of patients in PA have not had to forego seeing a physician within the last two years because of cost versus 84% in Florida and 89% in Maryland (approximately). The low rates of insurance coverage in Florida reflect higher unemployment and poverty rates, combined with a higher percentage of workers who labor part-time and do…
State scorecard. (2011). Maps and Data. Retrieved September 26, 2011 at http://www.commonwealthfund.org/Maps-and-Data/State-Data-Center/State-Scorecard.aspx
All figures are rounded up or down, based upon the available data
Aging and Social Policy
rends in Aging Social Policy
he Rise of the Contenders
he number of citizens above the age of 65 has expanded dramatically over the past 100 years. In 1900, the average life expectancy was just 47.3 years, but a child born in 2008 can expect to live another 30.8 years on average. From an economic perspective, the seniors alive 100 years ago were largely dependent on others for their survival and this realization triggered policy changes that provided many advantages, including a security net for retirees.
After World War II, the economy became robust enough that the aged began to experience a longer life expectancy and greater economic wealth. his resulted in the emergence of a politically powerful demographic that could begin to influence public policy on its own. his process has been viewed as cyclical, in that public policies strengthened a specific demographic and the…
The expectation is that this trend will put an enormous stress on the U.S. economy. By the time ACA was signed into law by President Obama in 2010, close to 16% of the nation's gross domestic product was being spent on healthcare. By 2035, this percentage is expected to double. As the baby boom generation begins retirement over the next two decades, the public will increasingly shoulder the burden of health care costs for the aged.
The ACA attempts to limit increasing Medicare costs by shifting the focus of providers from generating volume to improving care quality. For example, hospitals will be penalized for preventable hospital readmissions and diseases/injuries acquired during hospital stays. The ACA provisions also reduce payments to Medicare Advantage recipients, who tend to be retirees who want or need more flexibility and protections than standard Medicare coverage provides. By comparison, the most recent federal budget plan proposed by congressional Republicans calls for repeal of the ACA and converting Medicare into a voucher program. The Republican budget also calls for an increase in the retirement age. Although the White House budget plan has yet to be released, the expectations are that Medicare will remain intact as an entitlement program, but the wealthier beneficiaries will be expected to pay more.
The budget battle over federal entitlements is essentially a battle over values. From the Republican perspective, those that have earned their way when young will receive some measure of help when they retire, but there are no guarantees on how much help will be provided. In contrast, the White House and congressional Democrats view Medicare as something earned and therefore inviolate. Viewed another way, the Republicans envision a minimalist government and Democrats see a role for government in easing the fears many face when they become disabled or too old to care for themselves. In view of this perspective, seniors have benefited largely from the latter values for the past 78 years.
Does taking Metoprolol before cardiac surgery reduce the incidence of post-op atrial fibrillation
Postoperative atrial fibrillation (POAF) remains a prevalent supraventricular arrhythmia. PoAF has associated effects such as deteriorating hemodynamic, increased risk of stroke and increased probability of death. Beta-blockers have been recommended as effective intervention mechanism of preventing PoAF. Metoprolol is one such beta-blocker that is commonly administered to prevent the incidence of PoAF. The systematic review below entails an analysis of six clinical trials that explore the effectiveness of metoprolol. The analysis identifies reduced hospitalization length, reduced mortality and reduced financial burden as the beneficial impact associated with the administration of prophylactic. The small number of studies reviewed limits the validity of the conclusion warranting future large sample size research.
Annually, approximately 750,000 cardiac surgery are performed globally with postoperative atrial fibrillation (PoAF) being the prevalent complications (George, et al., 2018). With the increasing proportion of elderly population…
Standards of Evaluation
Module 2- Standards of Evaluation
The overall care offered under my current Aenta health insurance plan appears to be excellent with regards to freedom of care and flexibility. The plan is a group plan meaning that it is though an employer and therefor the rates and copay is lower and subsidized by the employer. As with any plan, there are pros and cons regarding the overall coverage.
With regard to access, my Aetna plan is by far superior to other plans. My plan is a PPO. This means that I never have to ask for approval before seeing any physician or seeking treatment. Whereas with HMO plans, participants have an assigned primary care physician and they must seek approval in advance before seeing any specialists. So, my choices are unlimited with regard to physicians.
The only area where access is in question is regarding alternative healthcare services…
Benefit Plan. Aetna Choice POS II. 2012.
BlueCross BlueShield of Arizona. BlueOptimum Plus PPO Plan Benefit Summary. Accessed 11 March 2012 at http://www.azblue.com/pdfs/iu65/BlueOptimum-Plus.pdf
Medical Plan Details. Aetna. Web. Accessed 11 Mach 2012 at https://member.aetna.com/memberSecure/featureRouter/balances?product=medical&typecode=M
EMS Bill is primarily designed to modernize and transform the current Emergency Medical Services System. One of the cornerstones of the bill is improved integration of services, to provide better coordination of service delivery. Currently, the EMS system is fragmented with several disparate federal, state, and local entities participating in EMS service. esulting tensions and miscommunications are not only costly, but can also create medical errors. However, the proposed Field EMS Bill is far from perfect, and has far from universal support. One of the main EMS stakeholders, the International Association of Fire Chiefs (IAFC) has expressed concern about the way the bill is currently worded. In short, the Field EMS Bill is worded in ambiguous language that promotes core concepts like "value" over ethics and quality of care. Cost reduction seems to be a primary focus on the Field EMS Bill, rather than ensuring that first responders have access…
Drennan, et al. (2014). Expanding paramedicine in the community. Trials 2014(15).
IAFC (2014). IAFC President Explains Concerns about Field EMS Bill. Retrieved online: http://www.iafc.org/Media/articlePR.cfm?Itemnumber=7673
Kizer, K.W., Shore, K. & Moulin, A. (2013). Community paramedicine. UC Davis Institute for Population Health Improvement.
Hospital Admission Analysis
Readmission Statistics (Denominator)
Total Number of Readmits
Total Number of Patients Readmitted
# of Patients with Multiple Readmits
In looking at readmissions, there were only three patients that were re-admitted more than once. Everyone else admitted once and, at most, readmitted once. For the readmits, no single hospital seems to have a problem. One sidenote is that one of the readmits (patient 740019266) was readmitted once to Crouse and then twice more to St. Joseph's. The reason for each readmit for that same patient is actually different. Further, the overall reason for readmits varies greatly and is not defined by any primary or common causes except perhaps breathing/pain issues of many kinds.
Overall Admission Statistics
Admissions of Males (Total)
Admission of Females (Total)
Readmissions of Females
Readmissions of Males
Multiple Admissions - Males
Multiple Admissions - Females
In looking at the rates of admissions, readmissions and multiple…
Future of Healthcare as it Relates to the Geriatric Population
Description and Problem Statement
The geriatric population in the United States is growing and compared to the population of health care providers the geriatric population growth is advancing much more rapidly. This presents a problem in making provision of health care to the future geriatric population. While there is a growth in the demand for geriatric health care services, there is not a matching growth in the population of health care providers and in fact, a shortage presently exists.
The population of geriatric patients is experiencing rapid growth while the population of health care providers specifically trained in geriatric medicine is seriously lagging behind. In fact, of the approximately 650,000 medical doctors who are practicing, only a small percentage receives the training and education required to provide geriatric care. Exacerbating the problem is the fact that only three medical schools…
Bagel, LM (2011) Designs to Support Aging Acute Care Patients. Elder Care. Health Facilities Management. Retrieved from: http://www.hfmmagazine.com/hfmmagazine/jsp/articledisplay.jsp?dcrpath=HFMMAGAZINE/Article/data/04APR2012/0412HFM_FEA_interiors&domain=HFMMAGAZINE
Gottlieb, S. (2013) Medicare Has Stopped Paying Bills For Medical Diagnostic Tests. Patients Will Feel The Effects. Forbes 27 Mar 2013. Retrieved from: http://www.forbes.com/sites/scottgottlieb/2013/03/27/medicare-has-stopped-paying-bills-for-medical-diagnostic-tests-patients-will-feel-the-effects/2/
Graverholt, B., et al. (2011) Acute hospital admissions among nursing home residents: a population-based observational study. BMC Health Services Research 2011. Retrieved from: http://www.biomedcentral.com/1472-6963/11/126
Healthcare in America: Trends in Utilization (2004) U.S. Department of Health and Human Services. Retrieved from: http://www.cdc.gov/nchs/data/misc/healthcare.pdf
Of the new consults 23 were transferred to ICU and 43 remained on the wards. The transfer of these patients was greatly facilitated and the inpatient ward staff was greatly satisfied with the interaction with the Outreach Team. edside education, expert resources and better patient-family communication were the most valued features of the team when the in-patient ward staff was surveyed. We noted a tremendous increase in the accessibility of the ICU to the hospital population. We did not, however, notice a decrease in the number of cardiac arrests in the hospital." (Simone, et al., 2007)
It was reported in the work entitled: "Pilot Project at TGH Shows that Critical Care Response Teams Can Significantly Reduce Cardiac and Respiratory Arrests and Hospital Deaths" in 2007 that data gathered between May 2005 and May 2006 "on the impact of the critical care response teams on 342 patients in Toronto General Hospital,…
Smith GB, Poplett N. (2004) Impact of attending a 1-day multi-professional course (ALERT) on the knowledge of acute care in trainee doctors. Resuscitation 2004; 61: 117-122.
Smith, Gary B. And Nolan, Jerry (2002) Medical Emergency Teams and Cardiac Arrests in Hospital: Results May Have Been Due to Education of Ward Staff. BMJ 2002 May 18; 324(7347): 1215.
White RJ, Garrioch MA.(2002) Time to train all doctors to look after seriously ill patients -- CCRiSP and IMPACT. Scot Med J. 2002; 47: 127.
Simone, Carmine, et al. (2007) the Introduction of a Critical Care Rapid Response Team in a Canadian Community Hospital. Critical Care: ICU Organization. 22 Oct. 2007. Online available at: http://meeting.chestpubs.org/cgi/reprint/132/4/445.pdf
Sigma methodology to help lower patient length of stay while simultaneously improving financial and patient health outcomes. This paper first discusses the theoretical basis for this, outlining the Six Sigma methodology. Its history in health care and its use specifically to lower patient length of stay are both covered in the literature review section. The next section looks at the different measures that should be used to guide the Six Sigma process. Measurement is essential to Six Sigma, so it is critical that measures used are relevant to the problem at hand, and that the organization has means by which to measure the variables in question. A number of variables are proposed, and where there are challenges with their measurement some solutions are also offered.
One of the challenges for hospital administrators is to improve both the efficiency of their facilities while simultaneously improving patient outcomes. There are certainly…
Allen, T.T., Tseng, S., Swanson, K., McClay, M.A. (2010). Improving the hospital discharge process with Six Sigma methods. Quality Engineering. 22: 13-20.
DeFrances, C.J., Hall, M.J. (2007). 2005 national hospital discharge survey. Advance Data. 385, 1-20.
DelliFraine, J., Langabeer, J. & Nembhard, I. (2010). Assessing the evidence of Six Sigma and lean in the health care industry. Quality Management in Health Care. Vol. 19 (3) 211-225.
Heuvel, J., Does, R., Bisgaard, S. (2005). Dutch hospital implements Six Sigma. Six Sigma Forum Magazine. Feb 2005, 11-14.
he most common progressive chronic lung situations that would require the rehabilitation include interstitial lung disease, chest wall disease, bronchiectasis, and pre and post thoracic surgery. he fourth category of patients to offered pulmonary rehabilitation is those with recent exacerbation of COPD requiring hospitalization, without the anticipated recovery path, and whose functional baseline has changed significantly ("Service Specification," 2012).
Chronic lung diseases have developed to become one of the most common respiratory illnesses across the country. As the diseases have become one of the major reasons for hospitalizations of patients, they usually affect individuals at the age of 35 years and above despite of the fact that these individuals are usually not diagnosed until they are 50 years and above. he growth and rapid increase of chronic diseases is attributed to the tendency of many people with the disease not to get medical assistance. While the conditions continue…
The most common progressive respiratory disease is the Chronic Obstructive Pulmonary Disease (COPD), which is a name that is also used to refer to a collection of lung diseases ("Introduction," 2012). The other common chronic lung diseases include emphysema, chronic bronchitis, chest wall disease, interstitial lung disease, chronic asthma, and obstructive airways disease. These chronic lung diseases usually involve a combination of three major factors i.e. airway diseases, lung circulation diseases, and lung tissue diseases. As the name suggests, the airway diseases affect the airways or tubes that transport oxygen and other gases to and from the lungs. In contrast, the lung tissues diseases affect the lung tissue structure through inflammation or scarring of the tissue. Lung circulation diseases affect the blood vessels in the lungs through scarring, clotting, or inflammation of these vessels. As a result, these diseases contribute to difficulties of the lungs to receive oxygen and release carbon dioxide. The severity of chronic lung diseases is basically dependent on the combination of these three conditions. However, most of the chronic lung diseases are attributed to the narrowing or blockage of the airways. For instance, emphysema, COPD, and chronic bronchitis are conditions that inhibit the ability of the tubes or airways to carry oxygen and other gases to and from the lungs. Generally, patients with chronic lung diseases such as COPD always have difficulties breathing because of airflow obstruction or narrowing of the airways.
As previously mentioned, these diseases account for a huge number of hospital emergency room visits and hospitalizations, although they are largely preventable. Despite being preventable, these diseases have become some of the major causes of death and key factors in the ever-increasing huge human and economic burden because of the tendency of patients to ignore their symptoms ('Emergency Department Support Fund Application," n.d). The major symptoms of these diseases include rising breathlessness, frequent chest infections, and constant cough with phlegm ("Introduction," 2012). The tendency to ignore these symptoms contributes to the many incidents of recidivism to acute care facilities.
The main cause of chronic lung diseases, especially chronic obstructive pulmonary disease is smoking. An individual enhances the risk of developing these diseases when he/she smokes more and for long periods of time. Smoking results in scarring that increases the risk of chronic lung diseases, through irritating or inflaming the lungs. The inflammation in turn results in permanent lung changes over many years. During this period, the walls of the tubes or airways thicken as more mucus is generated. In addition to making the lungs lose their normal elasticity, the damage or harm to the delicate walls of the air sacs in the lungs results in the development of emphysema. Moreover, the smaller airways or tubes become narrowed or scarred. The combination of these permanent changes to the lungs contributes to symptoms of cough, breathlessness, and phlegm linked to chronic obstructive pulmonary
(Shactman; Altman, 2002)
4. ecommendations for Overcoming these Barriers:
Some of the suggestions for overcoming these barriers are (i) appointment of a General Practitioner -- GP officers to work as a Liaison Officer between the ED and the community so that the communication is streamlined as well as processes of referral and feedback and development of clinical pathways. (ii) Expansion of community off-peak facilities, including the setting up of the capacity for community access to X-rays, Scanning, ultrasound, blood tests and observation beds. (iii) Initiation of a project to deal with frequent attenders to the ED through the development of management plans contributed to by the patient, their GP, the ED as also their specialist (iv) Education of the local community such that are aware as to when and under what situations to access ED care or alternative care in the community. (Ardagh; ichardson, 2004)
Ardagh, Michael; ichardson, Sandra.…
Ardagh, Michael; Richardson, Sandra. (2004) "Emergency department overcrowding- can be
fix it" Journal of the New Zealand Medical Association, vol. 117, no. 1189, pp: 27-31.
Brewster, Linda R; Rudell, Liza; Lesser, Cara S. (2001) "Emergency Room Diversions: A
Symptom of Hospitals under Stress-Increased Demand for ER Services" Center for Studying Health System Change. Issue Brief No. 38. Retrieved May, 2009 from http://www.hschange.com/CONTENT/312/
Shuttling the results from an outside provider, because the health insurance agency will only reimburse outside screening, forces the patient to wait and possibly incurs more costs, if the delays in obtaining diagnostic information worsen the patient's condition. This can ultimately result in more prolonged treatment. Many patients may also be put at risk because of the logistics of being transported to outpatient facilities for essential screening and rehabilitative services, while they are still convalescing.
Being able to conduct all necessary tests in-house results in great efficiency, swifter screening, and improves coordination between the different providers involved in the case. Our hospital has extensive resources for patients, and can provide a wide range of treatment options, particularly in its specializations of cardiac and orthopedic care. And improvements in technology that are keeping extremely sick patients alive for longer periods of time also mean that, quite often, patients require attention from…
Mertens, Maggie. (2010, October 4). More Medicaid payment for some doctors. But will it last?
Shots. NPR Blog. Retrieved November 24, 2010 at http://www.npr.org/blogs/health/2010/04/will_medicaid_payment_follow_u.html
TOTAL EQUITY AND LIABIULITIES
(2) Discussion topic: Technology and Tools
Lower start-up costs. Fewer issues with maintenance of hardware. More resources including personnel and sophisticated procedures for security and backup of the patient information.
More ongoing expense over the long-term.
Subject to interruptions to the Internet, which restricts access to the EM data.
The clinical information may be stored along with data from other practices.
Enhanced patient safety with respect to drug allergies or interactions and proper dosage. Enhanced documentation with access to digital imaging and special testing. Better integration between the clinic and the business department.
Although somewhat remote, a vendor providing web-based EM…
EMR & HER: A forum for EMR, EHR implementation, selection, and meaningful use. Retrieved from http://www.emrandehr.com/2010/12/28/the-pros-and-cons-of-server-based-emr-systems/
Pollack, P.J.(2010). Medical Practice Trends. www.emrsimplyput.com
Discharge Education to Promote Self-Efficacy in Heart Failure
An Education Intervention For Patients With Heart Failure
Management of congestive heart failure (CHF) continues to be a financial burden on the economy of the United States of America (USA); responsible for multiple hospital admissions and readmissions of patients with HF within thirty days post discharge. The disease has been associated with personal, physical, and economic challenges. As the population increases, the number of individuals affected with this condition is also increasing. According to the American Heart Association (2009), an estimated 400,000 to 500.000 new cases occur annually, with additional annual cost of more than $33 billion dollars added to the U.S. economy.
Discharge education, which attempts to reduce readmission rate, has become a valuable metric in the provision of health care. For effective management of heart failure symptoms, patient education is a necessity (Gruszczynski, 2010). Sara Paul (2008) discussed the importance…
Anderson, C., Deepak, B.V., Amoateng-Adjepongn, Y.,Zarich, S., (2005). Benefits of Comprehensive inpatient education and discharge planning combined with outpatient
Support in elderly patients with congestive heart failure. Congestive Heart Fail, 11(6),
Annema, C, Luttik ML, Jaarsma, T, (2009), Reasons for readmission in heart failure:
evidence- based practice project is to compare the effects of bedside handoff report to handoff report away from the bedside using the IOWA model of evidence-based practice. The efficacy of the bedside handoff shall be determined by the variations in the patient contentment scores on personnel responsiveness and nurse communication. The project shall actually be applied in a sub-acute unit having grownup post-operative patients. Presently in the facility, handover is conducted at the conference room with the nurses and not including involvement of the patients. In accordance to the TUTHPOINT survey, patients have been lamenting regarding the absence of nursing personnel on the unit to actually assist them during the report time that resulted to a drop in the satisfaction of the patients. In addition, the survey also stated that numerous patients felt as if there existed no communication between them and the nurses, and they were not taking part…
Deitrick, L., Paxton, H. & Swavely, D. (2012). Hourly rounding: Challenges with implementation of an evidence-based process. Journal of Nursing Care Quality, 27 (1), 13-19.
Ellerbe, S., & Regen, D. (2012). Responding to health care reform by addressing the Institute of Medicine report on the future of nursing. Nursing Administration Quarterly, 36(3), 210-216. doi:10.1097/NAQ.0b013e318258bfa7
Melnyk, B., & Fineout-Overholt, E. (2014). Evidence-based practice in nursing & healthcare: a guide to best practice. (3rd ed). Publisher: St. Louis: Wolters Kluwer Health.
U.S. Department of Veterans Affairs. (2013). VA NY Harbor Healthcare System. Retrieved October 29, 2015, from http://www.nyharbor.va.gov/NYHARBOR/features/Truthatthebedside.asp
ENEFITS, ARRIERS, CHALLENGES
ackground and Origin
Progressive mobility refers to a series of planned and sequential movements aimed at bringing the patient back to his or her baseline (Vollman, 2010). It consists of positioning and mobility techniques. A meta-analysis of 39 randomized trials was conducted to examine the effect of bed rest on 15 different medical conditions and procedures. Four short-term medical conditions were identified for critically ill patients. ut the major and long-term complication was the reduced quality of life after discharge on account of lost physical functions during their stay at the ICU. Another study conducted among survivors of acute respiratory conditions found that they lost 18% of their body weight and suffered much functional limitations from muscle wasting and fatigue. The more than 5 million who get confined at the ICU must come to terms with both the short- and long-term complications of immobility or prolonged…
Adler, J. And Malone, D. (2012). Early mobilization in the intensive care unit: a systematic review. Vol 23 # 1, Journal of Cardiopulmonary Physical Therapy:
American Physical Therapy Association. Retrieved on March 21, 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286494
Baker, C. And Mansfield, L. (2008). Physical rehabilitation following critical illness.
Vol. 9 # 2, Journal of the Intensive Care Society: The Intensive Care Society.
Healthcare Database for esearch and Analysis
South Carolina is amongst states that take part in the Health Cost and Utilization Program (HCUP). Sandra Kelly, the person to contact regarding all matters pertaining to the program is the Operations Manager in the Demographics and Health department. The evenue and Fiscal Affairs of South Carolina under which it operates is situated on 1919, Blanding Street in Colombia, SC 29201. (803) *** is her phone number and (803) *** her fax number. One can also contact her online through Sandra.- --, her official email-id. The data from South Carolina entails stays by inpatients from hospitals offering care for acute health. The data recorded from the hospitals does not cover a whole calendar year as some experience technical defects (SID File Composition - South Carolina, n.d.), while others close at some point in the year.
The HCUP is the state's main source of gathering…
Healthcare Cost and Utilization Project (HCUP). (n.d). Retrieved July 10, 2016, from http://www.ahrq.gov/research/data/hcup/index.html
HCUP Partners. (n.d.). Retrieved July 10, 2016, from https://www.hcup-us.ahrq.gov/partners.jsp?SASD
SID File Composition - South Carolina. (n.d.). Retrieved July 10, 2016, from https://www.hcup-us.ahrq.gov/db/state/siddist/siddist_filecompsc.jsp
Performance scorecards provide a straightforward means of integrating metrics into a healthcare organization’s strategic planning. Scorecards are most effective when they have a clear purpose, identifying specific patient populations and outcome measures. According to Baker (2015), “savvy organizations select the best metrics to track that are appropriate to what the organizational staff members wish to measure,” which could include specific issues like patient vital signs or patient satisfaction survey outcomes (p. 224). Moreover, performance scorecards need to be simple, kept on a manageable scale so that the data gleaned can be readily communicated to inform organizational practices, policies, and procedures (Hansel, n.d.). The following performance scorecard includes three core categories including performance, quality, patient safety, and employee engagement, all while focusing on addressing the needs of a specific patient population: adults over the age of 65 who have been diagnosed with Type II Diabetes.
Naylor, PhD,, Dorothy A. Brooten, PhD, oberta L. Campbell, PhD, Greg Maislin, MS, MA, Kathleen M. McCauley, PhD, and J. Sanford Schwartz, MD. All of the authors have graduate or post graduate degrees in the fields of health or medicine. This therefore makes them all qualified to write on the proposed study, and to carry out the research. They are, therefore, reliable and credible researchers in this field.
The title of the article itself; is appropriate to the title of the article; "Transitional Care of Older Adults Hospitalized with Heart Failure: A andomized, Controlled Trial." Since the study focuses on the transition of older adults with heart failure, and the title of the article is represented, the title of the article is appropriate to the title of the study.
The abstract discusses how recent research suggests older adults with heart conditions, facing therapeutic regimes, are often stressed out and vulnerable…
Naylor, M. Brooten, D, Campbell, R., Maislin, G. McCauley, K.J. Sanford Schwartz (2004). Transitional care of older adults hospitalized with heart failure: A randomized, controlled trial." American Geriatric Society. 52 (5).
Affordable Care Act & Nursing
There are a number of different provisions of the Affordable Care Act that were designed to improve the health care system -- well, all of the provisions were designed to do that. The most immediate improvements will be the provisions that low the cost of drugs (such as the Medicaid rebate for brand name drugs) and the generics approval change. The biggest change that affects the quality of care is probably the provision regarding readmissions. The core of this provision is the idea that high rates of readmissions indicates a relatively poor standard of care is being given; so penalties for high readmission rates will encourage hospitals to have a higher standard of care in the first place, doing more for underlying conditions instead of just treating symptoms. Another beneficial provision is that plans now need to cover several types of preventative screening.
Djukic, M. & Kovner, C. (2010). Overlap of registered nurse and physical practice: implications for U.S. health care reform. Policy, Politics & Nursing Practice. Vol. 11 (1) 13-22.
Sommer, A. (2001). How public health policy is created: Scientific process and political reality. American Journal of Epidemiology. Vol. 154 (12) S4-S6
Winkelstein, W. (2009). The development of American public health, a commentary: Three documents that made an impact. Journal of Public Health Policy. Vol. 30 (1) 40-48.
health care to the elderly.
In the next several years, many commentators argue that population aging will considerably affect the federal budget. When one turns sixty-five, his or her cost of care doesn't abruptly increase. However, the cost of healthcare to the federal government will go up since at that age Medicare usually becomes the main or primary insurer. According to studies by the CBO (Congressional Budget Office), over the next two decades, population aging will account for over fifty percent spending growth on various government healthcare programs (What Is Driving U.S. Health Care Spending? America's Unsustainable Health Care Cost Growth). As the baby boomers age, the population will lead to a higher percentage of seniors, which will in turn lead to an overall increase in per capita spending. Studies indicate that over the next decade or so, the aging American population will contribute to the increase in healthcare spending…
Barr. (n.d.). Hospitals & Health Networks - Hospital and Health Care Executives. Baby boomers will transform health care as they age - H&HN. Retrieved 2014, from http://www.hhnmag.com/articles/5298-Boomers-Will-Transform-Health-Care-as-They-Age
(2012). Bipartisan Policy Center. What Is Driving U.S. Health Care Spending? America's Unsustainable Health Care Cost Growth. Retrieved December 2, 2016, from http://bipartisanpolicy.org/wp-content/uploads/sites/default/files/BPC%20Health%20Care%20Cost%20Drivers%20Brief%20Sept%202012.pdf
Rice, & Gabel. (1986). Protecting the elderly against high health care costs. Health Affairs,5(3). Retrieved, from http://content.healthaffairs.org/content/5/3/5.full.pdf
(n.d.). The White House - whitehouse.gov. REDUCING COSTS AND IMPROVING THE QUALITY OF HEALTH CARE. Retrieved December 2, 2016, from http://www.whitehouse.gov/sites/default/files/docs/erp2013/ERP2013_Chapter_5.pdf
Since modern medicine can sustain patients with proper medical follow-up for years, it becomes incumbent on the profession to follow the patients and provide them with the knowledge and tracking to insure that they are observing the procedures and medications which prolong their quality of life. Given hospitals' short-term orientation with the patients, there is a need to bridge patient care before, during and after acute-care visits.
While there are some nursing specialties which can be regarded as solely hospital- or community-based, many of the specialties call for a more holistic notion of patient care. y combining the CNS and NP specialties, this profession has a better chance of assuring better patient outcomes, and a better quality of life for the patient.
ennett, .J. (1998). Psychiatric mental health nursing: thriving in a changing environment through outcomes-based measurements. Semin. Nurse Manage., 144-148.
erger, a.M.-F. (1996). Advanced practice roles for nurses…
Bennett, B.J. (1998). Psychiatric mental health nursing: thriving in a changing environment through outcomes-based measurements. Semin. Nurse Manage., 144-148.
Berger, a.M.-F. (1996). Advanced practice roles for nurses in tomorrow's healthcare systems. Clinical Nurse Specialist, 250-255.
Chaska, N.L. (2001). The Nursing Profession Tomorrow and Beyond. Thousand Oaks: Sage.
Cukr, P.L. (1997). The psychiatric clinical nurse specialist/nurse practitioner: an example of a combined role. Arch Psychiatr Nurs, 2-12.
business plan provides a process change for bedside patient handoffs at Samaritan Medical Center, Watertown, New York. An overview of the medical center is followed by its mission and vision statements, and organizational values. A discussion of the assumptions involved together with a breakdown of associated costs involved in the business plan are followed by a discussion of the importance of timely patient handoffs and a description of the proposed bedside handoff protocols for Samaritan Medical Center.
Overview of Samaritan Medical Center:
"Samaritan Medical Center (Watertown, New York) is a 294-bed not-for-profit community medical center, offering a full spectrum of inpatient and outpatient healthcare services. From primary and emergency care to highly specialized medical and surgical services, such as cancer treatment, neonatal intensive care, behavioural health and addiction services, and imaging services, Samaritan Medical Centre and its team of healthcare professionals proudly serves the medical needs of our civilian and…
Centers for Medicare & Medicaid Services. (2008). Facts sheet: HCAHP facts. Retrieved from http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2008-Fact-sheets-items/2008-03-28.html?DLPage=4&DLSort=0&DLSortDir=descending
Centers for Medicare & Medicaid Services. (2013). HCAHPS facts sheet (CAHPS hospital survey). Retrieved from http://www.hcahpsonline.org/Facts.aspx
Friesen, M.A., White, S.V., & Byers, J.F. (2008). Handoffs: Implications for nurses. In Hughes, R.G. (Ed.). Patient safety and quality: An evidence-based handbook for nurses,
(pp. 2-285 -- 2-332). Rockville, MD: Agency for Healthcare Research and Quality.
Stroke is identified as one of the leading causes of death and to decrease mortality rate a review of the causes is required. The importance of measuring and reviewing health care quality is no longer questioned. However quantifying quality is a difficult task one that involves a subjective element and judgment. Different methods are employed in measuring quality such as level of care provided, administration accuracy, staff sufficiency, hygiene level and therapies provided. The need to combine the facts and figures with judgments and evaluation is a complex process and needs to be done with utmost care. The quality measures need to be evaluated on a regular basis to ensure their relevance and validity in the given circumstances.
Measures used to monitor and review quality:
As the hospital administration began to realize the link between stroke patients death and the quality of service rendered the need to analyze data…
AHO, (2006). Joint Commission on Accreditation of Healthcare Organizations: 2006 Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Oakbrook Terrace, IL: Joint Commission Resources, 2005
American Heart Association, (1999) Heart and Stroke Statistical Update. Dallas, Tex. Available at: http://www.americanheart.org/statistics/index.html .
Donabedian, A. (1988). The quality of care: how can it be assessed? JAMA.. 1988;260:1743-1748.[Abstract/Free Full Text]
Ryan, T. Antman, E., Brooks N. (1999) update: ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation.. 1999;100:1016 -- 1030.
Ineffective Communication Between Shifts in Acute Care Settings
A recent statistics of the adverse effects arisen from ineffective communication between shifts in acute care setting range from 2.6% to 7.6%, however, Okoniewska, et al. (2015) believes that the adverse effects on in-patients can be between 19% and 23%. (Classen, esar, Griffin. et al. 2011).
The Study aims to discuss the adverse effective arisen from ineffective communication between shifts within acute care settings.
Consequences of not solving the problem
Without implementing the strategies that can enhance effective communication between shifts in an acute healthcare setting, the issue can lead to mortality, readmission, and post-hospital adverse effects. Moreover, poor communication between shifts can lead to medication problems resulting to therapeutic errors. (Okoniewska, et al. 2015). Moreover, lack of intervention to address the problem can lead to medical errors, which can lead to patients' harms. Communication failure has also been identified as…
Aebersold, M., Averhart, V., Keenan, G., Kocan, M. J., Lundy, F., Tschannen, D. (2011). Implications of Nurse-Physician Relations: Report of a Successful Intervention. Nursing Economics. 29 (3):127-135.
Almost, J., Wolff, A., Mildon, B., Price, S., Godfrey, C., Robinson, S., . . . Mercado-Mallari, S. (2015). Positive and negative behaviors in workplace relationships: a scoping review protocol. BMJ Open, 5(2). doi:10.1136/bmjopen-2015-007685
Carlson, E. A. (2012). Improving Patient Safety Through Improved Communication and Teamwork. Orthopaedic Nursing, 31(3), 190-192.
Classen, D.C., Resar, R, Griffin. F, et al. (2011). "Global trigger tool" shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff (Millwood). 30(4):581 -- 589.
With the ever-changing health care sector, reimbursement has increasingly been tied to care quality and health care outcomes. The Centers for Medicare and Medicaid Services (CMS) have particularly been changing the way hospitals are reimbursed, with hospitals that deliver high quality care and report better health outcomes getting higher reimbursements than those that perform poorly. This has led to increasing prominence of the pay-for-performance approach. Under this approach, hospitals that report greater patient satisfaction, reduced error rates, lower readmission rates, and higher recovery rates for chronic illness get higher reimbursements than their poorly-performing counterparts. The implication is that health care organizations must pay greater attention to performance, especially in terms of quality, safety, and individual performance. Measurement and models used in the commercial world for these three aspects are considerably relevant to the health care sector. This paper discusses the usefulness of the total quality management (TQM) model, the Organization…
EH Assessment and Evaluation to Support Healthcare Outcome Objectives
The outcome-related goals that the tertiary care hospital seeks to achieve include the following: 1) Strengthen adult admissions screening at intake for pain, depression, and adverse health behaviors such as smoking, excess alcohol intake, and body mass index (BMI) greater than 30; 2) implement comprehensive geriatric assessment for all adults 65 years of age and over who are hospitalized for more than seven days or readmitted within less than three days following discharge; and 3) promote care team performance. The electronic health record (EH) is the default system for adult admissions, and it includes documentation standards and structures such as SOAP and checklists. Hospital staff are provided periodic guidelines through educational venues or through referral to the electronic policy and procedure manual. Given this information, the data elements that should be included in the EH assessment and evaluation screens are as…
Lowry, S.Z., Quinn, M.T., Ramaiah, M., Schumacher, Gibbons, M.C., Patterson, E.S., North, R., Zhang, J., and Abbott, P. (2012, February 21). NISTIR 7804: Technical evaluation, testing and evaluation of the usability of electronic health records. Retrieved from http://www.emrandhipaa.com/emr-and-hipaa/2013/10/22/turf-an-ehr-usability-assessment-tool/
G1d, and G1g Planned Intervention
Description of Intervention:
Medication adherence is one of the effective interventions for diabetes management. Adherence to medication is the extent patients take medications being prescribed for them by health care providers. In other words, a medication adherence refers to the extent patients have conformed to providers recommendations with regards to dosages, timing as well as frequency of medication taking by patients. aising educational awareness about the importance of adherence to medication is very critical to reduce the rate of readmission. If there is an increase in the level of awareness among patients and educating them about how medications are very important for the management of diabetes, the rate of medication adherence will increase among patients.
The best intervention strategy for the medication adherence is to use SIMPLE model for patients. The SIMPLE model consists of:
S -- Simplify the medication regime
I -- Impart…
CDC (2013). Medication Adherence. Centers of Disease Control and Prevention. USA.
Diabetes Prevention Program (2002). The Diabetes Prevention Program (DPP): Description of lifestyle intervention. Diabetes Care, 25(12), 2165-2171.
Edelen, M. O. Joan, S. T. William, G. S. Et al. (2014). Advancing Behavioral Health Measurement: The PROMIS® Smoking Assessment Toolkit. Santa Monica, CA: RAND Corporation.
Responsibilities of Nurses to Patients
Why is it important
The role of nurses has a direct implication on the patients. For example, nurses observe and provide direct care to the patients. The physicians give orders and thus are the role of the nurses to implement (Aiken et al., 2014). Often, the work of the physicians is not complete without the help of the nurses. The nurses are responsible for changing clothes and giving the medications to patients. Often, the patients are unable to do basic tasks, and therefore the roles of nurses become very important. Nurses keep medical records for the patients and therefore give medications to the patients in time and monitor their progress.
Another important role of the nurse is assessing the response of the patients to medications. Keep the records for the progress of patients is an invaluable practice. The records help the nurses to monitor how…
The audience is realized to find that he has been dreaming, but the dread remains for both he father and the son. Early on in genetics was given some effect in diagnosis of schizophrenia:
In a classic 1966 paper, Leonard Heston compared foster children who were separated at birth from their schizophrenic biological mothers and foster children who were separated at birth from their psychologically healthy biological mothers. Schizophrenia appeared only in a subset (about 16%) of the children whose biological mothers had schizophrenia, a finding which suggested that rather than bad parenting, genetics plays a powerful although only partial role in the emergence of schizophrenia. (Parens, 2004)
But there are also environmental factors cited as well.
The way we perceive the world is created in large part by our nurturing environment. Highly critical parenting is one of the factors cited in those with schizophrenia as well as more serious…
Ackerson, B.J. (2003). Parents with Serious and Persistent Mental Illness: Issues in Assessment and Services. Social Work, 48(2), 187-195
Davidson, L. & Stayner, D. (1997). Loss, Loneliness and the Desire for Love: Perspectives on the Social Lives of People with Schizophrenia. The Psychiatric Journal, 20 (3), (Winter), pg. 3-12
Harrop, C., & Trower, P. (2003). Why Does Schizophrenia Develop at Late Adolescence? A Cognitive-Developmental Approach to Psychosis. Hoboken, NJ: John Wiley & Sons
Meuser, Kim T. (1996) Helping Families Manage Severe Mental Illness. Psychiatric Rehabilitation Skills, 1 (2) pg. 21-42
Patients in hospitals often complain of pain regardless of the diagnosis. Several activities in a patient's life contribute to pain. Some of the activities include amount of sleep, daily chores and quality of life (Alaloul, Williams, Myers, Jones, & Logdson, 2015). While health care expenses have increased significantly over the years, there have been great improvements in increasing both family and patient involvement in medical care. Hourly care is one of the strategies that have worked well in various healthcare settings. Hourly care has been a success in various areas but using it in urgent pediatric settings hasn't been well documented (Emerson, Chumra, & Walker, 2013). Opportunities still exist to look into pediatric family preferences and perspectives as pertains to the use of whiteboards (Cholli, et al., 2016). Several studies have been done in different setups and this paper references many of them. The research projects include in-patient surveys, quasi-experimental…
Alaloul, F., Williams, K., Myers, J., Jones, K. D., & Logdson, C. (2015). Impact of a Script-based Communication Intervention on Patient Satisfaction with Pain Management. Pain Management Nursing, 321 - 327.
Brosey, L., & March, K. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 153.
Cholli, P., Meyer, E., David, M., Moonam, M., Mahoney, J., Hession-Laband, E., . . . Bell, S. (2016). Family Perspectives on Whiteboard Use and Recommendations for Improved Practices. Hospital Pediatrics, 426 - 430.
Emerson, B., Chumra, K., & Walker, D. (2013). Hourly rounding in the pediatric emergency department: patient and family safety and satisfaction rounds. J Emerg Med, 99 - 104.
cute care facilities try to maintain low costs and employ quality nurses. Within this statement is a double standard. How can we have quality nurses and cut costs at the same time? This is where the skill mix comes into play. In the skill mix, there are Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and unlicensed staff. If the lesser skilled staff free RNs they can be better able to perform their nursing duties and assessments. If acute care facilities can agree on an appropriate number of each type of staff member within the facility, they might be better able to accomplish safe patient outcomes while keeping costs down.
Determining nurse-to-patient ratios is a complex issue where one solution is not sufficient to cover all circumstances. The merican Nurses ssociation assembled a panel of nursing and health professionals to research appropriate staffing levels. The panel developed the following Matrix for…
Aiken and colleagues have been pioneers in studying nurse patient ratios and their relationship to patient outcomes.
Aiken, Sochalski, and Lake (1997) demonstrated that nursing presence, whether measured as RN ratios or as RN hours relative to other nursing personnel hours, is significantly correlated to mortality. When studying patient outcomes in specialized AIDS units,
Aiken, Sloan, Lake, Sochalski, and Weber (1999) found that at 30 days post admission, mortality rates were 60% lower in magnet hospitals, and 40% lower in dedicated AIDS units than in conventional scattered bed units. The researchers concluded that higher nurse patient ratios were a major factor in these lower
One of the key reasons that was found to be a factor in readmissions is that insurance companies continue to push for shorter hospital stays. They have reduced the…Read Full Paper ❯
Health - Nursing
causes for Medicare and Medicaid patients to be readmitted to hospitals within thirty days of a prior discharge. This is a fairly pervasive and major problem and it is…Read Full Paper ❯
Hospitals with more elderly, poor patients likely to face readmission penalties" by Katie Sullivan (January 8, 2014) Are some hospitals discharging patients before they are ready, causing them to…Read Full Paper ❯
Amin, B et al. (2013). Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets. Journal of Neurosurgery: Spine, 18(2): 134-138. This study examines the University of…Read Full Paper ❯
eadmission of patients with diabetes is a problem that warrants consideration of the contributing factors. eadmission of patients within 30 days of discharge is considered to be an indicator…Read Full Paper ❯
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Health - Nursing
Quality Improvement Project Diabetes -- Chronic Condition Background Type 1 and Type 2 Diabetes isk factors for type 1 diabetes isk factors for prediabetes and type 2 diabetes isk…Read Full Paper ❯
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Health - Nursing
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Lagoe, R.J., et. al. (13 Aug 1999) "Analyzing hospital readmissions using statewide discharge databases." Nursing Care Quarterly 13(6): 57-67. Why did the authors select hospital readmissions as a way…Read Full Paper ❯
The results of this analysis highlight the need for hospitals to fine-tune their discharge process to reduce readmissions, and support the expenditure of additional resources for this purpose as…Read Full Paper ❯
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Transitional Care of Older Adults Hospitalized with Heart Failure Experiment Naylor, M.D., Brooten, D., Campbell, R.L., Maislan, G.,, McCauley, K.M. Schuartz, J. Transitional Care of Older Adults Hospitalized with…Read Full Paper ❯
EBP is to facilitate strategy to eradicate short cycle return to second readmission of psychiatric patients on hospital beds. Doing so will assist health care providers in addressing the…Read Full Paper ❯
Healthcare Administration -- New York State Care Act The New York State Care (Caregiver Advise, ecord and Enable) Act was implemented into law in April this year. The development…Read Full Paper ❯
home health care services in extending care delivery to the home setting is increasing in contemporary times. Home health care aims to shorten hospitalization and reduce the frequency of…Read Full Paper ❯
Health Care Improvements The health care industry is one that is much criticized in the United States. Many consumers look at this industry as one big giant industry that…Read Full Paper ❯
Health - Nursing
Furthermore, one of the pillars of collaborative care that will need to be firmly established is the fostering of clear dialogue and a means for strong communication within the…Read Full Paper ❯
download Chamberlain Library) the articles uploaded, upload the articles required reading This is for the "Telemonitoring…" article The purpose of this research is to determine if it is advantageous…Read Full Paper ❯
Sanford, J., Townsend-Rocchicciolli, J., Horigan, A., & Hall, P. (2011). A process of decision making by caregivers of family members with heart failure. Research & Theory for Nursing Practice,…Read Full Paper ❯
EClinicaWorks at ikers Island ikers Island is a correctional facility that currently utilizes eClinicalWorks, which has emerged as a leader in medical software solutions. This paper examines the use…Read Full Paper ❯
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auspices and with a variety of purposes; this particular study described its secondary purpose as a method for describing decision making and the decision making process undertaken by patients…Read Full Paper ❯
Healthcare Data Compare Healthcare Grade of Maryland to Florida Healthcare grades: The Commonwealth Fund The Commonwealth Fund grades all states on access to healthcare, avoidable hospital use and costs,…Read Full Paper ❯
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Hospital Admission Analysis Readmission Statistics (Denominator) Total Number of Readmits Total Number of Patients Readmitted # of Patients with Multiple Readmits In looking at readmissions, there were only three…Read Full Paper ❯
Future of Healthcare as it Relates to the Geriatric Population Description and Problem Statement The geriatric population in the United States is growing and compared to the population of…Read Full Paper ❯
Of the new consults 23 were transferred to ICU and 43 remained on the wards. The transfer of these patients was greatly facilitated and the inpatient ward staff was…Read Full Paper ❯
Health - Nursing
Sigma methodology to help lower patient length of stay while simultaneously improving financial and patient health outcomes. This paper first discusses the theoretical basis for this, outlining the Six…Read Full Paper ❯
he most common progressive chronic lung situations that would require the rehabilitation include interstitial lung disease, chest wall disease, bronchiectasis, and pre and post thoracic surgery. he fourth category…Read Full Paper ❯
(Shactman; Altman, 2002) 4. ecommendations for Overcoming these Barriers: Some of the suggestions for overcoming these barriers are (i) appointment of a General Practitioner -- GP officers to work…Read Full Paper ❯
Shuttling the results from an outside provider, because the health insurance agency will only reimburse outside screening, forces the patient to wait and possibly incurs more costs, if the…Read Full Paper ❯
Business Posts (1) Finance Balance Sheet ASSETS Non-current assets $30,000 Equipment $30,000 Current assets $170,000 Inventory $20,000 Accounts receivable $100,000 Cash $50,000 TOTAL ASSETS $200,000 LIABILITIES Accounts payable $12,000…Read Full Paper ❯
Discharge Education to Promote Self-Efficacy in Heart Failure An Education Intervention For Patients With Heart Failure Management of congestive heart failure (CHF) continues to be a financial burden on…Read Full Paper ❯
Health - Nursing
evidence- based practice project is to compare the effects of bedside handoff report to handoff report away from the bedside using the IOWA model of evidence-based practice. The efficacy…Read Full Paper ❯
Mobility ENEFITS, ARRIERS, CHALLENGES ackground and Origin Progressive mobility refers to a series of planned and sequential movements aimed at bringing the patient back to his or her baseline…Read Full Paper ❯
Health - Nursing
Healthcare Database for esearch and Analysis South Carolina is amongst states that take part in the Health Cost and Utilization Program (HCUP). Sandra Kelly, the person to contact regarding…Read Full Paper ❯
Introduction Performance scorecards provide a straightforward means of integrating metrics into a healthcare organization’s strategic planning. Scorecards are most effective when they have a clear purpose, identifying specific patient…Read Full Paper ❯
Naylor, PhD,, Dorothy A. Brooten, PhD, oberta L. Campbell, PhD, Greg Maislin, MS, MA, Kathleen M. McCauley, PhD, and J. Sanford Schwartz, MD. All of the authors have graduate…Read Full Paper ❯
Affordable Care Act & Nursing There are a number of different provisions of the Affordable Care Act that were designed to improve the health care system -- well, all…Read Full Paper ❯
health care to the elderly. In the next several years, many commentators argue that population aging will considerably affect the federal budget. When one turns sixty-five, his or her…Read Full Paper ❯
Health - Nursing
Since modern medicine can sustain patients with proper medical follow-up for years, it becomes incumbent on the profession to follow the patients and provide them with the knowledge and…Read Full Paper ❯
business plan provides a process change for bedside patient handoffs at Samaritan Medical Center, Watertown, New York. An overview of the medical center is followed by its mission and…Read Full Paper ❯
Stroke Stroke is identified as one of the leading causes of death and to decrease mortality rate a review of the causes is required. The importance of measuring and…Read Full Paper ❯
Ineffective Communication Between Shifts in Acute Care Settings Significant A recent statistics of the adverse effects arisen from ineffective communication between shifts in acute care setting range from 2.6%…Read Full Paper ❯
With the ever-changing health care sector, reimbursement has increasingly been tied to care quality and health care outcomes. The Centers for Medicare and Medicaid Services (CMS) have particularly been…Read Full Paper ❯
EH Assessment and Evaluation to Support Healthcare Outcome Objectives The outcome-related goals that the tertiary care hospital seeks to achieve include the following: 1) Strengthen adult admissions screening at…Read Full Paper ❯
Health - Nursing
G1d, and G1g Planned Intervention Intervention Description of Intervention: Medication adherence is one of the effective interventions for diabetes management. Adherence to medication is the extent patients take medications…Read Full Paper ❯
Responsibilities of Nurses to Patients Why is it important The role of nurses has a direct implication on the patients. For example, nurses observe and provide direct care to…Read Full Paper ❯
The audience is realized to find that he has been dreaming, but the dread remains for both he father and the son. Early on in genetics was given some…Read Full Paper ❯
Patients in hospitals often complain of pain regardless of the diagnosis. Several activities in a patient's life contribute to pain. Some of the activities include amount of sleep, daily…Read Full Paper ❯
cute care facilities try to maintain low costs and employ quality nurses. Within this statement is a double standard. How can we have quality nurses and cut costs at…Read Full Paper ❯