archive-org.com » ORG » M » MEDICARING.ORG

Total: 416

Choose link from "Titles, links and description words view":

Or switch to "Titles and links view".
  • Early Days: Chicago-Based CCTP Program Describes The Work To Date – MediCaring.org
    the Care Transitions Intervention training program help patients and families to set 30 day post discharge goals and to make and keep followup appointments In addition CJE received foundation funding which is enabling it to include a social work intervention very high risk patients are identified and receive followup with a social worker for six months post discharge We had to adapt the Coleman protocols says O Donnell We felt that for some patients those with chronic conditions and psychosocial problems thirty days of followup were insufficient We found that about 10 percent of the patients in our program would need more support services That part of our program is not covered by CMS but is funded with private foundation funds O Donnell says that pulling the project together has taken a great deal of collaboration with the participating hospitals from the on the ground work of finding the right contact people to developing specific strategies for the intervention But we felt that this was a good fit with what the hospitals were already doing she said It is very exciting work getting every provider in the community to think about the quality of care from the standpoint of preventing an unnecessary readmission Asked whether there had been any problems in bridging the divide between social services agencies and hospitals O Donnell said there had not This isn t about us versus them This is about everybody pulling together and undertaking a new initiative that s good for everybody good for the hospital the nursing home the patient It s a new approach CJE meets regularly with its partners at each participating hospital although the three are some miles apart and there is no reason to try to pull them all into one meeting Orchestrating such a meeting O Donnell said would be quite difficult given how busy people are and how hard it is to accomplish specific tasks when so many people are involved We ve found it s more effective to address each hospital and their concerns and our strategies individually CJE is however convening quarterly meetings of participating nursing homes at which it hopes participants will talk about their successes challenges and processes CJE is also mindful of the role to be played through partnerships with its local AAA Area Agency on Aging which is in the midst of applying for separate CCTP funding It is also keeping the Department of Health Care and Family Services apprised of its work The process of actually launching the program took several months of work with CMS to address questions and concerns and finalize a contract The application submitted in August received final approval in November The first wave of projects will begin in one hospital on March 1 with other hospitals launching in April and May ultimately the project anticipates serving some 2 700 people each year As O Donnell notes It is a significant undertaking and there are lots of details to be sorted out She also noted

    Original URL path: http://medicaring.org/2012/02/23/early-days-chicago-based-cctp-program-describes-the-work-to-date/ (2016-04-30)
    Open archived version from archive


  • CCTP funding – MediCaring.org
    and features a follow up home visit by a transitional care nurse within 72 hours of discharge These nurses who have participated in the Care Transitions Intervention training program help patients and families to set 30 day post discharge goals and to make and keep followup appointments In addition CJE received foundation funding which is enabling it to include a social work intervention very high risk patients are identified and receive followup with a social worker for six months post discharge We had to adapt the Coleman protocols says O Donnell We felt that for some patients those with chronic conditions and psychosocial problems thirty days of followup were insufficient We found that about 10 percent of the patients in our program would need more support services That part of our program is not covered by CMS but is funded with private foundation funds O Donnell says that pulling the project together has taken a great deal of collaboration with the participating hospitals from the on the ground work of finding the right contact people to developing specific strategies for the intervention But we felt that this was a good fit with what the hospitals were already doing she said It is very exciting work getting every provider in the community to think about the quality of care from the standpoint of preventing an unnecessary readmission Asked whether there had been any problems in bridging the divide between social services agencies and hospitals O Donnell said there had not This isn t about us versus them This is about everybody pulling together and undertaking a new initiative that s good for everybody good for the hospital the nursing home the patient It s a new approach CJE meets regularly with its partners at each participating hospital although the three are some miles apart and there is no reason to try to pull them all into one meeting Orchestrating such a meeting O Donnell said would be quite difficult given how busy people are and how hard it is to accomplish specific tasks when so many people are involved We ve found it s more effective to address each hospital and their concerns and our strategies individually CJE is however convening quarterly meetings of participating nursing homes at which it hopes participants will talk about their successes challenges and processes CJE is also mindful of the role to be played through partnerships with its local AAA Area Agency on Aging which is in the midst of applying for separate CCTP funding It is also keeping the Department of Health Care and Family Services apprised of its work The process of actually launching the program took several months of work with CMS to address questions and concerns and finalize a contract The application submitted in August received final approval in November The first wave of projects will begin in one hospital on March 1 with other hospitals launching in April and May ultimately the project anticipates serving some 2 700 people each

    Original URL path: http://medicaring.org/tag/cctp-funding/ (2016-04-30)
    Open archived version from archive

  • Dr. Eric Coleman on Care Transitions: 10/27 Webinar – MediCaring.org
    for the learning session at http www cfmc org caretransitions learning sessions htm The teleconference number is 1 866 639 0744 password community Key words Care Transitions Coleman Model four pillars Tweet Pin It One Response to Dr Eric Coleman on Care Transitions 10 27 Webinar John Lynn MD says September 17 2012 at 3 08 pm I would like to be notified about upcoming seminars regarding care transitions thank you John Lynn MD Reply Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite cite code del datetime em i q cite s strike strong Name required E mail required URI Dr Joanne Lynn Highlights Project RED to Improve Discharge Planning Room to Grow Palliative Care s Place in Care Transitions MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow Us To receive our email newsletter send a request to email protected Tweets by medicaring Care Transitions News Ringling Bros circus elephants set for final act Sunday USA TODAY April 29 2016 PMH announces Annette Schnabel as president CEO Bureau County Republican April 29 2016 College baseball Weekend Preview April 29 May 1 NCAA com April 29 2016 AbbVie Doubles Down on M A Bloomberg April 29 2016 Aspen Valley Hospital reaps awards for patient experience Aspen Times April 29 2016 Optimizing care transitions the role of the community pharmacist Dove Medical Press April 26 2016 3 lessons to improve patient care transitions FierceHealthcare April 21 2016 Dave Alfano Launches Caring Transitions of Central Connecticut PR Web press release April 19 2016 Older adults with dementia face increased mortality risk due to care transitions Bel Marra Health April 14 2016 Central Wyoming Caring Transitions Owners Recognized

    Original URL path: http://medicaring.org/2011/10/25/dr-eric-coleman-on-care-transitions-1027-webinar/ (2016-04-30)
    Open archived version from archive

  • Evidence-Based Interventions: Replicate or Adapt? – MediCaring.org
    stop the suffering of their discharged patients and simultaneously be expected to continue to do it wrong for all but a few of the patients Another challenge in the usual RCT is that the numbers affected are small often only a small subset of the patients in the test site While this works for a proof of concept improvement experts quickly note that scaling up is never just a matter of applying the same changes to a lot more people Instead scaling up poses its own problems As one scales up improvements in care transitions one has to work on incorporating many elements of the work into job descriptions and job routines so that the workflow is smooth One has to figure out fail safe strategies develop broad consensus in the community as to standards train a populace to take a more active role in managing transitions for themselves and their loved ones right size the community s supportive services and a dozen additional elements The research model is usually a discrete add on patch to a dysfunctional system Indeed an RCT relies upon not changing the underlying dysfunctional system As one tries to implement the improvement approach more broadly efficiency dictates that it become part of the system wherever possible Often this also means that the highly skilled and motivated people involved in the research are replaced by less skilled and often less motivated personnel providing routine services with lower pay and more stresses Adapting the work of a research nurse practitioner to a regular home care RN or of a skilled professional to a retiree volunteer is real work that takes testing innovation and creativity In the work of the Quality Improvement Organizations QIOs for instance as they implemented evidence based interventions many substantial adaptations were required One team trained certain nurses in a home health agency to be the bridging nurses in an adaptation of Naylor s model see http www innovations ahrq gov content aspx id 2674 One team used senior volunteers as trained coaches for patient activation in an adaptation of the Coleman model I don t believe that any of the 14 communities were able to implement a research based intervention exactly as it had been done in the research report The research was still quite important for laying down the path but following the path with larger numbers in varied contexts required adaptations Perhaps the most substantial challenge in our work is that small numbers do not threaten the hospitals overall patient flow while broad implementation could cut into occupancy rates and cause serious financial problems especially if done too quickly for the system to adapt and right size its services Scaling up requires considering the financial impact The good news is that there are usually good reasons to absorb this impact including the fact that most rehospitalizations and medical hospitalizations of Medicare patients do not make the hospital money or at least not much money Keywords quality improvement model adoption evidence based

    Original URL path: http://medicaring.org/2011/06/14/evidence-based-interventions-replicate-or-adapt/ (2016-04-30)
    Open archived version from archive

  • model adoption – MediCaring.org
    this example could you really generate the outrage that allows a nursing unit to make changes to stop repeated mistakes in transitions to stop the suffering of their discharged patients and simultaneously be expected to continue to do it wrong for all but a few of the patients Another challenge in the usual RCT is that the numbers affected are small often only a small subset of the patients in the test site While this works for a proof of concept improvement experts quickly note that scaling up is never just a matter of applying the same changes to a lot more people Instead scaling up poses its own problems As one scales up improvements in care transitions one has to work on incorporating many elements of the work into job descriptions and job routines so that the workflow is smooth One has to figure out fail safe strategies develop broad consensus in the community as to standards train a populace to take a more active role in managing transitions for themselves and their loved ones right size the community s supportive services and a dozen additional elements The research model is usually a discrete add on patch to a dysfunctional system Indeed an RCT relies upon not changing the underlying dysfunctional system As one tries to implement the improvement approach more broadly efficiency dictates that it become part of the system wherever possible Often this also means that the highly skilled and motivated people involved in the research are replaced by less skilled and often less motivated personnel providing routine services with lower pay and more stresses Adapting the work of a research nurse practitioner to a regular home care RN or of a skilled professional to a retiree volunteer is real work that takes testing innovation and creativity In the work of the Quality Improvement Organizations QIOs for instance as they implemented evidence based interventions many substantial adaptations were required One team trained certain nurses in a home health agency to be the bridging nurses in an adaptation of Naylor s model see http www innovations ahrq gov content aspx id 2674 One team used senior volunteers as trained coaches for patient activation in an adaptation of the Coleman model I don t believe that any of the 14 communities were able to implement a research based intervention exactly as it had been done in the research report The research was still quite important for laying down the path but following the path with larger numbers in varied contexts required adaptations Perhaps the most substantial challenge in our work is that small numbers do not threaten the hospitals overall patient flow while broad implementation could cut into occupancy rates and cause serious financial problems especially if done too quickly for the system to adapt and right size its services Scaling up requires considering the financial impact The good news is that there are usually good reasons to absorb this impact including the fact that most rehospitalizations and medical

    Original URL path: http://medicaring.org/tag/model-adoption/ (2016-04-30)
    Open archived version from archive

  • Getting the Treatment You Want: Is Anyone Listening? – MediCaring.org
    policy developments and calls for honest conversations among patients providers and family members as well as between policymakers and stakeholders to ensure that individuals get the care they want nothing more nothing less Production of the brief was supported by Compassion Choices the Elder Justice Coalition and the Consumer Coalition for Quality Health Care as supporters of a broad based Campaign to End Unwanted Medical Treatment Congratulations Anne on a job well done key words elder care overtreatment advanced illness NASI Tweet Pin It Leave a Reply Cancel reply Your Comment You may use these HTML tags and attributes a href title abbr title acronym title b blockquote cite cite code del datetime em i q cite s strike strong Name required E mail required URI Update on End of Improvement Standard New Medicare Policy Manuals Released One year anniversary of end of improvement standard MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow Us To receive our email newsletter send a request to email protected Tweets by medicaring Care Transitions News Ringling Bros circus elephants set for final act Sunday USA TODAY April 29 2016 PMH announces Annette Schnabel as president CEO Bureau County Republican April 29 2016 College baseball Weekend Preview April 29 May 1 NCAA com April 29 2016 AbbVie Doubles Down on M A Bloomberg April 29 2016 Aspen Valley Hospital reaps awards for patient experience Aspen Times April 29 2016 Optimizing care transitions the role of the community pharmacist Dove Medical Press April 26 2016 3 lessons to improve patient care transitions FierceHealthcare April 21 2016 Dave Alfano Launches Caring Transitions of Central Connecticut PR Web press release April 19 2016 Older adults with dementia face increased mortality risk due to care transitions Bel Marra Health April

    Original URL path: http://medicaring.org/2013/12/13/getting-the-treatment-you-want-is-anyone-listening/ (2016-04-30)
    Open archived version from archive

  • NASI – MediCaring.org
    they want nothing more nothing less Production of the brief was supported by Compassion Choices the Elder Justice Coalition and the Consumer Coalition for Quality Health Care as supporters of a broad based Campaign to End Unwanted Medical Treatment Congratulations Anne on a job well done key words elder care overtreatment advanced illness NASI MediCaring is a service of the Center for Elder Care and Advanced Illness at Altarum Institute Follow Us To receive our email newsletter send a request to email protected Tweets by medicaring Care Transitions News Ringling Bros circus elephants set for final act Sunday USA TODAY April 29 2016 PMH announces Annette Schnabel as president CEO Bureau County Republican April 29 2016 College baseball Weekend Preview April 29 May 1 NCAA com April 29 2016 AbbVie Doubles Down on M A Bloomberg April 29 2016 Aspen Valley Hospital reaps awards for patient experience Aspen Times April 29 2016 Optimizing care transitions the role of the community pharmacist Dove Medical Press April 26 2016 3 lessons to improve patient care transitions FierceHealthcare April 21 2016 Dave Alfano Launches Caring Transitions of Central Connecticut PR Web press release April 19 2016 Older adults with dementia face increased mortality

    Original URL path: http://medicaring.org/tag/nasi/ (2016-04-30)
    Open archived version from archive

  • overtreatment – MediCaring.org
    her in a limbo of unresponsive survival I call it a medical execution he says as he explains that the hospital will offer his mother comfort measures only The mother who has been in the ICU for 10 months has run up millions of dollars in costs to Medicare there is no indication that she could ever recover The son devoted and loving spends hours with her showing her old photos and talking to her Another poignant scene again an African American family shows the desperate family gathered around the patient s bedside the husband father is tethered to life support Although an ICU physician has explained in clinical terms that the patient is never likely to return to any semblance of fulfilling life the family is determined at first that he undergo any and all possible procedures His wife sobs Life is so unfair This family eventually acquiesces in the clinical team s plan to deal with any symptoms but to accept stopping treatment and allowing the dying that is in store The film underscores these personal tragedies with the larger social issues of how much we are willing to pay for endless medical tests and treatments and how much those tests will cost us in the future as the price of medical care becomes something our society will no longer be able to afford The program uses several common conditions and treatment options Cesarean section rates and breast cancer and prostate cancer screenings to bring home its points We have tremendously powerful prevention and detection procedures available to us But each is very costly to administer each exacts a psychological toll on patients and families and each is imprecise in targeting exactly who can benefit from it As one of the many experts interviewed for the program explains One person s story does not tell you the whole story At a population level certain tests have tremendously high rates of false positives But at an individual level patients are often willing to play that lottery All of this makes for an interesting contrast to our work in improving care transitions Some medical situations run up tremendous bills with modest justifications bringing into question the professionalism of those ordering the tests and treatments In contrast until now care transitions improvement efforts have been largely rooted in improving patient experiences and reducing patient suffering with no real chance of improving the bottom line The new penalties on hospitals with high readmission rates and the payments to community based organizations in the Community Based Care Transitions program and to physicians in the proposed Medicare physician payment rule may allow good practices to show modest gains The money at stake in the diagnoses and treatments in Money and Medicine are huge often more than 100 000 for an uncomplicated patient The care transitions work however relies on far less expensive interventions indeed many of the interventions involve virtually no cost changes in patient and provider communication in medication management and in patient

    Original URL path: http://medicaring.org/tag/overtreatment/ (2016-04-30)
    Open archived version from archive



  •