Evolving Health Care System Research Articles

Collaborating in an Evolving Health Care System: Opportunities for Redesigning Health Care Delivery.

Collaborating in an Evolving Health Care System: Opportunities for Redesigning Health Care Delivery.

Achieving Equity in an Evolving Healthcare System: Opportunities and Challenges

For decades, disparities in health have been well documented in the United States and regrettably, remain prevalent despite evidence and appeals for their elimination. Compared with the majority, racial and ethnic minorities continue to have poorer health status and health outcomes for most chronic conditions, including diabetes mellitus, cardiovascular disease, cancer and end-stage renal disease. Many factors, such as affordability, access and diversity in the healthcare system, influence care and outcomes, creating challenges that make the task of eliminating health disparities and achieving health equity daunting and elusive. Novel strategies are needed to bring about much needed change in the complex and evolving United States healthcare system. Although not exhaustive, opportunities such as (1) developing standardized race measurements across health systems, (2) implementing effective interventions, (3) improving workforce diversity, (4) using technological advances and (5) adopting practices such as personalized medicine may serve as appropriate starting points for moving toward health equity. Over the past several decades, diversity in the U.S. population has increased significantly and is expected to increase exponentially in the near future. As the population becomes more diverse, it is important to recognize the possibilities of new and emerging disparities. It is imperative that steps are taken to eliminate the current gap in care and prevent new disparities from developing. Therefore, we present challenges and offer recommendations for facilitating the process of eliminating health disparities and achieving health equity across diverse populations.

The Radiologist Will See You Now: Patients’ Perceptions of an Outpatient Interventional Clinic

Patient satisfaction is becoming an increasingly important part of America's healthcare system. Patient satisfaction is now a metric assessed for value-based incentive payments by the Center for Medicare and Medicaid Services, and the healthcare market is becoming increasingly consumer-driven as patients are provided with more options regarding where they receive care as well as improved access to medical information. Radiologists, while less involved with direct patient care than other medical specialties, are not immune to the changing medical landscape and need to adapt to a progressively value- and patient-oriented healthcare system. At our institution, first-year radiology residents take an active role in our outpatient interventional radiology clinic by performing clinical histories and physical exams in a dedicated radiology clinic examination rooms. Stressing the various opportunities for patient interaction and the potential benefits of patient- centered radiology in the evolving healthcare system may increase its perceived value among both radiology residents as well as practicing radiologists. ​Directly engaging patients may be unfamiliar territory for the practicing radiologist and an unexpected prospect for current residents, but available data suggests that patients do value direct interaction with radiologists during the course of their care.

SCAI: Enhancing patient care through quality.

Sunil V. Rao James C. Blankenship The QI Committee is one of 31 committees or task forces within SCAI. The specific task of the Committee is to provide guidance and recommendations for development of the Society's policies and positions related to healthcare QI initiatives, with emphasis on quality measures, public reporting of quality measures, pay-for-performance initiatives, interventional cardiology standards development, and radiation issues. It consists of a chairperson, a vice-chairperson, a staff liaison, an 11-member Executive Council, and 6 additional voting members. As with most SCAI committees, general membership is open to any member of the Society. The overall membership of the Committee has increased in recent years to a total of 60 members. The Committee holds monthly conference calls and meets in person during the SCAI Annual Scientific Sessions. The guiding principles of the Committee are best summarized in the two-part position statement by Klein et al. published in 2011 1, 2. Over the past 4 years, the Committee has developed 5 inter-related QI programs that fulfill the Society's mission to advance quality standards and improve patient care: 1) the SCAI Quality Improvement Toolkit (SCAI QIT); 2) the Cath Lab Best Practices Consensus Statement; 3); SCAI risk-assessment applications for bedside risk assessment; 4) the Quality Track at the SCAI Annual Scientific Sessions; and 5) the Cath Lab Leadership Boot Camp. Together, these programs provide a comprehensive educational QI initiative with practical tools to be used in daily practice. In 2011, then SCAI President Christopher White, MD, MSCAI, envisioned a set of tools to improve quality in catheterization laboratories. This wide-ranging toolkit would include education about the basic concepts of quality (i.e. structure, process, outcomes), as well as integral elements of a quality-based cath lab clinical program. The target audience of this toolkit is clinicians, nurses, technologists, cath lab directors, and hospital administrators. A taskforce comprised of members of the QI Committee developed the “SCAI QIT,” a modular slideset that includes topics such as clinical requirements for operators and staff, benchmarking and risk adjustment, key cath lab conferences, facility and environmental issues including radiation safety, and cath lab best practices. Downloadable presentation materials accompany each module. A series of webinars (available at SCAI.org) reinforce the QIT and to date 593 attendees have been designated as “QIT Champions.” A main source of content for the QIT was the SCAI consensus statement on catheterization laboratory “best practices” 3. This consensus statement summarizes cath lab-specific recommendations to improve and maintain quality and patient safety pre-procedure, intra-procedure, and post-procedure. Included in the publication are checklists for pre-procedure patient evaluation and for the “time out” process. Recommendations for access site management and post-procedure follow-up are also outlined. The document is available to download at SCAI.org. In order to implement “best practices” at the bedside, the QI Committee collaborated with the Blue Cross Blue Shield Consortium of Michigan to develop a set of smartphone applications to assess a patient's risk for post-PCI mortality, acute kidney injury and transfusion using validated risk models developed using the Blue Cross Blue Shield of Michigan Cardiovascular Consortium database. In addition to these apps, which can be downloaded to Apple and Android devices, Dr. Kalon Ho, vice chair of the QI Committee, has developed similar web-based apps using the National Cardiovascular Data Registry CathPCI risk models. Dr. Ho has also developed apps to assess procedure appropriateness for diagnostic cardiac catheterization and PCI that can be printed or pasted into the patient's medical record. Two other programs developed by the QI Committee in collaboration with other committees of SCAI include the Quality Track and the Cath Lab Leadership Boot Camp at the SCAI Scientific Sessions. The Quality Track is a program focused on QI that includes didactic lectures, case presentations, and debates by world-renowned experts in quality assessment. Interventional cardiology programs that have successfully implemented SCAI QI programs are highlighted. Related to the Quality Track is the Cath Lab Leadership Boot Camp. Originally conceived by SCAI Immediate Past President Charles Chambers, MD, MSCAI, the Boot Camp is a day-long symposium for cath lab directors and managers. It provides intensive training in management skills to help cath lab leaders overcome challenges posed by our evolving health care system. The above summarizes the work of the QI Committee over the past few years. These efforts provide practical tools that can be used at the bedside to fulfill the Society's objective to improve patient care. Integral to these achievements is the selfless participation of the Committee's members who have dedicated time outside of their usual clinical and research responsibilities. It is this active participation that makes SCAI the leader in QI for interventional cardiologists, their cath lab teams, and their patients.

An Innovative Longitudinal Educational Approach to Maternal‐Child Community Health

Poster Presentation Purpose for the Program The health care environment is rapidly changing. Nurse educators must develop innovative curricula to prepare future nurses to respond to the community maternal/child health needs of an evolving health care system. Proposed Change Starting in 2012, University of New Mexico (UNM) graduate and undergraduate faculty partnered to provide bachelor of science in nursing (BSN) students with a longitudinal community clinical experience through the Family Health Partnership (FHP). The FHP, a faculty practice located in rural Sandoval County, NM, is a federally funded, nurse‐managed practice center. Using the FHP as a clinical site, a three‐term sequence of community‐based maternal/child electives were developed to engage students in activities aimed at promoting maternal/child health, preventing disease, decreasing health care disparities, and increasing access to care. Implementation, Outcomes, and Evaluation BSN students worked with certified nurse–midwives, nurse practitioners, community health workers, and a mental health nurse practitioner to provide group prenatal care, well‐child group care, and labor support; perform extended family assessments; and research community resources. Student reported benefits included building connection to a community, increased understanding of the benefits of the provision of preventative services in the community, and an increased interest in working in maternal/child community settings and/or graduate nurse midwifery programs after graduation. Implications for Nursing Practice Partnerships between graduate and undergraduate nursing faculty and utilization of faculty practice sites can provide opportunities to provide longitudinal, innovative, clinical experiences for BSN students that increase interest in maternal–child health and community health.

Paramedic prescribing: a potion for success or a bitter pill to swallow?

In a climate of unprecedented demand on healthcare services, ageing demographics, population growth through immigration, a reduction in junior doctors' working hours, and overriding political agendas, the need to develop innovative new roles and expand the scope of practice for existing practitioners, including paramedics, is paramount if the NHS is to maintain resilience in an evolving healthcare system. Recent legislative changes now permit chiropodists/podiatrists and physiotherapists to independently prescribe, further fuelling other allied health professions (AHPs), such as paramedics' and radiographers' desire to become future independent prescribers. Implementation has the potential to enhance patient/clinician experiences through improved access to medicines, and would significantly reduce the need for multi-disciplinary involvement per care episode, yielding cost-efficiency savings through reduced ambulance journeys, fewer avoidable admissions, further augmenting patient care delivery. Paramedic independent prescribing (PIP) would also elicit improved inter-professional collaboration, enhance employability and promote professional autonomy in evolving advanced practice roles. Such innovation requires legislative changes, but remains paramount if paramedics are to actively contribute towards tackling the increasing burden of unprecedented demand, limited resources, and ongoing commitment to achieve cost-efficiency savings within the modern NHS.

A Proactive Innovation for Health Care Transformation: Health and Wellness Nurse Coaching.

A cohort of holistic nurses, recognizing opportunities inherent in health care transformation, organized and worked together from 2009 to 2012. The goal was to hold space for holistic nursing by developing a health and wellness coaching role and certification program for holistic nurses. The intent was to ensure that holistic nurses could work to the fullest of their ability within the evolving health care system, and others could discover the merit of holistic nursing as they explored the possibilities of nurse coaching. Challenges emerged that required the cohort plan strategies that would hold the space for nursing while also moving toward the intended goal. As they worked, this cohort demonstrated leadership skills, knowledge, values, and attitudes of holistic nursing that provide an example for others who follow in the wake of health care transformation. The American Holistic Credentialing Corporation's perspective of the events that unfolded and of the related decisions made by the coalition provides a record of the evolution of holistic nursing.

Leading change: evidence-based transition.

The purpose of this article was to provide a framework for evidence-based transition of patient populations within an acute care pediatric institution. Transition within a hospital is foreseeable, given the ever-changing needs of the patients within an evolving healthcare system. These changes include moving patient populations because of expansion, renovation, or cohorting similar patient diagnoses to provide care across a continuum. Over the past 1 to 2 years, Children's Health Children's Medical Center Dallas has experienced a wide variety of transition. To provide a smooth transition for patients and families into new care areas resulting in a healthy work environment for all team members. The planning phase for patient population moves, and transition should address key aspects to include physical location and care flow, supplies and equipment, staffing model and human resources (HR), education and orientation, change process and integrating teams, and family preparation. It is imperative to consider these aspects in order for transitions within a healthcare system to be successful. During a time of such transitions, the clinical nurse specialist (CNS) is a highly valuable team member offering a unique perspective and methodological approach, which is central to the new initiative's overall success. The themes addressed in this article on evidence-based transition are organized according to the CNS spheres of influence: system/organization, patient/family, and nursing. An evidence-based transition plan was developed and implemented successfully with the support from the CNS for 3 patient populations. Organizational leadership gained an increased awareness of the CNS role at the conclusion of each successful transition. The CNS plays a pivotal role as clinical experts and proponents of evidence-based practice and effects change in the system/organization, nursing, and patient/family spheres of influence. While transitions can be a source of stress for leaders and bedside staff, it is also a time that allows for growth and new opportunities for staff and may result in development of a healthier work environment. The CNS is able to provide leadership while working collaboratively to oversee the moves with a forward-thinking approach. There are key components to consider during times of transition. These include (1) organize, plan, and improve work efficiencies during a construction build; (2) identify the key elements for improvement in nurse and patient satisfaction; (3) develop or maintain healthy work environment standards; (4) establish adequate staffing levels and staff education to successfully care for patient populations following transition; and (5) support the staff and patients during transition.

Bringing Specialties Together: The Power of Intra-Professional Teams.

Bringing Specialties Together: The Power of Intra-Professional Teams.

In Pursuit of Best Practice in Physical Therapy Education

'Quality is not an act, it is a habit-AristotleThe concern about quality in physical therapist education is everywhere! The profession as a whole, particularly members of the profession committed to academic and clinical teaching roles, is engaged in several major projects to identify best practice in physical therapist education. The American Physical Therapy Association (APTA), Education Section, American Council of Academic Physical Therapy (ACAPT), Commission on Accreditation of Physical Therapy Education (CAPTE), and Federation of State Boards of Physical Therapy (FSBPT) have been supportive of several profession-wide projects over the past few years that will contribute to the debate surrounding best educational practice for physical therapist education. Consider the macro-level focus of several of these projects:* ACAPT supports the Benchmarks for Excellence task force, which seeks to develop quantitative and qualitative benchmarks that represent excellence in physical therapist education, against which, programs could assess themselves.* ACAPT, APTA, the Education Section, and the FSBPT collaborated to develop a shared vision for enhancing clinical education in physical therapy. A 2-year process of conferences, invited papers (published in JOPTE as a supplement in May 2014), and webinars culminated in the Clinical Education Summit in October 2014. Over 450 participants agreed on 15 recommendations that they believe represent best educational practice in physical therapist education. ACAPT will consider how to proceed with these recommendations for the profession this year.* APTA, the Education and Orthopeadic Sections, and ACAPT collaborated to fund a research project, Excellence and Innovation in Physical Therapist Education for the Twenty-First Century (PTE21). The research team has followed the research methods of former studies sponsored by the Carnegie Foundation for the Advancement of Teaching. These studies in medicine, nursing, clergy, engineering, and law focused on identifying what curricular structures, instructional practices, assessment approaches, and environmental/institutional characteristics optimally support the preparation and development of professionals in training. Preliminary data from this national study of physical therapist education in academic and clinical settings have been presented at conferences, with the final work expected to be published in 2015 and 2016.* APTA has identified the importance of quality physical therapist education through action of the 2014 House of Delegates by adopting a position statement on excellence, as well as a charge to identify best practices in clinical education. Also, APTA has charged a task force to provide strategic advice, counsel, and options to the Board of Directors regarding current and emerging issues impacting the ability of physical therapist education to produce practitioners that meet the needs of the current and evolving health care system. We are fortunate as a profession to havethe resources of these organizations and the commitment of learned colleagues to envision common and effective educational practices in the future. …

Preface

Preface

Report of the 2013-2014 Professional Affairs Standing Committee: Advancing the Pharmacy Profession Together through Pharmacy Technician and Pharmacy Education Partnerships

BACKGROUND AND CHARGES According to Bylaws of American Association of Colleges of Pharmacy (AACP), Professional Affairs Committee is to study issues associated with professional practice as they relate to pharmaceutical education, and to establish and improve working relationships with all other organizations in field of health affairs. The Committee is also encouraged to address related agenda items relevant to its Bylaws charge and to identify issues for consideration by subsequent committees, task forces, commissions, or other groups. President Peggy Piascik established theme for 2013-2014 as the relentless pursuit of excellence. (1) President Piascik acknowledges that academic pharmacy is at crossroads of many areas of change, including continuing evolution of pharmacy as a profession, how health care is delivered in America and rapid changes in higher education. As roles of pharmacists continue to change, pharmacy technician roles must also evolve, necessitating changes in pharmacy technician training and education. Specifically, 2013-2014 Professional Affairs Committee is charged to: (1) Describe elements that should be present in a quality technician education/ training program; (2) Identify potential role(s) of pharmacy academic institutions and pharmacy faculty in education, training, and certification of pharmacy technicians; and (3) Recommend strategies to develop collaborations/relationships between schools/colleges of pharmacy and pharmacy technician education/training programs to advance pharmacy practice in evolving health care system. Members of Professional Affairs Committee (PAC) include faculty representing multiple disciplines from various schools/colleges of pharmacy, a coordinator from an American Society of Health-Systems Pharmacists (ASHP) accredited pharmacy technician education/ training program as well as professional staff from ASHP, Pharmacy Technician Certification Board (PTCB) and Pharmacy Technician Educators Council (PTEC). Prior to an in-person meeting of committee, pertinent background information and resource materials were distributed, and a conference call was held to develop a strategy for addressing committee charges. The committee members met for a day and a half in Crystal City, Virginia on October 28-29, 2013, to discuss various facets related to this issue as well as to develop a process and strategies for addressing charges. Following process development and delegation of assignments related to committee charges, PAC communicated via electronic communications, as well as through personal exchanges via telephone and email. The result is following report, which discusses elements and importance of a well educated and trained pharmacy technician workforce and also provides information on current collaborations between schools/ colleges of pharmacy and pharmacy technician education/ training programs. Disseminating purpose and framework behind these collaborations may assist members of academy to identify potential strategies and roles for schools/colleges of pharmacy in education, training and certification of pharmacy technicians. In addition, these examples may help to guide development of these collaborations at other member institutions. Pharmacy technicians are viable members of health care sector and are necessary to pharmacy profession for pharmacists to satisfy Joint Commissioners of Pharmacy Practice (JCPP)Vision for Pharmacy Practice: (2) Patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers within patient-centered, team-based health care. Charge 1: Describe elements that should be present in a quality technician education/training program A pharmacy technician is an individual who, under supervision of a licensed pharmacist, assists in pharmacy activities that do not require professional judgment of a pharmacist. …

Pharmacists' Stellar experience can create Five-Star Success.

The evolving health care system has put an increasing emphasis on balancing quality, outcomes, and costs. As part of this evolution, the Centers for Medicare & Medicaid Services (CMS) is using a Five-Star Quality Rating System to evaluate the quality of care provided by Medicare Advantage and Part D prescription drug plans. At the same time, drug plans are using a Five-Star system to rate pharmacies, which contribute to the CMS ratings of nursing facilities. More than ever, pharmacists can play a significant role in helping facilities, plans, and even pharmacies achieve the highest possible ratings and maintain those standards over time.

Health Disparities in Unmet Support Needs of Women with Gynecologic Cancer: An Exploratory Study

International research suggests that many women with gynecological cancers have unmet supportive care needs that often correlate with greater psychological distress and poorer quality of life. The United States has a diverse population and evolving health care system, so this study aims to identify the support needs of women with gynecologic cancer in this geographic region. Furthermore, there are numerous health disparities with regards to cancer care; therefore, a second aim of this study is to explore health disparities in unmet support needs. Fifty-one women with gynecologic cancers completed an adapted version of the Supportive Care Needs Survey. Sociodemographic and cancer-related information were also collected. Findings revealed a high frequency of unmet support needs, particularly in the psychological, physical, and practical domains. Additionally, disparities in levels of support needs were found to be dependent on income and minority status. Specifically, unmet needs in the physical/daily living and practical domains were dependent on income, and minorities reported significantly higher support needs in the sexuality and psychological need domains than their majority counterparts. These results highlight the potential benefits of enhanced multidisciplinary services to better assess and address patients’ needs. Nonetheless even with enhanced services, the findings, consistent with other health disparities research, suggest lower income affects access to care, so more research is needed on how to overcome these barriers.

IPS: Learn About Integrating Care and Expanding Partnerships

IPS: Learn About Integrating Care and Expanding Partnerships

Implications of the Affordable Care Act for education and training in professional psychology.

With the ongoing implementation of the Patient Protection and Affordable Care Act (Public Law No: 111–148, March 23, 2010) and its impact on the evolving health care system, this article will focus on 4 broad domains of change that the education and training community in psychology must address to ensure that the next generations of health service psychologists are prepared to not just succeed, but lead those changes in health care. Interprofessionalism, workforce analysis and development (including practice settings), finances (reimbursement, health care cost offset, and advocacy), and professional accountability (including accreditation, competency, evidence-based care, specialization, identity and self-definition, and autonomy) will be discussed. Each domain reflects demands for both affordable care and enhanced accountability in the developing health care system. Recommendations for curricular content and clinical training modifications are offered.

Who will educate our nurses? A strategy to address the nurse faculty shortage in New Jersey

BackgroundThe nurse faculty shortage hampers the capacity of the nursing workforce to respond to the demands of the evolving health care system. As a strategy to address the shortage in New Jersey, the Robert Wood Johnson Foundation implemented the New Jersey Nursing Initiative Faculty Preparation Program to prepare nurses for the faculty role. This article highlights program implementation successes and challenges, scholar and faculty perceptions of the program, and provides recommendations for others interested in preparing nurse faculty. MethodsThis evaluation uses data from scholar surveys and focus groups, interviews with grantees, and grantee reports. ResultsFindings suggest that a program that includes generous monetary support, socialization to the nurse faculty role, and formal education courses produces graduates who readily assume a faculty position and are committed to at least a part-time career in nursing education. ConclusionsThis evaluation emphasizes the need to carefully design programs that integrate faculty preparation and advanced clinical training.

Progress and Potential: Training in Genomic Pathology

Genomic medicine is revolutionizing patient care. Physicians in areas as diverse as oncology, obstetrics, and infectious disease have begun using next-generation sequencing assays as standard diagnostic tools. To review the role of pathologists in genomic testing as well as current educational programs and future training needs in genomic pathology. Published literature as well as personal experience based on committee membership and genomic pathology curricular design. Pathologists, as the directors of the clinical laboratories, must be prepared to integrate genomic testing into their practice. The pathology community has made significant progress in genomics-related education. A continued coordinated and proactive effort will ensure a future vital role for pathologists in the evolving health care system and also the best possible patient care.

Lessons Learned at the Radiology Leadership Institute–Kellogg Leadership Development Program: A Resident's Perspective

The Radiology Leadership Institute (RLI) was established to prepare leaders to take on the challenges facing health care, particularly those unique to radiology. For many years, clinical expertise has been adequate to ensure a radiologist's success. This is no longer true, as the evolving health care system requires physicians to expand the breadth of their skills to include an understanding of concepts central to leaders in the fields of business, law, and health administration. Leaders in radiology interact with professionals from these fields on a daily basis yet receive relatively no comparable training.

Spread the word about provider status: Pharmacists Provide Care

APhA's number one priority is seeking the recognition of pharmacists as health care providers who, through their patient care services, improve the access, quality, and value of health care. The campaign to promote pharmacist provider status, Pharmacists Provide Care, is being unveiled right here, right now at the 2014 APhA Annual Meeting & Exposition. During APhA2014, pharmacists and student pharmacists can learn about provider status; share their patient care stories; and attend provider status education sessions, including the Second General Session and a three-part series on the issue.