Innovative Health Care Delivery Research Articles

CHOT LEADERSHIP

The first speaker is Dr. Thomas Ferris the Center Director of the NSF Center for Health Organization Transformation (CHOT). Dr. Ferris will provide a high-level overview of CHOT and provide the audience with a greater understanding of its history, funding, partners, and accomplishments. In this section, the mission, annual research model, and the I/UCRC planning integration framework will be reviewed and discussed. The NSF CHOT is the only Industry-University Cooperative Research Center (I/UCRC) focused on innovations in healthcare delivery in the nation. CHOT researchers work alongside the Industry Advisory Board (IAB) to conduct research that supports the implementation of evidence-based transformational strategies within the healthcare sector. During this symposium, Dr. Ferris will discuss some of the challenges and opportunities that can arise from these partnerships. More importantly, in this section will speak to how value is created through these collaborative efforts and how ultimately this can improve health outcomes.

1314. HOME CARE: Reaching Our Lost to Follow-up Patients and Overcoming Barriers to Care Utilizing Nontraditional Care Models

BackgroundOf the 11098 people living with HIV in southeast Michigan, over 30% are out of care, with transportation being the most commonly identified barriers. To address this barrier and re-engage patients into care, we introduced an HIV homecare program. The objective of this study was to describe the implementation of the homecare program and document the outcomes of patients enrolled.MethodsIn 2016, WSUPG ID clinic saw 1990 patients and had additional 95 clients who were virally unsuppressed and lost to care for 12 months. We called all 95 of these clients and offered homecare. We also advertised our program internally, to the Detroit Public Health Departments’ Data to Care Program (Link up Detroit), and to community-based organizations. Referred patients were seen by a NP/MA team supervised by an infectious disease attending. HIV medical care delivered in home utilized same standards of care as for outpatient setting, including lab draws and counseling. Patients also had the ability to text/call provider directly on the program cell phone. This project was funding through a Part A Ryan White MAI grant.ResultsOf the 95 clients out-of-care, 38 (40%) were unreachable, 41 (43%) were reachable and 16 (17%) did not qualify (relocation, incarcerated, deceased, in-care at the time of call). 5 (5%) enrolled in homecare and additional 29 patients were referred to our program. A total of 34 patients enrolled from September 20, 2017 to September 20, 2018. Among the 34 clients, mental health barriers were the most frequently reported (depression in 20, schizophrenia or bipolar in 7, anxiety in 23, and history of trauma in 11). Of the 34 clients, 24 have achieved virologic suppression at least once during their enrollment. Among the 26 clients with 6+ months of follow-up, 17 have achieved virologic suppression.ConclusionHomecare offers a new, innovative healthcare delivery system which is effective at achieving viral suppression in a challenging patient population and is a successful strategy to re-engage patients in care.Disclosures All authors: No reported disclosures.

Development of an Interprofessional Home Healthcare Management Service: Within an Urban Housing Development.

In response to the need for increased access to primary care services for a low-income, at-risk community, two local universities partnered with a nonprofit Housing and Urban Development affiliated provider of affordable housing to launch a primary care clinic within an urban public housing community. Although the establishment of this clinic represented progress in meeting many healthcare needs of the target population, an interprofessional team also identified a need for the initiation of a new home-based service line. The goal of this project was to establish an innovative, sustainable, and cost-effective healthcare delivery method that would improve the health of this population. The project focused on a literature review, needs-assessment, and development of a comprehensive medical home visit program to serve the homebound, frail elderly, and other at-risk adults with complex medical conditions who reside in this community. The medical needs of potential recipients were assessed by conducting interviews with key support staff including a health service coordinator, health advocates, and housing provider service coordinators. Residents were also interviewed using a newly developed health perception and information survey. The data derived from the needs-assessment and pertinent literature were used to draft an initial program guideline. Because the needs-assessment indicated this population would not derive maximum benefit from a traditional house calls program, the project team developed a Home Healthcare Management service with an expanded scope to provide enhanced care coordination, house visits (medical and nonmedical), and community outreach.

Client experiences with antenatal care waiting times in southern Mozambique

BackgroundAntenatal care (ANC) provides a range of critical health services during pregnancy that can improve maternal and neonatal health outcomes. In Mozambique, only half of women receive four or more ANC visits, which are provided for free at public health centers by maternal and child health (MCH) nurses. Waiting time has been shown to contribute to negative client experiences, which may be a driver of low maternity care utilization. A recent pilot study of a program to schedule ANC visits demonstrated that scheduling care reduces waiting time and results in higher rates of complete ANC. This study aims to explore client experiences with waiting time for ANC in standard practice and care and after the introduction of appointment scheduling.MethodsThis study uses a series of qualitative interviews to unpack client experiences with ANC waiting time with and without scheduled care, in order to better understand the impact of waiting time on client experiences. Thirty-eight interviews were collected in May to June 2017 at three pilot study clinics in southern Mozambique, with a focus on two paired intervention and comparison facilities sharing similar facility characteristics. Data were analyzed using inductive thematic analysis methods using NVivo software.ResultsClients described strong motivations to seek ANC, pointing to the need to address convenience of care, and highlighted direct and indirect costs of seeking care that were exacerbated by long waiting times. Direct costs include time and transport costs of going to the clinic, while indirect costs include being unable to fulfill household and work obligations. Other barriers to complete ANC utilization of four or more visits include transport costs, negative provider experiences, and delayed ANC initiation, which limit the potential number of clinic contacts.ConclusionsFindings demonstrate that the scheduling intervention improves the client experience of seeking care by allowing women to both seek ANC and fulfill other productive obligations. Innovation in healthcare delivery should consider adapting models that minimize waiting times.

From Data to Insights: Priorities for Maturing Your Health Analytics Strategy.

Health care is ready for a transformation in how we leverage data, technology, and analytics to improve care. This requires starting off with a focus on establishing trusted data and setting clear paths within organizational cultures to accommodate and empower innovation in health care delivery with better insights from data and analytics.

1533-P: Detecting Diabetes in Africans Is Improved by Both Modifying the A1C Threshold and Adding Glycated Albumin

A1C at the standard threshold of 6.5% has been a poor predictor of diabetes (DM) in Africans. Reasons for the poor performance of A1C are myriad and include hemoglobinopathies and anemia. To begin to address challenges with A1C as a diagnostic test for Africans, there needs to be a determination that the threshold for A1C of 6.5% is appropriate. In addition, there could be value in determining if glycated albumin (GA), a non-fasting marker of glycemia not affected by hemoglobinopathies and anemia, would improve detection of DM. Therefore, we tested in Africans (a) the ability of A1C and GA independently and combined to predict DM and (b) the optimal cut-points for A1C and GA. OGTT were performed in 366 African-born blacks (age 38±10 (mean± SD); BMI 27.5 ±4.4 kg/m2) who self-identified as healthy and currently living in the Washington, DC area. Diagnosis of DM was based on glucose criteria for the OGTT. Ability of A1C and GA to predict DM was estimated by area under the receiver operating characteristic curve (AROC). Youden index established optimal cut-points for A1C and GA. Diabetes was newly diagnosed in 6% (23/366). For the prediction of DM by A1C the AROC was 0.78 (95% CI 0.68-0.88), and the optimal cut point was ≥5.8%. For the prediction of DM by GA the AROC was 0.73 (95% CI 0.61-0.85), and the optimal cut point was ≥14.05%. At these cut-points, DM was identified by A1C in 61% (14/23) (sensitivity 61%, specificity of 82%), and by GA in 65% (15/23) (sensitivity 65%, specificity 72%). The combination of A1C and GA identified DM in 83% (19/23) (sensitivity 83%, specificity 60%). Overall, the combination of A1C ≥5.8% and GA ≥14.05% markedly improved the detection of undiagnosed diabetes in Africans. Combining two non-fasting markers of glycemia at African-specific thresholds may be an important innovation in healthcare delivery. Disclosure R. Mugeni: None. S.M. Briker: None. J.Y. Aduwo: None. C. DuBose: None. A.E. Sumner: None. M.F. Horlyck-Romanovsky: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases; National Institute on Minority Health and Health Disparities

338-OR: Leveraging the Project ECHO Model for Type 1 Diabetes (T1D) in California and Florida: Democratizing Knowledge in Underserved T1D Communities

T1D care for many patients in both the pediatric and adult populations in the U.S. falls on primary care providers (PCPs). Persistently suboptimal outcomes for people with T1D and a lack of access to subspecialty care mandates the development of innovative healthcare delivery models. Using the Project ECHO (Extension for Community Healthcare Outcomes) model, Stanford University and the University of Florida partnered to develop and pilot a “ECHO T1D” teleECHOTM clinic. The goal of the pilot was to demonstrate the feasibility of an ECHO model for T1D and improve the ability of PCPs to manage patients with T1D. Utilizing a “Hub-and-Spoke” model, we recruited and partnered with PCPs at non-specialty diabetes practices across Florida and California and held weekly hour teleECHO sessions consisting of didactic presentations and case reviews. Precision recruitment methods to target clinics in remote and medically underserved regions included: (1) geocoding to identify high-need areas, (2) claims data to identify PCPs treating T1D, (3) survey data from PCPs. The 18-month pilot program is ongoing and enrollment demonstrated extremely high interest amongst PCPs as the pilot program filled beyond capacity. In California, 11 Spoke sites enrolled with 37 clinics serving roughly 900 adult and pediatric patients with T1D who do not receive specialty T1D care. In Florida, 12 Spoke sites enrolled with 67 clinics who serve roughly 1,300 patients with T1D. PCPs and their clinic staff have become local experts in T1D, providing a more informed level of care for the many patients who lack access to endocrinologists. Project ECHO T1D is an innovative healthcare delivery model which appears capable of building capacity for diabetes management education in the medically underserved. Having demonstrated proof-of-concept for ECHO T1D, future efforts will focus on replicating the model and on designing studies to demonstrate improvements in patient level outcomes. Disclosure N. Cuttriss: None. C. Anez-Zabala: None. L.G. Baer: None. A. Bernier: None. M. Basina: None. S.L. Filipp: None. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute. M.J. Gurka: None. R. Lal: Consultant; Self; Abbott. M.J. Haller: Advisory Panel; Self; Pancreum, SAB Biotherapeutics. D.M. Maahs: Advisory Panel; Self; Novo Nordisk Inc. Consultant; Self; Abbott, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. H. Hu: None. M. Town: None. E. Sheehan: None. C. Wang: None. K. Yabut: None. A.F. Walker: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Implementation of a brief screening tool to identify needs of cancer survivors.

e23075 Background: Innovation in health care delivery is needed to improve care for cancer survivors. We report a pragmatic study intended to evaluate our experience with adopting screening guidelines from the National Comprehensive Cancer Network (NCCN) to the routine care of breast cancer survivors in primary care and oncology follow up. Methods: We adapted the NCCN recommended screening questions into a plain language self-administered 1 page intake questionnaire. The tool was administered to a convenience sample of female breast cancer survivors in routine follow-up at an oncology or primary care clinic from September through December 2018. Domains included symptoms, lifestyle concerns, and financial issues. Frequency of concerns was assessed as “never”, “rarely”, “sometimes”, “very frequently” and “always”. We dichotomized results and evaluated feasibility of administration, prevalence of reported symptoms and qualitative assessment of burden as well as utility of the tool among participating clinicians. Results: 165 out of 169 patients offered the questionnaire participated (98%). Office staff provided the questionnaire at routine visits without notable impact on clinic flow. Most commonly endorsed concerns (sometimes or more) were: desire to improve fitness or nutrition (80%), worry about cancer recurrence (72%), and problems with sleep (57%). A majority also reported feeling nervous or worried (55%) and aches or pains in limbs or joints (55%). Several issues known to be underreported in clinic visits were endorsed including lack of satisfaction with sexual function (30% sometimes or more, 12% very often or always) and difficulty remembering things (47% sometimes or more, 13% very often or always). Among 7 participating clinicians, the tool was deemed useful and not burdensome. Several noted that it led to discussing issues that may not otherwise have been addressed. Suggestions included systematically identifying resources and strategies to address common issues and incorporating the tool into the electronic health record to increase utility. Conclusions: Screening for individual needs among survivors is feasible and efficient and may identify prevalent issues that otherwise can be missed in routine survivorship care.

Innovations in Health Care Delivery: Drug Allergy

This review focuses on advances in health information technology in the detection, diagnosis, and management of drug allergy. The data regarding the use of electronic health records and social media for the detection of drug allergy are reviewed, along with predictive algorithms and clinical decision support systems for drug allergy diagnosis. Drug allergy pathways, algorithms, computerized decision support systems, and computerized physician order entry for patient management are discussed. The use of electronic consults (e-consults) and telehealth in this field is described, as are efforts to improve communication among patients and providers. Future directions for research are suggested.

Evaluation of an automated process for disclosure of negative noninvasive prenatal test results.

We designed and implemented a novel automated negative non-invasive prenatal test (NIPT) result disclosure process using a proprietary, HIPAA-compliant web-based portal. High-risk pregnant patients who opted for NIPT from 04/2017 to 12/2018 were given the option to receive their negative result through the automated process. Patients were required to watch a brief educational video and answer evaluative questions before downloading their result. After completing the process, patients completed a survey regarding their opinion of the efficiency and convenience of the process and their satisfaction. A total of 10,170 women registered online during the study period, and 8,965 completed the automated process (88%). Out of 8,965 women, 2,121 women responded to the survey (24%). Most (2,030 of 2,101) strongly agreed/agreed that they could easily navigate the patient portal (97%); 1,852 of 1,966 strongly agreed/agreed that disclosure was efficient and convenient (94%); 1,852 of 1,960 strongly agreed/agreed that they felt informed after watching a short educational video (94%); and 1,903 of 1,967 strongly agreed/agreed that they preferred downloading results rather than waiting for their next doctor's appointment (97%). This study demonstrates high patient satisfaction with this automated and scalable solution in a high-volume health system. As the utilization of genetic testingincreases, we predict greater need for innovative healthcare delivery models.

BKK: Commercializing a New Drug

Dr. Brad Worthington, surgeon and anesthesiologist, has created BKK, a nonopioid surgical pain reliever. A combination of three FDA-approved drugs, BKK has beneficial properties beyond those of the individual medications of which it is made. Having obtained a patent for BKK, Worthington and his business partner, Thurman Ballard, are evaluating three paths to market, each with its own risks, costs, timelines, and possible outcomes: 1) seek venture capital investment to fund a New Drug Application for FDA approval; 2) partner with a compounding pharmacy that can manufacture and distribute the drug wholesale; or 3) develop a relationship with a manufacturer that can produce convenience kits containing all three drugs, bottled separately, with directions for mixing and administering them.This case provides a close look into the barriers to entry for new drug commercialization for an individual or small business. Innovations in healthcare delivery, medical technology, and even new drug development or new uses for existing drugs are often generated by those closest to patient carenurses, doctors, and other medical personnel. But without significant resources, even the most ingenious new ideas require entrepreneurial thinking to bring them to market. Students have the opportunity to build a decision tree and explore the qualitative and quantitative data presented to justify all three options. Which should Worthington and Ballard choose? Excerpt UVA-QA-0909 Rev. Jan. 15, 2021 BKK: Commercializing a New Drug The Decision Dr. Brad Worthington and his friend, Thurman Ballard, needed to pull the trigger on a business decision. The choice was agonizing. It was January 2018, and Worthington had spent most of the last 18 years developing, using in his anesthesia practice, and teaching others how to use BKK, his unique and proprietary formulation of nonopioid anesthesia drugs. Worthington had created BKK by combining three other drugs approved by the US Food and Drug Administration (FDA)bupivacaine, ketorolac, and ketamineto form a locally infiltrated pain reliever at the surgical site that worked for up to 40 hours. Bupivacaine was a local anesthetic sometimes used as a nerve block; ketorolac was a nonsteroidal anti-inflammatory drug (NSAID); and ketamine was a common anesthesia drug with a long and safe history. When ketamine was administered in subanesthetic doses, it was currently the best-known drug for pain relief. The unique combination in BKK had many benefits. It prevented nausea and inflammationinflammation was the cause of a significant portion of a surgical patient's painand worked so well that it greatly reduced and often eliminated the patient's need to take opioid pain relievers during and after surgery. Some peers found it hard to believe, but even patients who had undergone complicated back, neck, and joint surgeries, which normally required one- or two-night inpatient stays, reported reduced opioid use and went home shortly after surgery. Many patients did not need any opioids after their procedures. . . .

QIM19-136: Developing an Ideal CAR-T Cell Therapy Patient Experience Through Human-Centered Design and Innovation

Background: The patient/caregiver experience during CAR-T therapy is stressful, overwhelming, terrifying, and often a patient’s last treatment option. The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Innovation and Design team has worked with the CAR-T therapy clinical team to develop a patient experience that provides patients with a sense of caring, supportive environment, timely knowledge, and realistic expectations. Using a human-centered design approach, the Innovation and Design team worked with patients and caregivers to understand latent and unspoken needs in order to develop an ideal CAR-T therapy patient journey. Methods: With qualitative interviewing techniques, patient observation, and low fidelity experimentation, 21 patients/caregiver pairs were interviewed throughout their CAR-T therapy experience in 2018. Patients were interviewed at several touch points as well as encouraged to reach out to the Innovation and Design team at any point with reflections on their experiences. Patients were recruited as they began their evaluation phase for CAR-T therapy. The interviews were unscripted to allow for a breadth of discovery by not constraining the conversations to previously developed themes. As themes emerged from patient/caregiver interviews, artifacts and interventions were designed to alleviate pain points and improve the patient/caregiver experience. These artifacts and interventions were integrated into the clinical processes in real time and patient/caregivers were interviewed to understand the impact of these activities. Results: Several themes emerged from qualitative interviews with patients and caregivers. From the themes, interventions were developed. We were able to demonstrate a qualitative improvement in patient/caregiver experience through these interventions (Figure 1). Conclusions: Patients/caregivers undergoing CAR-T therapy have unique issues surrounding the logistics of care, emotional burden, and physical effects of treatment. We implemented processes to address these issues and observed a qualitative improvement via patient interviews/feedback. Ongoing work includes optimizing remote monitoring, digital platforms for patient education, and a quantitative study looking at patient reported outcomes (PROs) in such patients. To our knowledge, this is the first report for care delivery optimization in real-world practice for this new therapy.

A Qualitative Exploration of Mothers' Experiences Receiving Mental Health Services in a Supermarket Setting.

Objectives Innovative mental health care delivery models have been proposed as a method to address disparities in access and utilization. The aim of this study is to characterize patients' perspectives and experiences of participating in one such innovative delivery model, group cognitive behavioral therapy within a supermarket setting. Methods In this qualitative study, 16 mothers were interviewed to explore their experiences and perspectives of receiving group-based cognitive behavioral therapy in a supermarket setting, as part of their participation in an academic-community research collaborative whose mission is to address mental health needs within low-resourced communities. Data from semi-structured interviews were analyzed using inductive coding. Results Five themes related to receiving mental health services in a supermarket setting emerged from the data: (1) Participants reported a convergence of life stressors and their introduction to supermarket-based services; (2) Participants perceived the supermarket setting as convenient; (3) Participants perceived the supermarket setting as less stigmatizing; (4) Participants perceived services in the supermarket as an acceptable form of mental health treatment; and (5) Participants described the program staff as an influential component of their treatment experience. Conclusions Understanding patient experiences of various service delivery models is critical to improving access to treatment and addressing disparities in mental health service utilization and outcomes. This study supports the use of innovative delivery models to increase access to mental health services in low-resourced communities.

Socio-economic impact of the mHealth adoption in managing diabetes

ABSTRACTThe increasing prevalence of prediabetes and diabetes has become a serious problem in Korea. This study aims to compare the effects of various policy options for mHealth proliferation for managing and preventing diabetes. To this end, we simulate the plausible possibility of mHealth using system dynamics modelling. There are several important findings of this study that are helpful to policy makers’ decisions. First, innovative healthcare delivery through mHealth has a positive influence on health to significantly reduce prediabetes and diabetes. Moreover, the gap between the healthcare system with and without mHealth increases over time. Second, the effectiveness of mHealth adoption depends on the timing of implementation of institutional reforms. Finally, mHealth adoption can stimulate national economic growth as the demand for a new healthcare system rises.

Integration of mental health services into an innovative health care delivery model for children with chronic conditions

Coordinated Healthcare for Complex Kids (CHECK) is an innovative health care delivery demonstration project for children with chronic conditions and is supported by the Centers for Medicare and Medicaid Services Health Care Innovation Award Round Two. CHECK integrated behavioral health care into the model of comprehensive healthcare delivery. CHECK has provided a total of 31,470 services to 5923 children and their families. CHECK has provided 12,243 mental health screenings, 18,411 preventive interventions, 7511 consultative services, 2443 direct interventions, and 3105 referral services. A significant relationship was found between type of mental health service and disease and age. Children received different types of mental health services based on their type of chronic medical condition and age. CHECK is a promising model that has the potential to inform the development of future integrated health and behavioral health care service delivery models for children and youth with chronic medical conditions.

83 Can Pharmacists Effectively Manage Blood Pressure for Discharged Urban Emergency Department Patients With Uncontrolled Hypertension?

Uncontrolled hypertension (HTN) leads to severe cardiovascular morbidity, and is commonly encountered in emergency department (ED) practice. Linkage to primary care is elusive for many ED patients, specifically in underserved communities, and thus alternative modalities are needed. Pharmacist-led HTN medication management has proven effective for patients with uncontrolled BP. However, no studies to date have addressed the ability of pharmacists to manage HTN in ED patients post-discharge. The objective of this study is to assess the effectiveness of a pharmacist-led HTN management clinic in the ED population. This a prospective, single arm trial of an innovative healthcare delivery system, a pharmacist-led HTN clinic. We recruited 89 patients with uncontrolled HTN, and lack of access to primary care from our urban ED from May 24, 2017 to May 18, 2018. Per protocol, 5 follow-up visits were planned in an outpatient pharmacy clinic, where antihypertensive medications were initiated and titrated by a pharmacist, under a collaborative agreement with emergency physicians. Information regarding the patient demographics and medical history were collected. Descriptive statistics were applied with graphic display of blood pressure change. These data represent an ad hoc, interim analysis of an ongoing study. The mean age was 42.5 years old (SD=9.9); 51% were males; 94% were African American; 81% had 12th grade or more education; 53% reported full-time employment and 18% had no health insurance. The mean BMI was 34.5 and 51.2% were current smokers. The median BP at ED admission was 160/102 mmHg. Of 89 patients recruited, only 32 (35%) actually attended the first visit. Both systolic and diastolic BP declined throughout the follow-up pharmacy clinic visits with the most impact on systolic BP (Figure), which showed a mean decrease of 48 mmHg (95% confidence interval 20-77). The pharmacist made 47 medication interventions (initiation or titration) during 95 follow-up visits, for a rate of 0.49 interventions/visit. At protocol completion the mean number of antihypertensive medications per patient was 3. Preliminary results show pharmacist-led HTN management provided to ED patients post-discharge is effective at lowering BP in a clinically meaningful manner. The pharmacist was proactive in medication titration, and patients received evidence based care. Linkage between recruitment in the ED, and actual study participation was suboptimal. These data are encouraging, and provide the rationale for future larger scale studies. To better understand the potential for clinical implementation, an exploration of factors influencing the effectiveness of treatment and a comparison with usual care are needed, with special attention paid to improving ED to pharmacy transition.

There's No Place Like Home: Exploring Home-Based, Acute-Level Healthcare.

Innovative healthcare delivery models that substitute for hospital admission are key to effective healthcare reforms. Ideal alternative strategies will promote patient-centered care and alleviate the burdens of an aging population and limited healthcare funding. An emerging strategy is home-based care, with roots in physician house calls of the past, enabling acute-level care to be provided to patients within their own places of residence. This type of home healthcare better integrates with the needs and preferences of chronically ill, frail, or cognitively deficient patients, for whom a hospital admission could be stressful, disruptive, and potentially harmful. A prominent, practical example of home-based, acute-level healthcare is the Hospital at Home® (HaH)8 program. HaH was developed at Johns Hopkins University Schools of Medicine and Public Health approximately 20 years ago and has since spread to other major US and international medical centers. Dr. Bruce Leff, a leader of the HaH initiative, defined this type of care as “the community-based provision of services usually associated with acute inpatient care.” Patients presenting to the emergency room (ER) or other clinics of a hospital with an affiliated HaH program are assessed for eligibility. Those with conditions such as community-acquired pneumonia, acutely exacerbated heart failure or chronic obstructive pulmonary disease, pulmonary embolism, or cellulitis are considered, but may be excluded if, for example, they also present with uncorrectable hypoxemia or ischemic chest pain. Instead of being admitted to the hospital, eligible patients are sent home with an HaH team, consisting minimally of a physician and nurse who can develop and implement a coordinated care plan to resolve the acute episode. In addition to the HaH model, there are other ongoing initiatives to provide home-based, acute-level care to patients. For example, a collaboration within Alberta Health Services in Canada has been developed to enable emergency medical …

How the global health community will need to shift to tackle the Sustainable Development Goals

The global health goals for the 2030 Agenda for Sustainable Development is bold and ambitious. Achieving the health targets requires complete departure from the healthcare delivery standards set to meet Millennium Development Goals (MDGs). The existing health systems, particularly in low-income countries and some middle-income countries are frail and a nationally-led overhaul is needed. Nations should operate in partnership with key actors including the community. Further, innovation and high-quality evidence should drive policy decisions, clinical or public health practice and further investment in health. Only through bolstered health systems, robust partnerships and innovative healthcare delivery, lofty targets in the health sustainable development goals can be met.

Diffusion Of Innovation

Health care providers are in the midst of a massive effort to diffuse innovative approaches to patient care. While most innovations fail, a few diffuse successfully and are sustained. This month's DataGraphic describes the spread or outcomes of four important health care delivery innovations adopted by hospitals or primary care clinicians: hospital palliative care, electronic consults for preoperative anesthesiology assessment, Medicare's free annual wellness visit, and a primary care improvement network.

Interservice Physician Assistant Program: Educators for an Expanding Profession.

The number of physician assistant (PA) programs has increased exponentially across the past decade, and the demand for PAs will likely remain strong through 2025. Because of this rapid growth, both new and established PA programs face significant challenges in recruiting experienced educators. We describe the value of using PAs trained through the Interservice Physician Assistant Program (IPAP) as civilian PA educators. The literature on IPAP and its graduates proved too limited to conduct a formal systematic review. We searched the PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for works speaking to the value that IPAP-trained PAs may bring to civilian PA training. Those findings were supplemented with informal conversations with IPAP-trained PAs currently employed in the military and those working in civilian PA education. Themes were identified supporting the potential value of IPAP-trained PAs in civilian training. Military PAs work within hierarchical organizations and may transition easily to academic settings. They leave military service not only as highly trained and proficient primary care providers but also as experienced educators. Military PAs must demonstrate professionalism across their entire military careers. They serve as leaders and work in teams, but they are also experienced in negotiating up chains of command. They are trained in and apply the latest innovations in health care delivery and have provided care with a degree of autonomy uncommon in civilian PA practice. The PAs trained through IPAP leave the service with skills and experiences valuable to civilian PA training. Employing these PAs in civilian education honors their service contributions while addressing emerging PA educator workforce demands.