The Experts below are selected from a list of 25386 Experts worldwide ranked by ideXlab platform
Mark W Friedberg - One of the best experts on this subject based on the ideXlab platform.
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effect of a multipayer patient centered medical home on health care utilization and quality the rhode island chronic care Sustainability Initiative pilot program
JAMA Internal Medicine, 2013Co-Authors: Meredith B Rosenthal, Mark W Friedberg, Sara J Singer, Diana Eastman, Zhonghe Li, Eric C SchneiderAbstract:Importance The patient-centered medical home is advocated to reduce health care costs and improve the quality of care. Objective To evaluate the effects of the pilot program of a multipayer patient-centered medical home on health care utilization and quality. Design An interrupted time series design with propensity score–matched comparison practices, including multipayer claims data from 2 years before (October 1, 2006–September 30, 2008) and 2 years after (October 1, 2008–September 30, 2010) the launch of the pilot program. Uptake of the intervention was measured with audit data from the National Committee for Quality Assurance patient-centered medical home recognition process. Setting Five independent primary care practices and 3 private insurers in the Rhode Island Chronic Care Sustainability Initiative. Participants Patients in 5 pilot and 34 comparison practices. Interventions Financial support, care managers, and technical assistance for quality improvement and practice transformation. Main Outcomes and Measures Hospital admissions, emergency department visits, and 6 process measures of quality of care (3 for diabetes mellitus and 3 for colon, breast, and cervical cancer screening). Results The mean National Committee for Quality Assurance recognition scores of the pilot practices increased from 42 to 90 points of a possible 100 points. The pilot and comparison practices had statistically indistinguishable baseline patient characteristics and practice patterns, except for higher numbers of attributed member months per year in the pilot practices (31 130 per practice vs 14 779, P = .01) and lower rates of cervical cancer screening in the comparison practices. Although estimates of the emergency department visits and inpatient admissions of patients in the pilot practices trended toward lower utilization, the only significant difference was a lower rate of ambulatory care sensitive emergency department visits in the pilot practices. The Chronic Care Sustainability Initiative pilot program was associated with a reduction in ambulatory care–sensitive emergency department visits of approximately 0.8 per 1000 member months or approximately 11.6% compared with the baseline rate of 6.9 for emergency department visits per 1000 member months ( P = .002). No significant improvements were found in any of the quality measures. Conclusion and Relevance After 2 years, a pilot program of a patient-centered medical home was associated with substantial improvements in medical home recognition scores and a significant reduction in ambulatory care sensitive emergency department visits. Although not achieving significance, there were downward trends in emergency department visits and inpatient admissions.
Julie Kinley - One of the best experts on this subject based on the ideXlab platform.
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27 implementing and sustaining the delivery of quality end of life care in care homes the importance of paying attention to three layers of learning
BMJ, 2018Co-Authors: Julie Kinley, Jo HockleyAbstract:Background Implementation of organisational change is recognised to be challenging. This is particularly true in a care home where organisational, financial and care barriers are known to exist. Early research demonstrated that education in palliative care alone did not achieve organisational change. Recently, ‘high facilitation’ of end-of-life care programmes, alongside a multi-layered approach to learning, has been identified as a research-based model to support organisational change in this setting. With growing numbers of people dying in care homes providing care to meet this need is now essential. Methods A Care Home Project Team (CHPT) was commissioned to deliver an end-of-life care programme within nursing care homes (NCHs) in 2008. The CHPT provides ‘face to face’ high facilitation to NCHs to implement and then sustain the programme in practice. Both implementation and Sustainability is based on facilitating individual learning (a single person), organisational learning (the NCH staff and external professionals) and appreciative learning systems (learning across NCHs). Results All 74 NCHs and all commissioners have remained engaged with the programme. Currently 27 NCHs are implementing and 45 sustaining an end-of-life care programme (the remaining two NCHs have closed). Monthly audit data show clear improvement with 75% residents dying in the 74 NCHs in 2015/2016 compared to 57% in the 19 NCHs at the outset in 2007/8. Over time the delivery of this Initiative has varied; from a practice development model, to one incorporating clinical care: vocational qualifications and more recently piloting the use of information technology. What has remained core within the Sustainability Initiative is the multi-layered approach to learning regardless of its format. Conclusion Within a NCH the on-going provision of multi-layered learning offers the potential to develop and sustain the delivery of high quality end-of-life care that is now required within this care setting.
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a practice development Initiative supporting care home staff deliver high quality end of life care
International Journal of Palliative Nursing, 2016Co-Authors: Jo Hockley, Julie KinleyAbstract:Background: The global population is changing with an increasing percentage of the oldest old, many of whom in the UK are looked after in care homes. Care homes now provide care for a fifth of the UK population who die each year. However, most nursing care homes are privately owned and not part of the NHS, which exposes staff to a lack of skills/knowledge in relation to end-of-life care. Methods: To implement the Gold Standards Framework in Care Homes Programme and audit outcomes within nursing care homes across five Clinical Commissioning Groups over a 7–year period using a research-based model of facilitation. Results: The percentage of residents dying in nursing care homes increased from 57% to 79%, with improvement in other outcomes. Conclusions: A ‘high’ facilitation model, including a Sustainability Initiative and ongoing audit, contributed to significant improvements when implementing the Programme. Reciprocity and trustworthiness underpin the success of this Initiative.
Jo Hockley - One of the best experts on this subject based on the ideXlab platform.
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27 implementing and sustaining the delivery of quality end of life care in care homes the importance of paying attention to three layers of learning
BMJ, 2018Co-Authors: Julie Kinley, Jo HockleyAbstract:Background Implementation of organisational change is recognised to be challenging. This is particularly true in a care home where organisational, financial and care barriers are known to exist. Early research demonstrated that education in palliative care alone did not achieve organisational change. Recently, ‘high facilitation’ of end-of-life care programmes, alongside a multi-layered approach to learning, has been identified as a research-based model to support organisational change in this setting. With growing numbers of people dying in care homes providing care to meet this need is now essential. Methods A Care Home Project Team (CHPT) was commissioned to deliver an end-of-life care programme within nursing care homes (NCHs) in 2008. The CHPT provides ‘face to face’ high facilitation to NCHs to implement and then sustain the programme in practice. Both implementation and Sustainability is based on facilitating individual learning (a single person), organisational learning (the NCH staff and external professionals) and appreciative learning systems (learning across NCHs). Results All 74 NCHs and all commissioners have remained engaged with the programme. Currently 27 NCHs are implementing and 45 sustaining an end-of-life care programme (the remaining two NCHs have closed). Monthly audit data show clear improvement with 75% residents dying in the 74 NCHs in 2015/2016 compared to 57% in the 19 NCHs at the outset in 2007/8. Over time the delivery of this Initiative has varied; from a practice development model, to one incorporating clinical care: vocational qualifications and more recently piloting the use of information technology. What has remained core within the Sustainability Initiative is the multi-layered approach to learning regardless of its format. Conclusion Within a NCH the on-going provision of multi-layered learning offers the potential to develop and sustain the delivery of high quality end-of-life care that is now required within this care setting.
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a practice development Initiative supporting care home staff deliver high quality end of life care
International Journal of Palliative Nursing, 2016Co-Authors: Jo Hockley, Julie KinleyAbstract:Background: The global population is changing with an increasing percentage of the oldest old, many of whom in the UK are looked after in care homes. Care homes now provide care for a fifth of the UK population who die each year. However, most nursing care homes are privately owned and not part of the NHS, which exposes staff to a lack of skills/knowledge in relation to end-of-life care. Methods: To implement the Gold Standards Framework in Care Homes Programme and audit outcomes within nursing care homes across five Clinical Commissioning Groups over a 7–year period using a research-based model of facilitation. Results: The percentage of residents dying in nursing care homes increased from 57% to 79%, with improvement in other outcomes. Conclusions: A ‘high’ facilitation model, including a Sustainability Initiative and ongoing audit, contributed to significant improvements when implementing the Programme. Reciprocity and trustworthiness underpin the success of this Initiative.
Eric C Schneider - One of the best experts on this subject based on the ideXlab platform.
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effect of a multipayer patient centered medical home on health care utilization and quality the rhode island chronic care Sustainability Initiative pilot program
JAMA Internal Medicine, 2013Co-Authors: Meredith B Rosenthal, Mark W Friedberg, Sara J Singer, Diana Eastman, Zhonghe Li, Eric C SchneiderAbstract:Importance The patient-centered medical home is advocated to reduce health care costs and improve the quality of care. Objective To evaluate the effects of the pilot program of a multipayer patient-centered medical home on health care utilization and quality. Design An interrupted time series design with propensity score–matched comparison practices, including multipayer claims data from 2 years before (October 1, 2006–September 30, 2008) and 2 years after (October 1, 2008–September 30, 2010) the launch of the pilot program. Uptake of the intervention was measured with audit data from the National Committee for Quality Assurance patient-centered medical home recognition process. Setting Five independent primary care practices and 3 private insurers in the Rhode Island Chronic Care Sustainability Initiative. Participants Patients in 5 pilot and 34 comparison practices. Interventions Financial support, care managers, and technical assistance for quality improvement and practice transformation. Main Outcomes and Measures Hospital admissions, emergency department visits, and 6 process measures of quality of care (3 for diabetes mellitus and 3 for colon, breast, and cervical cancer screening). Results The mean National Committee for Quality Assurance recognition scores of the pilot practices increased from 42 to 90 points of a possible 100 points. The pilot and comparison practices had statistically indistinguishable baseline patient characteristics and practice patterns, except for higher numbers of attributed member months per year in the pilot practices (31 130 per practice vs 14 779, P = .01) and lower rates of cervical cancer screening in the comparison practices. Although estimates of the emergency department visits and inpatient admissions of patients in the pilot practices trended toward lower utilization, the only significant difference was a lower rate of ambulatory care sensitive emergency department visits in the pilot practices. The Chronic Care Sustainability Initiative pilot program was associated with a reduction in ambulatory care–sensitive emergency department visits of approximately 0.8 per 1000 member months or approximately 11.6% compared with the baseline rate of 6.9 for emergency department visits per 1000 member months ( P = .002). No significant improvements were found in any of the quality measures. Conclusion and Relevance After 2 years, a pilot program of a patient-centered medical home was associated with substantial improvements in medical home recognition scores and a significant reduction in ambulatory care sensitive emergency department visits. Although not achieving significance, there were downward trends in emergency department visits and inpatient admissions.
Meredith B Rosenthal - One of the best experts on this subject based on the ideXlab platform.
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effect of a multipayer patient centered medical home on health care utilization and quality the rhode island chronic care Sustainability Initiative pilot program
JAMA Internal Medicine, 2013Co-Authors: Meredith B Rosenthal, Mark W Friedberg, Sara J Singer, Diana Eastman, Zhonghe Li, Eric C SchneiderAbstract:Importance The patient-centered medical home is advocated to reduce health care costs and improve the quality of care. Objective To evaluate the effects of the pilot program of a multipayer patient-centered medical home on health care utilization and quality. Design An interrupted time series design with propensity score–matched comparison practices, including multipayer claims data from 2 years before (October 1, 2006–September 30, 2008) and 2 years after (October 1, 2008–September 30, 2010) the launch of the pilot program. Uptake of the intervention was measured with audit data from the National Committee for Quality Assurance patient-centered medical home recognition process. Setting Five independent primary care practices and 3 private insurers in the Rhode Island Chronic Care Sustainability Initiative. Participants Patients in 5 pilot and 34 comparison practices. Interventions Financial support, care managers, and technical assistance for quality improvement and practice transformation. Main Outcomes and Measures Hospital admissions, emergency department visits, and 6 process measures of quality of care (3 for diabetes mellitus and 3 for colon, breast, and cervical cancer screening). Results The mean National Committee for Quality Assurance recognition scores of the pilot practices increased from 42 to 90 points of a possible 100 points. The pilot and comparison practices had statistically indistinguishable baseline patient characteristics and practice patterns, except for higher numbers of attributed member months per year in the pilot practices (31 130 per practice vs 14 779, P = .01) and lower rates of cervical cancer screening in the comparison practices. Although estimates of the emergency department visits and inpatient admissions of patients in the pilot practices trended toward lower utilization, the only significant difference was a lower rate of ambulatory care sensitive emergency department visits in the pilot practices. The Chronic Care Sustainability Initiative pilot program was associated with a reduction in ambulatory care–sensitive emergency department visits of approximately 0.8 per 1000 member months or approximately 11.6% compared with the baseline rate of 6.9 for emergency department visits per 1000 member months ( P = .002). No significant improvements were found in any of the quality measures. Conclusion and Relevance After 2 years, a pilot program of a patient-centered medical home was associated with substantial improvements in medical home recognition scores and a significant reduction in ambulatory care sensitive emergency department visits. Although not achieving significance, there were downward trends in emergency department visits and inpatient admissions.
