ANNUAL EVIDENCE BASED PRACTICE CONFERNECE HARTFORD HOSPITAL...
Transcript of ANNUAL EVIDENCE BASED PRACTICE CONFERNECE HARTFORD HOSPITAL...
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15TH ANNUAL EVIDENCE BASED PRACTICE CONFERNECE HARTFORD HOSPITAL
HEALTH CARE REFORM: CONNECTING PRACTICE TO POLICY Donna Nickitas, PhD, RN, NEA-BC, CNE
Professor, Hunter College &
Editor, Nursing Economics
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Quote For the Day
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Session Objectives: � 1. EXPLAIN HOW EMPIRICAL EVIDENCE IS USED TO
DRIVE IMPROVEMENTS TO GAIN BETTER EFFICIENCY AND EFFECTIVENESS IN A REFORMED HEALTH CARE SYSTEM.
� 2. DESCRIBE HOW SUCCESSFULLY DRIVEN EVIDENCE OCCURS THROUGH THE HEALTH CARE SYSTEM.
� 3. ILLUSTRATE WAYS NURSES AND NURSING STUDENTS CAN ADDRESS AND ATTEND TO USING EVIDENCE TO INFLUENCE PUBLIC AND HEALTH CARE POLICY.
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TWO YEARS LATER AND ABOUT $200,000.000
YOU TOO CAN HAVE THE MAGIC OF DINSEY!!!
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FLORIDA HOSPITAL FOR CHILDREN http://www.floridahospitalforchildren.com/en
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Hospital Compare http://www.hospitalcompare.hhs.gov/
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The care experience that are particularly meaningful to patients…
� Communication with doctors
� Communication with
nurses � Communication about
medications � Responsiveness of
hospital staff
� Pain management � Quality of discharge
instructions � Cleanliness of hospital
environment � Quiet of hospital
environment
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Policy Implications
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National Database of Nursing Quality Indicators® (NDNQI®)
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What are nursing-sensitive quality indicators?
� The structure of nursing care is indicated by the supply of nursing staff, the skill level of the nursing staff, and the education/certification of nursing staff.
� Process indicators measure aspects of nursing care such as assessment, intervention, and RN job satisfaction.
� Patient outcomes that are determined to be nursing sensitive are those that improve if there is a greater quantity or quality of nursing care (e.g., pressure ulcers, falls, IV infiltrations).
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On March 23, 2010, President Obama signed H.R. 3590, the Patient Protection and Affordable Care Act
(PPACA).
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Intersection of health care reform and national reports.
� Carnegie Report, Educating Nurses: A Call for Radical Reform;
� Josiah Macy Jr. Report, Who Will Provide Primary Care and How Will They Be Trained?;
� Lancet Commissions Report, Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World;
� The Institute of
Medicine/Robert Wood Johnson Foundation (IOM/RWJF) Report, The Future of Nursing: Leading Change, Advancing Health.
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Caring for the Future Rebuild the primary care
workforce Strengthen community
health centers through new funding to support the construction of and expand services at community health centers. (ACA, 2010)
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Caring for the Future � In 2011, the law provided for free
preventive care for seniors such as annual wellness visits and personalized prevention plans;
� establishes the Community Care Transitions program to help high risk older adults who are hospitalized avoid unnecessary readmissions by coordinating care and connecting patients to services in their communities; and increased reimbursement for primary care.
� (Riegel B, Carlson B. Facilitators and barriers to heart failure self-care. Patient Educ Couns 2002; 46(4):287-95
� Rich MW. Management of Heart Failure in the elderly. Heart Fail Rev 2002; 7(1):89-97)
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Caring for the Future � In 2012, the law provides for
incentives for physicians to join together to form “Accountable Care Organizations” (ACO) effective 1/1/2012. � ACOs are provider groups, at a
minimum, primary care physicians, specialists, and hospitals, that accept responsibility for the cost and quality of care delivered to a specific population of patients cared for by the group’s clinicians. ○ (Shortell SM, Casalino LP, Fisher
ES. How the center for medicare and mediaid innovation should test accountable care organizations. Health Aff (Millwood) 2010; 29(7):1293-8)
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Caring for the Future � In 2013, the law establishes a
national pilot program to encourage hospitals, doctors, and other providers to work together to improve coordination and quality patient care.
� Beginning January 1, 2015, physicians will be paid for value not volume.
� RNs will be an integral member of the ACO team as they will develop evidence-based and content-driven strategies for standardizing and improving care coordination and care transitions.
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RN-directed programs are associated with:
� improved patient
outcomes, � reduced costs in
high volume, � stable chronically
ill populations including patients with congestive heart failure, hypertension, diabetes, and patients requiring anticoagulation therapy.
- Riegel B, Carlson B. Facilitators and
- barriers to heart failure self-care. Patient Educ Couns 2002; 46(4):287-95.
- Fanning EL. Outcomes and cost effectiveness of treating type 2 diabetes with a nurse case manager following treatment algorithms versus primary care physicians [Doctorial dissertation] Houston: The University of Texas Health Sciences Center at Houston; 2002
- Henrick A. Cost-effective outpatient management of persons with heart failure. Prog Cardiovasc Nurs 2001; 16(2):50-6
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According to the Institute of Medicine's (IOM) definition,
� Patient-Centered care is "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions (p. 6). � Institute of Medicine. Crossing the Quality
Chasm: A New Health System for the 21st Century. 1st ed. Washington D.C. :National Academy Press; 2001
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The Picker Institute has delineated eight dimensions of patient-centered care:
1. respect for the patient's values, preferences, and expressed needs;
2. information,
communication, and education;
3. access to care; 4. emotional support to
relieve fear and
anxiety;
Gerteis M., Edgman-LevitanS.,Daley J.,Delbanco T.L. Through the Patient’s Eyes: Understanding and Promoting Patient- Centered Care. 1st ed. San Francisco: Jossey-Bass; 1993
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Eight dimensions of patient-centered care continued…
Patient Centered Outcomes Research Institute to identify national priorities for health outcomes research.
5. involvement of family and friends;
6. continuity and secure transition between health care settings;
7. physical comfort; and
8. coordination and integration of care.
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An Invitation: From the Editor
� The Call for Poster Abstracts and Poster Submission Guidelines for the 5th Nursing Economics Summit are now available on the journal's web site (www.nursingeconomics.net).
� In addition, visitors can also request a registration brochure for the Summit, which will be held June 6-8, 2012 in Washington, DC. Planning for the Summit is moving along nicely. The registration brochure will be mailed and online registration will be active in January 2012.
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References � 111th Congress. Patient Protection and Affordable Care
Act. 2010; 111-1 (2nd Session) � Institute of Medicine. The future of Nursing: leading
change, advancing health. Washington D.C. : National Academies Press; 2011
� Benner P, Sutphen M., Leonard V., Day L. Educating Nurses: A call for radical transformation. San Francisco: Jossey-Bass; 2009
� Josiah Macy Jr. Foundation. Who will provide primary care and how will they be trained? New York: Josiah Macy Jr. Foundation; 2010
� Frenk J et al. Health Professionals for a new century:Transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376 (9756) : 1854-65
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References � Riegel B, Carlson B. Facilitators and barriers to heart
failure self-care. Patient Educ Couns 2002; 46(4):287-95 � Rich MW. Management of Heart Failure in the elderly.
Heart Fail Rev 2002; 7(1):89-97 � Shortell SM, Casalino LP, Fisher ES. How the center for
medicare and mediaid innovation should test accountable care organizations. Health Aff (Millwood) 2010; 29(7):1293-8
� Haas SA, Hackbarth DP. Dimensions of the staff nurse role in ambulatory care: Part III—Using research data to design new models of nursing care delivery. Nurs Econ 1995;13(4):230-41
� Fanning EL. Outcomes and cost effectiveness of treating type 2 diabetes with a nurse case manager following treatment algorithms versus primary care physicians [Doctorial dissertation] Houston: The University of Texas Health Sciences Center at Houston; 2002
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References � Henrick A. Cost-effective outpatient management of
persons with heart failure. Prog Cardiovasc Nurs 2001; 16(2):50-6
� Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. 1st ed. Washington D.C. :National Academy Press; 2001
� Gerteis M., Edgman-Levitan S.,Daley J.,Delbanco T.L. Through the Patient’s Eyes: Understanding and Promoting Patient- Centered Care. 1st ed. San Francisco: Jossey-Bass; 1993
� Haas SA. Priming the pipeline: creating aspirations for new graduate nurses to enter ambulatory care nursing roles. Nurs Econ 2009; 27(1) : 58-60.