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Sample records for advance care plans

  1. Advance care planning.

    PubMed

    Lo, Bernard

    2004-01-01

    Advance directives allow patients to have some control over decisions even when they are no longer able to make decisions themselves. All states authorize written advance directives, such as the appointment of a health care proxy, but commonly impose procedural requirements. Some states have restricted the use of oral advance directives, although they are frequently used in everyday practice. Advance directives are limited because they are infrequently used, may not be informed, and may conflict with the patient's current best interests. Moreover, surrogates often cannot state patients' preferences accurately. Furthermore, discussions among physicians and patients about advance directives are flawed. Physicians can improve discussions about advance directives by asking the patient who should serve as proxy and by ascertaining the patient's values and general preferences before discussing specific clinical situations. PMID:15538068

  2. Advance Care Planning

    Cancer.gov

    The thirteenth module of the EPEC-O (Education in Palliative and End-of-Life Care for Oncology) Self-Study: Cultural Considerations When Caring for African Americans explores the attitudes and practices of African Americans related to completion of advance directives, and recommends effective strategies to improve decision-making in the setting of serious, life-threatening illness, in ways that augment patient autonomy and support patient-centered goal-setting and decision-making among African American patients and their families.

  3. Autonomy, liberalism and advance care planning.

    PubMed Central

    Ikonomidis, S; Singer, P A

    1999-01-01

    The justification for advance directives is grounded in the notion that they extend patient autonomy into future states of incompetency through patient participation in decision making about end-of-life care. Four objections challenge the necessity and sufficiency of individual autonomy, perceived to be a defining feature of liberal philosophical theory, as a basis of advance care planning. These objections are that the liberal concept of autonomy (i) implies a misconception of the individual self, (ii) entails the denial of values of social justice, (iii) does not account for justifiable acts of paternalism, and (iv) does not account for the importance of personal relationships in the advance care planning process. The last objection is especially pertinent in light of recent empirical research highlighting the importance of personal relationships in advance care planning. This article examines these four objections to autonomy, and the liberal theoretical framework with which it is associated, in order to re-evaluate the philosophical basis of advance care planning. We argue that liberal autonomy (i) is not a misconceived concept as critics assume, (ii) does not entail the denial of values of social justice, (iii) can account for justifiable acts of paternalism, though it (iv) is not the best account of the value of personal relationships that arise in advance care planning. In conclusion, we suggest that liberalism is a necessary component of a theoretical framework for advance care planning but that it needs to be supplemented with theories that focus explicitly on the significance of personal relationships. PMID:10635509

  4. Advance Care Planning for Serious Illness

    MedlinePlus

    ... conversations Caring Connections National Hospice and Palliative Care Organization Links to every state’s advance care directive forms http: / / www. caringinfo. org/ i4a/ pages/ index. cfm? ...

  5. Advance care planning in South Korea: Social work perspective.

    PubMed

    Kwon, Sung Ae; Kolomer, Stacey

    2016-08-01

    As ethical issues arise concerning the continuation of futile medical treatment for dying patients in Korean society, advance directive planning initiatives have been put into place to guide practice. This article describes the awareness and attitudes of social workers in Korea regarding advance care planning and related factors. A total of 246 gerontological/geriatric social workers completed a mailed or in-person survey regarding awareness and attitudes toward advance care planning. Seventy-three percent (n = 180) of the participants reported no knowledge of advance directives. Social workers who emphasized self-determination as a professional value, professed a preference for hospice care, and who were comfortable discussing death were more likely to have a positive attitudes toward advance care planning. This study reinforces the need for the infusion of advance care planning and end-of-life training in social work education in Korea. PMID:27428654

  6. Advanced Directives and Advanced Care Planning for Healthcare Professionals.

    PubMed

    Booth, Adam T; Lehna, Carlee

    2016-01-01

    The purposes of this study were to assess healthcare professionals' need for information on advanced directives and to implement and evaluate an educational plan for change in knowledge and behaviors related to advanced directives. End-of-life (EOL) care is an important topic for patients to discuss with their families and healthcare professionals (HP). Needs assessment data were collected from healthcare providers at an urban trauma intensive care unit (ICU) in Louisville, Kentucky on concepts related to end-of-life. Next, healthcare professionals participated in an educational intervention focused on: knowledge about advanced directives; communication techniques for healthcare professionals to use with patients and their families; awareness of the patient's level of illness in advanced care planning; and specifics about living wills in Kentucky and how to complete one. Pre- and post-test data were collected to evaluate change in knowledge, capability an average of 8.7 years (SD = 9.1; range = 1.9-35 years) in healthcare and worked an average of 8.4 years (SD = 9.3; range = 4 months to 35 years) in their respective ICUs. Eighty-seven percent did not have an AD in place even though their perceived knowledge about AD remained moderate throughout pre- and post-test scores (3.3 to 3.8 on a 5 point scale, respectively). Total post-test scores revealed a 2% improvement in correct responses. These findings point to the need for education of healthcare providers in the ICU to increase early AD and ACP discussions with patients and their families. PMID:27183766

  7. Adversaries at the Bedside: Advance Care Plans and Future Welfare.

    PubMed

    Kestigian, Aidan; London, Alex John

    2016-10-01

    Advance care planning refers to the process of determining how one wants to be cared for in the event that one is no longer competent to make one's own medical decisions. Some have argued that advance care plans often fail to be normatively binding on caretakers because those plans do not reflect the interests of patients once they enter an incompetent state. In this article, we argue that when the core medical ethical principles of respect for patient autonomy, honest and adequate disclosure of information, institutional transparency, and concern for patient welfare are upheld, a policy that would allow for the disregard of advance care plans is self-defeating. This is because when the four principles are upheld, a patient's willingness to undergo treatment depends critically on the willingness of her caretakers to honor the wishes she has outlined in her advance care plan. A patient who fears that her caretakers will not honor her wishes may choose to avoid medical care so as to limit the influence of her caretakers in the future, which may lead to worse medical outcomes than if she had undergone care. In order to avoid worse medical outcomes and uphold the four core principles, caregivers who are concerned about the future welfare of their patients should focus on improving advance care planning and commit to honoring their patients' advance care plans. PMID:27212709

  8. Adversaries at the Bedside: Advance Care Plans and Future Welfare.

    PubMed

    Kestigian, Aidan; London, Alex John

    2016-10-01

    Advance care planning refers to the process of determining how one wants to be cared for in the event that one is no longer competent to make one's own medical decisions. Some have argued that advance care plans often fail to be normatively binding on caretakers because those plans do not reflect the interests of patients once they enter an incompetent state. In this article, we argue that when the core medical ethical principles of respect for patient autonomy, honest and adequate disclosure of information, institutional transparency, and concern for patient welfare are upheld, a policy that would allow for the disregard of advance care plans is self-defeating. This is because when the four principles are upheld, a patient's willingness to undergo treatment depends critically on the willingness of her caretakers to honor the wishes she has outlined in her advance care plan. A patient who fears that her caretakers will not honor her wishes may choose to avoid medical care so as to limit the influence of her caretakers in the future, which may lead to worse medical outcomes than if she had undergone care. In order to avoid worse medical outcomes and uphold the four core principles, caregivers who are concerned about the future welfare of their patients should focus on improving advance care planning and commit to honoring their patients' advance care plans.

  9. Ethics and advance care planning in a culturally diverse society.

    PubMed

    Johnstone, Megan-Jane; Kanitsaki, Olga

    2009-10-01

    Emerging international research suggests that in multicultural countries, such as Australia and the United States, there are significant disparities in end-of-life care planning and decision making by people of minority ethnic backgrounds compared with members of mainstream English-speaking background populations. Despite a growing interest in the profound influence of culture and ethnicity on patient choices in end-of-life care, and the limited uptake of advance care plans and advance directives by ethnic minority groups in mainstream health care contexts, there has been curiously little attention given to cross-cultural considerations in advance care planning and end-of-life care. Also overlooked are the possible implications of cross-cultural considerations for nurses, policy makers, and others at the forefront of planning and providing end-of-life care to people of diverse cultural and language backgrounds. An important aim of this article is to redress this oversight.

  10. Advance care planning: thinking ahead to achieve our patients' goals.

    PubMed

    Cairns, Rosemary

    2011-09-01

    The End of Life Care Strategy for England describes advance care planning (ACP) as a 'voluntary process of discussion about future care...concerns and wishes...values or personal goals for care, their understanding of their illness and prognosis...wishes for types of care or treatment and the availability of these' (Department of Health (DH), 2008). In Scotland, Living and Dying Well: Building on Progress (Scottish Government (SG), 2011) referred to adopting a 'thinking ahead' philosophy.

  11. Legal Briefing: Medicare Coverage of Advance Care Planning.

    PubMed

    Pope, Thaddeus Mason

    2015-01-01

    This issue's "Legal Briefing" column covers the recent decision by the Centers for Medicare and Medicaid Services (CMS) to expand Medicare coverage of advance care planning, beginning 1 January 2016. Since 2009, most "Legal Briefings" in this journal have covered a wide gamut of judicial, legislative, and regulatory developments concerning a particular topic in clinical ethics. In contrast, this "Legal Briefing" is more narrowly focused on one single legal development. This concentration on Medicare coverage of advance care planning seems warranted. Advance care planning is a frequent subject of articles in JCE. After all, it has long been seen as an important, albeit only partial, solution to a significant range of big problems in clinical ethics. These problems range from medical futility disputes to decision making for incapacitated patients who have no available legally authorized surrogate. Consequently, expanded Medicare coverage of advance care planning is a potentially seismic development. It may materially reduce both the frequency and severity of key problems in clinical ethics. Since the sociological, medical, and ethical literature on advance care planning is voluminous, I will not even summarize it here. Instead, I focus on Medicare coverage. I proceed, chronologically, in six stages: 1. Prior Medicare Coverage of Advance Care Planning 2. Proposed Expanded Medicare Coverage in 2015 3. Proposed Expanded Medicare Coverage in 2016 4. The Final Rule Expanding Medicare Coverage in 2016 5. Remaining Issues for CMS to Address in 2017 6. Pending Federal Legislation.

  12. Legal Briefing: Medicare Coverage of Advance Care Planning.

    PubMed

    Pope, Thaddeus Mason

    2015-01-01

    This issue's "Legal Briefing" column covers the recent decision by the Centers for Medicare and Medicaid Services (CMS) to expand Medicare coverage of advance care planning, beginning 1 January 2016. Since 2009, most "Legal Briefings" in this journal have covered a wide gamut of judicial, legislative, and regulatory developments concerning a particular topic in clinical ethics. In contrast, this "Legal Briefing" is more narrowly focused on one single legal development. This concentration on Medicare coverage of advance care planning seems warranted. Advance care planning is a frequent subject of articles in JCE. After all, it has long been seen as an important, albeit only partial, solution to a significant range of big problems in clinical ethics. These problems range from medical futility disputes to decision making for incapacitated patients who have no available legally authorized surrogate. Consequently, expanded Medicare coverage of advance care planning is a potentially seismic development. It may materially reduce both the frequency and severity of key problems in clinical ethics. Since the sociological, medical, and ethical literature on advance care planning is voluminous, I will not even summarize it here. Instead, I focus on Medicare coverage. I proceed, chronologically, in six stages: 1. Prior Medicare Coverage of Advance Care Planning 2. Proposed Expanded Medicare Coverage in 2015 3. Proposed Expanded Medicare Coverage in 2016 4. The Final Rule Expanding Medicare Coverage in 2016 5. Remaining Issues for CMS to Address in 2017 6. Pending Federal Legislation. PMID:26752396

  13. Promoting perioperative advance care planning: a systematic review of advance care planning decision aids.

    PubMed

    Aslakson, Rebecca A; Schuster, Anne L R; Reardon, Jessica; Lynch, Thomas; Suarez-Cuervo, Catalina; Miller, Judith A; Moldovan, Rita; Johnston, Fabian; Anton, Blair; Weiss, Matthew; Bridges, John F P

    2015-11-01

    This systematic review identifies possible decision aids that promote perioperative advance care planning (ACP) and synthesizes the available evidence regarding their use. Using PubMed, EMBASE, Cochrane, SCOPUS, Web of Science, CINAHL, PsycINFO and Sociological Abstracts, researchers identified and screened articles for eligibility. Data were abstracted and risk of bias assessed for included articles. Thirty-nine of 5327 articles satisfied the eligibility criteria. Primarily completed in outpatient ambulatory populations, studies evaluated a variety of ACP decision aids. None were evaluated in a perioperative population. Fifty unique outcomes were reported with no head-to-head comparisons conducted. Findings are likely generalizable to a perioperative population and can inform development of a perioperative ACP decision aid. Future studies should compare the effectiveness of ACP decision aids.

  14. The Evolution of Health Care Advance Planning Law and Policy

    PubMed Central

    Sabatino, Charles P

    2010-01-01

    Context: The legal tools of health care advance planning have substantially changed since their emergence in the mid-1970s. Thirty years of policy development, primarily at the state legislative level addressing surrogate decision making and advance directives, have resulted in a disjointed policy landscape, yet with important points of convergence evolving over time. An understanding of the evolution of advance care planning policy has important implications for policy at both the state and federal levels. Methods: This article is a longitudinal statutory and literature review of health care advance planning from its origins to the present. Findings: While considerable variability across the states still remains, changes in law and policy over time suggest a gradual paradigm shift from what is described as a “legal transactional approach” to a “communications approach,” the most recent extension of which is the emergence of Physician Orders for Life-Sustaining Treatment, or POLST. The communications approach helps translate patients’ goals into visible and portable medical orders. Conclusions: States are likely to continue gradually moving away from a legal transactional mode of advance planning toward a communications model, albeit with challenges to authentic and reliable communication that accurately translates patients’ wishes into the care they receive. In the meantime, the states and their health care institutions will continue to serve as the primary laboratory for advance care planning policy and practice. PMID:20579283

  15. The need for safeguards in advance care planning.

    PubMed

    Billings, J Andrew

    2012-05-01

    The recent uproar about Medicare "death panels" draws attention to public and professional concerns that advance care planning might restrict access to desired life-sustaining care. The primary goal of advance care planning is to promote the autonomy of a decisionally incapacitated patient when choices about life-sustaining treatments are encountered, but the safety of this procedure has not received deserved scrutiny. Patients often do not understand their decisions or they may change their mind without changing their advance care directives. Likewise, concordance between patients' wishes and the understanding of the physicians and surrogate decision makers who need to represent these wishes is disappointingly poor. A few recent reports show encouraging outcomes from advance care planning, but most studies indicate that the procedure is ineffective in protecting patients from unwanted treatments and may even undermine autonomy by leading to choices that do not reflect patient values, goals, and preferences. Safeguards for advance care planning should be put in place, such as encouraging physicians to err on the side of preserving life when advance care directives are unclear, requiring a trained advisor to review non-emergent patient choices to limit life-sustaining treatment, training of clinicians in conducting such conversations, and structured discussion formats that first address values and goals rather than particular life-sustaining procedures. Key targets for research include: how to improve completion rates for person wanting advance care directives, especially among minorities; more effective and standardized approaches to advance care planning discussions, including how best to present prognostic information to patients; methods for training clinicians and others to assist patients in this process; and systems for assuring that directives are available and up-to-date.

  16. Advance Care Planning in Nursing Homes: Correlates of Capacity and Possession of Advance Directives

    ERIC Educational Resources Information Center

    Allen, Rebecca S.; DeLaine, Shermetra R.; Chaplin, William F.; Marson, Daniel C.; Bourgeois, Michelle S.; Dijkstra, Katinka; Burgio, Louis D.

    2003-01-01

    Purpose: The identification of nursing home residents who can continue to participate in advance care planning about end-of-life care is a critical clinical and bioethical issue. This study uses high quality observational research to identify correlates of advance care planning in nursing homes, including objective measurement of capacity. Design…

  17. Pediatric advance care planning from the perspective of health care professionals: A qualitative interview study

    PubMed Central

    Jox, Ralf J; Borasio, Gian Domenico; Führer, Monika

    2015-01-01

    Background: Pediatric advance care planning differs from the adult setting in several aspects, including patients’ diagnoses, minor age, and questionable capacity to consent. So far, research has largely neglected the professionals’ perspective. Aim: We aimed to investigate the attitudes and needs of health care professionals with regard to pediatric advance care planning. Design: This is a qualitative interview study with experts in pediatric end-of-life care. A qualitative content analysis was performed. Setting/participants: We conducted 17 semi-structured interviews with health care professionals caring for severely ill children/adolescents, from different professions, care settings, and institutions. Results: Perceived problems with pediatric advance care planning relate to professionals’ discomfort and uncertainty regarding end-of-life decisions and advance directives. Conflicts may arise between physicians and non-medical care providers because both avoid taking responsibility for treatment limitations according to a minor’s advance directive. Nevertheless, pediatric advance care planning is perceived as helpful by providing an action plan for everyone and ensuring that patient/parent wishes are respected. Important requirements for pediatric advance care planning were identified as follows: repeated discussions and shared decision-making with the family, a qualified facilitator who ensures continuity throughout the whole process, multi-professional conferences, as well as professional education on advance care planning. Conclusion: Despite a perceived need for pediatric advance care planning, several barriers to its implementation were identified. The results remain to be verified in a larger cohort of health care professionals. Future research should focus on developing and testing strategies for overcoming the existing barriers. PMID:25389347

  18. An unequivocal good? Acknowledging the complexities of advance care planning.

    PubMed

    Robins-Browne, K; Palmer, V; Komesaroff, P

    2014-10-01

    Over the past few decades advance care planning (ACP) has become the subject of debate, research and legislation in many countries. Encouraging people to express their preference for treatment in advance, ideally in written form, seems a natural way to identify what someone might have wanted when they can no longer participate in decision-making. The notion of ACP as an unequivocal good permeates much of the research and policy work in this area. For example, ACP is now actively encouraged in Australian federal and state government policies and the Victorian Government has recently published a practical ACP strategy for Victorian health services (2014-2018). However, advance care plan is ethically complex and the introduction of the Victorian health services strategy provides an opportunity to reflect on this complexity, particularly on the benefits and risks of ACP.

  19. Future care planning: a first step to palliative care for all patients with advanced heart disease.

    PubMed

    Denvir, M A; Murray, S A; Boyd, K J

    2015-07-01

    Palliative care is recommended for patients with end-stage heart failure with several recent, randomised trials showing improvements in symptoms and quality of life and more studies underway. Future care planning provides a framework for discussing a range of palliative care problems with patients and their families. This approach can be introduced at any time during the patient's journey of care and ideally well in advance of end-of-life care. Future care planning is applicable to a wide range of patients with advanced heart disease and could be delivered systematically by cardiology teams at the time of an unplanned hospital admission, akin to cardiac rehabilitation for myocardial infarction. Integrating cardiology care and palliative care can benefit many patients with advanced heart disease at increased risk of death or hospitalisation. Larger, randomised trials are needed to assess the impact on patient outcomes and experiences.

  20. Advance Care Planning among People Living with Dialysis

    PubMed Central

    Elliott, Barbara A.; Gessert, Charles E.

    2016-01-01

    Purpose: Recent nephrology literature focuses on the need for discussions regarding advance care planning (ACP) for people living with dialysis (PWD). PWD and their family members’ attitudes toward ACP and other aspects of late-life decision making were assessed in this qualitative study. Methodology: Thirty-one interviews were completed with 20 PWD over the age of 70 (mean dialysis 34 months) and 11 family members, related to life experiences, making medical decisions, and planning for the future. Interviews were recorded, transcribed and analyzed. Findings: Four themes regarding ACP emerged from this secondary analysis of the interviews: how completing ACP, advance directives (AD), and identifying an agent fit into PWD experiences; PWD understanding of their prognosis; what gives PWD lives meaning and worth; and PWD care preferences when their defined meaning and worth are not part of their experience. These PWD and family members revealed that ACP is ongoing and common among them. They did not seem to think their medical providers needed to be part of these discussions, since family members were well informed. Practical implications: These results suggest that if health care providers and institutions need AD forms completed, it will important to work with both PWD and their family members to assure personal wishes are documented and honored. PMID:27417605

  1. Disentangling consumer and provider predictors of advance care planning.

    PubMed

    Baughman, Kristin R; Ludwick, Ruth; Merolla, David; Palmisano, Barbara; Hazelett, Susan; Allen, Kyle R; Sanders, Margaret

    2013-11-01

    Factorial surveys were used to examine community-based long-term care providers' judgments about consumers' need for advance care planning (ACP) and comfort levels in discussing ACP. Providers (448 registered nurses and social workers) judged vignettes based on hypothetical consumers. Hierarchical linear models indicated providers judged consumers who were older, had end-stage diagnoses, multiple emergency department visits, and uninvolved caregivers as most in need of ACP. These variables explained 10% of the variance in judgments. Providers' beliefs about ACP predicted judgments of need for ACP and comfort level in discussing ACP. Provider characteristics explained more variance in comfort levels (44%) than in judgments of need (20%). This study demonstrates the need for tailored educational programs to increase comfort levels and address ACP misconceptions.

  2. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    PubMed

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population.

  3. Advance care planning for cancer patients in primary care: a feasibility study

    PubMed Central

    Boyd, Kirsty; Mason, Bruce; Kendall, Marilyn; Barclay, Stephen; Chinn, David; Thomas, Keri; Sheikh, Aziz; Murray, Scott A

    2010-01-01

    Background Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging. Aim To assess the feasibility of implementing advance care planning in UK primary care. Design of study Mixed methods evaluation of a pilot educational intervention. Setting Four general practices in south-east Scotland. Method Interviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK. Results End-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a ‘good death’. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of ‘tick-box’ approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care. Conclusion A clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes. PMID:21144189

  4. Advance care planning: identifying system-specific barriers and facilitators

    PubMed Central

    Hagen, N.A.; Howlett, J.; Sharma, N.C.; Biondo, P.; Holroyd-Leduc, J.; Fassbender, K.; Simon, J.

    2015-01-01

    Background Advance care planning (acp) is an important process in health care today. How to prospectively identify potential local barriers and facilitators to uptake of acp across a complex, multi-sector, publicly funded health care system and how to develop specific mitigating strategies have not been well characterized. Methods We surveyed a convenience sample of clinical and administrative health care opinion leaders across the province of Alberta to characterize system-specific barriers and facilitators to uptake of acp. The survey was based on published literature about the barriers to and facilitators of acp and on the Michie Theoretical Domains Framework. Results Of 88 surveys, 51 (58%) were returned. The survey identified system-specific barriers that could challenge uptake of acp. The factors were categorized into four main domains. Three examples of individual system-specific barriers were “insufficient public engagement and misunderstanding,” “conflict among different provincial health service initiatives,” and “lack of infrastructure.” Local system-specific barriers and facilitators were subsequently explored through a semi-structured informal discussion group involving key informants. The group identified approaches to mitigate specific barriers. Conclusions Uptake of acp is a priority for many health care systems, but bringing about change in multi-sector health care systems is complex. Identifying system-specific barriers and facilitators to the uptake of innovation are important elements of successful knowledge translation. We developed and successfully used a simple and inexpensive process to identify local system-specific barriers and enablers to uptake of acp, and to identify specific mitigating strategies. PMID:26300673

  5. Strategic targeting of advance care planning interventions: the Goldilocks phenomenon.

    PubMed

    Billings, J Andrew; Bernacki, Rachelle

    2014-04-01

    Strategically selecting patients for discussions and documentation about limiting life-sustaining treatments-choosing the right time along the end-of-life trajectory for such an intervention and identifying patients at high risk of facing end-of-life decisions-can have a profound impact on the value of advance care planning (ACP) efforts. Timing is important because the completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient's values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. Because much of the currently studied ACP efforts have led to a disappointingly small proportion of patients eventually benefitting from an AD, careful targeting of the intervention should also improve the efficacy of such projects. A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions. PMID:24493203

  6. Strategic targeting of advance care planning interventions: the Goldilocks phenomenon.

    PubMed

    Billings, J Andrew; Bernacki, Rachelle

    2014-04-01

    Strategically selecting patients for discussions and documentation about limiting life-sustaining treatments-choosing the right time along the end-of-life trajectory for such an intervention and identifying patients at high risk of facing end-of-life decisions-can have a profound impact on the value of advance care planning (ACP) efforts. Timing is important because the completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient's values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. Because much of the currently studied ACP efforts have led to a disappointingly small proportion of patients eventually benefitting from an AD, careful targeting of the intervention should also improve the efficacy of such projects. A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions.

  7. Reliability of an interactive computer program for advance care planning.

    PubMed

    Schubart, Jane R; Levi, Benjamin H; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

    2012-06-01

    Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83-0.95, and 0.86-0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830

  8. Reliability of an Interactive Computer Program for Advance Care Planning

    PubMed Central

    Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

    2012-01-01

    Abstract Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83–0.95, and 0.86–0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830

  9. An overview of advance care planning for patients with advanced chronic kidney disease: The basics.

    PubMed

    Wasylynuk, Betty Ann; Davison, Sara N

    2016-01-01

    As the number of Canadians living with end-stage kidney disease (ESKD) continues to grow, even higher numbers are living with advanced chronic kidney disease (CKD). Many of these people will eventually require renal replacement therapy (RRT), either dialysis or transplantation. More than 50% of patients starting RRT today are aged 65 or older, with the fastest growing group being patients 75 years and older. Despite advances to dialysis technology and dialysis care, the mortality rates remain high and dialysis patients' end-of-life care may not align with their preferences or values. Advance care planning (ACP) is an essential component of quality comprehensive kidney care. Kidney care teams develop strong relationships with their patients and are well positioned to integrate ACP into routine kidney care. This article defines ACP, outlines the essential components of ACP, and discusses the benefits, challenges, and special considerations of ACP. By enhancing the kidney care team's understanding of ACP, this article aims to assist in integrating ACP into routine kidney care for patients with advanced CKD. PMID:27215058

  10. Care of Patients at the End of Life: Advance Care Planning.

    PubMed

    Ackermann, Richard J

    2016-08-01

    Advance directives are legal documents that give instructions about how to provide care when patients develop life-threatening illnesses and can no longer communicate their wishes. Two types of documents are widely used-a living will and a durable power of attorney for health care. Most states also authorize physician orders for life-sustaining treatment. Physicians should encourage patients, particularly those with severe chronic or terminal conditions, to prepare advance directives. Medicare now reimburses billing codes for advance care consultations. Directions regarding cardiopulmonary resuscitation and artificial ventilation often are included in advance care plans, and use of artificial nutrition and hydration (ANH) also should be addressed, particularly for patients with advanced dementia. Evidence shows that in such patients, ANH does not prolong survival, increase comfort, or improve quality of life. Given the lack of benefit, physicians should recommend against use of ANH for patients with dementia. Finally, physicians should encourage use of hospice services by patients whose life expectancy is 6 months or less. Although Medicare and most other health care insurers cover hospice care, and despite evidence that patient and family satisfaction increase when hospice services are used, many patients do not use these services. PMID:27490070

  11. Education and Advance Care Planning in Nursing Homes: The Impact of Ownership Type.

    ERIC Educational Resources Information Center

    Walker, Leslie C.; Bradley, Elizabeth H.

    1998-01-01

    A study of 25 nonprofit and 87 for-profit nursing homes showed both types likely to offer education on advance care planning. However, nonprofits were more likely to have ongoing discussions that covered more than life support decisions and to have ethics committees to support advance care planning. (SK)

  12. Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process.

    PubMed

    Baughman, Kristin R; Aultman, Julie; Hazelett, Susan; Palmisano, Barbara; O'Neill, Anne; Ludwick, Ruth; Sanders, Margaret

    2012-01-01

    To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.

  13. The Era of “E”: The Use of New Technologies in Advance Care Planning

    PubMed Central

    Green, Michael J.; Levi, Benjamin H.

    2012-01-01

    In this paper, we review developments in technology that can help patients, their loved ones, and healthcare providers engage in more effective advance care planning (ACP). We begin with a brief description of ACP and its purpose; then proceed to discuss various electronically available resources for ACP in the U.S.; and finally provide a critical assessment of the achievements, challenges, and future prospects for electronic advance care planning, or “e-planning.” PMID:23141197

  14. The era of "e": the use of new technologies in advance care planning.

    PubMed

    Green, Michael J; Levi, Benjamin H

    2012-01-01

    In this article, the authors review developments in technology that can help patients, their loved ones, and healthcare providers engage in more effective advance care planning (ACP). The article begins with a brief description of ACP and its purpose and then discusses various electronically available resources for ACP in the U.S. Finally the authors provide a critical assessment of the achievements, challenges, and future prospects for electronic advance care planning, or "e-planning."

  15. The views of older Malaysians on advanced directive and advanced care planning: a qualitative study.

    PubMed

    Htut, Y; Shahrul, K; Poi, P J H

    2007-01-01

    The provision of optimum care for the ageing population is dependent on the understanding of their views and values on end of life issues. A qualitative descriptive study was conducted to describe views of elderly Malaysians on Advanced Care Planning (henceforth ACP) and Advanced Directives (henceforth AD), and explore factors influencing these views. Fifteen elderly subjects with ages ranging from 65 to 83 years, representing different ethnic and religious groups in Malaysia were selected for in-depth interviews guided by a questionnaire. Five core themes were extracted from the interviews: 1) Considering the future 2) Contingency plans for future illnesses 3) Attitudes towards life prolonging treatment procedures 4) Doctor-patient relationships and 5) Influence of religion on decisions related to future illness. Despite the lack of knowledge on ACP and AD, older respondents were very receptive to their concept. Although the majority agreed on the importance of planning for future medical management and having open discussion on end of life issues with their doctor, they felt it unnecessary to make a formal written AD. Most felt that the future was best left to fate or God, and none had made any contingency plan for severe future illnesses citing religion as reason for this view. Cardiopulmonary resuscitation, mechanical ventilation and dialysis were considered by most to be invasive life prolonging treatments. We suggest that doctors initiate discussions on end of life care with every older patient and their family so as to promote awareness and introduce the concept of ACP/AD to a Malaysian setting.

  16. Decision aids for advance care planning: an overview of the state of the science.

    PubMed

    Butler, Mary; Ratner, Edward; McCreedy, Ellen; Shippee, Nathan; Kane, Robert L

    2014-09-16

    Advance care planning honors patients' goals and preferences for future care by creating a plan for when illness or injury impedes the ability to think or communicate about health decisions. Fewer than 50% of severely or terminally ill patients have an advance directive in their medical record, and physicians are accurate only about 65% of the time when predicting patient preferences for intensive care. Decision aids can support the advance care planning process by providing a structured approach to informing patients about care options and prompting them to document and communicate their preferences. This review, commissioned as a technical brief by the Agency for Healthcare Research and Quality Effective Health Care Program, provides a broad overview of current use of and research related to decision aids for adult advance care planning. Using interviews of key informants and a search of the gray and published literature from January 1990 to May 2014, the authors found that many decision aids are widely available but are not assessed in the empirical literature. The 16 published studies testing decision aids as interventions for adult advance care planning found that most are proprietary or not publicly available. Some are constructed for the general population, whereas others address disease-specific conditions that have more predictable end-of-life scenarios and, therefore, more discrete choices. New decision aids should be designed that are responsive to diverse philosophical perspectives and flexible enough to change as patients gain experience with their personal illness courses. Future efforts should include further research, training of advance care planning facilitators, dissemination and access, and tapping potential opportunities in social media or other technologies. PMID:25069709

  17. Learning to Facilitate Advance Care Planning: The Novice Social Worker's Experience

    ERIC Educational Resources Information Center

    Washington, Karla; Bowland, Sharon; Mueggenburg, Kay; Pederson, Margaret; Otten, Sheila; Renn, Tanya

    2014-01-01

    Professional leaders have identified clear roles for social workers involved in advance care planning (ACP), a facilitated process whereby individuals identify their preferences for future medical care; yet information about effective teaching practices in this area is scant. This study reports on the experiences of 14 social workers who…

  18. An Assessment of Social Diffusion in the Respecting Choices Advance Care Planning Program

    ERIC Educational Resources Information Center

    Moorman, Sara M.; Carr, Deborah; Kirchhoff, Karin T.; Hammes, Bernard J.

    2012-01-01

    This study examines the potential social diffusion effects of the Respecting Choices advance care planning program administered in La Crosse, Wisconsin, since 1991. The program produces educational materials for patients, trains facilitators to help patients prepare for end of life, and ensures that advance directives are connected to patients'…

  19. Advance care directives

    MedlinePlus

    ... advance directive; Do-not-resuscitate - advance directive; Durable power of attorney - advance care directive; POA - advance care directive; Health care agent - advance care directive; Health care proxy - ...

  20. Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer

    PubMed Central

    Tisnado, Diana M.; Walling, Anne M.; Dy, Sydney M.; Asch, Steven M.; Ettner, Susan L.; Kim, Benjamin; Pantoja, Philip; Schreibeis-Baum, Hannah C.; Lorenz, Karl A.

    2015-01-01

    Abstract Background: Early patient-physician care planning discussions may influence the intensity of end-of-life (EOL) care received by veterans with advanced cancer. Objective: The study objective was to evaluate the association between medical record documentation of patient-physician care planning discussions and intensity of EOL care among veterans with advanced cancer. Methods: This was a retrospective cohort study. Subjects were 665 veteran decedents diagnosed with stage IV colorectal, lung, or pancreatic cancer in 2008, and followed till death or the end of the study period in 2011. We estimated the effect of patient-physician care planning discussions documented within one month of metastatic diagnosis on the intensity of EOL care measured by receipt of acute care, intensive interventions, chemotherapy, and hospice care, using multivariate logistic regression models. Results: Veterans in our study were predominantly male (97.1%), white (74.7%), with an average age at diagnosis of 66.4 years. Approximately 31% received some acute care, 9.3% received some intensive intervention, and 6.5% had a new chemotherapy regimen initiated in the last month of life. Approximately 41% of decedents received no hospice or were admitted within three days of death. Almost half (46.8%) had documentation of a care planning discussion within the first month after diagnosis and those who did were significantly less likely to receive acute care at EOL (OR: 0.67; p=0.025). Documented discussions were not significantly associated with intensive interventions, chemotherapy, or hospice care. Conclusion: Early care planning discussions are associated with lower rates of acute care use at the EOL in a system with already low rates of intensive EOL care. PMID:26186553

  1. Advance Care Planning and Goals of Care Communication in Older Adults with Cardiovascular Disease and Multi-Morbidity.

    PubMed

    Lum, Hillary D; Sudore, Rebecca L

    2016-05-01

    This article provides an approach to advance care planning (ACP) and goals of care communication in older adults with cardiovascular disease and multi-morbidity. The goal of ACP is to ensure that the medical care patients receive is aligned with their values and preferences. In this article, the authors outline common benefits and challenges to ACP for older adults with cardiovascular disease and multimorbidity. Recognizing that these patients experience diverse disease trajectories and receive care in multiple health care settings, the authors provide practical steps for multidisciplinary teams to integrate ACP into brief clinic encounters.

  2. Embracing a broad spirituality in end of life discussions and advance care planning.

    PubMed

    Churchill, Larry R

    2015-04-01

    Advance care planning for end of life typically focuses on the mechanics of completing living wills and durable power of attorney documents. Even when spiritual aspects of end of life care are discussed, the dominant assumptions are those of traditional religious systems. A broad view of spirituality is needed, one that may involve traditional religious beliefs but also includes personal understandings of what is holy or sacred. Embracing this broad practice of spirituality will help both familial and professional caregivers honor an essential aspect of end of life discussions and promote greater discernment of the deep meaning in advance care documents.

  3. Advance care planning in nursing homes: pre- and post-Patient Self-Determination Act.

    PubMed Central

    Castle, N G; Mor, V

    1998-01-01

    OBJECTIVES: (1) To identify resident and organizational factors associated with the use of advance care plans pre- and post-implementation of the Patient Self-Determination Act (PSDA), and (2) to identify changes (pre- and post-implementation of the PSDA) in the relationship between these factors and the use of advance care plans. DESIGN: Complex, multistage cluster sampling. SETTING: Ten states were selected for variation in geographic location, Medicaid reimbursement rate, and average staffing patterns. Participants were 4,215 nursing home residents in 268 facilities. PRINCIPAL FINDINGS: Seventeen resident and organizational factors were associated with the use of do-not-resuscitate (DNR) orders in 1990, and 12 resident and organizational factors were associated with their use in 1993. Five factors showed a significant change from 1990 to 1993: activities of daily living (ADL) scores, race, cognitive performance scale (CPS) scores, full-time equivalent (FTE) nurse aides per resident, and bed size. Ten resident and organizational factors were associated with use of do-not-hospitalize (DNH) orders in 1990 and six resident and organizational factors were associated with DNH orders in 1993. Four factors showed a significant change from 1990 to 1993: legal guardian, FTE LPNs per resident, Medicaid census, and forprofit ownership. Five resident and organizational factors were associated with the use of living wills in 1990 and seven resident and organizational factors were associated with the use of living wills in 1993. Four factors showed a significant change from 1990 to 1993: ADL scores, race, length of stay, and for-profit ownership. CONCLUSION: The results indicate that the PSDA may have been successful in increasing the use of advance care plans and in changing the types of residents who use advance care plans. However, they also show that the use of advance care plans is associated with organizational characteristics, indicating that some types of facilities

  4. An assessment of social diffusion in the Respecting Choices advance care planning program.

    PubMed

    Moorman, Sara M; Carr, Deborah; Kirchhoff, Karin T; Hammes, Bernard J

    2012-04-01

    This study examines the potential social diffusion effects of the Respecting Choices advance care planning program administered in La Crosse, Wisconsin, since 1991. The program produces educational materials for patients, trains facilitators to help patients prepare for end of life, and ensures that advance directives are connected to patients' medical records. Using data from a survey of more than 5,000 White Wisconsin high school graduates in their mid-60s, we found that participants who were living in the La Crosse area were significantly less likely than their peers living elsewhere to have executed a living will or appointed a health care power of attorney. This pattern may reflect psychological reactance, where individuals reject a message or lesson when they perceive compliance as a threat to their autonomy. There was no evidence of social diffusion effects; participants who lived in the La Crosse region themselves or who had social network members residing in the area were no more likely than those with no known ties to the region to have engaged in advance care planning. Future studies should explore the processes through which individuals learn and share with others their knowledge of advance care planning.

  5. End-of-life communication in Korean older adults: With focus on advance care planning and advance directives.

    PubMed

    Shin, Dong Wook; Lee, Ji Eun; Cho, BeLong; Yoo, Sang Ho; Kim, SangYun; Yoo, Jun-Hyun

    2016-04-01

    The present article aimed to provide a comprehensive review of current status of end-of-life (EOL) care and sociocultural considerations in Korea, with focus on the EOL communication and use of advance directives (AD) in elderly Koreans. Through literature review, we discuss the current status of EOL care and sociocultural considerations in Korea, and provide a look-ahead. In Korea, patients often receive life-sustaining treatment until the very end of life. Advance care planning is rare, and most do-not-resuscitate decisions are made between the family and physician at the very end of patient's life. Koreans, influenced mainly by Confucian tradition, prefer a natural death and discontinuation of life-sustaining treatment. Although Koreans generally believe that death is natural and unavoidable, they tend not to think about or discuss death, and regard preparation for death as unnecessary. As a result, AD are completed by just 4.7% of the general adult population. This situation can be explained by several sociocultural characteristics including opting for natural death, wish not to burden others, preference for family involvement and trust in doctor, avoidance of talking about death, and filial piety. Patients often receive life-sustaining treatment until the very EOL, advance care planning and the use of AD is not common in Korea. This was related to unique sociocultural characteristics of Korea. A more active role of physicians, development of a more deliberate EOL discussion process, development of culturally appropriate AD and promotion of advance care planning might be required to provide good EOL care in Korea.

  6. Exploring the district nurse role in facilitating individualised advance care planning.

    PubMed

    Boot, Michelle

    2016-03-01

    Health-care policy recognises the importance of engaging people in making decisions related to the management of their health. Advance care planning (ACP) offers a framework for decision making on end-of-life care. There are positive indicators that ACP enables health professionals to meet people's preferences. However, there are reports of insensitive attempts to engage people in end-of-life care decision making. District nurses are in the ideal position to facilitate ACP, as they have the opportunity to build relationships with the people they are caring for--an antecedent to sensitive ACP--and in recognising and fulfilling this role, they could ameliorate the risk of insensitive ACP. Distric nurse leaders also have a role to play in ensuring that organisational and environmental factors support appropriate ACP facilitation including: training, fostering a team culture that empowers district nurses to recognise and meet their ACP role, and advocating for appropriate ACP evaluation outcome measures. PMID:26940617

  7. Exploring the district nurse role in facilitating individualised advance care planning.

    PubMed

    Boot, Michelle

    2016-03-01

    Health-care policy recognises the importance of engaging people in making decisions related to the management of their health. Advance care planning (ACP) offers a framework for decision making on end-of-life care. There are positive indicators that ACP enables health professionals to meet people's preferences. However, there are reports of insensitive attempts to engage people in end-of-life care decision making. District nurses are in the ideal position to facilitate ACP, as they have the opportunity to build relationships with the people they are caring for--an antecedent to sensitive ACP--and in recognising and fulfilling this role, they could ameliorate the risk of insensitive ACP. Distric nurse leaders also have a role to play in ensuring that organisational and environmental factors support appropriate ACP facilitation including: training, fostering a team culture that empowers district nurses to recognise and meet their ACP role, and advocating for appropriate ACP evaluation outcome measures.

  8. Development of advance care planning research priorities: a call to action.

    PubMed

    Johnson, Ana P; Hanvey, Louise; Baxter, Sharon; Daren, K

    2013-01-01

    The objective of this study was to develop a national, prioritized research agenda for advance care planning (ACP). We first identified a list of comprehensive ACP research topics and determined priority criteria through focus groups. We next conducted a survey wherein importance weights were assigned to priority criteria and each ACP topic was rated. We combined weights and ratings into overall scores. A total of 17 ACP topics were developed and placed into four categories: patients and family members, the general public, professionals, and the healthcare system. Four main priority criteria were created: feasibility, consistency with ethical and societal values, economic considerations, and impact. Of the 100 individuals we invited to participate in the survey, 62 accepted. Prioritized topics centred largely on the impact of ACP on health resource utilization, communicating advance care planning across settings, and the preferred manner of engaging patients in ACP.

  9. Advance care planning: A systematic review of randomised controlled trials conducted with older adults.

    PubMed

    Weathers, Elizabeth; O'Caoimh, Rónán; Cornally, Nicola; Fitzgerald, Carol; Kearns, Tara; Coffey, Alice; Daly, Edel; O'Sullivan, Ronan; McGlade, Ciara; Molloy, D William

    2016-09-01

    Advance care planning (ACP), involving discussions between patients, families and healthcare professionals on future healthcare decisions, in advance of anticipated impairment in decision-making capacity, improves satisfaction and end-of-life care while respecting patient autonomy. It usually results in the creation of a written advanced care directive (ACD). This systematic review examines the impact of ACP on several outcomes (including symptom management, quality of care and healthcare utilisation) in older adults (>65years) across all healthcare settings. Nine randomised controlled trials (RCTs) were identified by searches of the CINAHL, PubMed and Cochrane databases. A total of 3646 older adults were included (range 72-88 years). Seven studies were conducted with community dwellers and the other two RCTs were conducted in nursing homes. Most studies did not implement a standardised ACD, or measure the impact on quality of end-of-life care or on the death and dying experience. All studies had some risk of bias, with most scoring poorly on the Oxford Quality Scale. While ACP interventions are well received by older adults and generally have positive effects on outcomes, this review highlights the need for well-designed RCTs that examine the economic impact of ACP and its effect on quality of care in nursing homes and other sectors. PMID:27451328

  10. Trends in Engagement in Advance Care Planning Behaviors and the Role of Socioeconomic Status.

    PubMed

    Khosla, Nidhi; Curl, Angela L; Washington, Karla T

    2016-08-01

    We investigated the trends in advance care planning (ACP) between 2002 and 2010 and whether socioeconomic status explained such trends. We conducted a pooled regression analysis of Health and Retirement Study data from 6052 proxies of deceased individuals. We studied 3 ACP behaviors, discussing end-of-life (EOL) care preferences, providing written EOL care instructions, and appointing a durable power of attorney for health care (DPAHC). ACP increased by 12% to 23% every 2 years from 2002 to 2010. Higher household income increased the odds of having a DPAHC. Education was not associated with ACP. Socioeconomic status alone appears to play a very limited role in predicting ACP. Engagement in ACP likely depends on a constellation of many social and contextual factors.

  11. "I Don't Want to Die like that...": The Impact of Significant Others' Death Quality on Advance Care Planning

    ERIC Educational Resources Information Center

    Carr, Deborah

    2012-01-01

    Purpose of the Study: I examine whether 5 aspects of a significant other's death quality (pain, decision-making capacity, location, problems with end-of life care, and preparation) affect whether one does advance care planning (ACP). I also identify specific aspects of others' deaths that respondents say triggered their own planning. Design and…

  12. Knowledge About and Perceptions of Advance Care Planning and Communication of Chinese-American Older Adults.

    PubMed

    Yonashiro-Cho, Jeanine; Cote, Sarah; Enguidanos, Susan

    2016-09-01

    Although advance care planning (ACP) is associated with better care at the end of life, better quality of death, and less psychological distress in survivors, ethnic disparities in ACP completion rates have been documented and may be attributable to lack of knowledge about ACP or differences in cultural values and preferences. Despite rapid increases in the size of the Asian-American population, little is known about ACP preferences of Chinese Americans. The purpose of this study is to explore the knowledge, attitudes, and preferences of older Chinese Americans toward ACP. Focus groups with Chinese older adults (n = 34) were conducted in Mandarin, Cantonese, and English, and transcripts were analyzed using a grounded theory approach. Identified themes included knowledge and experience with ACP and end-of-life care options, health as a factor in timing of ACP and communication, and communication of end-of-life care preferences. Knowledge of and experience with ACP and end-of-life decision-making varied according to focus group, although few participants had an advance directive. Findings suggest that Chinese older adults prefer to use indirect communication strategies, such as commenting on the circumstances of others rather than directly stating their wishes, and informal contexts, such as during a family dinner rather than formal meeting, to convey their care preferences to loved ones and may employ similar tactics when communicating with clinicians. This is particularly important given the recent decision by the Centers for Medicare and Medicaid Services to provide reimbursement to physicians for engaging in advance care planning conversations. PMID:27584825

  13. Difficult but necessary conversations--the case for advance care planning.

    PubMed

    Scott, Ian A; Mitchell, Geoffrey K; Reymond, Elizabeth J; Daly, Michael P

    2013-11-18

    Many patients at the end of life receive care that is inappropriate or futile and, if given the opportunity to discuss their care preferences well ahead of death, may well have chosen to forgo such care. Advance care planning (ACP) is a process of making decisions about future health care for patients in consultation with clinicians, family members and important others, and to safeguard such decisions if patients were to lose decisional capacity. Although ACP has existed as an idea for decades, acceptance and operationalisation of ACP within routine practice has been slow, despite evidence of its benefits. The chief barriers have been social and personal taboos about discussing the dying process, avoidance by medical professionals of responsibility for initiating, coordinating and documenting discussions about ACP, absence of robust and standardised procedures for recording and retrieving ACP documents across multiple care settings, and legal and ethical concerns about the validity of such documents. For ACP to become part of mainstream patient-centred care, accountable clinicians working in primary care, hospitals and nursing homes must effectively educate colleagues and patients about the purpose and mechanics of ACP, mandate ACP for all eligible patients, document ACP in accessible formats that enable patient wishes to accurately guide clinical management, devise methods for reviewing ACP decisions when clinically appropriate, and evaluate congruence between expressed patient wishes and actual care received. Public awareness campaigns coupled with implementation of ACP programs sponsored by collaborations between hospital and health services, Medicare locals and residential care facilities will be needed in making system-wide ACP a reality.

  14. Honoring Choices Minnesota: Preliminary Data from a Community-Wide Advance Care Planning Model

    PubMed Central

    Wilson, Kent S; Kottke, Thomas E; Schettle, Sue

    2014-01-01

    Advance care planning (ACP) increases the likelihood that individuals who are dying receive the care that they prefer. It also reduces depression and anxiety in family members and increases family satisfaction with the process of care. Honoring Choices Minnesota is an ACP program based on the Respecting Choices model of La Crosse, Wisconsin. The objective of this report is to describe the process, which began in 2008, of implementing Honoring Choices Minnesota in a large, diverse metropolitan area. All eight large healthcare systems in the metropolitan area agreed to participate in the project, and as of April 30, 2013, the proportion of hospitalized individuals 65 and older with advance care directives in the electronic medical record was 12.1% to 65.6%. The proportion of outpatients aged 65 and older was 11.6% to 31.7%. Organizations that had sponsored recruitment initiatives had the highest proportions of records containing healthcare directives. It was concluded that it is possible to reduce redundancy by recruiting all healthcare systems in a metropolitan area to endorse the same ACP model, although significantly increasing the proportion of individuals with a healthcare directive in their medical record requires a campaign with recruitment of organizations and individuals. PMID:25516036

  15. How Do General Practitioners Conceptualise Advance Care Planning in Their Practice? A Qualitative Study

    PubMed Central

    De Vleminck, Aline; Pardon, Koen; Beernaert, Kim; Houttekier, Dirk; Vander Stichele, Robert; Deliens, Luc

    2016-01-01

    Objectives To explore how GPs conceptualise advance care planning (ACP), based on their experiences with ACP in their practice. Methods Five focus groups were held with 36 GPs. Discussions were analysed using a constant comparative method. Results Four overarching themes in the conceptualisations of ACP were discerned: (1) the organisation of professional care required to meet patients’ needs, (2) the process of preparing for death and discussing palliative care options, (3) the discussion of care goals and treatment decisions, (4) the completion of advance directives. Within these themes, ACP was both conceptualised in terms of content of ACP and/or in terms of tasks for the GP. A specific task that was mentioned throughout the discussion of the four different themes was (5) the task of actively initiating ACP by the GP versus passively waiting for patients’ initiation. Conclusions This study illustrates that GPs have varying conceptualisations of ACP, of which some are more limited to specific aspects of ACP. A shared conceptualisation and agreement on the purpose and goals of ACP is needed to ensure successful implementation, as well as a systematic integration of ACP in routine practice that could lead to a better uptake of all the important elements of ACP. PMID:27096846

  16. Honoring Choices Minnesota: preliminary data from a community-wide advance care planning model.

    PubMed

    Wilson, Kent S; Kottke, Thomas E; Schettle, Sue

    2014-12-01

    Advance care planning (ACP) increases the likelihood that individuals who are dying receive the care that they prefer. It also reduces depression and anxiety in family members and increases family satisfaction with the process of care. Honoring Choices Minnesota is an ACP program based on the Respecting Choices model of La Crosse, Wisconsin. The objective of this report is to describe the process, which began in 2008, of implementing Honoring Choices Minnesota in a large, diverse metropolitan area. All eight large healthcare systems in the metropolitan area agreed to participate in the project, and as of April 30, 2013, the proportion of hospitalized individuals 65 and older with advance care directives in the electronic medical record was 12.1% to 65.6%. The proportion of outpatients aged 65 and older was 11.6% to 31.7%. Organizations that had sponsored recruitment initiatives had the highest proportions of records containing healthcare directives. It was concluded that it is possible to reduce redundancy by recruiting all healthcare systems in a metropolitan area to endorse the same ACP model, although significantly increasing the proportion of individuals with a healthcare directive in their medical record requires a campaign with recruitment of organizations and individuals.

  17. Measuring engagement in advance care planning: a cross-sectional multicentre feasibility study

    PubMed Central

    Howard, Michelle; Bonham, Aaron J; Heyland, Daren K; Sudore, Rebecca; Fassbender, Konrad; Robinson, Carole A; McKenzie, Michael; Elston, Dawn; You, John J

    2016-01-01

    Objectives To assess the feasibility, acceptability and clinical sensibility of a novel survey, the advance care planning (ACP) Engagement Survey, in various healthcare settings. Setting A target sample of 50 patients from each of primary care, hospital, cancer care and dialysis care settings. Participants A convenience sample of patients without cognitive impairment who could speak and read English was recruited. Patients 50 and older were eligible in primary care; patients 80 and older or 55 and older with clinical markers of advanced chronic disease were recruited in hospital; patients aged 19 and older were recruited in cancer and renal dialysis centres. Outcomes We assessed feasibility, acceptability and clinical sensibility of the ACP Engagement Survey using a 6-point scale. The ACP Engagement Survey measures ACP processes (knowledge, contemplation, self-efficacy and readiness) on 5-point Likert scales and actions (yes/no). Results 196 patients (38–96 years old, 50.5% women) participated. Mean (±SD) time to administer was 48.8±19.6 min. Mean acceptability scores ranged from 3.2±1.3 in hospital to 4.7±0.9 in primary care, and mean relevance ranged from 3.5±1.0 in hospital to 4.9±0.9 in dialysis centres (p<0.001 for both). The mean process score was 3.1±0.6 and the mean action score was 11.2±5.6 (of a possible 25). Conclusions The ACP Engagement Survey demonstrated feasibility and acceptability in outpatient settings but was less feasible and acceptable among hospitalised patients due to length. A shorter version may improve feasibility. Engagement in ACP was low to moderate. PMID:27338877

  18. Advance Care Planning and HIV Infection in the Era of Antiretroviral Therapy: A Review.

    PubMed

    Sangarlangkarn, Aroonsiri; Merlin, Jessica S; Tucker, Rodney O; Kelley, Amy S

    In the era of antiretroviral therapy, HIV infection has become a chronic illness with associated multimorbidity, and practitioners are faced with an emerging population of HIV-infected patients with evolving needs for advance care planning (ACP), defined as communication between individuals and their proxies to plan for future health care decisions. This article provides a review of original research studies on ACP in HIV-infected adults in the era of antiretroviral therapy (1996-present) from PubMed, EMBASE, and PsycINFO. Eleven studies conducted between 1996 and 2015 met the selection criteria, with study sizes ranging from 9 to 2864 participants. Most studies consisted of white men in outpatient settings and had poorly defined definitions of ACP. Prevalence of ACP was variable (36%-54% had end-of-life communication, 8%-47% had advance directives). Lack of ACP was most commonly associated with low income, followed by lower severity of illness, low education level, black or Hispanic race, female sex, younger age, injection drug use, and social isolation. Practitioners reported limited time or energy and inadequate preparation or training as barriers to ACP. Existing literature on ACP in the era of antiretroviral therapy is limited, but shows that ACP prevalence in HIV-infected individuals is variable depending on socioeconomic factors, severity of illness, and practitioner resources and training. More research is needed to increase ACP among HIV-infected individuals. PMID:27398771

  19. Early experience with digital advance care planning and directives, a novel consumer-driven program.

    PubMed

    Fine, Robert L; Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-07-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digital ACP/AD tool, to achieve proportional representation of all 50 states by population size and then reviewed their responses. The 900 participants had an average age of 50.8 years (SD = 16.6); 84% of the men and 91% of the women were in self-reported good health when signing their ADs. Among the respondents, 94% wanted their physicians to consult a supportive and palliative care team if they were seriously ill; nearly 85% preferred cessation of life-sustaining treatments during their final days; 76% preferred to spend their final days at home or in a hospice; and 70% would accept attempted cardiopulmonary resuscitation in limited circumstances. Most respondents wanted an autopsy under certain conditions, and 62% wished to donate their organs. In conclusion, analysis of early experience with this ACP/AD platform demonstrates that individuals of different ages and conditions can engage in an interrogatory process about values, develop ADs that are more nuanced than traditional paper-based ADs in reflecting those values, and easily make changes to their ADs. Online ADs have the potential to remove barriers to ACP/AD and thus further improve patient-centered end-of-life care.

  20. Early experience with digital advance care planning and directives, a novel consumer-driven program

    PubMed Central

    Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-01-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digital ACP/AD tool, to achieve proportional representation of all 50 states by population size and then reviewed their responses. The 900 participants had an average age of 50.8 years (SD = 16.6); 84% of the men and 91% of the women were in self-reported good health when signing their ADs. Among the respondents, 94% wanted their physicians to consult a supportive and palliative care team if they were seriously ill; nearly 85% preferred cessation of life-sustaining treatments during their final days; 76% preferred to spend their final days at home or in a hospice; and 70% would accept attempted cardiopulmonary resuscitation in limited circumstances. Most respondents wanted an autopsy under certain conditions, and 62% wished to donate their organs. In conclusion, analysis of early experience with this ACP/AD platform demonstrates that individuals of different ages and conditions can engage in an interrogatory process about values, develop ADs that are more nuanced than traditional paper-based ADs in reflecting those values, and easily make changes to their ADs. Online ADs have the potential to remove barriers to ACP/AD and thus further improve patient-centered end-of-life care. PMID:27365867

  1. Early experience with digital advance care planning and directives, a novel consumer-driven program.

    PubMed

    Fine, Robert L; Yang, Zhiyong; Spivey, Christy; Boardman, Bonnie; Courtney, Maureen

    2016-07-01

    Barriers to traditional advance care planning (ACP) and advance directive (AD) creation have limited the promise of ACP/AD for individuals and families, the healthcare team, and society. Our objectives were to determine the results of a digital ACP/AD through which consumers create, store, locate, and retrieve their ACP/AD at no charge and with minimal physician involvement, and the ACP/AD can be integrated into the electronic health record. The authors chose 900 users of MyDirectives, a digital ACP/AD tool, to achieve proportional representation of all 50 states by population size and then reviewed their responses. The 900 participants had an average age of 50.8 years (SD = 16.6); 84% of the men and 91% of the women were in self-reported good health when signing their ADs. Among the respondents, 94% wanted their physicians to consult a supportive and palliative care team if they were seriously ill; nearly 85% preferred cessation of life-sustaining treatments during their final days; 76% preferred to spend their final days at home or in a hospice; and 70% would accept attempted cardiopulmonary resuscitation in limited circumstances. Most respondents wanted an autopsy under certain conditions, and 62% wished to donate their organs. In conclusion, analysis of early experience with this ACP/AD platform demonstrates that individuals of different ages and conditions can engage in an interrogatory process about values, develop ADs that are more nuanced than traditional paper-based ADs in reflecting those values, and easily make changes to their ADs. Online ADs have the potential to remove barriers to ACP/AD and thus further improve patient-centered end-of-life care. PMID:27365867

  2. Health Care Outcomes and Advance Care Planning in Older Adults Who Receive Home-Based Palliative Care: A Pilot Cohort Study

    PubMed Central

    Thorsteinsdottir, Bjorg; Cha, Stephen S.; Hanson, Gregory J.; Peterson, Stephanie M.; Rahman, Parvez A.; Naessens, James M.; Takahashi, Paul Y.

    2015-01-01

    Abstract Background: Approximately 20% of seniors live with five or more chronic medical illnesses. Terminal stages of their lives are often characterized by repeated burdensome hospitalizations and advance care directives are insufficiently addressed. This study reports on the preliminary results of a Palliative Care Homebound Program (PCHP) at the Mayo Clinic in Rochester, Minnesota to service these vulnerable populations. Objective: The study objective was to evaluate inpatient hospital utilization and the adequacy of advance care planning in patients who receive home-based palliative care. Methods: This is a retrospective pilot cohort study of patients enrolled in the PCHP between September 2012 and March 2013. Two control patients were matched to each intervention patient by propensity scoring methods that factor in risk and prognosis. Primary outcomes were six-month hospital utilization including ER visits. Secondary outcomes evaluated advance care directive completion and overall mortality. Results: Patients enrolled in the PCHP group (n=54) were matched to 108 controls with an average age of 87 years. Ninety-two percent of controls and 33% of PCHP patients were admitted to the hospital at least once. The average number of hospital admissions was 1.36 per patient for controls versus 0.35 in the PCHP (p<0.001). Total hospital days were reduced by 5.13 days. There was no difference between rates of ER visits. Advanced care directive were completed more often in the intervention group (98%) as compared to controls (31%), with p<0.001. Goals of care discussions were held at least once for all patients in the PCHP group, compared to 41% in the controls. PMID:25375663

  3. Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?

    PubMed

    Lyon, Cheryl

    2007-12-01

    Background  Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. Objectives  The objectives of the study were to document implementation of best practice in advance care planning in a residential aged care facility using a cycle of audit, feedback and re-audit cycle audit with a clinical audit software program, the Practical Application of Clinical Evidence System. The evidence-based guidelines found in 'Guidelines for a Palliative Approach in Residential Aged Care' were used to inform the process of clinical practice review and to develop a program to implement advance care planning. Results  The pre-implementation audit results showed that advance care planning practice was not based on high level evidence as initial compliance with five audit criteria was 0%. The barriers to implementation that became apparent during the feedback stage included the challenge of creating a culture where advance care planning policy, protocols and guidelines could be implemented, and advance care planning discussions held, by adequately prepared health professionals and carers. Opportunities were made to equip the resident to discuss their wishes with family, friends and healthcare staff. Some residents made the decision to take steps to formally document those wishes and/or appoint a Medical Enduring Power of Attorney to act on behalf of the resident when they

  4. Advanced Planning.

    ERIC Educational Resources Information Center

    Lupinacci, Jeffrey A.

    2000-01-01

    Explains the importance of developing a comprehensive security plan prior to purchasing more equipment and resources to bolster school safety. Decision making following the plan's development is addressed including equipment choices, ID cards, access control, exit alarms, and video monitors. (GR)

  5. 38 CFR 17.32 - Informed consent and advance care planning.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) Definitions: Advance Directive. Specific written statements made by a patient who has decision-making capacity regarding future health care decisions in any of the following: (i) VA Living Will. A written statement made.... (ii) VA Durable Power of Attorney for Health Care. A written instruction on a VA form which...

  6. Role of Advance Care Planning in Proxy Decision Making Among Individuals With Dementia and Their Family Caregivers.

    PubMed

    Kwak, Jung; De Larwelle, Jessica A; Valuch, Katharine O'Connell; Kesler, Toni

    2016-01-01

    Health care proxies make important end-of-life decisions for individuals with dementia. A cross-sectional survey was conducted to examine the role of advance care planning in proxy decision making for 141 individuals with cognitive impairment, Alzheimer's disease, or other types of dementia. Proxies who did not know the preferences of individuals with dementia for life support treatments reported greater understanding of their values. Proxies of individuals with dementia who did not want life support treatments anticipated receiving less support and were more uncertain in decision making. The greater knowledge proxies had about dementia trajectory, family support, and trust of physicians, the more informed, clearer, and less uncertain they were in decision making. In addition to advance care planning, multiple factors influence proxy decision making, which should be considered in developing interventions and future research to support informed decision making for individuals with dementia and their families.

  7. Peer education for advance care planning: volunteers’ perspectives on training and community engagement activities

    PubMed Central

    Seymour, Jane E; Almack, Kathryn; Kennedy, Sheila; Froggatt, Katherine

    2013-01-01

    Background Peer education by volunteers may aid attitudinal change, but there is little understanding of factors assisting the preparation of peer educators. This study contributes to conceptual understandings of how volunteers may be prepared to work as peer educators by drawing on an evaluation of a training programme for peer education for advance care planning (ACP). Objectives To report on volunteers’ perspectives on the peer education training programme, their feelings about assuming the role of volunteer peer educators and the community engagement activities with which they engaged during the year after training. To examine broader implications for peer education. Design Participatory action research employing mixed methods of data collection. Participants Twenty-four older volunteers and eight health and social care staff. Data collection methods Evaluative data were gathered from information provided during and at the end of training, a follow-up survey 4 months post-training; interviews and focus groups 6 and 12 months post-training. Findings Volunteers’ personal aims ranged from working within their communities to using what they had learnt within their own families. The personal impact of peer education was considerable. Two-thirds of volunteers reported community peer education activities 1 year after the training. Those who identified strongly with a community group had the most success. Conclusion We reflect on the extent to which the programme aided the development of ‘critical consciousness’ among the volunteers: a key factor in successful peer education programmes. More research is needed about the impact on uptake of ACP in communities. PMID:21615641

  8. Advance Care Planning: A Qualitative Study of Dialysis Patients and Families

    PubMed Central

    Eneanya, Nwamaka D.; Feinberg, Rebecca; Germain, Michael J.; Marr, Lisa; Berzoff, Joan; Cohen, Lewis M.; Unruh, Mark

    2015-01-01

    Background and objectives More than 90,000 patients with ESRD die annually in the United States, yet advance care planning (ACP) is underutilized. Understanding patients’ and families’ diverse needs can strengthen systematic efforts to improve ACP. Design, setting, participants, & measurements In-depth interviews were conducted with a purposive sample of patients and family/friends from dialysis units at two study sites. Applying grounded theory, interviews were audiotaped, professionally transcribed, and analyzed in an iterative process. Emergent themes were identified, discussed, and organized into major themes and subthemes. Results Thirteen patients and nine family/friends participated in interviews. The mean patient age was 63 years (SD 14) and five patients were women. Participants identified as black (n=1), Hispanic (n=4), Native American (n=4), Pacific Islander (n=1), white (n=11), and mixed (n=1). Three major themes with associated subthemes were identified. The first theme, “Prior experiences with ACP,” revealed that these discussions rarely occur, yet most patients desire them. A potential role for the primary care physician was broached. The second theme, “Factors that may affect perspectives on ACP,” included a desire for more of a connection with the nephrologist, positive and negative experiences with the dialysis team, disenfranchisement, life experiences, personality traits, patient-family/friend relationships, and power differentials. The third theme, “Recommendations for discussing ACP,” included thoughts on who should lead discussions, where and when discussions should take place, what should be discussed and how. Conclusions Many participants desired better communication with their nephrologist and/or their dialysis team. A number expressed feelings of disenfranchisement that could negatively impact ACP discussions through diminished trust. Life experiences, personality traits, and relationships with family and friends may

  9. The process of advance care planning in HCT candidates and proxies: self-efficacy, locus of control, and anxiety levels.

    PubMed

    Duckworth, Katharine E; Forti, Allison M; Russell, Gregory B; Naik, Seema; Hurd, David; McQuellon, Richard P

    2014-11-01

    The purpose of this study was to examine the relationship between hematopoietic cell transplant candidate and proxy advance care planning (ACP) behavior and attitudes. A total of 49 candidates and 44 proxies completed the Advance Directive Attitudes Survey, Multidimensional Health Locus of Control Scale, Family Decision Making Self-Efficacy Scale, and the State-Trait Anxiety Inventory. In all, 45% of candidates reported completing an advance directive (AD), while only 26% had ADs on file; 80% of candidates discussed ACP wishes with their loved ones and 15% discussed ACP wishes with their medical team. The AD completers were significantly (1) older, (2) more positive about ADs, and (3) were less likely to believe that health events happen by chance. Discrepancies between reported ACP behavior and communication with health care practitioners have implications for end-of-life care.

  10. Advance Care Planning Discussions: Why They Should Happen, Why They Don't, and How We Can Facilitate the Process.

    PubMed

    Norals, Taira Everett; Smith, Thomas J

    2015-08-01

    Recent data suggest that we are not successfully getting the message across about the importance of advance care planning for patients who have a life-ending illness. Half to three-quarters of patients with incurable cancer think that they might be cured by chemotherapy, radiation, or surgery. The source of this denial may lie with them, it may be traceable to their physicians, or it may be a combination of the two. This avoidance has consequences, since those patients with "prognostic awareness" have end-of-life care pathways that involve little use of the hospital, ICU, end-of-life chemo, or "codes" with almost no chance of success, and much more dying at home with hospice care. If we can successfully initiate advance care planning discussions with our patients and families, their end-of-life processes will improve, resulting in better care, less use of the hospital, and more honoring of newly discerned choices. We show how this can be done in regular oncology practice by introducing the Johns Hopkins "Palliative Care Temporary Tattoo" and by providing some ways to discuss cardiopulmonary resuscitation in settings where it will not be helpful.

  11. The Role of Social Workers in Spiritual Care to Facilitate Coping With Chronic Illness and Self-Determination in Advance Care Planning.

    PubMed

    Francoeur, Richard B; Burke, Nancy; Wilson, Alicia M

    2016-01-01

    Spiritual values and beliefs of patients and families influence resilience during chronic illness and shape patient choices during advance care planning. The spiritual needs of Baby Boomers will be more diverse than previous generations, in connection with the questioning, experimental mind-set of this group and the fact that it includes a higher proportion of immigrant populations outside the Judeo-Christian tradition. Social workers are trained explicitly to intervene with diverse populations and are well positioned to offer spiritual support in ways that do not necessarily conform to traditional religions. To the extent of their individual expertise and competence, social workers should assess and provide spiritual care to clients, including those who either are underserved or prefer not to seek assistance from clergy or chaplains because they feel alienated from religious institutions and representatives. They should also be aware of ethical dilemmas in consulting with spiritual care professionals in developing spiritual interventions. Social work education should address clients' humanistic and existential concerns, beliefs and behaviors of the major religions, and forms of nontraditional religious and spiritual experiences; it should also provide experiential opportunities for engaging with grief and earlier advance care planning. There should be attention to different theodical perspectives of the major religions regarding the problem of good and evil, which may preoccupy even clients who no longer participate in organized religion, because these unresolved existential issues may weaken client coping with chronic conditions and may diminish clarity and self-awareness for engaging authentically and effectively in advance care planning.

  12. The Role of Social Workers in Spiritual Care to Facilitate Coping With Chronic Illness and Self-Determination in Advance Care Planning.

    PubMed

    Francoeur, Richard B; Burke, Nancy; Wilson, Alicia M

    2016-01-01

    Spiritual values and beliefs of patients and families influence resilience during chronic illness and shape patient choices during advance care planning. The spiritual needs of Baby Boomers will be more diverse than previous generations, in connection with the questioning, experimental mind-set of this group and the fact that it includes a higher proportion of immigrant populations outside the Judeo-Christian tradition. Social workers are trained explicitly to intervene with diverse populations and are well positioned to offer spiritual support in ways that do not necessarily conform to traditional religions. To the extent of their individual expertise and competence, social workers should assess and provide spiritual care to clients, including those who either are underserved or prefer not to seek assistance from clergy or chaplains because they feel alienated from religious institutions and representatives. They should also be aware of ethical dilemmas in consulting with spiritual care professionals in developing spiritual interventions. Social work education should address clients' humanistic and existential concerns, beliefs and behaviors of the major religions, and forms of nontraditional religious and spiritual experiences; it should also provide experiential opportunities for engaging with grief and earlier advance care planning. There should be attention to different theodical perspectives of the major religions regarding the problem of good and evil, which may preoccupy even clients who no longer participate in organized religion, because these unresolved existential issues may weaken client coping with chronic conditions and may diminish clarity and self-awareness for engaging authentically and effectively in advance care planning. PMID:27187806

  13. Thinking ahead – the need for early Advance Care Planning for people on haemodialysis: A qualitative interview study

    PubMed Central

    Horsley, Helen L; Shepherd, Kate; Brown, Heather; Carey, Irene; Matthews, Beverley; O’Donoghue, Donal; Vinen, Katie; Murtagh, Felicity EM

    2015-01-01

    Background: There is a need to improve end-of-life care for people with end-stage kidney disease, particularly due to the increasingly elderly, frail and co-morbid end-stage kidney disease population. Timely, sensitive and individualised Advance Care Planning discussions are acceptable and beneficial for people with end-stage kidney disease and can help foster realistic hopes and goals. Aim: To explore the experiences of people with end-stage kidney disease regarding starting haemodialysis, its impact on quality of life and their preferences for future care and to explore the Advance Care Planning needs of this population and the timing of this support. Study design: Semi-structured qualitative interview study of people receiving haemodialysis. Interviews were analysed using thematic analysis. Recruitment ceased once data saturation was achieved. Setting/participants: A total of 20 patients at two UK National Health Service hospitals, purposively sampled by age, time on haemodialysis and symptom burden. Results: Themes emerged around: Looking Back, emotions of commencing haemodialysis; Current Experiences, illness and treatment burdens; and Looking Ahead, facing the realities. Challenges throughout the trajectory included getting information, communicating with staff and the ‘conveyor belt’ culture of haemodialysis units. Participants reported a lack of opportunity to discuss their future, particularly if their health deteriorated, and variable involvement in treatment decisions. However, discussion of these sensitive issues was more acceptable to some than others. Conclusion: Renal patients have considerable unmet Advance Care Planning needs. There is a need to normalise discussions about preferences and priorities in renal and haemodialysis units earlier in the disease trajectory. However, an individualised approach is essential – one size does not fit all. PMID:25527527

  14. Exploring uncertainty in advance care planning in African Americans: does low health literacy influence decision making preference at end of life.

    PubMed

    Melhado, Lolita; Bushy, Angeline

    2011-11-01

    African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. But health needs are the same at end of life, yet care is less than optimal. African Americans are less likely to have advance directives nonetheless desire communication, information, respect, and a trusting doctor-patient relationship. Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans.

  15. Exploring uncertainty in advance care planning in African Americans: does low health literacy influence decision making preference at end of life.

    PubMed

    Melhado, Lolita; Bushy, Angeline

    2011-11-01

    African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. But health needs are the same at end of life, yet care is less than optimal. African Americans are less likely to have advance directives nonetheless desire communication, information, respect, and a trusting doctor-patient relationship. Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans. PMID:21398263

  16. An Exploratory Study of Spirituality in HIV Infected Adolescents and their Families: FAmily CEntered Advance Care Planning and Medication Adherence

    PubMed Central

    Lyon, Maureen E.; Garvie, Patricia A.; Kao, Ellin; Briggs, Linda; He, Jianping; Malow, Robert; D’Angelo, Lawrence J.; McCarter, Robert

    2010-01-01

    Purpose To explore the impact of spirituality and religious beliefs on FAmily CEntered (FACE) Advance Care Planning and medication adherence in HIV+ adolescents and their surrogate decision-makers. Methods A sample of HIV+ adolescents (n=40) and their surrogates, age 21 or older, (n=40) was randomized to an active Healthy Living Control group or the FACE Advance Care Planning intervention, guided by transactional stress and coping theory. Adolescents’ spirituality was assessed at baseline and 3 months post-intervention, using the FACIT-SP-4-EX, as was the belief that HIV is a punishment from God. Results Control adolescents increased faith and meaning/purpose more so than FACE adolescents (p=0.02). At baseline more behaviorally (16%) vs. perinatally (8%) infected adolescents believed HIV was a punishment from God, but not at 3-months post-intervention. Adolescents endorsing HIV was a punishment scored lower on spirituality (p=.05) and adherence to HAART (p= .04). Surrogates were more spiritual than adolescents (p=<.0001). Conclusion Providing family support in a friendly, facilitated, environment enhanced adolescents’ spirituality. Facilitated family conversations had an especially positive effect on behaviorally infected adolescents’ medication adherence and spiritual beliefs. PMID:21575826

  17. [Advance Care Planning and Decisions to limit treatment at the end of life - the view from medical ethics and psychooncology].

    PubMed

    Winkler, Eva C; Heußner, Pia

    2016-03-01

    Decisions to limit treatment are important in order to avoid overtreatment at the end of life. They proceed more than half of expected deaths in Europe and the US, but are not always communicated with the patient in advance. One reason for non-involvement is that conversations that prepare patients for end-of-life decisions and work out their preferences do not take place on a regular basis. At the same time there is growing evidence that such communication improves patients' quality of life, reduces anxiety and depression and allows patients to develop a realistic understanding of their situation - which in turn is a prerequisite for shared decision making about limiting treatment. In this paper we define "treatment limitation" and explain the medical ethics perspective. The main focus, however, is on the causes that hinder advanced care planning and conversations about limiting treatment in the care of patients with advanced disease. Finally the evidence for approaches to improve the situation is presented with concrete suggestions for solutions.

  18. Advance care planning for Māori, Pacific and Asian people: the views of New Zealand healthcare professionals.

    PubMed

    Frey, Rosemary; Raphael, Deborah; Bellamy, Gary; Gott, Merryn

    2014-05-01

    Despite the benefits of advance care planning (ACP), international research has suggested that in pluralistic and multicultural societies such as New Zealand, significant differences exist in the uptake of ACP between European-based populations and other cultural groups [Crawley (2005)]. The purpose of this study was to therefore explore the views of generalist palliative care providers in both the community and hospital settings regarding the barriers to ACP adoption as well as methods to increase knowledge about ACP among Māori, Pacific and Asian cultural groups within New Zealand society. Eleven individual interviews, two joint interviews and three focus groups were conducted with health and social care professionals with a wide range of knowledge and experience in palliative care. Challenges were related to a number of issues based on culture, including family decision-making style, a need to 'do everything' and a reluctance to discuss issues surrounding dying and death. Suggestions to increase the knowledge of ACP included techniques to improve information access and the utilisation of shared norms and values to assist with discussions between Māori, Pacific and Asian health professionals and their patients and families/whānau. Findings indicate a need for more family/whānau-centred models of ACP, addressed much earlier in the healthcare process and within the community setting.

  19. Barriers to Advance Care Planning at the End of Life: An Explanatory Systematic Review of Implementation Studies

    PubMed Central

    Lund, Susi; Richardson, Alison; May, Carl

    2015-01-01

    Context Advance Care Plans (ACPs) enable patients to discuss and negotiate their preferences for the future including treatment options at the end of life. Their implementation poses significant challenges. Objective To investigate barriers and facilitators to the implementation of ACPs, focusing on their workability and integration in clinical practice. Design An explanatory systematic review of qualitative implementation studies. Data sources Empirical studies that reported interventions designed to support ACP in healthcare. Web of Knowledge, Ovid MEDLINE, CINAHL, PsycINFO, British Nursing Index and PubMed databases were searched. Methods Direct content analysis, using Normalization Process Theory, to identify and characterise relevant components of implementation processes. Results 13 papers identified from 166 abstracts were included in the review. Key factors facilitating implementation were: specially prepared staff utilizing a structured approach to interactions around ACPs. Barriers to implementation were competing demands of other work, the emotional and interactional nature of patient-professional interactions around ACPs, problems in sharing decisions and preferences within and between healthcare organizations. Conclusions This review demonstrates that doing more of the things that facilitate delivery of ACPs will not reduce the effects of those things that undermine them. Structured tools are only likely to be partially effective and the creation of a specialist cadre of ACP facilitators is unlikely to be a sustainable solution. The findings underscore both the challenge and need to find ways to routinely incorporate ACPs in clinical settings where multiple and competing demands impact on practice. Interventions most likely to meet with success are those that make elements of Advance Care Planning workable within complex and time pressured clinical workflows. PMID:25679395

  20. 38 CFR 17.32 - Informed consent and advance care planning.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-authorized consent form is valid for a period of 60 calendar days. If, however, the treatment plan involves... documentation so long as the course of treatment proceeds as planned, even if treatment extends beyond the 60...) Close friend. (f) Consent for patients without surrogates. (1) If none of the surrogates listed...

  1. 38 CFR 17.32 - Informed consent and advance care planning.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-authorized consent form is valid for a period of 60 calendar days. If, however, the treatment plan involves... documentation so long as the course of treatment proceeds as planned, even if treatment extends beyond the 60...) Close friend. (f) Consent for patients without surrogates. (1) If none of the surrogates listed...

  2. Residency training in advance care planning: can it be done in the outpatient clinic?

    PubMed

    Alderman, Jeffrey S; Nair, Baishali; Fox, Mark D

    2008-01-01

    Resident physicians are expected to assist their outpatients to understand and complete advance directives, but their efficacy in doing so remains uncertain. After receiving educational training, internal medicine residents identified at-risk patients and solicited them about advance directives. Residents completed pretest and posttest questionnaires that assessed their knowledge, skills, attitude, and comfort with advance directives. Patients were also surveyed about their attitudes regarding advance directives. Ten internal medicine residents and 88 patients participated. Residents' self-assessed knowledge rose from 6.0 to 9.2 on a 10-point Likert scale. Skills using advance directives increased from 4.0 to 7.9, attitudes improved from 6.0 to 8.4, and comfort rose from 5.4 to 8.9. Eighty-four percent of patients expressed interest in completing advance directives, and 16% actually completed documents. An educational intervention improved knowledge, skills, attitudes, and comfort with advance directives among internal medicine residents practicing in the outpatient setting. Meanwhile, patients demonstrated a strong interest in completing advance directives.

  3. Health advance directives, policy and clinical practice: a perspective on the synergy of an effective advance care planning framework.

    PubMed

    Seal, Marion

    2010-03-01

    The delivery of quality care at the end of life should be seamless across all health care settings and independent from variables such as institutional largeness, charismatic leadership, funding sources and blind luck ... People have come to fear the prospect of a technologically protracted death or abandonment with untreated emotional and physical stress.

  4. They know!—Do they? A qualitative study of residents and relatives views on advance care planning, end-of-life care, and decision-making in nursing homes

    PubMed Central

    Bollig, Georg; Gjengedal, Eva; Rosland, Jan Henrik

    2015-01-01

    Background: Residents living in long-term care facilities are a vulnerable population. For many residents, a nursing home is their place of death. Palliative care and end-of-life decisions are important components of their care provision. Aim: To study the views of cognitively able residents and relatives on advance care planning, end-of-life care, and decision-making in nursing homes. Design: A qualitative study with in-depth interviews with nursing home residents and focus group interviews with relatives of nursing home residents. Analysis is based on interpretive description. Setting/participants: In total, 43 informants from nine nursing homes participated in the study (25 nursing home residents and 18 relatives). All included residents had capacity to provide informed consent and lived in long-term care. Results: The main findings of this study were the differing views about decision-making and advance care planning of residents and relatives. Residents do trust relatives and staff to make important decisions for them. The relatives are in contrast insecure about the residents’ wishes and experience decision-making as a burden. The majority of the residents had not participated in advance care planning. None of the residents stated challenges connected to end-of-life care or mentioned the wish for euthanasia. Conclusion: Although most residents seem to be satisfied with decision-making and end-of life care, there is a need for systematic advance care planning. Advance care planning could help to explore future wishes for care and ease decision-making for the relatives, physicians, and staff and should be offered to all cognitively able nursing homes residents. PMID:26396227

  5. Your cancer survivorship care plan

    MedlinePlus

    ... ency/patientinstructions/000822.htm Your cancer survivorship care plan To use the sharing features on this page, ... get one. What Is a Cancer Survivorship Care Plan? A cancer survivorship care plan is a document ...

  6. Role of the community matron in advance care planning and 'do not attempt CPR' decision-making: a qualitative study.

    PubMed

    Kazmierski, Mandy; King, Nigel

    2015-01-01

    The community matron (CM) is often the key worker caring for patients with chronic, life-limiting, long-term conditions, but these patients are not always recognised as palliative cases. This study explored the experiences of CMs with regard to advance care planning (ACP) and 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision-making to understand whether or not they felt adequately prepared for this aspect of their role, and why. Qualitative data were generated from six CMs using a broad interpretive phenomenological approach. Face-to-face recorded interviews were analysed using template analysis. The study found that although participants faced complex ethical situations around ACP and DNACPR almost on a daily basis, none had received any formal training despite the emphasis on training in national and local guidelines. Participants often struggled to get their patients accepted on to the Gold Standards Framework. The research found variability and complexity of cases to be the main barriers to clear identification of the palliative phase.

  7. Pathways From Religion to Advance Care Planning: Beliefs About Control Over Length of Life and End-of-Life Values

    PubMed Central

    Garrido, Melissa M.

    2013-01-01

    Purpose of the Study: To evaluate the extent to which religious affiliation and self-identified religious importance affect advance care planning (ACP) via beliefs about control over life length and end-of-life values. Design and Methods: Three hundred and five adults aged 55 and older from diverse racial and socioeconomic groups seeking outpatient care in New Jersey were surveyed. Measures included discussion of end-of-life preferences; living will (LW) completion; durable power of attorney for healthcare (DPAHC) appointment; religious affiliation; importance of religion; and beliefs about who/what controls life length, end-of-life values, health status, and sociodemographics. Results: Of the sample, 68.9% had an informal discussion and 46.2% both discussed their preferences and did formal ACP (LW and/or DPAHC). Conservative Protestants and those placing great importance on religion/spirituality had a lower likelihood of ACP. These associations were largely accounted for by beliefs about God’s controlling life length and values for using all available treatments. Implications: Beliefs and values about control account for relationships between religiosity and ACP. Beliefs and some values differ by religious affiliation. As such, congregations may be one nonclinical setting in which ACP discussions could be held, as individuals with similar attitudes toward the end of life could discuss their treatment preferences with those who share their views. PMID:23161430

  8. Uptake of a newly implemented advance care planning program in a dementia diagnostic service.

    PubMed

    2016-05-27

    Through a three-stage project in a specialist memory clinic in Australia, researchers introduced ACP to clients with mild cognitive impairment or recently diagnosed dementia and their families. Clients and carers were initially posted a survey assessing completed documentation for future care, understanding of the principles of ACP and willingness to receive further information. Those wanting more information were invited to a seminar introducing the ACP programme and service. Participants wanting to complete ACP documentation could make an appointment with the ACP clinicians. PMID:27231080

  9. Discussing dying in the diaspora: attitudes towards advance care planning among first generation Dutch and Italian migrants in rural Australia.

    PubMed

    Sinclair, Craig; Smith, Jessica; Toussaint, Yann; Auret, Kirsten

    2014-01-01

    Western cultural practices and values have largely shaped advance care planning (ACP) policies across the world. Low uptake of ACP among ethnic minority groups in Western countries has been interpreted with reference to cultural differences. This paper adopts a life-history approach to explore attitudes towards ACP among older, first-generation Dutch-Australian and Italian-Australian migrants. Thirty people participated in extended ethnographic interviews (N = 17) and group discussions (N = 13) during 2012. Transcripts were thematically analyzed and interpreted using a Foucauldian perspective on knowledge and power. Migration experiences, ongoing contact with the native country and participation in migrant community support networks influenced attitudes towards ACP. Dutch participants framed ACP discussions with reference to euthanasia, and adopted a more individualist approach to medical decision-making. Italian participants often spoke of familial roles and emphasized a family-based decision making style. The importance of migrant identity has been neglected in previous discussions of cultural factors influencing ACP uptake among ethnic minority groups. The unique migration experience should be considered alongside culturally appropriate approaches to decision-making, in order to ensure equitable access to ACP among migrant groups. PMID:24560228

  10. Advance Care Planning in Dementia: Do Family Carers Know the Treatment Preferences of People with Early Dementia?

    PubMed Central

    King, Michael; Jones, Louise; Vickestaff, Victoria; Sampson, Elizabeth L.

    2016-01-01

    Background and Aims When a person with dementia (PWD) has lost the ability to make treatment decisions, clinicians often rely on family carers to know and articulate these preferences with assumed accuracy. This study used the Life Support Preferences Questionnaire (LSPQ) to explore whether family carers’ choices show agreement with the end of life care preferences of the person with dementia for whom they care and what factors influence this. Methods A cross-sectional study interviewing 60 dyads (a person with early dementia and preserved capacity and their family carer) each completing a modified LSPQ. We assessed how closely carers’ choices resembled the PWD’s preferences for treatment in three proposed health states: the here and now; severe stroke with coma; terminal cancer. Agreement between the PWD and their family carer responses was assessed using Kappa and Prevalence-Adjusted Bias-Adjusted Kappa (PABAK) statistics. We examined whether carer burden and distress, and relationship quality, influenced agreement. Results In interviews PWD were able to indicate their treatment preferences across all three scenarios. In the here-and-now most wanted antibiotics (98%), fewer cardio-pulmonary resuscitation (CPR) (50%) and tube feeding (47%). In severe stroke and coma antibiotics remained the more preferred treatment (88%), followed by CPR (57%) and tube feeding (30%). In advanced cancer PWD expressed lower preferences for all treatments (antibiotics 68%; CPR 50%; tube feeding 37%). Carers’ choices were similar to the PWDs’ preferences in the here-and-now (71% (k = 0.03; PABAK = 0.4) with less agreement for future hypothetical health states. In severe stroke and coma carers tended wrongly to suggest that the PWD preferred more intervention (antibiotic, 67%; k = -0.022; PABAK = -0.60; CPR, 73%; k = 0.20; PABAK = -0.20, tube feeding, 66%; k = 0.25; PABAK = -0.12). In advanced cancer the agreement between PWD and carers was low (antibiotics; k = -0.03; PABAK

  11. “I Don’t Want to Die Like That …”: The Impact of Significant Others’ Death Quality on Advance Care Planning

    PubMed Central

    Carr, Deborah

    2012-01-01

    Purpose of the Study: I examine whether 5 aspects of a significant other’s death quality (pain, decision-making capacity, location, problems with end-of life care, and preparation) affect whether one does advance care planning (ACP). I also identify specific aspects of others’ deaths that respondents say triggered their own planning. Design and Methods: Data are from the New Jersey End of Life study, a survey of 305 adults age 55+ seeking care at 2 major New Jersey medical centers. I estimate multivariate logistic regression models for a subsample of 253 participants who recently lost a loved one and provide descriptive findings from an open-ended question regarding the motivation for one’s ACP. Results: Multivariate analyses revealed “positive” role model effects; persons who witnessed significant others’ deaths that occurred at home, were free of problems associated with end-of-life care, and where advance directives were used are more likely to make end-of-life preparations. Open-ended data showed that 19% cited others’ deaths as the main trigger for their own planning, with most citing negative factors (pain, connection to machines, coma) that they hoped to avoid. Implications: Practitioners should encourage patients to use conversations about others’ deaths as springboards for discussions about one’s own end-of-life care, and to engage in ACP together with family. Implications for health care reform are highlighted. PMID:22547085

  12. The life care planning process.

    PubMed

    Johnson, Cloie B; Weed, Roger O

    2013-08-01

    This article discusses the history and evolution of what is now known as a life care plan. The qualifications of professionals who perform the specialty practice of life care planning are reviewed. The standards of practice for life care planning have been a long-standing guide for the practitioner and its core components are discussed.

  13. Measuring patient treatment preferences in end-of-life care research: applications for advance care planning interventions and response shift research.

    PubMed

    Schwartz, Carolyn E; Merriman, Melanie P; Reed, George W; Hammes, Bernard J

    2004-04-01

    Understanding the dynamics of patient treatment preferences can be important for end-of life are research, and has particular salience not only to guide a process of advance care planning (ACP) but also as an outcome measure. Ascertaining the reliability and responsiveness of preferences for life-sustaining treatments within and between patients is a necessary foundation for utilizing patient-agent congruence as an outcome for ACP interventions. This study validated a modified version of the Emanuel and Emanuel Medical Directive for use in both research and clinical applications. Seriously ill patients (n = 168) were asked at baseline and 21 days to consider four common end-of-life health state scenarios, to indicate their goals for treatment, and to state their preferences for six specific treatments. We investigated the reliability and validity of this tool. We found that preferences for life-sustaining treatments were highly intercorrelated, and internally consistent across treatments by scenario and across scenarios by treatment. Preferences for pain medications were, however, distinct from preferences for other treatments. Preference scores exhibited stability over follow-up, and demonstrated both concurrent and discriminant validity. We detected a small effect size for change in preferences as a function of health state change, suggesting that re-prioritization response shifts do occur but are small in magnitude in these patient samples over this time frame. We conclude that this measure is reliable and valid for use in clinical settings and for evaluating interventions designed to improve patient-agent congruence about patient preferences for life-sustaining treatments. Clinical applications of the tool are discussed. PMID:15130201

  14. Advancement Planning: An Objectives View.

    ERIC Educational Resources Information Center

    Druck, Kalman B.

    1986-01-01

    Planning must revolve around objectives related to students, faculty, money, and political support. When it is understood that all of the institution's advancement activity should help produce these four things, planning is easy. (MLW)

  15. Phase 2 Randomised Controlled Trial and Feasibility Study of Future Care Planning in Patients with Advanced Heart Disease

    PubMed Central

    Denvir, Martin A.; Cudmore, Sarah; Highet, Gill; Robertson, Shirley; Donald, Lisa; Stephen, Jacqueline; Haga, Kristin; Hogg, Karen; Weir, Christopher J.; Murray, Scott A.; Boyd, Kirsty

    2016-01-01

    Future Care Planning (FCP) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost. We assessed the feasibility, acceptability and tested a design of a randomised trial evaluating the impact of FCP in patients and carers. 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of >20% were randomly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks. Quality of life, symptoms and anxiety/distress were assessed by questionnaire. Hospitalisation and mortality events were documented for 6 months post-discharge. FCP increased implementation and documentation of key decisions linked to end-of-life care. FCP did not increase anxiety/distress (Kessler score -E 16.7 (7.0) vs D 16.8 (7.3), p = 0.94). Quality of life was unchanged (EQ5D: E 0.54(0.29) vs D 0.56(0.24), p = 0.86) while unadjusted hospitalised nights was lower (E 8.6 (15.3) vs D 11.8 (17.1), p = 0.01). Qualitative interviews indicated that FCP was highly valued by patients, carers and family physicians. FCP is feasible in a randomised clinical trial in patients with acute high risk cardiac conditions. A Phase 3 trial is needed urgently. PMID:27090299

  16. Advance Directives and Do-Not-Resuscitate Orders in Patients with Cancer with Metastatic Spinal Cord Compression: Advanced Care Planning Implications

    PubMed Central

    Palmer, J. Lynn; Bianty, Josephine; Konzen, Benedict; Shin, Ki; Bruera, Eduardo

    2010-01-01

    Abstract Objectives Communication about end-of-life decisions is crucial. Although patients with metastatic spinal cord compression (MSCC) have a median survival time of 3 to 6 months, few data are available concerning the presence of advance directives and do-not-resuscitate (DNR) orders in this population. The objective of this study was to determine presence of advance directives and DNR order among patients with MSCC. Methods We retrospectively reviewed data concerning advance directives for 88 consecutive patients with cancer who had MSCC and required rehabilitation consultation at The University of Texas M. D. Anderson Cancer Center from September 20, 2005 to August 29, 2008. We characterized the data using univariate descriptive statistics and used the Fisher exact test to find correlations. Results The mean age of this patient population was 55 years (range, 24–81). Thirty patients (33%) were female. Twenty patients (23%) had a living will, 27 patients (31%) had health care proxies, and 10 patients (11%) had either out-of-hospital DNR order and/or dictated DNR note. The median survival time for these patients was 4.3 months. Conclusion Despite strong evidence showing short survival times for MSCC patients, it seems many of these patients are not aware of the urgency to have an advance directive. This may be an indicator of delayed end-of-life palliative care and suboptimal doctor–patient communication. Using the catastrophic event of a diagnosis of MSCC to trigger communication and initiate palliative care may be beneficial to patients and their families. PMID:20192843

  17. Clinical Impact of Education Provision on Determining Advance Care Planning Decisions among End Stage Renal Disease Patients Receiving Regular Hemodialysis in University Malaya Medical Centre

    PubMed Central

    Hing (Wong), Albert; Chin, Loh Ee; Ping, Tan Li; Peng, Ng Kok; Kun, Lim Soo

    2016-01-01

    Introduction: Advance care planning (ACP) is a process of shared decision-making about future health-care plans between patients, health care providers, and family members, should patients becomes incapable of participating in medical treatment decisions. ACP discussions enhance patient's autonomy, focus on patient's values and treatment preferences, and promote patient-centered care. ACP is integrated as part of clinical practice in Singapore and the United States. Aim: To assess the clinical impact of education provision on determining ACP decisions among end-stage renal disease patients on regular hemodialysis at University Malaya Medical Centre (UMMC). To study the knowledge and attitude of patients toward ACP and end-of-life issues. Materials and Methods: Fifty-six patients were recruited from UMMC. About 43 questions pretest survey adapted from Lyon's ACP survey and Moss's cardiopulmonary resuscitation (CPR) attitude survey was given to patients to answer. An educational brochure is then introduced to these patients, and a posttest survey carried out after that. The results were analyzed using SPSS version 22.0. Results: Opinion on ACP, including CPR decisions, showed an upward trend on the importance percentage after the educational brochure exposure, but this was statistically not significant. Seventy-five percent of participants had never heard of ACP before, and only 3.6% had actually prepared a written advanced directive. Conclusion: The ACP educational brochure clinically impacts patients’ preferences and decisions toward end-of-life care; however, this is statistically not significant. Majority of patients have poor knowledge on ACP. This study lays the foundation for execution of future larger scale clinical trials, and ultimately, the incorporation of ACP into clinical practice in Malaysia. PMID:27803566

  18. Improving advance care planning for English-speaking and Spanish-speaking older adults: study protocol for the PREPARE randomised controlled trial

    PubMed Central

    Sudore, Rebecca L; Barnes, Deborah E; Le, Gem M; Ramos, Roberto; Osua, Stacy J; Richardson, Sarah A; Boscardin, John; Schillinger, Dean

    2016-01-01

    Introduction Advance care planning (ACP) is a process that allows patients to identify their goals for medical care. Traditionally, ACP has focused on completing advance directives; however, we have expanded the ACP paradigm to also prepare patients to communicate their wishes and make informed decisions. To this end, we created an ACP website called PREPARE (http://www.prepareforyourcare.org) to prepare diverse English-speaking and Spanish-speaking older adults for medical decision-making. Here, we describe the study protocol for a randomised controlled efficacy trial of PREPARE in a safety-net setting. The goal is to determine the efficacy of PREPARE to engage diverse English-speaking and Spanish-speaking older adults in a full spectrum of ACP behaviours. Methods and analysis We include English-speaking and Spanish-speaking adults from an urban public hospital who are ≥55 years old, have ≥2 chronic medical conditions and have seen a primary care physician ≥2 times in the last year. Participants are randomised to the PREPARE intervention (review PREPARE and an easy-to-read advance directive) or the control arm (only the easy-to-read advance directive). The primary outcome is documentation of an advance directive and/or ACP discussion. Secondary outcomes include ACP behaviour change processes measured with validated surveys (eg, self-efficacy, readiness) and a broad range of ACP actions (eg, choosing a surrogate, identifying goals for care, discussing ACP with clinicians and/or surrogates). Using blinded outcome ascertainment, outcomes will be measured at 1 week and at 3, 6 and 12 months, and compared between study arms using mixed-effects logistic regression and mixed-effects linear, Poisson or negative binomial regression. Ethics and dissemination This study has been approved by the appropriate Institutional Review Boards and is guided by input from patient and clinical advisory boards and a data safety monitoring board. The results of this study will

  19. Types of Managed Care Plans

    MedlinePlus

    ... AAP Find a Pediatrician Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting ... Your Community Healthy Children > Family Life > Medical Home > Health Insurance > Types of Managed Care Plans Family Life Listen ...

  20. [Physician-assisted suicide and advance care planning--ethical considerations on the autonomy of dementia patients at their end of life].

    PubMed

    Gather, Jakov; Vollmann, Jochen

    2014-10-01

    Physician-assisted suicide (PAS), which is currently the subject of intense and controversial discussion in medical ethics, is barely discussed in psychiatry, albeit there are already dementia patients in Germany and other European countries who end their own lives with the assistance of physicians. Based on the finding that patients who ask for medical assistance in suicide often have in mind the loss of their mental capacity, we submit PAS to an ethical analysis and put it into a broader context of patient autonomy at the end of life. In doing so, we point to advance care planning, through which the patient autonomy of the person concerned can be supported as well as respected in later stages of the disease. If patients adhere to their autonomous wish for PAS, physicians find themselves in an ethical dilemma. A further tabooing of the topic, however, does not provide a solution; rather, an open societal and professional ethical discussion and regulation are essential. PMID:25068685

  1. [Physician-assisted suicide and advance care planning--ethical considerations on the autonomy of dementia patients at their end of life].

    PubMed

    Gather, Jakov; Vollmann, Jochen

    2014-10-01

    Physician-assisted suicide (PAS), which is currently the subject of intense and controversial discussion in medical ethics, is barely discussed in psychiatry, albeit there are already dementia patients in Germany and other European countries who end their own lives with the assistance of physicians. Based on the finding that patients who ask for medical assistance in suicide often have in mind the loss of their mental capacity, we submit PAS to an ethical analysis and put it into a broader context of patient autonomy at the end of life. In doing so, we point to advance care planning, through which the patient autonomy of the person concerned can be supported as well as respected in later stages of the disease. If patients adhere to their autonomous wish for PAS, physicians find themselves in an ethical dilemma. A further tabooing of the topic, however, does not provide a solution; rather, an open societal and professional ethical discussion and regulation are essential.

  2. [Advances in wound care].

    PubMed

    Raffoul, Wassim

    2008-03-01

    Wound care made great progress during last years related to several factors. The first is an awakening of the importance of wounds. The progress made in the comprehension of the physiopathology of wounds led to innovations in all stages of this complex process which is the wound healing. Autologus platelet concentrate producing growth factors are in use to stimulate the first phase of the healing. The second phase which is the phase of proliferation and secretion is currently better managed with new categories of bandages which are true local treatments. The nutrition became one of the pillars of wound treatments especially among old patients. The reconstructive surgery took great steps since the physiology and the vascular anatomy of the skin and soft tissues are better known. Finally the bio-engineering has entered the treatment of the wound there is more than 20 years ago and methods have improved and become more reliable.

  3. Planning Ahead: Advanced Heart Failure

    MedlinePlus

    ... Pressure Tools & Resources Stroke More Planning Ahead: Advanced Heart Failure Updated:Aug 24,2016 An important part of ... content was last reviewed on 04/16/2015. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  4. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers

    PubMed Central

    Kimmel, Allison L.; Wang, Jichuan; Scott, Rachel; Briggs, Linda; Lyon, Maureen E.

    2016-01-01

    Although the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered Advance Care Planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18-month post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥21 years of age; surrogates will be ≥18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS. PMID:26044463

  5. FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers.

    PubMed

    Kimmel, Allison L; Wang, Jichuan; Scott, Rachel K; Briggs, Linda; Lyon, Maureen E

    2015-07-01

    Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.

  6. Moving survivorship care plans forward: focus on care coordination.

    PubMed

    Salz, Talya; Baxi, Shrujal

    2016-07-01

    After completing treatment for cancer, the coordination of oncology and primary care presents a challenge for cancer survivors. Many survivors need continued oncology follow-up, and all survivors require primary care. Coordinating the shared care of a cancer survivor, or facilitating an informed handoff from oncology to primary care, is essential for cancer survivors. Survivorship care plans are personalized documents that summarize cancer treatment and outline a plan of recommended ongoing care, with the goal of facilitating the coordination of post-treatment care. Despite their face validity, five trials have failed to demonstrate the effectiveness of survivorship care plans. We posit that these existing trials have critical shortcomings and do not adequately address whether survivorship care plans improve care coordination. Moving forward, we propose four criteria for future trials of survivorship care plans: focusing on high-needs survivor populations, tailoring the survivorship care plan to the care setting, facilitating implementation of the survivorship care plan in clinical practice, and selecting appropriate trial outcomes to assess care coordination. When trials meet these criteria, we can finally assess whether survivorship care plans help cancer survivors receive optimal oncology and primary care. PMID:27075650

  7. Moving survivorship care plans forward: focus on care coordination.

    PubMed

    Salz, Talya; Baxi, Shrujal

    2016-07-01

    After completing treatment for cancer, the coordination of oncology and primary care presents a challenge for cancer survivors. Many survivors need continued oncology follow-up, and all survivors require primary care. Coordinating the shared care of a cancer survivor, or facilitating an informed handoff from oncology to primary care, is essential for cancer survivors. Survivorship care plans are personalized documents that summarize cancer treatment and outline a plan of recommended ongoing care, with the goal of facilitating the coordination of post-treatment care. Despite their face validity, five trials have failed to demonstrate the effectiveness of survivorship care plans. We posit that these existing trials have critical shortcomings and do not adequately address whether survivorship care plans improve care coordination. Moving forward, we propose four criteria for future trials of survivorship care plans: focusing on high-needs survivor populations, tailoring the survivorship care plan to the care setting, facilitating implementation of the survivorship care plan in clinical practice, and selecting appropriate trial outcomes to assess care coordination. When trials meet these criteria, we can finally assess whether survivorship care plans help cancer survivors receive optimal oncology and primary care.

  8. Advancing the role of nonprofit health care.

    PubMed

    Metcalfe, Marcia

    2002-01-01

    This article comes out of a series of discussions among a diverse group of chief executive officers (CEOs) and other leaders of nonprofit hospitals, long-term care facilities, health maintenance organizations, and other insurance providers, including several nonprofit Blue Cross Blue Shield (BCBS) plans. The group was convened as part of Howard Berman's Walter J. McNerney Fellowship project. (Berman is CEO of Excellus, Inc., a nonprofit Blue Cross Blue Shield affiliate that insures the health of more than 2.15 million people in upstate New York. He was awarded the McNerney Fellowship in April 2001 by the Health Research and Educational Trust, an American Hospital Association affiliate. The Fellowship goes annually to at least one fellow to highlight or pursue work that will provide new insights into how different sectors of the health care system can better work together for improved outcomes.) The group has met several times over the past year around a shared concern: the current challenges to nonprofit health care organizations and the future role for nonprofits in the re-visioning and creation of an American health care system that is characterized by universal access, patient-centered quality, and national affordability. Members have supported the public relations campaign of the "Alliance for Advancing Nonprofit Health Care," an effort initiated by the Caucus, an independent group of nonprofit BCBS plans. The group continues to explore the need for a broad-based coalition of providers, insurers, and other organizations to effectively protect and enhance the role of nonprofit health care.

  9. Interdisciplinary Care Planning and the Written Care Plan in Nursing Homes: A Critical Review

    ERIC Educational Resources Information Center

    Dellefield, Mary Ellen

    2006-01-01

    Purpose: This article is a critical review of the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. Design and Methods: We reviewed educational and empirical literature. Results: Interdisciplinary care planning and the written care plan are…

  10. A typology of advance statements in mental health care.

    PubMed

    Henderson, Claire; Swanson, Jeffrey W; Szmukler, George; Thornicroft, Graham; Zinkler, Martin

    2008-01-01

    Advance statements documenting mental health service consumers' preferences for treatment during a future mental health crisis or period of incapacity have gained currency in recent years in the United States and some European countries. Several kinds of advance statements have emerged -- some as legal instruments, others as treatment planning methods -- but no formal comparison has been made among them. This article reviews the literature in English and German to develop a comparative typology of advance statements: joint crisis plans, crisis cards, treatment plans, wellness recovery action plans, and psychiatric advance directives (with and without formal facilitation). The features that distinguish them are the extent to which they are legally binding, whether health care providers are involved in their production, and whether an independent facilitator assists in their production. The differing nature of advance statements is related to the diverse models of care upon which they are based and the legislative and service contexts in which they have been developed. However, there is recent convergence between the United Kingdom and the United States with respect to research interventions that facilitate the production of advance statements, as evidence emerges for the effectiveness of facilitated psychiatric advance directives and joint crisis plans. Different types of advance statements can coexist and in some cases may interact in complementary ways. However, the relationship of advance statements to involuntary treatment is more problematic, as is their effective implementation in many mental health service settings. PMID:18182541

  11. Planning and Decision Making for Care Transitions

    PubMed Central

    Sörensen, Silvia; Mak, Wingyun; Pinquart, Martin

    2015-01-01

    The need to plan for future health care and residential adjustments increases with age, growing frailty, and restrictions in coverage of long-term care and will continue to grow with population aging. Older adults’ lack of financial preparation for health care costs, insufficient knowledge about available options, and inadequate communication about care-related values has become an increasing public health challenge. This chapter describes a model of Preparation for Future Care (PFC), which encompasses different levels and domains of planning. Research about the extent to which planning is helpful in navigating care transitions is reviewed, and barriers and facilitators of planning including individual, familial, cultural, and national long-term care policy factors are discussed. Planning in the context of dementia and practical approaches that can be taken to enhance PFC is addressed, as well as recommendations for future research in the area of planning and decision making in the context of care transitions. PMID:26207079

  12. Preconception care: promoting reproductive planning

    PubMed Central

    2014-01-01

    Introduction Preconception care recognizes that many adolescent girls and young women will be thrust into motherhood without the knowledge, skills or support they need. Sixty million adolescents give birth each year worldwide, even though pregnancy in adolescence has mortality rates at least twice as high as pregnancy in women aged 20-29 years. Reproductive planning and contraceptive use can prevent unintended pregnancies, unsafe abortions and sexually-transmitted infections in adolescent girls and women. Smaller families also mean better nutrition and development opportunities, yet 222 million couples continue to lack access to modern contraception. Method A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. Results Comprehensive interventions can prevent first pregnancy in adolescence by 15% and repeat adolescent pregnancy by 37%. Such interventions should address underlying social and community factors, include sexual and reproductive health services, contraceptive provision; personal development programs and emphasizes completion of education. Appropriate birth spacing (18-24 months from birth to next pregnancy compared to short intervals <6 months) can significantly lower maternal mortality, preterm births, stillbirths, low birth weight and early neonatal deaths. Conclusion Improving adolescent health and preventing adolescent pregnancy; and promotion of birth spacing through increasing correct and consistent use of effective contraception are fundamental to preconception care. Promoting reproductive planning on a wider scale is closely interlinked with the

  13. Is it safe? Talking to teens with HIV/AIDS about death and dying: a 3-month evaluation of Family Centered Advance Care (FACE) planning – anxiety, depression, quality of life

    PubMed Central

    Lyon, Maureen E; Garvie, Patricia A; Briggs, Linda; He, Jianping; Malow, Robert; D’Angelo, Lawrence J; McCarter, Robert

    2010-01-01

    Purpose To determine the safety of engaging HIV-positive (HIV+) adolescents in a Family Centered Advance Care (FACE) planning intervention. Patients and methods We conducted a 2-armed, randomized controlled clinical trial in 2 hospital-based outpatient clinics from 2006–2008 with HIV+ adolescents and their surrogates (n = 76). Three 60–90 minutes sessions were conducted weekly. FACE intervention groups received: Lyon FCACP Survey©, the Respecting Choices® interview, and completion of The Five Wishes©. The Healthy Living Control (HLC) received: Developmental History, Healthy Tips, Future Planning (vocational, school or vocational rehabilitation). Three-month post-intervention outcomes were: completion of advance directive (Five Wishes©); psychological adjustment (Beck Depression, Anxiety Inventories); quality of life (PedsQL™); and HIV symptoms (General Health Self-Assessment). Results Adolescents had a mean age, 16 years; 40% male; 92% African-American; 68% with perinatally acquired HIV, 29% had AIDS diagnosis. FACE participants completed advance directives more than controls, using time matched comparison (P < 0.001). Neither anxiety, nor depression, increased at clinically or statistically significant levels post-intervention. FACE adolescents maintained quality of life. FACE families perceived their adolescents as worsening in their school (P = 0.018) and emotional (P = 0.029) quality of life at 3 months, compared with controls. Conclusions Participating in advance care planning did not unduly distress HIV+ adolescents. PMID:22096382

  14. State Plan for Child Day Care [Virginia].

    ERIC Educational Resources Information Center

    Gravett, Marty; And Others

    Virginia's first state plan for child day care begins with 14 sections covering several aspects of child care. Section I reviews child care history and trends. Sections II, III, IV, and V argue, respectively, that child day care is important to government, business, families, and children. Elements of a comprehensive child day care delivery system…

  15. Training Advanced Practice Palliative Care Nurses.

    ERIC Educational Resources Information Center

    Sherman, Deborah Witt

    1999-01-01

    Describes the role and responsibilities of advanced-practice nurses in palliative care and nursing's initiative in promoting high-quality care through the educational preparation of these nurses. (JOW)

  16. Interdependence and life care planning.

    PubMed

    Condeluci, A; Gooden-Ledbetter, M; Walker, C; Porro, J M

    1998-01-01

    Today's society is more litigant in accidental injury occurrences. With many injuries involving children, malpractice suits have resulted in an influx of information and rehabilitation supports. To address the growing need for legal representation in life care planning for injured persons, this easily understood tool provides the injured party with a viable approach to community interdependence and inclusion. Contrary to the conventionally medical model, where the person with a disability is viewed as needing 'fixed', this approach examines culture, community and the long term effects of disability. The individual with a disability is seen and understood within four aspects of personhood: capacities, gifts and passions; inclusive relationships; personal involvement; and understanding their culture and community. This life care planning process examines five eras in one's life cycle: formative/school age years, early work years, later work years, and retirement years. The specific needs of the individual in each life era are examined and specific costs itemized. The provision of adequate services and supports affords tremendous opportunities and inclusion into the community.

  17. Care plans and care planning in long-term conditions: a conceptual model.

    PubMed

    Burt, Jenni; Rick, Jo; Blakeman, Thomas; Protheroe, Joanne; Roland, Martin; Bower, Pete

    2014-10-01

    The prevalence and impact of long-term conditions continues to rise. Care planning for people with long-term conditions has been a policy priority for chronic disease management in a number of health-care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between 'care planning' (the process by which health-care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a 'care plan' (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health-care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans.

  18. Health Instruction Packages: Nursing Care Plans.

    ERIC Educational Resources Information Center

    Kowalski, Dorcas S.; And Others

    Text, illustrations, and exercises are provided in this set of learning modules to teach nurses and nursing students various patient care skills. The first module, "How to Write a Nursing Care Plan" by Dorcas S. Kowalski, discusses three tasks in developing patient care plans: identifying and prioritizing a patient's needs, gathering information…

  19. Advanced Fuels Campaign Execution Plan

    SciTech Connect

    Kemal Pasamehmetoglu

    2011-09-01

    The purpose of the Advanced Fuels Campaign (AFC) Execution Plan is to communicate the structure and management of research, development, and demonstration (RD&D) activities within the Fuel Cycle Research and Development (FCRD) program. Included in this document is an overview of the FCRD program, a description of the difference between revolutionary and evolutionary approaches to nuclear fuel development, the meaning of science-based development of nuclear fuels, and the 'Grand Challenge' for the AFC that would, if achieved, provide a transformational technology to the nuclear industry in the form of a high performance, high reliability nuclear fuel system. The activities that will be conducted by the AFC to achieve success towards this grand challenge are described and the goals and milestones over the next 20 to 40 year period of research and development are established.

  20. Advanced Fuels Campaign Execution Plan

    SciTech Connect

    Kemal Pasamehmetoglu

    2010-10-01

    The purpose of the Advanced Fuels Campaign (AFC) Execution Plan is to communicate the structure and management of research, development, and demonstration (RD&D) activities within the Fuel Cycle Research and Development (FCRD) program. Included in this document is an overview of the FCRD program, a description of the difference between revolutionary and evolutionary approaches to nuclear fuel development, the meaning of science-based development of nuclear fuels, and the “Grand Challenge” for the AFC that would, if achieved, provide a transformational technology to the nuclear industry in the form of a high performance, high reliability nuclear fuel system. The activities that will be conducted by the AFC to achieve success towards this grand challenge are described and the goals and milestones over the next 20 to 40 year period of research and development are established.

  1. Managed Care Plans: Getting Good Care for Your Child

    MedlinePlus

    ... AAP Find a Pediatrician Family Life Medical Home Health Insurance Pediatric Specialists Family Dynamics Media Work & Play Getting ... Your Community Healthy Children > Family Life > Medical Home > Health Insurance > Managed Care Plans: Getting Good Care for Your ...

  2. Advanced planetary analyses. [for planetary mission planning

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The results are summarized of research accomplished during this period concerning planetary mission planning are summarized. The tasks reported include the cost estimations research, planetary missions handbook, and advanced planning activities.

  3. Care plans and care planning in long term conditions: a conceptual model

    PubMed Central

    Burt, J; Rick, J; Blakeman, T; Protheroe, J; Roland, M; Bower, P

    2013-01-01

    The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planning’ (the process by which health care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a ‘care plan’ (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans. PMID:23883621

  4. Future Care Planning for patients approaching end-of-life with advanced heart disease: an interview study with patients, carers and healthcare professionals exploring the content, rationale and design of a randomised clinical trial

    PubMed Central

    Denvir, Martin A; Highet, Gill; Robertson, Shirley; Cudmore, Sarah; Reid, Janet; Ness, Andrea; Hogg, Karen; Weir, Christopher; Murray, Scott; Boyd, Kirsty

    2014-01-01

    Objective To explore the optimal content and design of a clinical trial of an end-of-life intervention for advanced heart disease with patients, carers and healthcare professionals. Design Qualitative interview and focus group study. Setting Community and hospital-based focus groups and interviews. Participants Stable community-dwelling patients, informal carers (PC, n=15) and primary and secondary care based healthcare professionals (HCP, n=11). Results PC highlighted fragmentation of services and difficulty in accessing specialist care as key barriers to good care. They felt that time for discussion with HCP was inadequate within current National Health Service (NHS) healthcare systems. HCP highlighted uncertainty of prognosis, explaining mortality risk to patients and switching from curative to palliative approaches as key challenges. Patient selection, nature of the intervention and relevance of trial outcomes were identified by HCP as key challenges in the design of a clinical trial. Conclusions PC and HCP expressed a number of concerns relevant to the nature and content of an end-of-life intervention for patients with advanced heart disease. The findings of this study are being used to support a phase II randomised clinical trial of Future Care Planning in advanced heart disease. PMID:25023130

  5. Advanced Life Support Project Plan

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Life support systems are an enabling technology and have become integral to the success of living and working in space. As NASA embarks on human exploration and development of space to open the space frontier by exploring, using and enabling the development of space and to expand the human experience into the far reaches of space, it becomes imperative, for considerations of safety, cost, and crew health, to minimize consumables and increase the autonomy of the life support system. Utilizing advanced life support technologies increases this autonomy by reducing mass, power, and volume necessary for human support, thus permitting larger payload allocations for science and exploration. Two basic classes of life support systems must be developed, those directed toward applications on transportation/habitation vehicles (e.g., Space Shuttle, International Space Station (ISS), next generation launch vehicles, crew-tended stations/observatories, planetary transit spacecraft, etc.) and those directed toward applications on the planetary surfaces (e.g., lunar or Martian landing spacecraft, planetary habitats and facilities, etc.). In general, it can be viewed as those systems compatible with microgravity and those compatible with hypogravity environments. Part B of the Appendix defines the technology development 'Roadmap' to be followed in providing the necessary systems for these missions. The purpose of this Project Plan is to define the Project objectives, Project-level requirements, the management organizations responsible for the Project throughout its life cycle, and Project-level resources, schedules and controls.

  6. Oncology Advanced Practitioners Bring Advanced Community Oncology Care.

    PubMed

    Vogel, Wendy H

    2016-01-01

    Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring. PMID:27249776

  7. Planning Campus Health Care Services 2.

    ERIC Educational Resources Information Center

    Douglas, Bruce L.

    1975-01-01

    In a context of forecasts of major changes for America's entire health care system, colleges and universities are exploring the implications of new trends in campus health care delivery. On January 30-31, 1975, the Society for College and University Planning sponsored a workshop on "Campus Health Care Services" in Chicago to discuss such issues as…

  8. Advances in prehospital trauma care

    PubMed Central

    Williamson, Kelvin; Ramesh, Ramaiah; Grabinsky, Andreas

    2011-01-01

    Prehospital trauma care developed over the last decades parallel in many countries. Most of the prehospital emergency medical systems relied on input or experiences from military medicine and were often modeled after the existing military procedures. Some systems were initially developed with the trauma patient in mind, while other systems were tailored for medical, especially cardiovascular, emergencies. The key components to successful prehospital trauma care are the well-known ABCs of trauma care: Airway, Breathing, Circulation. Establishing and securing the airway, ventilation, fluid resuscitation, and in addition, the quick transport to the best-suited trauma center represent the pillars of trauma care in the field. While ABC in trauma care has neither been challenged nor changed, new techniques, tools and procedures have been developed to make it easier for the prehospital provider to achieve these goals in the prehospital setting and thus improve the outcome of trauma patients. PMID:22096773

  9. Center to Advance Palliative Care palliative care clinical care and customer satisfaction metrics consensus recommendations.

    PubMed

    Weissman, David E; Morrison, R Sean; Meier, Diane E

    2010-02-01

    Data collection and analysis are vital for strategic planning, quality improvement, and demonstration of palliative care program impact to hospital administrators, private funders and policymakers. Since 2000, the Center to Advance Palliative Care (CAPC) has provided technical assistance to hospitals, health systems and hospices working to start, sustain, and grow nonhospice palliative care programs. CAPC convened a consensus panel in 2008 to develop recommendations for specific clinical and customer metrics that programs should track. The panel agreed on four key domains of clinical metrics and two domains of customer metrics. Clinical metrics include: daily assessment of physical/psychological/spiritual symptoms by a symptom assessment tool; establishment of patient-centered goals of care; support to patient/family caregivers; and management of transitions across care sites. For customer metrics, consensus was reached on two domains that should be tracked to assess satisfaction: patient/family satisfaction, and referring clinician satisfaction. In an effort to ensure access to reliably high-quality palliative care data throughout the nation, hospital palliative care programs are encouraged to collect and report outcomes for each of the metric domains described here. PMID:19922199

  10. Advanced Respite Care: Medically Challenged. Teacher Edition. Respite Care Series.

    ERIC Educational Resources Information Center

    Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

    This curriculum guide is designed to help teachers to provide advanced-level training for care providers who want to work with individuals who are chronically or terminally ill and require specialized care. The curriculum contains seven units. Each of the instructional units includes some or all of these basic components: performance objectives,…

  11. Center to Advance Palliative Care

    MedlinePlus

    ... Take me to the Registry Registry Jobs For Job Seekers CAPC posts positions for palliative care professionals ... field. Browse the listings , and please contact the job poster directly for further information. Browse Jobs For ...

  12. Medicare and Caregivers: Planning for Medical Care

    MedlinePlus

    ... turn Javascript on. Medicare and Caregivers Planning for Medical Care If you find that an older relative ... friend needs your help to deal with a medical condition, there are a number of steps you ...

  13. 42 CFR 441.155 - Individual plan of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Individual plan of care. 441.155 Section 441.155... Individual plan of care. (a) “Individual plan of care” means a written plan developed for each recipient in... care is no longer necessary. (b) The plan of care must— (1) Be based on a diagnostic evaluation...

  14. Health care reform and family planning services.

    PubMed

    Policar, M

    1993-01-01

    With the reforms expected for US health care, the question remains as to the impact on family planning services. Although the focus is on health care finance reform, the mix of patients seen, the incentives for decision making, and the interactions between health care providers will change. Definition of key concepts is provided for universal access, managed competition, and managed care. The position of the obstetrician/gynecologist (Ob/Gyn) does not fit well within the scheme for managed health care, because Ob/Gyns are both primary care providers and specialists in women's health care. Most managed health care systems presently consider Ob/Gyn to be a specialty. Public family planning clinics, which have a client constituency of primarily uninsured women, may have to compete with traditional private sector providers. "Ambulatory health care providers" have developed a reputation for high quality, cost effective preventive health care services; this record should place providers with a range of services in a successful position. Family planning providers in a managed competition system will be at a disadvantage. 3 scenarios possible under managed competition are identified as the best case, out of the mainstream, and most likely. The best case is when primary reproductive health care services, contraception, sexually transmitted disease screening and management, and preventive services are all obtained directly from reproductive health care providers. Under managed care, this means allowing for an additional entry gatekeeper to specialized services. The benefits are to clients who prefer seeing reproductive health care providers first; reproductive services would be separated from medical services. The out of the mainstream scenario would place contraceptive services and other preventive services as outside the mandated benefits. The government would still provide Title X type programs for the indigent. The most likely scenario is one where primary care providers

  15. The Caring Connections Project: Providing palliative care to Medicaid patients with advanced cancer.

    PubMed

    Pfeifer, Mark P; Ritchie, Christine; Scharfenberger, Jennifer; Keeney, Cynthia; Hermann, Carla; Berwick, Marilyn; Head, Barbara

    2006-01-01

    Palliative care, with its focus on symptom management, patient-centered goals, preparation for life's end, and preservation of quality of life in the face of advancing illness, is a rapidly advancing component of mainstream American medicine. Yet, access to palliative care is often lacking in the community setting and may be further hindered by the presence of healthcare disparities that impact the poor. This article presents a unique approach to assuring the availability of palliative care to Medicaid patients receiving case management services. This descriptive article describes the evolution of a palliative care management pilot program, the Caring Connections Program, beginning with the initial planning and progressing through implementation and provision of services to 56 persons. "Lessons learned" are shared to enable other providers to develop similar programs with success. Patient profiles and intervention strategies are offered to illustrate the work accomplished.

  16. Advanced planning for ISS payload ground processing

    NASA Astrophysics Data System (ADS)

    Page, Kimberly A.

    2000-01-01

    Ground processing at John F. Kennedy Space Center (KSC) is the concluding phase of the payload/flight hardware development process and is the final opportunity to ensure safe and successful recognition of mission objectives. Planning for the ground processing of on-orbit flight hardware elements and payloads for the International Space Station is a responsibility taken seriously at KSC. Realizing that entering into this operational environment can be an enormous undertaking for a payload customer, KSC continually works to improve this process by instituting new/improved services for payload developer/owner, applying state-of-the-art technologies to the advanced planning process, and incorporating lessons learned for payload ground processing planning to ensure complete customer satisfaction. This paper will present an overview of the KSC advanced planning activities for ISS hardware/payload ground processing. It will focus on when and how KSC begins to interact with the payload developer/owner, how that interaction changes (and grows) throughout the planning process, and how KSC ensures that advanced planning is successfully implemented at the launch site. It will also briefly consider the type of advance planning conducted by the launch site that is transparent to the payload user but essential to the successful processing of the payload (i.e. resource allocation, executing documentation, etc.) .

  17. Planning an ambulatory care joint venture.

    PubMed

    Harpster, L M

    1988-01-01

    This article discusses ambulatory care joint ventures by hospitals and selected members of their medical staffs and emphasizes the resolution of problems in the early planning stages. Failure to follow an orderly and thoughtful planning process not only risks valuable resources of the venture partners, but also jeopardizes the working relationship between the hospital and its medical staff.

  18. 42 CFR 456.180 - Individual written plan of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Plan of Care § 456.180 Individual written plan of care. (a) Before admission to a mental hospital or... review each plan of care at least every 90 days. ... 42 Public Health 4 2010-10-01 2010-10-01 false Individual written plan of care. 456.180...

  19. Advanced access: reducing waiting and delays in primary care.

    PubMed

    Murray, Mark; Berwick, Donald M

    2003-02-26

    Delay of care is a persistent and undesirable feature of current health care systems. Although delay seems to be inevitable and linked to resource limitations, it often is neither. Rather, it is usually the result of unplanned, irrational scheduling and resource allocation. Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce waiting times in primary care. The core principle of advanced access is that patients calling to schedule a physician visit are offered an appointment the same day. Advanced access is not sustainable if patient demand for appointments is permanently greater than physician capacity to offer appointments. Six elements of advanced access are important in its application balancing supply and demand, reducing backlog, reducing the variety of appointment types, developing contingency plans for unusual circumstances, working to adjust demand profiles, and increasing the availability of bottleneck resources. Although these principles are powerful, they are counter to deeply held beliefs and established practices in health care organizations. Adopting these principles requires strong leadership investment and support.

  20. Advanced access: reducing waiting and delays in primary care.

    PubMed

    Murray, Mark; Berwick, Donald M

    2003-02-26

    Delay of care is a persistent and undesirable feature of current health care systems. Although delay seems to be inevitable and linked to resource limitations, it often is neither. Rather, it is usually the result of unplanned, irrational scheduling and resource allocation. Application of queuing theory and principles of industrial engineering, adapted appropriately to clinical settings, can reduce delay substantially, even in small practices, without requiring additional resources. One model, sometimes referred to as advanced access, has increasingly been shown to reduce waiting times in primary care. The core principle of advanced access is that patients calling to schedule a physician visit are offered an appointment the same day. Advanced access is not sustainable if patient demand for appointments is permanently greater than physician capacity to offer appointments. Six elements of advanced access are important in its application balancing supply and demand, reducing backlog, reducing the variety of appointment types, developing contingency plans for unusual circumstances, working to adjust demand profiles, and increasing the availability of bottleneck resources. Although these principles are powerful, they are counter to deeply held beliefs and established practices in health care organizations. Adopting these principles requires strong leadership investment and support. PMID:12597760

  1. Advancing the Community College Strategic Plan.

    ERIC Educational Resources Information Center

    Herbkersman, Neil; Hibbert-Jones, Karla

    2002-01-01

    Discusses the importance of developing a comprehensive grants development process to advance community college strategic plans, especially in the current economic climate. Details the process as developed and implemented by Sinclair Community College (Ohio). States that colleges that employ methodical processes and effective operating systems to…

  2. 42 CFR 460.106 - Plan of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... comprehensive plan of care for each participant. (b) Content of plan of care. The plan of care must meet the following requirements: (1) Specify the care needed to meet the participant's medical, physical, emotional...) The team must continuously monitor the participant's health and psychosocial status, as well as...

  3. 42 CFR 460.106 - Plan of care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... comprehensive plan of care for each participant. (b) Content of plan of care. The plan of care must meet the following requirements: (1) Specify the care needed to meet the participant's medical, physical, emotional...) The team must continuously monitor the participant's health and psychosocial status, as well as...

  4. 42 CFR 460.106 - Plan of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... comprehensive plan of care for each participant. (b) Content of plan of care. The plan of care must meet the following requirements: (1) Specify the care needed to meet the participant's medical, physical, emotional...) The team must continuously monitor the participant's health and psychosocial status, as well as...

  5. 42 CFR 460.106 - Plan of care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... comprehensive plan of care for each participant. (b) Content of plan of care. The plan of care must meet the following requirements: (1) Specify the care needed to meet the participant's medical, physical, emotional...) The team must continuously monitor the participant's health and psychosocial status, as well as...

  6. 42 CFR 460.106 - Plan of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... comprehensive plan of care for each participant. (b) Content of plan of care. The plan of care must meet the following requirements: (1) Specify the care needed to meet the participant's medical, physical, emotional...) The team must continuously monitor the participant's health and psychosocial status, as well as...

  7. Social marketing: planning before conceiving preconception care.

    PubMed

    Prue, Christine E; Daniel, Katherine Lyon

    2006-09-01

    Social marketing approaches can help to shape the formation of and to create demand for preconception care services. This article describes four components of social marketing, often referred to as the 4 P's, that should be carefully researched and set in place before a national effort to launch and sustain preconception care services is pursued. First, the product or package of services must be defined and adapted using the latest in scientific and health care standards and must be based on consumer needs and desires. Second, the pricing of the services in financial or opportunity costs must be acceptable to the consumer, insurers, and health care service providers. Third, the promotion of benefits must be carefully crafted to reach and appeal to both consumers and providers. Fourth, the placement and availability of services in the marketplace must be researched and planned. With the application of market research practices that incorporate health behavior theories in their exploration of each component, consumer demand for preconception care can be generated, and providers can take preconception care to the market with confidence.

  8. End-of-Life Decisions and Palliative Care in Advanced Heart Failure.

    PubMed

    Meyers, Deborah E; Goodlin, Sarah J

    2016-09-01

    Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan. Use of defined triggers for FCP can stimulate important patient-caregiver conversations. Guidelines advocate an annual review of HF status and future care preferences. Advance directives are important for any individual with a chronic, life-limiting illness and should be integrated into FCP. Nevertheless, use of advance directives by HF patients is extremely low. Consideration of illness trajectories and risk-scoring tools might facilitate prognostication and delivery of appropriate HF care. Decisions about heart transplantation or left ventricular assist device implantation should include planning for potential complications associated with these therapies. Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions.

  9. End-of-Life Decisions and Palliative Care in Advanced Heart Failure.

    PubMed

    Meyers, Deborah E; Goodlin, Sarah J

    2016-09-01

    Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan. Use of defined triggers for FCP can stimulate important patient-caregiver conversations. Guidelines advocate an annual review of HF status and future care preferences. Advance directives are important for any individual with a chronic, life-limiting illness and should be integrated into FCP. Nevertheless, use of advance directives by HF patients is extremely low. Consideration of illness trajectories and risk-scoring tools might facilitate prognostication and delivery of appropriate HF care. Decisions about heart transplantation or left ventricular assist device implantation should include planning for potential complications associated with these therapies. Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions. PMID:27568873

  10. Palliative care for patients with advance chronic kidney disease.

    PubMed

    Douglas, C A

    2014-01-01

    Over the past three decades there has been a dramatic rise in the number of patients with advanced chronic kidney disease. The fastest expanding group receiving dialysis has been the elderly. However, for those patients who are very elderly with co-morbidity, dialysis may not offer a survival advantage. Therefore, active conservative management is a growing service offered by many renal units in the UK and focuses on non-dialytic correction of fluid and electrolyes, management of renal anaemia, and assessment and management of symptoms. The five-year survival of a patient over 75 years of age starting dialysis is 20% and if a patient is over 75 years, has co-morbidity, or a poor performance status, dialysis may not offer any survival advantage. Whether a patient is managed by dialysis or by conservative management the symptom burden suffered is high. These symptoms are under-recognised and often managed poorly because of increased drug toxicity in renal failure. This complex group of patients require close working between renal, palliative care, medicine for the elderly, and community teams, to allow best quality of life and end of life care. This review describes some of the challenges in providing Advanced Care Planning for dialysis and conservatively managed patients, highlights the symptom burden of patients with advanced chronic kidney disease, and offers guidance in how to manage the symptoms effectively.

  11. Pain: advances and issues in critical care.

    PubMed

    Harrison, M; Cotanch, P H

    1987-09-01

    The milieu of the critical care unit is stressful for both the patient and health care professionals. As such, it has the potential to increase pain perception in patients, and decrease the nurse's awareness of pain relief needs of the patient. Several physical and pharmacologic methods of pain relief were discussed in this article. Nontechnologic analgesia such as hypnosis and relaxation were introduced as adjuncts or alternatives to more familiar methods of pain relief. Although critically ill patients are not always able to express their discomfort, it is the responsibility of the nurse to recognize the potential for pain, and plan treatment accordingly. This article suggests several strategies for dealing with pain in critically ill patients. PMID:3302958

  12. District of Columbia Early Care and Education Strategic Plan.

    ERIC Educational Resources Information Center

    District of Columbia Univ., Washington, DC. Center for Applied Research and Urban Policy.

    This report details the early care and education strategic plan for the District of Columbia. Following an executive summary, the report provides the rationale for developing an early care and education strategic plan and describes the process used to develop the plan. The top 10 early care and education issues in the district are then delineated…

  13. 42 CFR 456.80 - Individual written plan of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Plan of Care § 456.80 Individual written plan of care. (a) Before admission to a hospital or before authorization for... personnel involved in the recipient's case must review each plan of care at least every 60 days....

  14. Advanced Materials Laboratory User Test Planning Guide

    NASA Technical Reports Server (NTRS)

    Orndoff, Evelyne

    2012-01-01

    Test process, milestones and inputs are unknowns to first-time users of the Advanced Materials Laboratory. The User Test Planning Guide aids in establishing expectations for both NASA and non-NASA facility customers. The potential audience for this guide includes both internal and commercial spaceflight hardware/software developers. It is intended to assist their test engineering personnel in test planning and execution. Material covered includes a roadmap of the test process, roles and responsibilities of facility and user, major milestones, facility capabilities, and inputs required by the facility. Samples of deliverables, test article interfaces, and inputs necessary to define test scope, cost, and schedule are included as an appendix to the guide.

  15. Advanced Stirling Radioisotope Generator Life Certification Plan

    NASA Technical Reports Server (NTRS)

    Rusick, Jeffrey J.; Zampino, Edward

    2013-01-01

    An Advanced Stirling Radioisotope Generator (ASRG) power supply is being developed by the Department of Energy (DOE) in partnership with NASA for potential future deep space science missions. Unlike previous radioisotope power supplies for space exploration, such as the passive MMRTG used recently on the Mars Curiosity rover, the ASRG is an active dynamic power supply with moving Stirling engine mechanical components. Due to the long life requirement of 17 years and the dynamic nature of the Stirling engine, the ASRG project faced some unique challenges trying to establish full confidence that the power supply will function reliably over the mission life. These unique challenges resulted in the development of an overall life certification plan that emphasizes long-term Stirling engine test and inspection when analysis is not practical. The ASRG life certification plan developed is described.

  16. Understanding and supporting African Americans' perspectives of end-of-life care planning and decision making.

    PubMed

    Waters, C M

    2001-05-01

    Ethnicity has been found to explain some differences across ethnic groups regarding end-of-life care choices. African Americans appear to be less likely to know about advance directives and to complete them. Five community-based focus groups, consisting of 27 African Americans, were convened to explore their perspectives of end-of-life care planning and decision making. Content analysis revealed six themes: death is not an option, religiosity and end-of-life care planning is a paradox, the health care system is a microcosm of societal and historical events, a "trusted" family member or friend is the contract for life-and-death options, ethnically relevant initiatives are essential to increase advance directives participation, and people are people. These themes serve to guide health care professionals in minimizing actions that increase African Americans' mistrust of the health care system not only in end-of-life situations but also in all of health care-related interactions.

  17. [Clinical case: Complicated grief in primary care. Care plan].

    PubMed

    Ruymán Brito-Brito, Pedro; Rodríguez-Ramos, Mercedes; Pérez-García-Talavera, Carlos

    2009-01-01

    This is the case of a 61-year-old patient woman that visits her nurse in Primary Health Care to get the control of blood pressure and glycemia. In the last two years has suffered the loss of her husband and of two brothers beside having lived through other vital stressful events that have taken her to a situation of complicated grief. The care plan is realized using the M. Gordon assessment system and standardized languages NANDA, NOC and NIC. The principal aims were the improvement of the depression level and the improvement in the affliction resolution. As suggested interventions were proposed to facilitate the grief and the derivation to a mental health unit. A follow-up of the patient was realized in nursing consultation at Primary health care to weekly intervals, in the beginning, and monthly, later. The evaluation of the care plan reflects an improvement in the criteria of Prigerson's complicated grief; an increase of the recreative activities; the retreat of the mourning that still she was guarding; as well as an improvement in the control of the blood pressure numbers. The attention of nurses before a case of complicated grief turns out to be complex. Nevertheless the suitable accomplishment of certain interventions orientated to facilitating the grief, with a follow-up in consultation, shows the efficiency. The difficulty in the boarding of the psychosocial problems meets increased at the moment of are necessary the nursing diagnostics adapted for every individual case. The work in group between nurses could improves the consensus.

  18. Ready or not: planning for health declines in couples with advanced multiple sclerosis.

    PubMed

    Chen, Hannah; Habermann, Barbara

    2013-02-01

    This study explored how couples living with advanced multiple sclerosis approach planning for health changes together. A qualitative descriptive approach was used, with multiple in-depth interviews. Ten couples were interviewed, consisting of 10 participants with advanced multiple sclerosis and their 10 respective spouses. Interviews were transcribed verbatim and analyzed for themes related to dyad decision making. Particular focus was paid to how or if couples planned for worsening health, including advance care planning. Characteristics of couples who had made plans for worsening health included a desire to make decisions ahead of time, work in a healthcare field, and a life-threatening health event for the care-giving partner. Characteristics of couples who had not discussed plans for worsening health included diminished quality of communication between partners and hoping for a cure. Findings suggest that providers may need to assess quality of communication between partners, because strained communication may negatively affect the process of informed healthcare decision making. PMID:23291870

  19. [Palliative care needs in advanced chronic illness].

    PubMed

    Tripodoro, Vilma A; Rynkiewicz, María C; Llanos, Victoria; Padova, Susana; De Lellis, Silvina; De Simone, Gustavo

    2016-01-01

    About 75% of population will die from one or more chronic progressive diseases. From this projection WHO urged countries to devise strategies for strengthening palliative treatment as part of comprehensive care. In Catalonia, Spain, direct measurement of the prevalence of these patients with NECPAL CCOMS-ICO© tool was 1.5% of the population. This tool is an indicative, not dichotomous, quali-quantitative multifactorial evaluation to be completed by the treating physician. In Argentina there is no information on these patients. Our goal was to explore and characterize the proportion of chronically ill patients in palliative care needs, by NECPAL CCOMS-ICO© tool, in an accessible population of the City of Buenos Aires. General hospitals of the Health Region 2 (Piñero, álvarez and Santojanni) and its program areas were surveyed. In Health Region 1, we surveyed the Udaondo gastroenterology hospital. A total of 53 physicians (704 patients) were interviewed. It was identified that 29.5% of these patients were affected by advanced chronic diseases; 72.1% of them were NECPAL positive, younger (median 64) than in others studies, and more than 98% presented high levels of comorbidity. Palliative care demand (31.4%) and needs (52.7%) were recorded. Specific indicators of fragility, progression, severity and kind of chronic disease were described. The main finding was to identify, with an instrument not based on mortality that, in Buenos Aires City, 1 in 3 patients with chronic diseases could die in the next year and had palliative care needs. PMID:27295702

  20. [The child with osteogenesis imperfecta. Care plans].

    PubMed

    Fernández Maldonado, Ana I; Gutiérrez Alonso, José Luis

    2002-06-01

    The authors state what is the nursing care to follow with a child affected by imperfect osteogenesis. This treatment is divided into three fundamental parts. In the first part, one plans out the psycho-sociological assistance the parents in question need in order to achieve their acceptance of a child suffering from a serious illness. In the second part, the authors describe the physical and psychological treatment which patients suffering imperfect osteogenesis should receive in order to avoid serious complications which can develop during their growth, treatment directed towards the family and the professional who shall care for this child. Finally in the third part, a child suffering imperfect osteogenesis shall receive the necessary knowledge and skills so that he/she can achieve maximum social integration. PMID:14508948

  1. Advance Care Planning: Medical Issues to Consider

    MedlinePlus

    ... can be forced into the stomach, causing distress. Dialysis What does it entail? If a person develops ... kidneys and build up in the body. A dialysis machine filters the toxins out of the blood. ...

  2. Strategic planning by the palliative care steering committee of the Middle East Cancer Consortium.

    PubMed

    Moore, Shannon Y; Pirrello, Rosene D; Christianson, Sonya K; Ferris, Frank D

    2011-04-01

    High quality comprehensive palliative care is a critical need for millions of patients and families, but remains only a dream in many parts of the world. The failure to do a strategic planning process is one obstacle to advancing education and pain prevention and relief. The Middle Eastern Cancer Consortium Steering Committee attendees completed an initial strategic planning process and identified "developmental steps" to advance palliative care. Underscoring the multi-disciplinary nature of comprehensive palliative care, discipline-specific planning was done (adult and pediatric cancer and medicine, pharmacy, nursing) in a separate process from country-specific planning. Delineating the layers of intersection and differences between disciplines and countries was very powerful. Finding the common strengths and weaknesses in the status quo creates the potential for a more powerful regional response to the palliative care needs. Implementing and refining these preliminary strategic plans will augment and align the efforts to advance palliative care education and pain management in the Middle East. The dream to prevent and relieve suffering for millions of patients with advanced disease will become reality with a powerful strategic planning process well implemented.

  3. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... Engineering Proposals § 151.111 Advance planning proposals: General. (a) Each advance planning and engineering... application, under §§ 151.21(c) and 151.27, or both. (c) Each proposal must relate to planning and engineering... “Airport Activity Statistics of Certificated Route Air Carriers” (published jointly by FAA and the...

  4. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... Engineering Proposals § 151.111 Advance planning proposals: General. (a) Each advance planning and engineering... application, under §§ 151.21(c) and 151.27, or both. (c) Each proposal must relate to planning and engineering... “Airport Activity Statistics of Certificated Route Air Carriers” (published jointly by FAA and the...

  5. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... Engineering Proposals § 151.111 Advance planning proposals: General. (a) Each advance planning and engineering... application, under §§ 151.21(c) and 151.27, or both. (c) Each proposal must relate to planning and engineering... “Airport Activity Statistics of Certificated Route Air Carriers” (published jointly by FAA and the...

  6. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... Engineering Proposals § 151.111 Advance planning proposals: General. (a) Each advance planning and engineering... application, under §§ 151.21(c) and 151.27, or both. (c) Each proposal must relate to planning and engineering... “Airport Activity Statistics of Certificated Route Air Carriers” (published jointly by FAA and the...

  7. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... Engineering Proposals § 151.111 Advance planning proposals: General. (a) Each advance planning and engineering... application, under §§ 151.21(c) and 151.27, or both. (c) Each proposal must relate to planning and engineering... “Airport Activity Statistics of Certificated Route Air Carriers” (published jointly by FAA and the...

  8. Advanced Education and Technology Business Plan, 2008-11

    ERIC Educational Resources Information Center

    Alberta Advanced Education and Technology, 2008

    2008-01-01

    The Ministry of Advanced Education and Technology's 2008-11 business plan identifies how it plans to work over the next three years to enhance advanced learning opportunities and innovation for all Albertans. Alberta's advanced learning system is composed of public board-governed institutions, the apprenticeship and industry training system,…

  9. Concept mapping: reducing clinical care plan paperwork and increasing learning.

    PubMed

    Schuster, P M

    2000-01-01

    The author describes how concept maps were used in place of nursing care plans to reduce care planning paperwork in fundamentals and medical-surgical clinical courses in acute care facilities. In addition to less paperwork, clinical concept mapping enhances students' critical thinking skills and clinical reasoning because students and faculty can clearly and succinctly visualize priorities and identify relationships in clinical patient data.

  10. Advanced practice nursing in performing arts health care.

    PubMed

    Weslin, Anna T; Silva-Smith, Amy

    2010-06-01

    Performing arts medicine is a growing health care profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique health care needs requiring a more collaborative and holistic health care program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts health care. APNs, with focus on collaborative and holistic health care, are ideally suited to join other health care professionals in developing and implementing comprehensive health care programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts health care.

  11. Usage analysis of a shared care planning system.

    PubMed

    Warren, Jim; Gu, Yulong; Humphrey, Gayl

    2012-01-01

    We examined the content of electronically mediated communications in a trial of shared care planning (SCP) for long-term condition management. Software supports SCP by sharing patient records and care plans among members of the multidisciplinary care team (with patient access). Our analysis focuses on a three-month period with 73 enrolled patients, 149 provider-assigned tasks, 64 clinical notes and 48 care plans with 162 plan elements. Results show that content of notes entries is often related to task assignment and that nurses are the most active users. Directions for refinement of the SCP technology are indicated, including better integration of notes, tasks and care team notifications, as well as the central role of nurses for design use cases. Broader issues are raised about workforce roles and responsibilities for SCP, integrating patient-provider and provider-provider communications, and the centrality of care plans as the key entity in mediation of the care team.

  12. Advanced Education and Technology Business Plan, 2010-13

    ERIC Educational Resources Information Center

    Alberta Advanced Education and Technology, 2010

    2010-01-01

    This paper presents the business plan of the Ministry of Advanced Education and Technology for 2010 to 2013. Advanced Education and Technology supports the advanced learning system by providing funding for advanced learning providers, coordinating and approving programs of study at public institutions, licensing and approving programs at private…

  13. Palliative care for advanced dementia in Japan: knowledge and attitudes.

    PubMed

    Nakanishi, Miharu; Miyamoto, Yuki

    This study examined factors contributing to the knowledge and attitudes of nursing home staff regarding palliative care for advanced dementia in Japan. A cross-sectional survey of 275 nurses and other care workers from 74 long-term care facilities was conducted across three prefectures in August 2014. The Japanese versions of the Questionnaire on Palliative Care for Advanced Dementia (qPAD) and Frommelt Attitudes Toward Care of the Dying scale, Form B (FATCOD-B-J) were used. Greater knowledge was exhibited among nursing home staff in facilities that established a manual for end-of-life care. Higher levels of positive attitudes were observed among nursing home staff in facilities that had established a manual and those in facilities with a physician's written opinions on end-of-life care. An organisational effort should be explored to establish end-of-life care policies among nursing home staff for advanced dementia.

  14. Communicating Nursing Care Using the Health Level Seven Consolidated Clinical Document Architecture Release 2 Care Plan.

    PubMed

    Matney, Susan A; Dolin, Gay; Buhl, Lindy; Sheide, Amy

    2016-03-01

    A care plan provides a patient, family, or community picture and outlines the care to be provided. The Health Level Seven Consolidated Clinical Document Architecture (C-CDA) Release 2 Care Plan Document is used to structure care plan data when sharing the care plan between systems and/or settings. The American Nurses Association has recommended the use of two terminologies, Logical Observation Identifiers Names and Codes (LOINC) for assessments and outcomes and Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) for problems, procedures (interventions), outcomes, and observation findings within the C-CDA. This article describes C-CDA, introduces LOINC and SNOMED CT, discusses how the C-CDA Care Plan aligns with the nursing process, and illustrates how nursing care data can be structured and encoded within a C-CDA Care Plan.

  15. Careful Planning Key to Accurate Fixed Reports Assets.

    ERIC Educational Resources Information Center

    MaRous, Arnold M.

    1986-01-01

    Only with careful planning can school business managers develop fixed asset information and good recordkeeping. Use of a simple inventory system and discussion with school districts already utilizing this system will assist planning. (CJH)

  16. Advanced Planning for Tsunamis in California

    NASA Astrophysics Data System (ADS)

    Miller, K.; Wilson, R. I.; Larkin, D.; Reade, S.; Carnathan, D.; Davis, M.; Nicolini, T.; Johnson, L.; Boldt, E.; Tardy, A.

    2013-12-01

    The California Tsunami Program is comprised of the California Governor's Office of Emergency Services (CalOES) and the California Geological Survey (CGS) and funded through the National Tsunami Hazard Mitigation Program (NTHMP) and the Federal Emergency Management Agency (FEMA). The program works closely with the 20 coastal counties in California, as well as academic, and industry experts to improve tsunami preparedness and mitigation in shoreline communities. Inundation maps depicting 'worst case' inundation modeled from plausible sources around the Pacific were released in 2009 and have provided a foundation for public evacuation and emergency response planning in California. Experience during recent tsunamis impacting the state (Japan 2011, Chile 2010, Samoa 2009) has brought to light the desire by emergency managers and decision makers for even more detailed information ahead of future tsunamis. A solution to provide enhanced information has been development of 'playbooks' to plan for a variety of expected tsunami scenarios. Elevation 'playbook' lines can be useful for partial tsunami evacuations when enough information about forecast amplitude and arrival times is available to coastal communities and there is sufficient time to make more educated decisions about who to evacuate for a given scenario or actual event. NOAA-issued Tsunami Alert Bulletins received in advance of a distant event will contain an expected wave height (a number) for each given section of coast. Provision of four elevation lines for possible inundation enables planning for different evacuation scenarios based on the above number potentially alleviating the need for an 'all or nothing' decision with regard to evacuation. Additionally an analytical tool called FASTER is being developed to integrate storm, tides, modeling errors, and local tsunami run-up potential with the forecasted tsunami amplitudes in real-time when a tsunami Alert is sent out. Both of these products will help

  17. Patient Satisfaction With Breast and Colorectal Cancer Survivorship Care Plans

    PubMed Central

    Sprague, Brian L.; Dittus, Kim L.; Pace, Claire M.; Dulko, Dorothy; Pollack, Lori A.; Hawkins, Nikki A.; Geller, Berta M.

    2015-01-01

    Cancer survivors face several challenges following the completion of active treatment, including uncertainty about late effects of treatment and confusion about coordination of follow-up care. The authors evaluated patient satisfaction with personalized survivorship care plans designed to clarify those issues. The authors enrolled 48 patients with breast cancer and 10 patients with colorectal cancer who had completed treatment in the previous two months from an urban academic medical center and a rural community hospital. Patient satisfaction with the care plan was assessed by telephone interview. Overall, about 80% of patients were very or completely satisfied with the care plan, and 90% or more agreed that it was useful, it was easy to understand, and the length was appropriate. Most patients reported that the care plan was very or critically important to understanding an array of survivorship issues. However, only about half felt that it helped them better understand the roles of primary care providers and oncologists in survivorship care. The results provide evidence that patients with cancer find high value in personalized survivorship care plans, but the plans do not eliminate confusion regarding the coordination of follow-up care. Future efforts to improve care plans should focus on better descriptions of how survivorship care will be coordinated. PMID:23722604

  18. Development and implementation of an interdisciplinary plan of care.

    PubMed

    Lewis, Cynthia; Hoffmann, Mary Lou; Gard, Angela; Coons, Jacqueline; Bichinich, Pat; Euclid, Jeff

    2005-01-01

    In January 2002 Aurora Health Care Metro Region chartered an interdisciplinary team to develop a process and structure for patient-centered interdisciplinary care planning. This unique endeavor created a process that includes the patient, family, and all clinical disciplines involved in planning and providing care to patients from system point of entry throughout the entire acute care episode. The interdisciplinary plan of care (IPOC) demonstrates the integration of prioritized problems, outcomes, and measurement toward goal attainment. This article focuses on the journey of this team to the successful implementation of an IPOC.

  19. Health Care in the United States [and] Health Care Issues: A Lesson Plan.

    ERIC Educational Resources Information Center

    Lewis, John; Dempsey, Joanne R.

    1984-01-01

    An article on American health care which focuses on health care costs and benefits is combined with a lesson plan on health care issues to enable students to consider both issues of cost effectiveness and morality in decisions about the allocation of health care. The article covers the history of interest in health care, the reasons for the…

  20. An Incentive Pay Plan for Advanced Practice Registered Nurses: Impact On Provider and Organizational Outcomes.

    PubMed

    Rhodes, Catherine A; Bechtle, Mavis; McNett, Molly

    2015-01-01

    Advanced practice registered nurses (APRNs) are integral to the provision of quality, cost-effective health care throughout the continuum of care. To promote job satisfaction and ultimately decrease turnover, an APRN incentive plan based on productivity and quality was formulated. Clinical productivity in the incentive plan was measured by national benchmarks for work relative value units for nonphysician providers. After the first year of implementation, APRNs were paid more for additional productivity and quality and the institution had an increase in patient visits and charges. The incentive plan is a win-win for hospitals that employ APRNs. PMID:26259336

  1. Plan for advanced microelectronics processing technology application

    SciTech Connect

    Goland, A.N.

    1990-10-01

    The ultimate objective of the tasks described in the research agreement was to identify resources primarily, but not exclusively, within New York State that are available for the development of a Center for Advanced Microelectronics Processing (CAMP). Identification of those resources would enable Brookhaven National Laboratory to prepare a program plan for the CAMP. In order to achieve the stated goal, the principal investigators undertook to meet the key personnel in relevant NYS industrial and academic organizations to discuss the potential for economic development that could accompany such a Center and to gauge the extent of participation that could be expected from each interested party. Integrated of these discussions was to be achieved through a workshop convened in the summer of 1990. The culmination of this workshop was to be a report (the final report) outlining a plan for implementing a Center in the state. As events unfolded, it became possible to identify the elements of a major center for x-ray lithography on Lone Island at Brookhaven National Laboratory. The principal investigators were than advised to substitute a working document based upon that concept in place of a report based upon the more general CAMP workshop originally envisioned. Following that suggestion from the New York State Science and Technology Foundation, the principals established a working group consisting of representatives of the Grumman Corporation, Columbia University, the State University of New York at Stony Brook, and Brookhaven National Laboratory. Regular meetings and additional communications between these collaborators have produced a preproposal that constitutes the main body of the final report required by the contract. Other components of this final report include the interim report and a brief description of the activities which followed the establishment of the X-ray Lithography Center working group.

  2. [The palliative treatment plan as basis for informed decisions in palliative or emergency care].

    PubMed

    Lederer, Wolfgang; Feichtner, Angelika; Medicus, Elisabeth

    2011-11-01

    Acute vital crisis in end-of-life situations may result in a person being hospitalized and thus, expelled from his intimate environment, which aggravates the continuity of care. This entails a heavy burden for patients and necessitates an emergency medical services (EMS) call without recognizable benefit in many cases. Crisis episodes frequently mark the beginning of the dying process. Advance care planning or end-of-life care in elderly patients can help prevent such situations and ensure high contentment of patients, families and caregivers. Frequently, the question arises whether the burden arising from further hospitalization or from certain medical treatment options is reasonably balanced by the potential benefits of the steps taken. In such comprehensive care settings a custom-tailored palliative treatment plan may serve as an instrument for advance care planning. A palliative treatment plan set up by a physician together with a caregiver helps ensure that acute problems can be solved quickly and satisfactorily in the patient's customary surroundings. If EMS assistance is still needed, the emergency physician has written information on the patient's situation and can act quickly to meet the patient's immediate needs. This also means that EMS personnel must be properly trained in providing palliative care. In this way the palliative treatment plan can help caregivers continue to care for patients in their intimate surroundings.

  3. [Nurses' knowledge about the health care proxy and advance directives].

    PubMed

    Georget, Jean-Philippe; Cecire-Denoyer, Catherine

    2015-06-01

    The Basse-Normandie palliative care nurses' group carried out a survey regarding nurses' knowledge of the health care proxy and advance directives. The study revealed a lack of connection between these two arrangements, poor knowledge about advance directives but an understanding of the role of the health care proxy. How, therefore, can patients be effectively informed? How should they be supported in this process of determining themselves the conditions of their end of life? PMID:26146326

  4. 45 CFR 1355.54 - Submittal of advance planning documents.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... accordance with procedures specified by 45 CFR part 95, subpart F. ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Submittal of advance planning documents. 1355.54... § 1355.54 Submittal of advance planning documents. The State title IV-E agency must submit an APD for...

  5. 14 CFR 151.119 - Advance planning proposals: Procedures; funding.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Advance planning proposals: Procedures; funding. 151.119 Section 151.119 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Engineering Proposals § 151.119 Advance planning proposals: Procedures; funding. The funding...

  6. 14 CFR 151.119 - Advance planning proposals: Procedures; funding.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Advance planning proposals: Procedures; funding. 151.119 Section 151.119 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Engineering Proposals § 151.119 Advance planning proposals: Procedures; funding. The funding...

  7. 14 CFR 151.119 - Advance planning proposals: Procedures; funding.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Advance planning proposals: Procedures; funding. 151.119 Section 151.119 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Engineering Proposals § 151.119 Advance planning proposals: Procedures; funding. The funding...

  8. 14 CFR 151.119 - Advance planning proposals: Procedures; funding.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Advance planning proposals: Procedures; funding. 151.119 Section 151.119 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... Engineering Proposals § 151.119 Advance planning proposals: Procedures; funding. The funding...

  9. Dateline Child Care: President Unveils Child Care Plan.

    ERIC Educational Resources Information Center

    Child Care Information Exchange, 1989

    1989-01-01

    Discusses such topics as President Bush's proposed low-income tax credits for child care; the Act for Better Child Care Services; the coming Americanization of child care in Great Britain; and state courts' upholding of church day care licensing exemptions. (BB)

  10. Clinical Curriculum Reform and Advanced Care Training at the New England College of Optometry.

    ERIC Educational Resources Information Center

    Wilson, Roger

    1998-01-01

    Discusses how the New England College of Optometry has expanded clinical education so graduates are equipped to handle new and advanced clinical and patient-care responsibilities and meet the changing standards of professional entry-level competency. The reform process, third- and fourth-year curriculum components, rotations, and plans for…

  11. 42 CFR 441.103 - Alternate plans of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases § 441.103 Alternate plans of... would otherwise need care in an institution for mental diseases. (b) These alternate plans of care...

  12. 42 CFR 441.103 - Alternate plans of care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases § 441.103 Alternate plans of... would otherwise need care in an institution for mental diseases. (b) These alternate plans of care...

  13. Abbreviated Pandemic Influenza Planning Template for Primary Care Offices

    SciTech Connect

    HCTT CHE

    2010-01-01

    The Abbreviated Pandemic Influenza Plan Template for Primary Care Provider Offices is intended to assist primary care providers and office managers with preparing their offices for quickly putting a plan in place to handle an increase in patient calls and visits, whether during the 2009-2010 influenza season or future influenza seasons.

  14. 42 CFR 441.103 - Alternate plans of care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases § 441.103 Alternate plans of... otherwise need care in an institution for mental diseases. (b) These alternate plans of care must— (1)...

  15. 42 CFR 441.103 - Alternate plans of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases § 441.103 Alternate plans of... otherwise need care in an institution for mental diseases. (b) These alternate plans of care must— (1)...

  16. A Planning Guide for Food Service in Child Care Centers.

    ERIC Educational Resources Information Center

    Food and Nutrition Service (USDA), Washington, DC.

    This publication is designed to help child care center directors and other personnel in programs receiving funding through the Child Care Food Program plan their food service. Included are sections on: (1) planning food for a day; (2) meal patterns (information on the necessary food groups, a chart of vegetables and fruits containing vitamin A, C…

  17. My Cancer Care Plan as a Web-Solution.

    PubMed

    Westman, Bodil; Cornelius, Birgitta

    2016-01-01

    The Swedish National Cancerplan states that patients should be offered an Individual Care Plan (ICP) for the treatment and survivorship care and rehabilitation planning. As there is no web-solution for ICP available, the project aim is to develop a non-commercial web-solution based on communication between the contact nurse and the patient. PMID:27332410

  18. The Con Edison Emergency Child Care Plan for Management Employees: Summary Plan Description.

    ERIC Educational Resources Information Center

    Consolidated Edison Co., Brooklyn, NY.

    This summary plan description offers guidelines for participation in a pilot program that provides short-term emergency care for children of Con Edison managers who are under 13 years old. The plan offers professional, in-home child care that can be used when usual arrangements have collapsed. The summary plan description addresses the following…

  19. The person with amputation and their life care plan.

    PubMed

    Meier, Robert H; Choppa, Anthony J; Johnson, Cloie B

    2013-08-01

    This article describes the collaborative relationship between the physiatrist and life care planner/case manager when preparing a life care plan for a person with an amputation. The complexities and interrelationship of physical, emotional, and pain issues require medical expertise and knowledge for the development of prognosis and relevant recommendations. The life care plan requires coordination between medical and rehabilitation professionals to address the impact of amputation and its associated impairment on all life roles.

  20. Technological Advances in Nursing Care Delivery.

    PubMed

    Sullivan, Debra Henline

    2015-12-01

    Technology is rapidly changing the way nurses deliver patient care. The Health Information Technology for Economic and Clinical Health Act of 2009 encourages health care providers to implement electronic health records for meaningful use of patient information. This development has opened the door to many technologies that use this information to streamline patient care. This article explores current and new technologies that nurses will be working with either now or in the near future.

  1. Discharge planning and follow-up care: the asphyxiated infant.

    PubMed

    Parker, L

    1991-01-01

    Discharge planning and follow-up care of the asphyxiated infant is a complex process. Models of discharge planning, team member responsibilities, and teaching responsibilities are components of hospital discharge plans. Special care needs of these infants may include vision, hearing, immunizations, seizures, medications, and feeding. Families and health care professionals need to be familiar with programs providing financial resources for care of the infant such as private insurance, prepaid health care, Medicaid, Medical Needy program, Children with Special Health Care Needs (CSHCN), federal legislation mandating education and services for high-risk infants (PL 99-142 and PL 99-457) and intervention programs. Families returning to Newborn Follow-up programs become acquainted with a variety of professionals and types of neonatal and infant assessments. Providing teaching materials and information regarding special health problems, services and outcome, as it becomes known, is the responsibility of the extended health care team of nurses, physicians, home health services, psychologists, and therapists.

  2. 42 CFR 494.90 - Condition: Patient plan of care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Patient plan of care. 494.90 Section 494.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  3. 42 CFR 494.90 - Condition: Patient plan of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... 42 Public Health 5 2012-10-01 2012-10-01 false Condition: Patient plan of care. 494.90 Section 494.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  4. 42 CFR 494.90 - Condition: Patient plan of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Patient plan of care. 494.90 Section 494.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  5. 42 CFR 494.90 - Condition: Patient plan of care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... 42 Public Health 5 2013-10-01 2013-10-01 false Condition: Patient plan of care. 494.90 Section 494.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  6. 42 CFR 494.90 - Condition: Patient plan of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... personal care, home dialysis and self-care, quality of life, rehabilitation, transplantation, and the... 42 Public Health 5 2014-10-01 2014-10-01 false Condition: Patient plan of care. 494.90 Section 494.90 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  7. Health Care Provider Initiative Strategic Plan

    ERIC Educational Resources Information Center

    National Environmental Education & Training Foundation, 2012

    2012-01-01

    This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on…

  8. CareMAP: Caring for Someone with Advanced Parkinson Disease

    MedlinePlus

    ... and General Health Activities at Home Travel and Transportation Rest and Sleep Changes Around the House Plans ... and General Health Activities at Home Travel and Transportation Rest and Sleep More Videos Changes Around the ...

  9. Identifying the factors that facilitate or hinder advance planning by persons with dementia.

    PubMed

    Hirschman, Karen B; Kapo, Jennifer M; Karlawish, Jason H T

    2008-01-01

    We performed semistructured interviews with 30 family members of patients with advanced dementia to identify the factors that facilitate or hinder advance planning by persons with dementia. All interviews were analyzed using qualitative data analysis techniques. The majority (77%) of family members reported that their relative had some form of written advance directive, and at least half reported previous discussions about health care preferences (57%), living situation or placement issues (50%), and finances or estate planning (60%) with the patient. Family members reported some themes that prompted planning and others that were barriers to planning. Events that most often triggered planning were medical, living situation, or financial issues associated with a friend or family member of the patient (57%). Barriers to planning included both passive and active avoidance. The most common form of passive avoidance was not realizing the importance of planning until it was too late to have the discussion (63%). The most common form of active avoidance was avoiding the discussion (53%). These data suggest potentially remediable strategies to address barriers to advance planning discussions.

  10. Advanced Education Business Plan 2005-2008

    ERIC Educational Resources Information Center

    Alberta Advanced Education, 2005

    2005-01-01

    In collaboration with learning providers, the advanced education system, industry, communities, government agencies and non-governmental organizations, Advanced Education strives to create accessible, affordable and quality learning opportunities that are responsive to the ongoing learning needs of Albertans. The Ministry's 2005-08 Business Plan…

  11. [Technological advances and hospital-at-home care].

    PubMed

    Tibaldi, Vittoria; Aimonino Ricauda, Nicoletta; Rocco, Maurizio; Bertone, Paola; Fanton, Giordano; Isaia, Giancarlo

    2013-05-01

    Advances in the miniaturization and portability of diagnostic technologies, information technologies, remote monitoring, and long-distance care have increased the viability of home-based care, even for patients with serious conditions. Telemedicine and teleradiology projects are active at the Hospital at Home Service of Torino. PMID:23748683

  12. [Technological advances and hospital-at-home care].

    PubMed

    Tibaldi, Vittoria; Aimonino Ricauda, Nicoletta; Rocco, Maurizio; Bertone, Paola; Fanton, Giordano; Isaia, Giancarlo

    2013-05-01

    Advances in the miniaturization and portability of diagnostic technologies, information technologies, remote monitoring, and long-distance care have increased the viability of home-based care, even for patients with serious conditions. Telemedicine and teleradiology projects are active at the Hospital at Home Service of Torino.

  13. Advanced practice roles in the managed care environment.

    PubMed

    Madden, M J; Ponte, P R

    1994-01-01

    The role of the advanced practice nurse is based on expert clinical knowledge and skill and is practiced in multiple settings. As healthcare reform emerges, the context in which healthcare is delivered changes. The authors describe a creative approach to packaging and marketing the services of advanced practice nurses to the customers of the managed care system. PMID:8308561

  14. Integration of Palliative Care Principles into the Ongoing Care of Children with Cancer: Individualized Care Planning and Coordination

    PubMed Central

    Baker, Justin N; Hinds, Pamela S; Spunt, Sheri L; Barfield, Raymond C; Allen, Caitlin; Powell, Brent C; Anderson, Lisa H; Kane, Javier R

    2008-01-01

    Synopsis The Individualized Care Planning and Coordination Model is designed to integrate palliative care principles and practices into the ongoing care of children with cancer. Application of the model helps clinicians to generate a comprehensive individualized care plan that is implemented through Individualized Care Coordination processes as detailed here. Clinicians’ strong desire to provide compassionate, competent and sensitive care to the seriously ill child and the child’s family can be effectively translated into clinical practice through these processes. “To cure sometimes, to relieve often, to comfort always -- this is our work.” Author Unknown PMID:18242323

  15. Voyager: Perils of advanced planning, 1960 - 1967

    NASA Technical Reports Server (NTRS)

    1984-01-01

    Contract proposals; phased project planning; budgetary problems; Saturn 1 B-Centaur versus Saturn V; mission guidelines and management assignments; and the origins of the Voyager project are discussed.

  16. Advancing the state of the art in healthcare strategic planning.

    PubMed

    Zuckerman, Alan M

    2006-01-01

    A recent survey of the state of strategic planning among healthcare organizations indicates that planners and executives believe that healthcare strategic planning practices are effective and provide the appropriate focus and direction for their organizations. When compared to strategic planning practices employed outside of the healthcare field, however, most healthcare strategic planning processes have not evolved to the more advanced, state-of-the-art levels of planning being used successfully outside of healthcare. While organizations that operate in stable markets may be able to survive using basic strategic planning practices, the volatile healthcare market demands that providers be nimble competitors with advanced, ongoing planning processes that drive growth and organizational effectiveness. What should healthcare organizations do to increase the rigor and sophistication of their strategic planning practices? This article identifies ten current healthcare strategic planning best practices and recommends five additional innovative approaches from pathbreaking companies outside of healthcare that have used advanced strategic planning practices to attain high levels of organizational success.

  17. Revised Faculty Compensation, Evaluation, and Advancement Plan. March, 1998.

    ERIC Educational Resources Information Center

    May, Joe

    This report provides the revised faculty compensation, evaluation, and advancement plan for Pueblo Community College (PCC) in Colorado. Section 1 contains the PCC three-level salary plan and discusses guidelines for initial appointment and level placement of faculty, initial salary computations, and minimum initial employment requirements. Section…

  18. Do Personality Traits Moderate the Impact of Care Receipt on End-of-Life Care Planning?

    ERIC Educational Resources Information Center

    Ha, Jung-Hwa; Pai, Manacy

    2012-01-01

    Purpose of the Study: This study examines (a) the association between being a care recipient and end-of-life care planning (EOLCP) and (b) the extent to which personality traits moderate the relationship between care receipt and EOLCP. Design and Methods: Data are drawn from the Wisconsin Longitudinal Study, a survey of Wisconsin high school…

  19. Plan for an Advanced Turbine Systems Program

    SciTech Connect

    Bajura, R.A.; Webb, H.A.; Parks, W.P.

    1993-03-01

    A draft version of this paper was presented at the Clemson Clean, affordable, and reliable natural gas utilization technologies will play a growing role in meeting future power generation needs in the United States. The US Department of Energy`s (DOE) National Energy Strategy projected that total demand for natural gas will rise from 18.5 trillion cubic feet (tcf) in 1990 to 24.2 tcf by the year 2000. Much of this increase is attributed to the increased use of natural gas as a fuel for electric power generation. Candidate technologies for gas fired power generation include gas turbine and fuel cell systems. The first workshop on research needs for advanced gas turbine systems for power generation was held on April 8-10, 1991 in Greenville, South Carolina. The goals of the Clemson-I Workshop were to identify research needs which would accelerate the development of advanced gas turbines and to consider new approaches to implement this research. The Clemson-I Workshop focused on advanced gas turbine systems which would have a lower cost of electricity or better environmental performance than systems currently under development. The workshop was cosponsored by the DOE`s Morgantown Energy Technology Center (METC), Clemson University, and the South Carolina Energy Research and Development Center. The proceedings from the workshop have been published. The 75 participants in the Clemson-I Workshop represented a broad spectrum of the gas turbine Research & Development (R&D) community as well as potential users of advanced gas turbines. Gas turbine manufacturers, the electric utility industry, the university community, as well as government and private sector R&D sponsors were represented. Participants in the Clemson-I Workshop concluded that it is technically feasible to develop advanced turbine systems and that Government participation would accelerate the developmental effort. Advanced turbine systems could be operated on natural gas or adapted to coal or biomass firing.

  20. Plan for an Advanced Turbine Systems Program

    SciTech Connect

    Bajura, R.A.; Webb, H.A. ); Parks, W.P. )

    1993-01-01

    A draft version of this paper was presented at the Clemson Clean, affordable, and reliable natural gas utilization technologies will play a growing role in meeting future power generation needs in the United States. The US Department of Energy's (DOE) National Energy Strategy projected that total demand for natural gas will rise from 18.5 trillion cubic feet (tcf) in 1990 to 24.2 tcf by the year 2000. Much of this increase is attributed to the increased use of natural gas as a fuel for electric power generation. Candidate technologies for gas fired power generation include gas turbine and fuel cell systems. The first workshop on research needs for advanced gas turbine systems for power generation was held on April 8-10, 1991 in Greenville, South Carolina. The goals of the Clemson-I Workshop were to identify research needs which would accelerate the development of advanced gas turbines and to consider new approaches to implement this research. The Clemson-I Workshop focused on advanced gas turbine systems which would have a lower cost of electricity or better environmental performance than systems currently under development. The workshop was cosponsored by the DOE's Morgantown Energy Technology Center (METC), Clemson University, and the South Carolina Energy Research and Development Center. The proceedings from the workshop have been published. The 75 participants in the Clemson-I Workshop represented a broad spectrum of the gas turbine Research Development (R D) community as well as potential users of advanced gas turbines. Gas turbine manufacturers, the electric utility industry, the university community, as well as government and private sector R D sponsors were represented. Participants in the Clemson-I Workshop concluded that it is technically feasible to develop advanced turbine systems and that Government participation would accelerate the developmental effort. Advanced turbine systems could be operated on natural gas or adapted to coal or biomass firing.

  1. [Individualised care plan during extracorporeal membrane oxygenation. A clinical case].

    PubMed

    Call Mañosa, S; Pujol Garcia, A; Chacón Jordan, E; Martí Hereu, L; Pérez Tejero, G; Gómez Simón, V; Estruga Asbert, A; Gallardo Herrera, L; Vaquer Araujo, S; de Haro López, C

    2016-01-01

    An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy.

  2. 42 CFR 456.80 - Individual written plan of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Individual written plan of care. 456.80 Section 456.80 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... and rehabilitative services; (iv) Activities; (v) Social services; (vi) Diet; (4) Plans for...

  3. 42 CFR 456.80 - Individual written plan of care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Individual written plan of care. 456.80 Section 456.80 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... and rehabilitative services; (iv) Activities; (v) Social services; (vi) Diet; (4) Plans for...

  4. 42 CFR 456.80 - Individual written plan of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Individual written plan of care. 456.80 Section 456.80 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... and rehabilitative services; (iv) Activities; (v) Social services; (vi) Diet; (4) Plans for...

  5. 42 CFR 441.103 - Alternate plans of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Alternate plans of care. 441.103 Section 441.103 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Medicaid for Individuals Age 65 or Over in Institutions for Mental Diseases § 441.103 Alternate plans...

  6. 24 CFR 578.39 - Continuum of Care planning activities.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 3 2013-04-01 2013-04-01 false Continuum of Care planning activities. 578.39 Section 578.39 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT...

  7. 24 CFR 578.39 - Continuum of Care planning activities.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 3 2014-04-01 2013-04-01 true Continuum of Care planning activities. 578.39 Section 578.39 Housing and Urban Development Regulations Relating to Housing and Urban Development (Continued) OFFICE OF ASSISTANT SECRETARY FOR COMMUNITY PLANNING AND DEVELOPMENT, DEPARTMENT...

  8. 20 strategies for marketing your managed care plan.

    PubMed

    Firshein, J

    1996-01-01

    In today's fiercely competitive managed care marketplace, healthcare executives must find a way to set their plans apart from the competition and build a sufficient customer base. At the same time, they must confront a growing anti-managed care backlash among a wary and confused public. Healthcare executive magazine talked with managed care experts to gather their views on key strategies to help executives meet both of these challenges. Here's what they suggest. PMID:10153671

  9. Advanced units: quality measures in urgency and emergency care

    PubMed Central

    Viola, Dan Carai Maia; Cordioli, Eduardo; Pedrotti, Carlos Henrique Sartorato; Iervolino, Mauro; Bastos, Antonio da Silva; de Almeida, Luis Roberto Natel; Neves, Henrique Sutton de Sousa; Lottenberg, Claudio Luiz

    2014-01-01

    Objective To evaluate, through care indicators, the quality of services rendered to patients considered urgency and emergency cases at an advanced emergency care unit. Methods We analyzed data from managerial reports of 64,891 medical visits performed in the Emergency Care Unit of the Ibirapuera Unit at Care during the period from June 1st, 2012 through May 31st, 2013. The proposed indicators for the assessment of care were rate of death in the emergency care unit; average length of stay of patients in the unit; rate of unplanned return visits; admission rate for patients screened as level 1 according to the Emergency Severity Index; rate of non-finalized medical consultations; rate of complaints; and door-to-electrocardiogram time. Results The rate of death in the emergency care unit was zero. Five of the 22 patients classified as Emergency Severity Index 1 (22.7%) arrived presenting cardiac arrest. All were treated with cardiopulmonary resuscitation and reestablishment of vital functions. The average length of stay of patients in the unit was 3 hours, 33 minutes, and 7 seconds. The rate of unscheduled return visits at the emergency care unit of the Ibirapuera unit was 13.64%. Rate of complaints was 2.8/1,000 patients seen during the period Conclusion The model of urgency and emergency care in advanced units provides an efficient and efficaious service to patients. Both critically ill patients and those considered less complex can receive proper treatment for their needs. PMID:25628203

  10. Health Care Procedure Considerations and Individualized Health Care Plans

    ERIC Educational Resources Information Center

    Heller, Kathryn Wolff; Avant, Mary Jane Thompson

    2011-01-01

    Teachers need to maintain a safe, healthy environment for all their students in order to promote learning. However, there are additional considerations when students require health care procedures, such as tube feeding or clean intermittent catheterization. Teachers must effectively monitor their students and understand their roles and…

  11. Action Planning for Daily Mouth Care in Long-Term Care: The Brushing Up on Mouth Care Project

    PubMed Central

    McNally, Mary E.; Martin-Misener, Ruth; Wyatt, Christopher C. L.; McNeil, Karen P.; Crowell, Sandra J.; Matthews, Debora C.; Clovis, Joanne B.

    2012-01-01

    Research focusing on the introduction of daily mouth care programs for dependent older adults in long-term care has met with limited success. There is a need for greater awareness about the importance of oral health, more education for those providing oral care, and organizational structures that provide policy and administrative support for daily mouth care. The purpose of this paper is to describe the establishment of an oral care action plan for long-term care using an interdisciplinary collaborative approach. Methods. Elements of a program planning cycle that includes assessment, planning, implementation, and evaluation guided this work and are described in this paper. Findings associated with assessment and planning are detailed. Assessment involved exploration of internal and external factors influencing oral care in long-term care and included document review, focus groups and one-on-one interviews with end-users. The planning phase brought care providers, stakeholders, and researchers together to design a set of actions to integrate oral care into the organizational policy and practice of the research settings. Findings. The establishment of a meaningful and productive collaboration was beneficial for developing realistic goals, understanding context and institutional culture, creating actions suitable and applicable for end-users, and laying a foundation for broader networking with relevant stakeholders and health policy makers. PMID:22550572

  12. Center for Advanced Energy Studies Program Plan

    SciTech Connect

    Kevin Kostelnik

    2005-09-01

    The world is facing critical energy-related challenges regarding world and national energy demands, advanced science and energy technology delivery, nuclear engineering educational shortfalls, and adequately trained technical staff. Resolution of these issues is important for the United States to ensure a secure and affordable energy supply, which is essential for maintaining U.S. national security, continued economic prosperity, and future sustainable development. One way that the U.S. Department of Energy (DOE) is addressing these challenges is by tasking the Battelle Energy Alliance, LLC (BEA) with developing the Center for Advanced Energy Studies (CAES) at the Idaho National Laboratory (INL). By 2015, CAES will be a self-sustaining, world-class, academic and research institution where the INL; DOE; Idaho, regional, and other national universities; and the international community will cooperate to conduct critical energy-related research, classroom instruction, technical training, policy conceptualization, public dialogue, and other events.

  13. Later life care planning conversations for older adults and families.

    PubMed

    Stolee, Paul; Zaza, Christine; Sharratt, Michael T

    2014-09-01

    While most older adults have thought about their future care needs, few have discussed their preferences with family members. We interviewed older persons (24), adult children (24), health professionals (23), and representatives of stakeholder associations (3) to understand their views and experiences on later life care (LLC) planning conversations, in terms of (a) their respective roles, and (b) barriers and facilitators that should be taken into account when having these conversations. Roles described included that of information user (older persons), information seeker (family members), and information provider (health care providers). The study identified practical and emotional considerations relevant to LLC planning conversations. This study found strong support for planning for LLC before the need arises, as well as important potential benefits for older adults, family members, and health professionals. There is interest in, and need for, resources to guide families in LLC planning. PMID:24652903

  14. Advanced Simulation and Computing Business Plan

    SciTech Connect

    Rummel, E.

    2015-07-09

    To maintain a credible nuclear weapons program, the National Nuclear Security Administration’s (NNSA’s) Office of Defense Programs (DP) needs to make certain that the capabilities, tools, and expert staff are in place and are able to deliver validated assessments. This requires a complete and robust simulation environment backed by an experimental program to test ASC Program models. This ASC Business Plan document encapsulates a complex set of elements, each of which is essential to the success of the simulation component of the Nuclear Security Enterprise. The ASC Business Plan addresses the hiring, mentoring, and retaining of programmatic technical staff responsible for building the simulation tools of the nuclear security complex. The ASC Business Plan describes how the ASC Program engages with industry partners—partners upon whom the ASC Program relies on for today’s and tomorrow’s high performance architectures. Each piece in this chain is essential to assure policymakers, who must make decisions based on the results of simulations, that they are receiving all the actionable information they need.

  15. Careful telemedicine planning limits costly liability exposure.

    PubMed

    Edelstein, S A

    1999-12-01

    Recent Federal and state legislation and new payment opportunities from Medicare, Medicaid, and private payers may make it possible to offer telemedicine as a viable, cost-effective alternative to traditional care delivery in communities where access to health care is limited. Originally, nonexistent payment and expensive technology held back telemedicine but, these barriers are giving way to specific applications that can yield dramatic cost savings for group practices in the delivery of medical care while adding features and benefits not typically available in traditional delivery settings. Before joining a telemedicine network, group practices need to negotiate a variety of legal issues related to the corporate practice of medicine, patient confidentiality and privacy, malpractice, informed consent, licensure and credentialing, intellectual property, Medicare and Medicaid payment, fraud and abuse, medical device regulation, and antitrust.

  16. Models for Designing Long-Term Care Service Plans and Care Programs for Older People

    PubMed Central

    Tsuru, Satoko; Iizuka, Yoshinori

    2013-01-01

    The establishment of a system for providing appropriate long-term care services for older people is a national issue in Japan, and it will likely become a worldwide issue in the years to come. Under Japanese Long-term Care Insurance System, long-term care is provided based on long-term care programs, which were designed by care providers on the basis of long-term care service plans, which were designed by care managers. However, defined methodology for designing long-term care service plans and care programs has not been established yet. In this paper, we propose models for designing long-term care service plans and care programs for older people, both by incorporating the technical issues from previous studies and by redesigning the total methodology according to these studies. Our implementation model consists of “Function,” “Knowledge Structure,” and “Action Flow.” In addition, we developed the concrete knowledgebases based on the Knowledge Structure by visualizing, summarizing, and structuring the inherent knowledge of healthcare/welfare professionals. As the results of the workshop and retrospective verification, the adequacy of the models was suggested, while some further issues were pointed. Our models, knowledgebases, and application make it possible to ensure the quality of long-term care for older people. PMID:23589773

  17. End-of-life care in advanced dementia.

    PubMed

    Heron, Christopher R; Simmons, B Brent

    2014-10-01

    In the next 30 years, the average age of the population will continue to increase, as will the prevalence of dementia. The management of advanced dementia requires the careful orchestration of communication, prognostication, patient care, and caregiver education. Understanding the specific tools available to establish prognosis and guide medical management in these complicated medical patients greatly improves patient and caregiver satisfaction at the end of the patient's life. In caring for patients with advanced-stage dementia, providers should be knowledgeable regarding the terminal nature of the condition and its common comorbid diseases, and should be prepared to educate the patients' caregivers, building a structure of support for the patient's benefit and navigating the complexities of end-of-life care. PMID:25414940

  18. Evidence for the Will Rogers Phenomenon in Migration of Employees to Managed Care Plans

    PubMed Central

    Young, Mark J; Lenhart, Jack; Wasser, Thomas E; Czerwonka, Christopher; Davidyock, John; Sussman, Elliot J

    1999-01-01

    Employees have increasing opportunities to enroll in managed care plans, and employers tend to favor these plans because of their lower costs. However, lower costs may be the result of selection of healthier patients into managed care plans. This study measured differences in health care utilization across an indemnity plan and a managed care plan, and for all employees together. We found that apparent increases in utilization in both indemnity and managed care plans disappeared when the plans were viewed together, reflecting the migration of sicker patients from indemnity plans to managed care plans. PMID:10491247

  19. Advance directives, living wills, and futility in perioperative care.

    PubMed

    Goede, Matthew; Wheeler, Matthew

    2015-04-01

    Patient autonomy is preserved through the use of advance directives. A living will defines treatment by establishing parameters under which patients want to be treated. A durable power of attorney for health care establishes a surrogate for patients if they are unable to make decisions for themselves. In the perioperative setting, advance directives are applied with significant variation between surgeons, likely due to surgeons implying from informed consent discussions that patients want to pursue aggressive treatment. Futility is a rare occurrence in patient care that is difficult to define; however, there are some classic surgical conditions in which futility is part of the decision process.

  20. Neonatal ethical issues: viability, advance directives, family centered care.

    PubMed

    Sudia-Robinson, Tanya

    2011-01-01

    Ethical issues in perinatal and NICU settings can arise from a variety of situations. This article focuses on issues surrounding viability and the incorporation of advance directives and family-centered care. Prenatal education about infant viability, probable scenarios, and parental involvement in decision-making are addressed. Considerations for advance directives for complex births and critical decisions at the time of birth are also discussed. Implications for nurses and suggested dialogue strategies are provided. PMID:21407121

  1. [Part I. End-stage chronic organ failures: a position paper on shared care planning. The Integrated Care Pathway].

    PubMed

    Gristina, Giuseppe R; Orsi, Luciano; Carlucci, Annalisa; Causarano, Ignazio R; Formica, Marco; Romanò, Massimo

    2014-01-01

    In Italy the birth rate decrease together with the continuous improvement of living conditions on one hand, and the health care progress on the other hand, led in recent years to an increasing number of patients with chronic mono- or multi-organ failures and in an extension of their life expectancy. However, the natural history of chronic failures has not changed and the inescapable disease's worsening at the end makes more rare remissions, increasing hospital admissions rate and length of stay. Thus, when the "end-stage" get close clinicians have to engage the patient and his relatives in an advance care planning aimed to share a decision making process regarding all future treatments and related ethical choices such as patient's best interests, rights, values, and priorities. A right approach to the chronic organ failures end-stage patients consists therefore of a careful balance between the new powers of intervention provided by the biotechnology and pharmacology (intensive care), both with the quality of remaining life supplied by physicians to these patients (proportionality and beneficence) and the effective resources rationing and allocation (distributive justice). However, uncertainty still marks the criteria used by doctors to assess prognosis of these patients in order to make decisions concerning intensive or palliative care. The integrated care pathway suggested in this position paper shared by nine Italian medical societies, has to be intended as a guide focused to identify end-stage patients and choosing for them the best care option between intensive treatments and palliative care. PMID:24553592

  2. Health Care Consumerism: Lessons My 401(k) Plan Taught Me.

    PubMed

    Steinberg, Allen T

    2015-01-01

    Changes to the U.S. health care system are here. As we think about how individuals will pay for health care--while actively employed and while retired--our experiences with 401(k) plans provide some valuable lessons. In order to support employees in this new health care world--a challenge arguably more daunting than the 401(k) challenge we faced 20 years ago--some very different types of support are needed. Employers should consider providing their employees with the resources to manage health care changes. PMID:26666089

  3. Health Care Consumerism: Lessons My 401(k) Plan Taught Me.

    PubMed

    Steinberg, Allen T

    2015-01-01

    Changes to the U.S. health care system are here. As we think about how individuals will pay for health care--while actively employed and while retired--our experiences with 401(k) plans provide some valuable lessons. In order to support employees in this new health care world--a challenge arguably more daunting than the 401(k) challenge we faced 20 years ago--some very different types of support are needed. Employers should consider providing their employees with the resources to manage health care changes.

  4. Implementation of Advanced Health Care Technology into Existing Competency-Based Health Care Program. Final Report.

    ERIC Educational Resources Information Center

    Klemovage, Shirley

    A project was undertaken to develop new curriculum materials that could be incorporated into an existing health assistant program to cover recent advances in health care technology. Area physicians' offices were toured and meetings were held with administrators of local hospitals in order to discover what kinds of advances in health care…

  5. Alzheimer's disease care management plan: maximizing patient care.

    PubMed

    Treinkman, Anna

    2005-03-01

    Nurse practitioners have the potential to significantly impact the care of patients with dementia. Healthcare providers can now offer patients medications that will control symptoms and prolong functioning. As a result of ongoing contact with patients, NPs play an important role in assessing and screening patients for AD and educating the patients, families, and caregivers about the disease. Alzheimer's disease is a chronic, progressive illness that requires long-term management. Nurse practitioners should be familiar with available medications and appreciate the need to individualize therapy to maximize efficacy and minimize potential adverse drug reactions.

  6. 42 CFR 417.801 - Agreements between CMS and health care prepayment plans.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Agreements between CMS and health care prepayment... MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Health Care Prepayment Plans § 417.801 Agreements between CMS and health care prepayment plans. (a) General requirement. (1) In order to participate and...

  7. 42 CFR 417.801 - Agreements between CMS and health care prepayment plans.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Agreements between CMS and health care prepayment..., COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Health Care Prepayment Plans § 417.801 Agreements between CMS and health care prepayment plans. (a) General requirement. (1) In order to participate...

  8. 42 CFR 417.801 - Agreements between CMS and health care prepayment plans.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Agreements between CMS and health care prepayment... MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Health Care Prepayment Plans § 417.801 Agreements between CMS and health care prepayment plans. (a) General requirement. (1) In order to participate and...

  9. 42 CFR 417.801 - Agreements between CMS and health care prepayment plans.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Agreements between CMS and health care prepayment..., COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Health Care Prepayment Plans § 417.801 Agreements between CMS and health care prepayment plans. (a) General requirement. (1) In order to participate...

  10. 42 CFR 417.801 - Agreements between CMS and health care prepayment plans.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Agreements between CMS and health care prepayment..., COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Health Care Prepayment Plans § 417.801 Agreements between CMS and health care prepayment plans. (a) General requirement. (1) In order to participate...

  11. Advanced Technology Applications for Combat Casualty Care

    NASA Technical Reports Server (NTRS)

    Watkins, Sharmila; Baumann, David; Wu, Jimmy

    2010-01-01

    Exploration Medical Capability (ExMC) is an element of NASA s Human Research Program (HRP). ExMC s goal is to address the risk of the "Inability to Adequately Recognize or Treat an Ill or Injured Crewmember." This poster highlights the approach ExMC has taken to address this goal and our current areas of interest. The Space Medicine Exploration Medical Condition List (SMEMCL) was created to identify medical conditions of concern during exploration missions. The list was derived from space flight medical incidents, the shuttle medical checklist, the International Space Station medical checklist, and expert opinion. The conditions on the list were prioritized according to mission type by a panel comprised of flight surgeons, physician astronauts, engineers, and scientists. From the prioritized list, the ExMC element determined the capabilities needed to address the medical conditions of concern. Where such capabilities were not currently available, a gap was identified. The element s research plan outlines these gaps and the tasks identified to achieve the desired capabilities for exploration missions.

  12. [Advances and challenges of the Unified Health System planning].

    PubMed

    Vieira, Fabíola Sulpino

    2009-10-01

    Since the Unified Health System creation, managers have been expending efforts to discuss the planning and, made attempts to institutionalize it, considering that it's a basic management component. However, despite advances obtained, there are aspects that are priorities and that constitute challenges for the institutionalization of the planning at the Unified Health System. In this direction, this study describes the planning evolution in the system, by legal and technician material analysis of published documents by Ministry of Health. From the planning conception in these publications, it leads a reflection on the used approach, considering the established management instruments, and its entailing to the more currently accepted theory and methodology of health planning. Aspects that need to be observed are pointed for the effectiveness to ascendant planning at the Unified Health System.

  13. Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

    PubMed Central

    Mazutti, Sandra Regina Gonzaga; Nascimento, Andréia de Fátima; Fumis, Renata Rego Lins

    2016-01-01

    Objective To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care. Methods This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance. Results A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations. Conclusion The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means. PMID:27626949

  14. Advanced systems engineering and network planning support

    NASA Technical Reports Server (NTRS)

    Walters, David H.; Barrett, Larry K.; Boyd, Ronald; Bazaj, Suresh; Mitchell, Lionel; Brosi, Fred

    1990-01-01

    The objective of this task was to take a fresh look at the NASA Space Network Control (SNC) element for the Advanced Tracking and Data Relay Satellite System (ATDRSS) such that it can be made more efficient and responsive to the user by introducing new concepts and technologies appropriate for the 1997 timeframe. In particular, it was desired to investigate the technologies and concepts employed in similar systems that may be applicable to the SNC. The recommendations resulting from this study include resource partitioning, on-line access to subsets of the SN schedule, fluid scheduling, increased use of demand access on the MA service, automating Inter-System Control functions using monitor by exception, increase automation for distributed data management and distributed work management, viewing SN operational control in terms of the OSI Management framework, and the introduction of automated interface management.

  15. Recent advances in topical wound care

    PubMed Central

    Sarabahi, Sujata

    2012-01-01

    There are a wide variety of dressing techniques and materials available for management of both acute wounds and chronic non-healing wounds. The primary objective in both the cases is to achieve a healed closed wound. However, in a chronic wound the dressing may be required for preparing the wound bed for further operative procedures such as skin grafting. An ideal dressing material should not only accelerate wound healing but also reduce loss of protein, electrolytes and fluid from the wound, and help to minimize pain and infection. The present dictum is to promote the concept of moist wound healing. This is in sharp contrast to the earlier practice of exposure method of wound management wherein the wound was allowed to dry. It can be quite a challenge for any physician to choose an appropriate dressing material when faced with a wound. Since wound care is undergoing a constant change and new products are being introduced into the market frequently, one needs to keep abreast of their effect on wound healing. This article emphasizes on the importance of assessment of the wound bed, the amount of drainage, depth of damage, presence of infection and location of wound. These characteristics will help any clinician decide on which product to use and where,in order to get optimal wound healing. However, there are no ‘magical dressings’. Dressings are one important aspect that promotes wound healing apart from treating the underlying cause and other supportive measures like nutrition and systemic antibiotics need to be given equal attention. PMID:23162238

  16. Advancing infection control in dental care settings

    PubMed Central

    Cleveland, Jennifer L.; Bonito, Arthur J.; Corley, Tammy J.; Foster, Misty; Barker, Laurie; Brown, G. Gordon; Lenfestey, Nancy; Lux, Linda

    2015-01-01

    Background and Overview The authors set out to identify factors associated with implementation by U.S. dentists of four practices first recommended in the Centers for Disease Control and Prevention’s Guidelines for Infection Control in Dental Health-Care Settings—2003. Methods In 2008, the authors surveyed a stratified random sample of 6,825 U.S. dentists. The response rate was 49 percent. The authors gathered data regarding dentists’ demographic and practice characteristics, attitudes toward infection control, sources of instruction regarding the guidelines and knowledge about the need to use sterile water for surgical procedures. Then they assessed the impact of those factors on the implementation of four recommendations: having an infection control coordinator, maintaining dental unit water quality, documenting percutaneous injuries and using safer medical devices, such as safer syringes and scalpels. The authors conducted bivariate analyses and proportional odds modeling. Results Responding dentists in 34 percent of practices had implemented none or one of the four recommendations, 40 percent had implemented two of the recommendations and 26 percent had implemented three or four of the recommendations. The likelihood of implementation was higher among dentists who acknowledged the importance of infection control, had practiced dentistry for less than 30 years, had received more continuing dental education credits in infection control, correctly identified more surgical procedures that require the use of sterile water, worked in larger practices and had at least three sources of instruction regarding the guidelines. Dentists with practices in the South Atlantic, Middle Atlantic or East South Central U.S. Census divisions were less likely to have complied. Conclusions Implementation of the four recommendations varied among U.S. dentists. Strategies targeted at raising awareness of the importance of infection control, increasing continuing education

  17. A patient-centered longitudinal care plan: vision versus reality

    PubMed Central

    Dykes, Patricia C; Samal, Lipika; Donahue, Moreen; Greenberg, Jeffrey O; Hurley, Ann C; Hasan, Omar; O'Malley, Terrance A; Venkatesh, Arjun K; Volk, Lynn A; Bates, David W

    2014-01-01

    Objective As healthcare systems and providers move toward meaningful use of electronic health records, longitudinal care plans (LCPs) may provide a means to improve communication and coordination as patients transition across settings. The objective of this study was to determine the current state of communication of LCPs across settings and levels of care. Materials and methods We conducted surveys and interviews with professionals from emergency departments, acute care hospitals, skilled nursing facilities, and home health agency settings in six regions in the USA. We coded the transcripts according to the Agency for Healthcare Research and Quality (AHRQ) ‘Broad Approaches’ to care coordination to understand the degree to which current practice meets the definition of an LCP. Results Participants (n=22) from all settings reported that LCPs do not exist in their current state. We found LCPs in practice, and none of these were shared or reconciled across settings. Moreover, we found wide variation in the types and formats of care plan information that was communicated as patients transitioned. The most common formats, even when care plan information was communicated within the same healthcare system, were paper and fax. Discussion These findings have implications for data reuse, interoperability, and achieving widespread adoption of LCPs. Conclusions The use of LCPs to support care transitions is suboptimal. Strategies are needed to transform the LCP from vision to reality. PMID:24996874

  18. Advancing Alzheimer's disease diagnosis, treatment, and care: recommendations from the Ware Invitational Summit.

    PubMed

    Naylor, Mary D; Karlawish, Jason H; Arnold, Steven E; Khachaturian, Ara S; Khachaturian, Zaven S; Lee, Virginia M-Y; Baumgart, Matthew; Banerjee, Sube; Beck, Cornelia; Blennow, Kaj; Brookmeyer, Ron; Brunden, Kurt R; Buckwalter, Kathleen C; Comer, Meryl; Covinsky, Kenneth; Feinberg, Lynn Friss; Frisoni, Giovanni; Green, Colin; Guimaraes, Renato Maia; Gwyther, Lisa P; Hefti, Franz F; Hutton, Michael; Kawas, Claudia; Kent, David M; Kuller, Lewis; Langa, Kenneth M; Mahley, Robert W; Maslow, Katie; Masters, Colin L; Meier, Diane E; Neumann, Peter J; Paul, Steven M; Petersen, Ronald C; Sager, Mark A; Sano, Mary; Schenk, Dale; Soares, Holly; Sperling, Reisa A; Stahl, Sidney M; van Deerlin, Vivianna; Stern, Yaakov; Weir, David; Wolk, David A; Trojanowski, John Q

    2012-09-01

    To address the pending public health crisis due to Alzheimer's disease (AD) and related neurodegenerative disorders, the Marian S. Ware Alzheimer Program at the University of Pennsylvania held a meeting entitled "State of the Science Conference on the Advancement of Alzheimer's Diagnosis, Treatment and Care," on June 21-22, 2012. The meeting comprised four workgroups focusing on Biomarkers; Clinical Care and Health Services Research; Drug Development; and Health Economics, Policy, and Ethics. The workgroups shared, discussed, and compiled an integrated set of priorities, recommendations, and action plans, which are presented in this article. PMID:22959699

  19. Protein Innovations Advance Drug Treatments, Skin Care

    NASA Technical Reports Server (NTRS)

    2012-01-01

    Dan Carter carefully layered the sheets of tracing paper on the light box. On each sheet were renderings of the atomic components of an essential human protein, one whose structure had long been a mystery. With each layer Carter laid down, a never-before-seen image became clearer. Carter joined NASA s Marshall Space Flight Center in 1985 and began exploring processes of protein crystal growth in space. By bouncing intense X-rays off the crystals, researchers can determine the electron densities around the thousands of atoms forming the protein molecules, unveiling their atomic structures. Cultivating crystals of sufficient quality on Earth was problematic; the microgravity conditions of space were far more accommodating. At the time, only a few hundred protein structures had been mapped, and the methods were time consuming and tedious. Carter hoped his work would help reveal the structure of human serum albumin, a major protein in the human circulatory system responsible for ferrying numerous small molecules in the blood. More was at stake than scientific curiosity. Albumin has a high affinity for most of the world s pharmaceuticals, Carter explains, and its interaction with drugs can change their safety and efficacy. When a medication enters the bloodstream a cancer chemotherapy drug, for example a majority of it can bind with albumin, leaving only a small percentage active for treatment. How a drug interacts with albumin can influence considerations like the necessary effective dosage, playing a significant role in the design and application of therapeutic measures. In spite of numerous difficulties, including having no access to microgravity following the 1986 Space Shuttle Challenger disaster, the image Carter had hoped to see was finally clarifying. In 1988, his lab had acquired specialized X-ray and detection equipment a tipping point. Carter and his colleagues began to piece together albumin s portrait, the formation of its electron densities coalescing on

  20. Homecare Nurses' Decision-Making During Admission Care Planning.

    PubMed

    Sockolow, Paulina; Bass, Ellen J; Eberle, Carl L; Bowles, Kathryn H

    2016-01-01

    The re-hospitalization rate of homecare patients within 60 days of hospital discharge is 30%. Enhanced care planning based on better information may reduce this rate. However, very little is known about the homecare admission and care planning processes. The research team collected data during observations of three nursing visits to admit homecare patients in Camden NJ, and conducted thematic content analysis on these data. Human factors methods helped to identify nurse decision-making related to selection of the plan of care problems, non-nursing resources, and the nursing visit pattern. They identified how the electronic health record (EHR) assisted the nurse in visit pattern frequency decisions. Major themes that emerged included reduced efficiency due to use of redundant intra-team communication methods to augment EHR documentation, redundant documentation, and workarounds and reorganization of clinical workflow.

  1. Homecare Nurses' Decision-Making During Admission Care Planning.

    PubMed

    Sockolow, Paulina; Bass, Ellen J; Eberle, Carl L; Bowles, Kathryn H

    2016-01-01

    The re-hospitalization rate of homecare patients within 60 days of hospital discharge is 30%. Enhanced care planning based on better information may reduce this rate. However, very little is known about the homecare admission and care planning processes. The research team collected data during observations of three nursing visits to admit homecare patients in Camden NJ, and conducted thematic content analysis on these data. Human factors methods helped to identify nurse decision-making related to selection of the plan of care problems, non-nursing resources, and the nursing visit pattern. They identified how the electronic health record (EHR) assisted the nurse in visit pattern frequency decisions. Major themes that emerged included reduced efficiency due to use of redundant intra-team communication methods to augment EHR documentation, redundant documentation, and workarounds and reorganization of clinical workflow. PMID:27332156

  2. Strategic Planning for Health Care Cost Controls in a Constantly Changing Environment.

    PubMed

    Hembree, William E

    2015-01-01

    Health care cost increases are showing a resurgence. Despite recent years' comparatively modest increases, the projections for 2015 cost increases range from 6.6% to 7%--three to four times larger than 2015's expected underlying inflation. This resurgence is just one of many rapidly changing external and internal challenges health plan sponsors must overcome (and this resurgence advances the date when the majority of employers will trigger the "Cadillac tax"). What's needed is a planning approach that is effective in overcoming all known and yet-to-be-discovered challenges, not just affordability. This article provides detailed guidance in adopting six proven strategic planning steps. Following these steps will proactively and effectively create a flexible strategic plan for the present and future of employers' health plans that will withstand all internal and external challenges. PMID:26666091

  3. Strategic Planning for Health Care Cost Controls in a Constantly Changing Environment.

    PubMed

    Hembree, William E

    2015-01-01

    Health care cost increases are showing a resurgence. Despite recent years' comparatively modest increases, the projections for 2015 cost increases range from 6.6% to 7%--three to four times larger than 2015's expected underlying inflation. This resurgence is just one of many rapidly changing external and internal challenges health plan sponsors must overcome (and this resurgence advances the date when the majority of employers will trigger the "Cadillac tax"). What's needed is a planning approach that is effective in overcoming all known and yet-to-be-discovered challenges, not just affordability. This article provides detailed guidance in adopting six proven strategic planning steps. Following these steps will proactively and effectively create a flexible strategic plan for the present and future of employers' health plans that will withstand all internal and external challenges.

  4. Clinton's Child Care Plan: Helping Families to Secure and Pay for Child Care. Family Review.

    ERIC Educational Resources Information Center

    Lindjord, Denise

    1998-01-01

    Reviews features of President Bill Clinton's proposed $22 billion child care plan, a set of spending measures and tax credits designed to make child care more affordable, available, and safe for low- and middle-income families. Features noted include Head Start and after-school programs, and business tax credits. (HTH)

  5. Solving the Puzzle of Child Care: Report of the Cuyahoga County Child Day Care Planning Project.

    ERIC Educational Resources Information Center

    Child Day Care Planning Project, Cleveland, OH.

    This report describes the Child Day Care Planning Project, which was developed by private and public representatives to meet the needs for child care in Cuyahoga County, Ohio. The project consisted of five major components. The first component, the Data Project, documented the needs and resources of the community. The second component, the Quality…

  6. The transition to managed care: experiences of planned parenthood patients.

    PubMed

    Lewis, V; Lawler, K

    1998-11-01

    A review of the findings from a 1996 survey of women visiting a Planned Parenthood clinic reveals that some members of managed care organizations (MCOs) may not be receiving appropriate preventive services and information from their primary care providers. This article details the results of a survey of 115 women who attended a Planned Parenthood of New York City clinic for reproductive health services. Based on these survey findings, the authors provide recommendations for MCOs and traditional providers of reproductive health to improve service delivery.

  7. Marketing a managed care plan: achieving product differentiation.

    PubMed

    Romeo, N C

    1996-01-01

    The health care marketplace is changing dramatically, even without federal reform measures. This is a volatile, yet promising, time to market a managed care plan. Before marketing the product, it is critical that the competition is thoroughly evaluated and consumer and employer needs are researched. The final product should be distinguishable from the competition and address market needs. Promotion can then begin, utilizing a proactive public relations and advertising campaign in addition to traditional methods of marketing.

  8. Advanced Hybrid Particulate Collector Project Management Plan

    SciTech Connect

    Miller, S.J.

    1995-11-01

    As the consumption of energy increases, its impact on ambient air quality has become a significant concern. Recent studies indicate that fine particles from coal combustion cause health problems as well as atmospheric visibility impairment. These problems are further compounded by the concentration of hazardous trace elements such as mercury, cadmium, selenium, and arsenic in fine particles. Therefore, a current need exists to develop superior, but economical, methods to control emissions of fine particles. Since most of the toxic metals present in coal will be in particulate form, a high level of fine- particle collection appears to be the best method of overall air toxics control. However, over 50% of mercury and a portion of selenium emissions are in vapor form and cannot be collected in particulate control devices. Therefore, this project will focus on developing technology not only to provide ultrahigh collection efficiency of particulate air toxic emissions, but also to capture vapor- phase trace metals such as mercury and selenium. Currently, the primary state-of-the-art technologies for particulate control are fabric filters (baghouses) and electrostatic precipitators (ESPs). However, they both have limitations that prevent them from achieving ultrahigh collection of fine particulate matter and vapor-phase trace metals. The objective of this project is to develop a highly reliable advanced hybrid particulate collector (AHPC) that can provide > 99.99 % particulate collection efficiency for all particle sizes between 0.01 and 50 14m, is applicable for use with all U.S. coals, and is cost-0443competitive with existing technologies. Phase I of the project is organized into three tasks: Task I - Project Management, Reporting, and Subcontract Consulting Task 2 - Modeling, Design, and Construction of 200-acfm AHPC Model Task 3 - Experimental Testing and Subcontract Consulting

  9. Modalities of palliative care in hospitalized patients with advanced AIDS.

    PubMed

    Vincent, I; D'Hérouville, D; Moulin, P; Bugler, C; Fraval, J; Mallet, D; Salamagne, M H; Vildé, J L; Jodelet, D; Leport, C

    2000-04-01

    This prospective multidisciplinary survey started in October 1994. The survey assessed the modalities of care of hospitalized patients with advanced AIDS in an Infectious and Tropical Diseases Unit with regards to the practices of palliative care in a Palliative Care Unit. Seventy-eight (78) AIDS patients with CD4 < or = 30/mm3 who had 102 consecutive hospitalizations were recruited. Types (symptomatic or curative) and number of drugs administered to the patients, as well as biological and radiological investigations performed were recorded. Symptoms were concomitantly assessed on a weekly basis by self-evaluation of the patients themselves and by physicians. The results showed that the practices of care were different in the two units according to the specific goals and norms of each unit. A higher density of care was delivered at the Infectious and Tropical Diseases Unit. Symptoms assessed by both patients and physicians were underestimated by physicians in frequency and in intensity. In conclusion, an integrated approach including objective and subjective criteria should enable a better adjustment of the palliative and curative therapeutic strategies in advanced AIDS. These would concomitantly take into account the wishes of the patient and the goals regarding care in the unit where the patient is hospitalized.

  10. Convergence of long-term care planning and retirement planning at the work place.

    PubMed

    Silva, Ajith

    2004-01-01

    There is an increasing expectation that the private-sector should provide needed solutions to pressing problems in long-term care. Long-term care insurance has figured prominently in recent discussions. Within the long-term care insurance market, the potential of the employer in making such insurance available to employees has been discussed extensively. This paper traces the increasing convergence of retirement planning and long-term care planning at the work place. The long-term care insurance market has come a long way, and the employer-sponsored segment of the market has recorded the highest rate of growth in recent times. Furthermore, the employer-sponsored market is beginning to diversify. Low take-up rates still remain a problem. Recent rapid growth of the market coupled with the federal government's involvement as an employer offering long-term care insurance is bound to expand the market further. PMID:15148046

  11. Changing workforce demographics necessitates succession planning in health care.

    PubMed

    Collins, Sandra K; Collins, Kevin S

    2007-01-01

    Health care organizations continue to be plagued by labor shortage issues. Further complicating the already existing workforce challenges is an aging population poised to retire en masse within the next few years. With fewer cohorts in the age group of 25 to 44 years (Vital Speeches Day. 2004:71:23-27), a more mobile workforce (Grow Your Own Leaders: How to Identify, Develop, and Retain Leadership Talent, 2002), and an overall reduction in the number of individuals seeking employment in the health care field (J Healthc Manag. 2003:48:6-11), the industry could be faced with an unmanageable number of vacant positions throughout the organization. Bracing for the potential impact of these issues is crucial to the ongoing business continuity of health care organization. Many health care organizations have embraced succession planning to combat the potential labor famine. However, the health care industry as a whole seems to lag behind other industries in terms of succession planning efforts (Healthc Financ Manage. 2005;59:64-67). This article seeks to provide health care managers with a framework for improving the systematic preparation of the next generation of managers by analyzing the succession planning process. The proposition of these models is to initiate and simplify the gap reduction between theoretical concepts and future organizational application.

  12. Changing workforce demographics necessitates succession planning in health care.

    PubMed

    Collins, Sandra K; Collins, Kevin S

    2007-01-01

    Health care organizations continue to be plagued by labor shortage issues. Further complicating the already existing workforce challenges is an aging population poised to retire en masse within the next few years. With fewer cohorts in the age group of 25 to 44 years (Vital Speeches Day. 2004:71:23-27), a more mobile workforce (Grow Your Own Leaders: How to Identify, Develop, and Retain Leadership Talent, 2002), and an overall reduction in the number of individuals seeking employment in the health care field (J Healthc Manag. 2003:48:6-11), the industry could be faced with an unmanageable number of vacant positions throughout the organization. Bracing for the potential impact of these issues is crucial to the ongoing business continuity of health care organization. Many health care organizations have embraced succession planning to combat the potential labor famine. However, the health care industry as a whole seems to lag behind other industries in terms of succession planning efforts (Healthc Financ Manage. 2005;59:64-67). This article seeks to provide health care managers with a framework for improving the systematic preparation of the next generation of managers by analyzing the succession planning process. The proposition of these models is to initiate and simplify the gap reduction between theoretical concepts and future organizational application. PMID:17992105

  13. Discharge Planning in Acute Care Hospitals in Israel: Services Planned and Levels of Implementation and Adequacy

    ERIC Educational Resources Information Center

    Auslander, Gail K.; Soskolne, Varda; Stanger, Varda; Ben-Shahar, Ilana; Kaplan, Giora

    2008-01-01

    This study aimed to examine the implementation, adequacy, and outcomes of discharge planning. The authors carried out a prospective study of 1,426 adult patients discharged from 11 acute care hospitals in Israel. Social workers provided detailed discharge plans on each patient. Telephone interviews were conducted two weeks post-discharge. Findings…

  14. Care planning as a strategy to manage variation in practice: from care plan to integrated person-based record.

    PubMed

    Hoy, J D; Hyslop, A Q

    1995-01-01

    This article begins with a summary of the trend toward a person-based health record, and the need to integrate data from a variety of sources to achieve this. A project is described that demonstrated problems with the structure of nursing care plans. These problems affected the ability to integrate care plan data into a clinical database capable of analysis to link control of process with clinical outcome. A second project is described that focused on the development of data sets holding higher-level descriptions suitable for the maintenance of a person-based record, but at a summarized level and with no clinical detail. Finally, a prototype care planning system is described that, while maintaining the data required by the Nursing Process, was more flexibly structured to support analysis and hierarchical levels of description. PMID:7583650

  15. 45 CFR 95.610 - Submission of advance planning documents.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... will comply with all State and Federal requirements including the retention of software ownership... conversion, vendor and state personnel, computer capacity planning, supplies, training, hardware, software... contained at §§ 1355.54 through 1355.57, § 307.15 and 42 CFR subchapter C, part 433. (c) Advance...

  16. 45 CFR 95.610 - Submission of advance planning documents.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... will comply with all State and Federal requirements including the retention of software ownership... conversion, vendor and state personnel, computer capacity planning, supplies, training, hardware, software... contained at §§ 1355.54 through 1355.57, § 307.15 and 42 CFR subchapter C, part 433. (c) Advance...

  17. 45 CFR 95.610 - Submission of advance planning documents.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... will comply with all State and Federal requirements including the retention of software ownership... conversion, vendor and state personnel, computer capacity planning, supplies, training, hardware, software... contained at §§ 1355.54 through 1355.57, § 307.15 and 42 CFR subchapter C, part 433. (c) Advance...

  18. 45 CFR 95.610 - Submission of advance planning documents.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... will comply with all State and Federal requirements including the retention of software ownership... conversion, vendor and state personnel, computer capacity planning, supplies, training, hardware, software... contained at §§ 1355.54 through 1355.57, § 307.15 and 42 CFR subchapter C, part 433. (c) Advance...

  19. 14 CFR 151.125 - Allowable advance planning costs.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Allowable advance planning costs. 151.125 Section 151.125 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... as preliminary topographic and soil exploration; (2) Site evaluation; (3) Preliminary...

  20. 14 CFR 151.125 - Allowable advance planning costs.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Allowable advance planning costs. 151.125 Section 151.125 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... as preliminary topographic and soil exploration; (2) Site evaluation; (3) Preliminary...

  1. 14 CFR 151.125 - Allowable advance planning costs.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Allowable advance planning costs. 151.125 Section 151.125 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... as preliminary topographic and soil exploration; (2) Site evaluation; (3) Preliminary...

  2. 14 CFR 151.125 - Allowable advance planning costs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Allowable advance planning costs. 151.125 Section 151.125 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... as preliminary topographic and soil exploration; (2) Site evaluation; (3) Preliminary...

  3. 14 CFR 151.125 - Allowable advance planning costs.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Allowable advance planning costs. 151.125 Section 151.125 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... as preliminary topographic and soil exploration; (2) Site evaluation; (3) Preliminary...

  4. Career Advancement of Nurse Executives: Planned or Accidental?

    ERIC Educational Resources Information Center

    Price, Sylvia A.; And Others

    1987-01-01

    A survey of 12 nurse executives indicated that most did not originally plan to be administrators when they entered nursing. However, all had pursued advanced degrees and most had been involved in nursing education prior to their administrator-level position. (CH)

  5. Advanced Education and Technology Business Plan, 2009-12. Highlights

    ERIC Educational Resources Information Center

    Alberta Advanced Education and Technology, 2009

    2009-01-01

    Advanced Education and Technology provides strategic leadership for the development of the next generation economy in Alberta through the provision of accessible, affordable and quality learning opportunities for all Albertans and support for a dynamic and integrated innovation system. This paper provides the highlights of the business plan of the…

  6. Experiences of the advanced nurse practitioner role in acute care.

    PubMed

    Cowley, Alison; Cooper, Joanne; Goldberg, Sarah

    2016-05-01

    The aim of the service evaluation presented in this article was to explore the multidisciplinary team's (MDT) experiences and perception of the advanced nurse practitioner (ANP) role on an acute health care of the older person ward. A qualitative case study was carried out comprising semi-structured interviews with members of the MDT, exploring their experiences of the ANP role. An overarching theme of 'Is it a nurse? Is it a doctor? No, it's an ANP' emerged from the data, with three subthemes: the missing link; facilitating and leading holistic care; and safe, high quality care. The ANP role is valued by the MDT working with them and provides a unique skill set that has the potential to enhance care of older patients living with frailty. While there are challenges to its introduction, it is a role worth introducing to older people's wards.

  7. Experiences of the advanced nurse practitioner role in acute care.

    PubMed

    Cowley, Alison; Cooper, Joanne; Goldberg, Sarah

    2016-05-01

    The aim of the service evaluation presented in this article was to explore the multidisciplinary team's (MDT) experiences and perception of the advanced nurse practitioner (ANP) role on an acute health care of the older person ward. A qualitative case study was carried out comprising semi-structured interviews with members of the MDT, exploring their experiences of the ANP role. An overarching theme of 'Is it a nurse? Is it a doctor? No, it's an ANP' emerged from the data, with three subthemes: the missing link; facilitating and leading holistic care; and safe, high quality care. The ANP role is valued by the MDT working with them and provides a unique skill set that has the potential to enhance care of older patients living with frailty. While there are challenges to its introduction, it is a role worth introducing to older people's wards. PMID:27125941

  8. [Integrated care for patients with advanced chronic obstructive pulmonary disease].

    PubMed

    Jassem, Ewa; Górecka, Dorota; Krakowiak, Piotr; Kozielski, Jerzy; Słomiński, J Marek; Krajnik, Małgorzata; Fal, Andrzej M

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) is the third cause of mortality and disability (assessed by DALY) among patients above 60 year old. Severe and very severe COPD (FEV(1) = equal or less than 50% and 30% of expected value, respectively) is estimated at 20% of all COPD patients. Advanced COPD usually leads to physical and mental deterioration, the patients often manage with the problems caused by the disease and other comorbidities poorly. This leads to increased risk of COPD exacerbations and further deterioration of the patient's status, increased costs of medical care and eventually increased risk of death. Current organization of medical care for those patients does not provide adequate health and social support for them. However, it seems that introducing an integrated approach proposed by World Health Organization, could improve the situation of advanced COPD patients. In Poland, this kind of care has been provided in advanced cancer patients throughout stationary palliative care units and hospices during the last several years. This experience should be helpful in integrating actions of general practitioners and specialized nurses, as well as providing access for the specialists' consultations according to the individual needs of the patients. It should also allow for broad cooperation with auxiliary staff, such as social workers, medical assistants and volunteers, as well as psychologists and clergymen (especially in the terminal phase of the disease).

  9. Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

    PubMed

    George, Susan; Leasure, A Renee

    2016-01-01

    Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care. PMID:26836596

  10. Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

    PubMed

    George, Susan; Leasure, A Renee

    2016-01-01

    Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care.

  11. Understanding the Context for Long-Term Care Planning.

    PubMed

    Broyles, Ila H; Sperber, Nina R; Voils, Corrine I; Konetzka, R Tamara; Coe, Norma B; Van Houtven, Courtney Harold

    2016-06-01

    Evolving family structure and economic conditions may affect individuals' ability and willingness to plan for future long-term care (LTC) needs. We applied life course constructs to analyze focus group data from a study of family decision making about LTC insurance. Participants described how past exposure to caregiving motivated them to engage in LTC planning; in contrast, child rearing discouraged LTC planning. Perceived institutional and economic instability drove individuals to regard financial LTC planning as either a wise precaution or another risk. Perceived economic instability also shaped opinions that adult children are ill-equipped to support parents' LTC. Despite concerns about viability of social insurance programs, some participants described strategies to maximize gains from them. Changing norms around aging and family roles also affected expectations of an active older age, innovative LTC options, and limitations to adult children's involvement. Understanding life course context can inform policy efforts to encourage LTC planning.

  12. Understanding the Context for Long-Term Care Planning.

    PubMed

    Broyles, Ila H; Sperber, Nina R; Voils, Corrine I; Konetzka, R Tamara; Coe, Norma B; Van Houtven, Courtney Harold

    2016-06-01

    Evolving family structure and economic conditions may affect individuals' ability and willingness to plan for future long-term care (LTC) needs. We applied life course constructs to analyze focus group data from a study of family decision making about LTC insurance. Participants described how past exposure to caregiving motivated them to engage in LTC planning; in contrast, child rearing discouraged LTC planning. Perceived institutional and economic instability drove individuals to regard financial LTC planning as either a wise precaution or another risk. Perceived economic instability also shaped opinions that adult children are ill-equipped to support parents' LTC. Despite concerns about viability of social insurance programs, some participants described strategies to maximize gains from them. Changing norms around aging and family roles also affected expectations of an active older age, innovative LTC options, and limitations to adult children's involvement. Understanding life course context can inform policy efforts to encourage LTC planning. PMID:26553887

  13. Replacement-ready? Succession planning tops health care administrators' priorities.

    PubMed

    Husting, P M; Alderman, M

    2001-09-01

    Nurses' increasing age coupled with health care's rapidly changing environment moves succession planning, originally only a business sector tool, to a top administrative priority. Through active support of your facility's executive leadership and a clear linkage to long range organization objectives, you can implement this progressive procedure.

  14. 42 CFR 456.380 - Individual written plan of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Individual written plan of care. 456.380 Section 456.380 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special procedures designed to...

  15. 42 CFR 456.180 - Individual written plan of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...; (vii) Diet; and (viii) Special procedures recommended for the health and safety of the patient; (5... 42 Public Health 4 2012-10-01 2012-10-01 false Individual written plan of care. 456.180 Section 456.180 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

  16. 42 CFR 456.380 - Individual written plan of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Individual written plan of care. 456.380 Section 456.380 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...; (iv) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special...

  17. 42 CFR 456.380 - Individual written plan of care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Individual written plan of care. 456.380 Section 456.380 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special procedures designed to...

  18. 42 CFR 456.380 - Individual written plan of care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Individual written plan of care. 456.380 Section 456.380 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...; (iv) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special...

  19. 42 CFR 456.180 - Individual written plan of care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...; (vii) Diet; and (viii) Special procedures recommended for the health and safety of the patient; (5... 42 Public Health 4 2011-10-01 2011-10-01 false Individual written plan of care. 456.180 Section 456.180 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

  20. 42 CFR 456.180 - Individual written plan of care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...; (vii) Diet; and (viii) Special procedures recommended for the health and safety of the patient; (5... 42 Public Health 4 2014-10-01 2014-10-01 false Individual written plan of care. 456.180 Section 456.180 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

  1. 42 CFR 456.180 - Individual written plan of care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Individual written plan of care. 456.180 Section 456.180 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental...

  2. Strategic business planning and development for competitive health care systems.

    PubMed

    Nauert, Roger C

    2005-01-01

    The health care industry has undergone enormous evolutionary changes in recent years. Competitive transitions have accelerated the compelling need for aggressive strategic business planning and dynamic system development. Success is driven by organizational commitments to farsighted market analyses, timely action, and effective management. PMID:18975726

  3. 25 CFR 1000.49 - Who can apply for an advance planning grant?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... Tribe and needs advance funding to complete the planning phase requirement may apply. Tribes/Consortia... 25 Indians 2 2010-04-01 2010-04-01 false Who can apply for an advance planning grant? 1000.49...-DETERMINATION AND EDUCATION ACT Section 402(d) Planning and Negotiation Grants Advance Planning Grant...

  4. Marketing health care to employees: the structure of employee health care plan satisfaction.

    PubMed

    Mascarenhas, O A

    1993-01-01

    Providing cost-contained comprehensive quality health care to maintain healthy and productive employees is a challenging problem for all employers. Using a representative panel of metropolitan employees, the author investigates the internal and external structure of employee satisfaction with company-sponsored health care plans. Employee satisfaction is differentiated into four meaningful groups of health care benefits, whereas its external structure is supported by the traditional satisfaction paradigms of expectation-disconfirmation, attribution, and equity. Despite negative disconfirmation, employees register sufficiently high health care satisfaction levels, which suggests some useful strategies that employers may consider implementing.

  5. Planning parenthood: Health care providers' perspectives on pregnancy intention, readiness, and family planning.

    PubMed

    Stevens, Lindsay M

    2015-08-01

    A major health care goal in the United States is increasing the proportion of pregnancies that are planned. While many studies examine family planning from the perspective of individual women or couples, few investigate the perceptions and practices of health care providers, who are gatekeepers to medicalized fertility control. In this paper, I draw on 24 in-depth interviews with providers to investigate how they interpret and enact the objective to "plan parenthood" and analyze their perspectives in the context of broader discourses about reproduction, family planning, and motherhood. Interviews reveal two central discourses: one defines pregnancy planning as an individual choice, that is as patients setting their own pregnancy intentions; the second incorporates normative expectations about what it means to be ready to have a baby that exclude poor, single, and young women. In the latter discourse, planning is a broader process of achieving middle-class life markers like a long-term relationship, a good job, and financial stability, before having children. Especially illuminating are cases where a patient's pregnancy intention and the normative expectations of "readiness" do not align. With these, I demonstrate that providers may prioritize normative notions of readiness over a patient's own intentions. I argue that these negotiations of intention and readiness reflect broader tensions in family planning and demonstrate that at times the seemingly neutral notion of "planned parenthood" can mask a source of stratification in reproductive health care.

  6. ‘Reality and desire’ in the care of advanced chronic kidney disease

    PubMed Central

    Marrón, Belén; Craver, Lourdes; Remón, César; Prieto, Mario; Gutiérrez, Josep Mª; Ortiz, Alberto

    2010-01-01

    There is a long distance between the actual worldwide reality in advanced chronic kidney disease care and the desire of how these patients should be managed to decrease cardiovascular and general morbidity and mortality. Implementation of adequate infrastructures may improve clinical outcomes and increase the use of home renal replacement therapies (RRT). Current pitfalls should be addressed to optimise care: inadequate medical training for nephrological referral and RRT selection, late referral to nephrologists, inadequate patient education for choice of RRT modality, lack of multidisciplinary advanced kidney disease clinics and lack of programmed RRT initiation. These deficiencies generate unintended consequences, such as inequality of care and limitations in patient education and selection-choice for RRT technique with limited use of peritoneal dialysis. Multidisciplinary advanced kidney disease clinics may have a direct impact on patient survival, morbidity and quality of life. There is a common need to reduce health care costs and scenarios increasing PD incidence show better efficiency. The following proposals may help to improve the current situation: defining the scope of the problem, disseminating guidelines with specific targets and quality indicators, optimising medical speciality training, providing adequate patient education, specially through the use of general decision making tools that will allow patients to choose the best possible RRT in accordance with their values, preferences and medical advice, increasing planned dialysis starts and involving all stakeholders in the process. PMID:25984045

  7. 'Reality and desire' in the care of advanced chronic kidney disease.

    PubMed

    Marrón, Belén; Craver, Lourdes; Remón, César; Prieto, Mario; Gutiérrez, Josep M; Ortiz, Alberto

    2010-10-01

    There is a long distance between the actual worldwide reality in advanced chronic kidney disease care and the desire of how these patients should be managed to decrease cardiovascular and general morbidity and mortality. Implementation of adequate infrastructures may improve clinical outcomes and increase the use of home renal replacement therapies (RRT). Current pitfalls should be addressed to optimise care: inadequate medical training for nephrological referral and RRT selection, late referral to nephrologists, inadequate patient education for choice of RRT modality, lack of multidisciplinary advanced kidney disease clinics and lack of programmed RRT initiation. These deficiencies generate unintended consequences, such as inequality of care and limitations in patient education and selection-choice for RRT technique with limited use of peritoneal dialysis. Multidisciplinary advanced kidney disease clinics may have a direct impact on patient survival, morbidity and quality of life. There is a common need to reduce health care costs and scenarios increasing PD incidence show better efficiency. The following proposals may help to improve the current situation: defining the scope of the problem, disseminating guidelines with specific targets and quality indicators, optimising medical speciality training, providing adequate patient education, specially through the use of general decision making tools that will allow patients to choose the best possible RRT in accordance with their values, preferences and medical advice, increasing planned dialysis starts and involving all stakeholders in the process.

  8. Do Survivorship Care Plans Make a Difference? A Primary Care Provider Perspective

    PubMed Central

    Shalom, Marina Mor; Hahn, Erin E.; Casillas, Jacqueline; Ganz, Patricia A.

    2011-01-01

    Introduction: The growing numbers of cancer survivors will challenge the ability of oncologists to provide ongoing surveillance care. Tools such as survivorship care plans (SCPs) are needed to effectively care for these patients. The UCLA-LIVESTRONG Survivorship Center of Excellence has been providing SCPs to cancer survivors and their providers since 2006. We sought to examine views on the value and impact of SCPs from a primary care provider (PCP) perspective. Methods: As part of a quality improvement project, we invited 32 PCPs who had received at least one SCP to participate in a semistructured interview focused on (1) the perceived value of SCPs for patient management and (2) PCP attitudes toward follow-up care for cancer survivors. Interviews were tape-recorded, transcribed, and analyzed. Results: Fifteen PCPs participated in the interviews and had received a total of 30 SCPs. Ten of them indicated reading the SCPs before being contacted for the interview. All 10 PCPs indicated that the SCP provided additional information about the patient's cancer history and/or recommendations for follow-up care, and eight reported a resulting change in patient care. PCPs identified useful elements of the SCP that assisted them with patient care, and they valued the comprehensive format of the SCP. PCPs indicated that after reading the SCPs they felt more confident and better prepared to care for the cancer survivor. Conclusion: SCPs were highly valued by these PCPs, increasing their knowledge about survivors' cancer history and recommended surveillance care and influencing patient care. PMID:22211129

  9. Islam and family planning: changing perceptions of health care providers and medical faculty in Pakistan

    PubMed Central

    Mir, Ali Mohammad; Shaikh, Gul Rashida

    2013-01-01

    ABSTRACT A USAID-sponsored family planning project called “FALAH” (Family Advancement for Life and Health), implemented in 20 districts of Pakistan, aimed to lower unmet need for family planning by improving access to services. To enhance the quality of care offered by the public health system, the FALAH project trained 10,534 facility-based health care providers, managers, and medical college faculty members to offer client-centered family planning services, which included a module to explain the Islamic viewpoint on family planning developed through an iterative process involving religious scholars and public health experts. At the end of the FALAH project, we conducted a situation analysis of health facilities including interviews with providers to measure family planning knowledge of trained and untrained providers; interviewed faculty to obtain their feedback about the training module; and measured changes in women's contraceptive use through baseline and endline surveys. Trained providers had a better understanding of family planning concepts than untrained providers. In addition, discussions with trained providers indicated that the training module on Islam and family planning helped them to become advocates for family planning. Faculty indicated that the module enhanced their confidence about the topic of family planning and Islam, making it easier to introduce and discuss the issue with their students. Over the 3.5-year project period, which included several components in addition to the training activity, we found an overall increase of 9 percentage points in contraceptive prevalence in the project implementation districts—from 29% to 38%. The Islam and family planning module has now been included in the teaching program of major public-sector medical universities and the Regional Training Institutes of the Population Welfare Department. Other countries with sizeable Muslim populations and low contraceptive prevalence could benefit from this module

  10. End-of-Life Care for Undocumented Immigrants With Advanced Cancer: Documenting the Undocumented.

    PubMed

    Jaramillo, Sylvia; Hui, David

    2016-04-01

    There are approximately 11.1 million undocumented immigrants in the United States, with a majority being Latino. Cancer is now the leading cause of death in Latinos. There is little research guiding providers on how to deliver optimal end-of-life care in this population. We describe a case of an undocumented Latino patient with advanced cancer, and provide a review of the literature on end-of-life care in undocumented immigrants. Our patient encountered many challenges as he navigated through the healthcare system in the last months of life. These included delayed diagnosis, limited social support, financial issues, fear of deportation, and language and cultural barriers, which resulted in significant physical and psychological distress. Within the undocumented patient population, there is often a lack of advance care planning, prognostic understanding, mistrust, religious practices, and cultural beliefs that may affect decision making. Given the growing number of undocumented immigrants in the United States, it is important for clinicians and policy makers to have a better understanding of the issues surrounding end-of-life care for undocumented immigrants, and work together to improve the quality of life and quality of end-of-life care for these disadvantaged individuals.

  11. LGBT people's knowledge of and preparedness to discuss end-of-life care planning options.

    PubMed

    Hughes, Mark; Cartwright, Colleen

    2014-09-01

    Despite the devastating impact of HIV/AIDS, end-of-life care planning among lesbian, gay, bisexual and transgender (LGBT) communities is relatively under-researched, especially in Australia. This paper reports findings of a survey of 305 LGBT people living in New South Wales, which examined their knowledge of and attitudes towards end-of-life care. The focus of this paper is their preparedness to discuss with healthcare providers any end-of-life care plans. The results highlight that while the majority of respondents were aware of three of the four key end-of-life care planning options available in New South Wales--enduring powers of attorney, enduring guardians and person responsible (only a minority had heard of advance healthcare directives)--a much smaller number of people had actually taken up these options. Only a minority of respondents were able to identify correctly who had the legal right to make treatment decisions for a person who is unconscious following a car accident. A small proportion of people had discussed end-of-life care options with general practitioners or another main healthcare provider, and only in very few cases were these issues raised by the practitioners themselves. Those most likely to not feel comfortable discussing these issues with practitioners included younger people, those not fully open about their sexuality to family members, and transgender people and others who do not define their gender as male or female. The paper highlights the importance of education strategies to raise awareness of the end-of-life care planning options among LGBT people, as well as strategies for increasing health providers' preparedness to discuss these issues with LGBT patients.

  12. Meaningful Use of Data in Care Coordination by the Advanced Practice Registered Nurse: The TeleFamilies Project

    PubMed Central

    Looman, Wendy S.; Erickson, Mary M.; Garwick, Ann W.; Cady, Rhonda G.; Kelly, Anne; Pettey, Carrie; Finkelstein, Stanley M.

    2012-01-01

    Meaningful use of electronic health records to coordinate care requires skillful synthesis and integration of subjective and objective data by practitioners to provide context for information. This is particularly relevant in the coordination of care for children with complex special health care needs. The purpose of this paper is to present a conceptual framework and example of meaningful use within an innovative telenursing intervention to coordinate care for children with complex special health care needs. The TeleFamilies intervention engages an advanced practice nurse in a full-time care coordinator role within an existing hospital-based medical home for children with complex special health care needs. Care coordination is facilitated by the synthesis and integration of internal and external data using an enhanced electronic health record and telehealth encounters via telephone and videoconferencing between the advanced practice nurse and the family at home. The advanced practice nurse’s ability to maintain an updated plan of care that is shared across providers and systems and build a relationship over time with the patient and family supports meaningful use of these data. PMID:22948406

  13. End-of-life care in patients with advanced lung cancer.

    PubMed

    Lim, Richard B L

    2016-10-01

    Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline. Once the needs are recognized, the second key area is appropriate communication, where the clinician should assist patients and family members in understanding where they are in the disease trajectory and what to expect. This involves developing rapport, breaking bad news, managing expectations and navigating care plans. Subsequently, the third key area is symptom management that focuses on the goals to first and foremost provide comfort and dignity. Symptoms that are common towards the end of life in lung cancer include pain, dyspnoea, delirium and respiratory secretions. Such symptoms need to be anticipated and addressed promptly with appropriate medications and explanations to the patient and family. Lastly, in order for physicians to provide quality end-of-life care, it is necessary to understand the ethical principles applied to end-of-life-care interventions. Misconceptions about euthanasia versus withholding or withdrawing life-sustaining treatments may lead to physician distress and inappropriate decision making. PMID:27585597

  14. Urinary Stone Disease: Advancing Knowledge, Patient Care, and Population Health.

    PubMed

    Scales, Charles D; Tasian, Gregory E; Schwaderer, Andrew L; Goldfarb, David S; Star, Robert A; Kirkali, Ziya

    2016-07-01

    Expanding epidemiologic and physiologic data suggest that urinary stone disease is best conceptualized as a chronic metabolic condition punctuated by symptomatic, preventable stone events. These acute events herald substantial future chronic morbidity, including decreased bone mineral density, cardiovascular disease, and CKD. Urinary stone disease imposes a large and growing public health burden. In the United States, 1 in 11 individuals will experience a urinary stone in their lifetime. Given this high incidence and prevalence, urinary stone disease is one of the most expensive urologic conditions, with health care charges exceeding $10 billion annually. Patient care focuses on management of symptomatic stones rather than prevention; after three decades of innovation, procedural interventions are almost exclusively minimally invasive or noninvasive, and mortality is rare. Despite these advances, the prevalence of stone disease has nearly doubled over the past 15 years, likely secondary to dietary and health trends. The NIDDK recently convened a symposium to assess knowledge and treatment gaps to inform future urinary stone disease research. Reducing the public health burden of urinary stone disease will require key advances in understanding environmental, genetic, and other individual disease determinants; improving secondary prevention; and optimal population health strategies in an increasingly cost-conscious care environment. PMID:26964844

  15. Medicare Managed Care plan Performance: A Comparison across Hospitalization Types

    PubMed Central

    Basu, Jayasree; Mobley, Lee Rivers

    2012-01-01

    Objective The study evaluates the performance of Medicare managed care (Medicare Advantage [MA]) Plans in comparison to Medicare fee-for-service (FFS) Plans in three states with historically high Medicare managed care penetration (New York, California, Florida), in terms of lowering the risks of preventable or ambulatory care sensitive conditions (ACSC) hospital admissions and providing increased referrals for admissions for specialty procedures. Study Design/Methods Using 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Healthcare Research and Quality, ACSC admissions are compared with ‘marker’ admissions and ‘referral-sensitive’ admissions, using a multinomial logistic regression approach. The year 2004 represents a strategic time to test the impact of MA on preventable hospitalizations, because the HMOs dominated the market composition in that time period. Findings MA enrollees in California experienced 22% lower relative risk (RRR= 0.78, p<0.01), those in Florida experienced 16% lower relative risk (RRR= 0.84, p<0.01), while those in New York experienced 9% lower relative risk (RRR=0.91, p<0.01) of preventable (versus marker) admissions compared to their FFS counterparts. MA enrollees in New York experienced 37% higher relative risk (RRR=1.37, p<0.01) and those in Florida had 41% higher relative risk (RRR=1.41, p<0.01)—while MA enrollees in California had 13% lower relative risk (RRR=0.87, p<0.01)—of referral-sensitive (versus marker) admissions compared to their FFS counterparts. Conclusion While MA plans were associated with reductions in preventable hospitalizations in all three states, the effects on referral-sensitive admissions varied, with California experiencing lower relative risk of referral-sensitive admissions for MA plan enrollees. The lower relative risk of preventable admissions for MA plan enrollees in New York and Florida became more pronounced after accounting for selection

  16. Care planning and decision-making in teams in Swedish elderly care: a study of interprofessional collaboration and professional boundaries.

    PubMed

    Duner, Anna

    2013-05-01

    In front-line practice, joint working between different professionals in health/social care and rehabilitation is regarded as a means to reach a comprehensive assessment of the needs of the older care recipients, leading to decisions on appropriate care and services. The aim of this study was to examine professional collaboration and professional boundaries in interprofessional care planning teams. Two different care planning teams were studied, one performing care planning in the homes of older individuals and the other performing care planning for older people in hospital wards. The empirical data consisted of audio-recorded care planning meetings and interviews with the professionals in the teams. The integration between the professionals involved was most noticeable in the investigation and assessment phase, while it was lower in the planning phase and almost non-existent in decision-making. The home care planning team tended to work in a more integrated manner than the discharge planning team. The importance of clarifying the roles of all professions concerned with needs assessment and care planning for older people became evident in this study.

  17. Planning Nurses in Maternity Care: a Stochastic Assignment Problem

    NASA Astrophysics Data System (ADS)

    Phillipson, Frank

    2015-05-01

    With 23 percent of all births taking place at home, The Netherlands have the highest rate of home births in the world. Also if the birth did not take place at home, it is not unusual for the mother and child to be out of hospital in a few hours after the baby was born. The explanation for both is the very well organised maternity care system. However, getting the right maternity care nurse available on time introduces a complex planning issue that can be recognized as a Stochastic Assignment Problem. In this paper an expert rule based approach is combined with scenario analysis to support the planner of the maternity care agency in his work.

  18. Making twin concerns of family planning and primary health care.

    PubMed

    Wang, Y

    1985-10-01

    The implementation of the Integrated FP/MCH/Parasite Control project by JOICFP in 1984 was envisioned to strengthen international cooperation, promote international exchange of knowledge and expand approaches in the practice of family planning. 2 municipalities in China were selected as pilot project areas. The objectives set in the 3-year plan of the integrated project are: to publicize the advantages of family planning and improve people's knowledge and practice of family planning; to stengthen technical guidance on family planning and control the growth and improve the quality of the population; to improve maternal and child care; and to reduce the infection rate of soil-transmitted helminthiasis. Steering committees on the integrated project at the municipal, county, township and village levels were set up in the pilot areas; the significance of the project has been communicated through film and slide presentations. Training courses for the administrative workers and technicians have been held. As a result of the family planning education activities, the contraceptive rates in the 2 pilot areas remained stable at 85%. Neonatal mortality was reduced significantly. Parasite control has benefitted 52,546 people in the pilot areas. An improvement was noted in environmental hygiene, the proper disposal of waste and the provision of safe drinking water. Further improvement can be achieved by intensifying public health education in the project areas, improving working systems and accomplishing all the tasks that the integrated project has set forth.

  19. Optimism and Planning for Future Care Needs among Older Adults

    PubMed Central

    Sörensen, Silvia; Hirsch, Jameson K.; Lyness, Jeffrey M.

    2015-01-01

    Aging is associated with an increase in need for assistance. Preparation for future care (PFC) is related to improved coping ability as well as better mental and physical health outcomes among older adults. We examined the association of optimism with components of PFC among older adults. We also explored race differences in the relationship between optimism and PFC. In Study 1, multiple regression showed that optimism was positively related to concrete planning. In Study 2, optimism was related to gathering information. An exploratory analysis combining the samples yielded a race interaction: For Whites higher optimism, but for Blacks lower optimism was associated with more planning. High optimism may be a barrier to future planning in certain social and cultural contexts. PMID:26045699

  20. Corporate buying of health care plans: a framework for marketing theory and practice.

    PubMed

    Lindenmuth, L J; Burger, P C

    1990-06-01

    Much of the research in health care plan and provider selection has focused on the patient's selection process. The authors report on the increasing need to understand the corporation's decision process in selecting health care plans and providers. Managed care marketers need to understand this process in order to design and market such plans successfully.

  1. 42 CFR 456.481 - Admission certification and plan of care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Individuals Under Age 21: Admission and Plan of Care Requirements § 456.481 Admission certification and plan of care. If a facility provides inpatient psychiatric services to a recipient under age 21— (a) The... 42 Public Health 4 2010-10-01 2010-10-01 false Admission certification and plan of care....

  2. Antimicrobial stewardship in the intensive care unit: advances and obstacles.

    PubMed

    Lawrence, Kevin L; Kollef, Marin H

    2009-03-15

    Antimicrobial stewardship involves a multifaceted approach that strives to combat the emergence of resistance, improve clinical outcomes, and control costs by improving antimicrobial use. Therefore, stewardship is of great importance and relevance in the intensive care unit. Clinical decision support systems, biomarker-derived treatment algorithms, and improved knowledge regarding the different components of antimicrobial therapy represent some of the advances that have been made in stewardship. Yet, significant obstacles have prevented the full achievement of stewardship's goals, and approaches to confronting these obstacles should be appreciated. Clinicians should realize that antimicrobials are important therapeutic agents and strive to use them wisely.

  3. Advanced hemodynamic monitoring: principles and practice in neurocritical care.

    PubMed

    Lazaridis, Christos

    2012-02-01

    Advanced hemodynamic monitoring is necessary for many patients with acute brain and/or spinal cord injury. Optimizing cerebral and systemic physiology requires multi-organ system function monitoring. Hemodynamic manipulations are cardinal among interventions to regulate cerebral perfusion pressure and cerebral blood flow. The pulmonary artery catheter is not any more the sole tool available; less invasive and potentially more accurate methodologies have been developed and employed in the operating room and among diverse critically ill populations. These include transpulmonary thermodilution, arterial pressure pulse contour, and waveform analysis and bedside critical care ultrasound. A thorough understanding of hemodynamics and of the available monitoring modalities is an essential skill for the neurointensivist.

  4. The Meaning of Parenteral Hydration to Family Caregivers and Patients with Advanced Cancer Receiving Hospice Care

    PubMed Central

    Cohen, Marlene Z; Torres-Vigil, Isabel; Burbach, Beth E.; de Rosa, Allison; Bruera, Eduardo

    2012-01-01

    Context In the U.S., patients with advanced cancer who are dehydrated or have decreased oral intake virtually always receive parenteral hydration in acute care facilities but rarely in the hospice setting. Objectives To describe the meaning of hydration for terminally ill cancer patients in home hospice care and for their primary caregivers. Methods Phenomenological interviews were conducted at two time points with 85 patients and 84 caregivers enrolled in a randomized, double-blind, controlled trial examining the efficacy of parenteral hydration in patients with advanced cancer receiving hospice care in the southern U.S. Transcripts were analyzed hermeneutically by the interdisciplinary research team until consensus on the theme labels was reached. Results Patients and their family caregivers both saw hydration as meaning hope and comfort. Hope was the view that hydration might prolong a life of dignity and enhance quality of life by reducing symptoms such as fatigue and increasing patients’ alertness. Patients and caregivers also described hydration as improving patients’ comfort by reducing pain, enhancing the effectiveness of pain medication, and nourishing the body, mind and spirit. Conclusion These findings differ from traditional hospice beliefs that dehydration enhances patient comfort given that patients and their families in the study viewed fluids as enhancing comfort, dignity and quality of life. Discussion with patients and families about their preferences for hydration may help tailor care plans to meet specific patient needs. PMID:22459230

  5. 25 CFR 1000.52 - What criteria will the Director use to award advance planning grants?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... planning grants? 1000.52 Section 1000.52 Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS... INDIAN SELF-DETERMINATION AND EDUCATION ACT Section 402(d) Planning and Negotiation Grants Advance Planning Grant Funding § 1000.52 What criteria will the Director use to award advance planning...

  6. 25 CFR 1001.9 - Selection criteria for tribes/consortia seeking advance planning grant funding.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... participate in self-governance. (e) Can tribes/consortia that receive advance planning grants also apply for a... planning grant funding. 1001.9 Section 1001.9 Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS... advance planning grant funding. (a) Who is eligible to apply for a planning grant that will be...

  7. Advanced High-Level Waste Glass Research and Development Plan

    SciTech Connect

    Peeler, David K.; Vienna, John D.; Schweiger, Michael J.; Fox, Kevin M.

    2015-07-01

    The U.S. Department of Energy Office of River Protection (ORP) has implemented an integrated program to increase the loading of Hanford tank wastes in glass while meeting melter lifetime expectancies and process, regulatory, and product quality requirements. The integrated ORP program is focused on providing a technical, science-based foundation from which key decisions can be made regarding the successful operation of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) facilities. The fundamental data stemming from this program will support development of advanced glass formulations, key process control models, and tactical processing strategies to ensure safe and successful operations for both the low-activity waste (LAW) and high-level waste (HLW) vitrification facilities with an appreciation toward reducing overall mission life. The purpose of this advanced HLW glass research and development plan is to identify the near-, mid-, and longer-term research and development activities required to develop and validate advanced HLW glasses and their associated models to support facility operations at WTP, including both direct feed and full pretreatment flowsheets. This plan also integrates technical support of facility operations and waste qualification activities to show the interdependence of these activities with the advanced waste glass (AWG) program to support the full WTP mission. Figure ES-1 shows these key ORP programmatic activities and their interfaces with both WTP facility operations and qualification needs. The plan is a living document that will be updated to reflect key advancements and mission strategy changes. The research outlined here is motivated by the potential for substantial economic benefits (e.g., significant increases in waste throughput and reductions in glass volumes) that will be realized when advancements in glass formulation continue and models supporting facility operations are implemented. Developing and applying advanced

  8. Cost accounting, management control, and planning in health care.

    PubMed

    Siegrist, R B; Blish, C S

    1988-02-01

    Advantages and pharmacy applications of computerized hospital management-control and planning systems are described. Hospitals must define their product lines; patient cases, not tests or procedures, are the end product. Management involves operational control, management control, and strategic planning. Operational control deals with day-to-day management on the task level. Management control involves ensuring that managers use resources effectively and efficiently to accomplish the organization's objectives. Management control includes both control of unit costs of intermediate products, which are procedures and services used to treat patients and are managed by hospital department heads, and control of intermediate product use per case (managed by the clinician). Information from the operation and management levels feeds into the strategic plan; conversely, the management level controls the plan and the operational level carries it out. In the system developed at New England Medical Center, Boston, Massachusetts, the intermediate product-management system enables managers to identify intermediate products, develop standard costs, simulate changes in departmental costs, and perform variance analysis. The end-product management system creates a patient-level data-base, identifies end products (patient-care groupings), develops standard resource protocols, models alternative assumptions, performs variance analysis, and provides concurrent reporting. Examples are given of pharmacy managers' use of such systems to answer questions in the areas of product costing, product pricing, variance analysis, productivity monitoring, flexible budgeting, modeling and planning, and comparative analysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3284338

  9. [Evaluation of care quality in the ICU through a computerized nursing care plan].

    PubMed

    Goñi Viguria, R; García Santolaya, M P; Vázquez Calatayud, M; Margall Coscojuela, M A; Asiaín Erro, M C

    2004-01-01

    The computerized systems that are being implemented for the recording of the Nursing Care Plan may facilitate the performance of continuing follow-up of the care quality. This retrospective descriptive study has been performed in a polyvalent Intensive Care Unit with the following objectives: a) describe the evaluation of the care quality, performed through the computerized record of the Nursing Care Plan; and 2) compare this evaluation with that performed in 1998, when the Nursing Care Plan had not yet been computerized. In the 98 revised computerized Nursing Care Plans, corresponding to the same number of patients with a mean stay of 13.8 days, the following results were obtained. Artificial airway. 74 patients had an endotracheal tube with a mean stay of 5.4 days, 11 patients had a cannula tracheotomy (time period of 45.7 days); no events occurred. Central venous lines: 91 patients were carriers of 163 catheters, the mean presence time was 9.9 days; three with withdrawn due to obstruction, there was one accident withdrawal and two were self-removed. Arterial catheter: the total number of arterial lines, corresponding to 87 patients, was 101 with a mean presence of 6.7 days; 15 obstructions, six accidental withdrawals and four self-removals were recorded. Bladder catheter: 91 patients had a bladder catheter (mean presence 12.9 days); no event occurred. Nasogastric tube: 83 patients were carriers of 98 tubes (63 Salem type and 35 for nutrition), with a mean presence of 10.1 days; five were withdrawn due to obstruction, three accidental withdrawals and 40 self-removed (23 in one patient). Skin integrity: nine patients developed bedsores, eight grade II and two grade III, the mean stay was 26.6 days. No patients had an accidental fall. As study conclusions, it stands out that the preestablished standards for the evaluation of the care were achieved in most and the care quality is maintained in relationship with our 1998 study, remaining within a level considered as

  10. Knowledge Management Platform in Advanced Product Quality Planning

    NASA Astrophysics Data System (ADS)

    Chiliban, Bogdan; Baral, Lal Mohan; Kifor, Claudiu

    2014-12-01

    Knowledge is an essential part of organizational competitiveness. This vital resource must be managed correctly within organizations in order to achieve desired performance levels within all undertakings. The process of managing knowledge is a very difficult one due to the illusive nature of the resource itself. Knowledge is stored within every aspect of an organization starting from people and ending with documents and processes. The Knowledge Management Platform is designed as a facilitator for managers and employees in all endeavours knowledge related within the Advanced Product Quality Planning Procedure

  11. Emergency planning and management in health care: priority research topics

    PubMed Central

    Boyd, Alan; Chambers, Naomi; French, Simon; Shaw, Duncan; King, Russell; Whitehead, Alison

    2014-01-01

    Many major incidents have significant impacts on people's health, placing additional demands on health-care organisations. The main aim of this paper is to suggest a prioritised agenda for organisational and management research on emergency planning and management relevant to U.K. health care, based on a scoping study. A secondary aim is to enhance knowledge and understanding of health-care emergency planning among the wider research community, by highlighting key issues and perspectives on the subject and presenting a conceptual model. The study findings have much in common with those of previous U.S.-focused scoping reviews, and with a recent U.K.-based review, confirming the relative paucity of U.K.-based research. No individual research topic scored highly on all of the key measures identified, with communities and organisations appearing to differ about which topics are the most important. Four broad research priorities are suggested: the affected public; inter- and intra-organisational collaboration; preparing responders and their organisations; and prioritisation and decision making. PMID:25013721

  12. Assessing the financial health of Medicaid managed care plans and the quality of patient care they provide.

    PubMed

    McCue, Michael J; Bailit, Michael H

    2011-06-01

    In many states, Medicaid programs have contracted out the delivery of health care services to publicly traded health plans that are focused on managing the care of Medicaid members. Under the health reform law, states will be expanding the enrollment of their Medicaid programs and these publicly traded companies are expected to capitalize on this growing market. This study examined how publicly traded health plans differ from non-publicly traded ones in terms of administrative expenses, quality of care, and financial stability and found publicly traded plans that focused primarily on Medicaid enrollees paid out the lowest percentage of their Medicaid premium revenues in medical expenses and reported the highest percentage in administrative expenses across different types of health plans. The publicly traded plans also received lower scores for quality-of care measures related to preventive care, treatment of chronic conditions, members' access to care, and customer service.

  13. Health Care Financing Administration--Fiscal year 1980 regulation plan. Notice of regulation plan.

    PubMed

    1980-06-12

    HCFA has adopted a new regulation management system which includes a process for developing a regulation plan at the beginning of each fiscal year. Each initiative in the plan is designed to achieve specific programmatic goals and objectives in accordance with priorities. The plan includes a projected schedule for publishing each regulatory initiative in priority order. The annual HCFA plan supplements the Semi-Annual Agenda of Regulations published by HHS in June and December of each year in accordance with Executive Order 12044 "Improving Federal Government Regulations" (See 43 FR 12661 published March 23, 1978), and the Department's procedures which implement the Executive Order (See 43 FR 23119 published May 30, 1978, and 44 FR 59662 published October 16, 1979). The HCFA plan includes: [1] initiatives which appear in the Semi-Annual Agenda of Regulations because HCFA and the Secretary of HHS have concluded that specific regulation changes are needed; [2] new initiatives at an early stage of consideration where HCFA and the Secretary have not yet concluded that specific regulation changes are needed; and [3] routine initiatives that provide guidelines for existing regulations. HCFA is publishing the plan to provide the public with advance notice as early as possible of regulation initiatives that are planned or under active consideration. HCFA welcomes comments on the content of the plan, the priority set for each initiative, and projected publications targets.

  14. [The Regional Health Care Strategic Plan in Nagano Prefecture: process and principles].

    PubMed

    Koizumi, Noriaki

    2014-01-01

    The Regional Health Care Strategic Plan has included mental disorders as the fifth "priority disease". Nagano Prefecture should develop its own mental health care plan. The Community Mental Health and Welfare Center is expected to support municipalities and collaborate with medical care institutions and other resources in the community. Adding mental disorders to the Regional Health Care Strategic Plan will help integrate mental health care into general health care, to improve access to psychiatric care including emergency psychiatry, and facilitate the accountability of community mental health care. The new Regional Health Care Strategic Plan plays a pivotal role in the development of community mental health care in Nagano Prefecture, with improved access to care and standardized treatment.

  15. Advanced Launch System advanced development oxidizer turbopump program: Technical implementation plan

    NASA Technical Reports Server (NTRS)

    Ferlita, F.

    1989-01-01

    The Advanced Launch Systems (ALS) Advanced Development Oxidizer Turbopump Program has designed, fabricated and demonstrated a low cost, highly reliable oxidizer turbopump for the Space Transportation Engine that minimizes the recurring cost for the ALS engines. Pratt and Whitney's (P and W's) plan for integrating the analyses, testing, fabrication, and other program efforts is addressed. This plan offers a comprehensive description of the total effort required to design, fabricate, and test the ALS oxidizer turbopump. The proposed ALS oxidizer turbopump reduces turbopump costs over current designs by taking advantage of design simplicity and state-of-the-art materials and producibility features without compromising system reliability. This is accomplished by selecting turbopump operating conditions that are within known successful operating regions and by using proven manufacturing techniques.

  16. Family support and family-centered care in the neonatal intensive care unit: origins, advances, impact.

    PubMed

    Gooding, Judith S; Cooper, Liza G; Blaine, Arianna I; Franck, Linda S; Howse, Jennifer L; Berns, Scott D

    2011-02-01

    Family-centered care (FCC) has been increasingly emphasized as an important and necessary element of neonatal intensive care. FCC is conceptualized as a philosophy with a set of guiding principles, as well as a cohort of programs, services, and practices that many hospitals have embraced. Several factors drive the pressing need for family-centered care and support of families of infants in NICUs, including the increase in the number of infants in NICUs; growth in diversity of the population and their concurrent needs; identification of parental and familial stress and lack of parenting confidence; and gaps in support for families, as identified by parents and NICU staff. We explore the origins of and advances in FCC in the NICU and identify various delivery methods and aspects of FCC and family support in the NICU. We examine the research and available evidence supporting FCC in the NICU and offer recommendations for increased dissemination and for future study.

  17. Cohort effects on the need for health care and implications for health care planning in Canada.

    PubMed

    Whittaker, William; Birch, Stephen; MacKenzie, Adrian; Murphy, Gail Tomblin

    2016-01-01

    The sustainability of publicly funded health care systems is an issue for governments around the world. The economic climate limits governments' fiscal capacity to continue to devote an increasing share of public funds to health care. Meanwhile the demands for health care within populations continue to increase. Planning the future requirements for health care is typically based on applying current levels of health service use by age to demographic projections of the population. But changes in age-specific levels of health over time would undermine this 'constant use by age' assumption. We use representative Canadian survey data (Canadian Community Health Survey) covering the period 2001-2012, to identify the separate trends in demography (population ageing) and epidemiology (population health) on self-reported health. We propose an approach to estimating future health care requirements that incorporates cohort trends in health. Overall health care requirements for the population increase as the size and mean age of the population increase, but these effects are mitigated by cohort trends in health-we find the estimated need for health care is lower when models account for cohort effects in addition to age effects. PMID:26586614

  18. End-of-life care policy: An integrated care plan for the dying

    PubMed Central

    Myatra, Sheila Nainan; Salins, Naveen; Iyer, Shivakumar; Macaden, Stanley C.; Divatia, Jigeeshu V.; Muckaden, Maryann; Kulkarni, Priyadarshini; Simha, Srinagesh; Mani, Raj Kumar

    2014-01-01

    Purpose: The purpose was to develop an end-of-life care (EOLC) policy for patients who are dying with an advanced life limiting illness and to develop practical procedural guidelines for limiting inappropriate therapeutic medical interventions and improve the quality of care of the dying within an ethical framework and through a professional and family/patient consensus process. Evidence: The Indian Society of Critical Care Medicine (ISCCM) published its first guidelines on EOLC in 2005 [1] which was later revised in 2012.[2] Since these publications, there has been an exponential increase in empirical information and discussion on the subject. The literature reviewed observational studies, surveys, randomized controlled studies, as well as guidelines and recommendations, for education and quality improvement published across the world. The search terms were: EOLC; do not resuscitate directives; withdrawal and withholding; intensive care; terminal care; medical futility; ethical issues; palliative care; EOLC in India; cultural variations. Indian Association of Palliative Care (IAPC) also recently published its consensus position statement on EOLC policy for the dying.[3] Method: An expert committee of members of the ISCCM and IAPC was formed to make a joint EOLC policy for the dying patients. Proposals from the chair were discussed, debated, and recommendations were formulated through a consensus process. The members extensively reviewed national and international established ethical principles and current procedural practices. This joint EOLC policy has incorporated the sociocultural, ethical, and legal perspectives, while taking into account the needs and situation unique to India. PMID:25249748

  19. A conceptual framework for advanced practice nursing in a pediatric tertiary care setting: the SickKids' experience.

    PubMed

    LeGrow, Karen; Hubley, Pam; McAllister, Mary

    2010-05-01

    Advanced practice nurses (APNs) at The Hospital for Sick Children (SickKids) are pediatric healthcare providers who integrate principles and theories of advanced nursing with specialty knowledge to provide autonomous, independent, accountable, ethical and developmentally appropriate care in complex, often ambiguous and rapidly changing healthcare environments. Caring for children and adolescents requires culturally sensitive and family-centred approaches to care that incorporate a unique body of knowledge. Family-centred care is an approach to planning, delivery and evaluation of healthcare that is governed by the establishment of mutually beneficial partnerships among APNs, health professionals and children/families. The cornerstone of APN practice at SickKids is the recognition of "family" as the recipients of care. By valuing and developing relationships with families, APNs promote excellence in healthcare across the care continuum to optimize the child's and family's physical, emotional, social, psychological and spiritual well-being. This paper outlines the evolution of advanced practice nursing at SickKids, beginning with the introduction of APN roles in the 1970s and culminating in the current critical mass of APNs who have been integrated throughout the hospital's infrastructure. We describe the process used to create a common vision and a framework to guide pediatric advanced nursing practice.

  20. Developing a promotion plan for health care marketing.

    PubMed

    Hallums, A

    1994-07-01

    Promotion of a health care provider's services is essential for communication with its customers and consumers. It is relevant to an organization's marketing strategy and is an element of what is described as the marketing mix. This paper considers the relationship of promotion to the marketing of services and proposes a plan for the promotion of the organization as a whole which can also be applied to an individual service or specialty. Whilst specific reference is made to an National Health Service (NHS) Trust it is also relevant to a Directly Managed Unit. PMID:7952707

  1. Developing a promotion plan for health care marketing.

    PubMed

    Hallums, A

    1994-07-01

    Promotion of a health care provider's services is essential for communication with its customers and consumers. It is relevant to an organization's marketing strategy and is an element of what is described as the marketing mix. This paper considers the relationship of promotion to the marketing of services and proposes a plan for the promotion of the organization as a whole which can also be applied to an individual service or specialty. Whilst specific reference is made to an National Health Service (NHS) Trust it is also relevant to a Directly Managed Unit.

  2. Quality Nursing Care for Hospitalized Patients with Advanced Illness: Concept Development

    PubMed Central

    Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.

    2011-01-01

    The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability. PMID:20572095

  3. Center for Advanced Energy Studies (CAES) Strategic Plan

    SciTech Connect

    Kevin Kostelnik; Keith Perry

    2007-07-01

    Twenty-first century energy challenges include demand growth, national energy security, and global climate protection. The Center for Advanced Energy Studies (CAES) is a public/private partnership between the State of Idaho and its academic research institutions, the federal government through the U.S. Department of Energy (DOE) and the Idaho National Laboratory (INL) managed by the Battelle Energy Alliance (BEA). CAES serves to advance energy security for our nation by expanding the educational opportunities at the Idaho universities in energy-related areas, creating new capabilities within its member institutions, and delivering technological innovations leading to technology-based economic development for the intermountain region. CAES has developed this strategic plan based on the Balanced Scorecard approach. A Strategy Map (Section 7) summarizes the CAES vision, mission, customers, and strategic objectives. Identified strategic objectives encompass specific outcomes related to three main areas: Research, Education, and Policy. Technical capabilities and critical enablers needed to support these objectives are also identified. This CAES strategic plan aligns with and supports the strategic objectives of the four CAES institutions. Implementation actions are also presented which will be used to monitor progress towards fulfilling these objectives.

  4. Advanced Reactor Technology -- Regulatory Technology Development Plan (RTDP)

    SciTech Connect

    Moe, Wayne Leland

    2015-05-01

    This DOE-NE Advanced Small Modular Reactor (AdvSMR) regulatory technology development plan (RTDP) will link critical DOE nuclear reactor technology development programs to important regulatory and policy-related issues likely to impact a “critical path” for establishing a viable commercial AdvSMR presence in the domestic energy market. Accordingly, the regulatory considerations that are set forth in the AdvSMR RTDP will not be limited to any one particular type or subset of advanced reactor technology(s) but rather broadly consider potential regulatory approaches and the licensing implications that accompany all DOE-sponsored research and technology development activity that deal with commercial non-light water reactors. However, it is also important to remember that certain “minimum” levels of design and safety approach knowledge concerning these technology(s) must be defined and available to an extent that supports appropriate pre-licensing regulatory analysis within the RTDP. Final resolution to advanced reactor licensing issues is most often predicated on the detailed design information and specific safety approach as documented in a facility license application and submitted for licensing review. Because the AdvSMR RTDP is focused on identifying and assessing the potential regulatory implications of DOE-sponsored reactor technology research very early in the pre-license application development phase, the information necessary to support a comprehensive regulatory analysis of a new reactor technology, and the resolution of resulting issues, will generally not be available. As such, the regulatory considerations documented in the RTDP should be considered an initial “first step” in the licensing process which will continue until a license is issued to build and operate the said nuclear facility. Because a facility license application relies heavily on the data and information generated by technology development studies, the anticipated regulatory

  5. Communicating advance directives from long-term care facilities to emergency departments.

    PubMed

    Pauls, M A; Singer, P A; Dubinsky, I

    2001-07-01

    Many residents of long-term care (LTC) facilities are transferred to Emergency Departments without advance directives (AD). The goal of this study was to describe an ideal model for the transfer of AD from LTC facilities to Emergency Departments. Health care providers were asked to describe their ideal model for the completion and transfer of the ADs of LTC residents. A grounded theory methodology was used to identify significant themes. The model we present as a result of this analysis acknowledges the importance of simplifying and standardizing ADs, but focuses more attention on the process of completing and transferring the AD. A key feature of this model is an emphasis on the education of LTC residents and their relatives about ADs and advance-care planning. This education should involve a variety of resources used in creative ways; it should begin as soon as LTC placement is being considered, and the emphasis should be on providing information and discussing options rather than pressuring residents to make a decision.

  6. 14 CFR 151.123 - Procedures: Offer; amendment; acceptance; advance planning agreement.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Procedures: Offer; amendment; acceptance... Planning and Engineering Proposals § 151.123 Procedures: Offer; amendment; acceptance; advance planning.... FAA's offer and the sponsor's acceptance constitute an advance planning grant agreement between...

  7. Certification standards of professionals coordinating life care plans for individuals who have acquired brain injury.

    PubMed

    Johnson, Cloie B; Lacerte, Michel; Fountaine, John D

    2015-01-01

    This article will discuss the history and evolution of what is now known as a life care plan. The objectives will be to understand that a life care plan is a tool of case management. A life care plan is based on a proper medical, psychological, case management, and/or rehabilitation foundation. The development of a life care plan requires following generally accepted and peer-reviewed methodology and standards of practice. Life care planning is a trans-disciplinary specialty practice. A life care plan is a dynamic document based upon published standards of practice, comprehensive assessment, data analysis and research that provides an organized, concise plan for current and future needs with associated costs for individuals who have experienced catastrophic injury or have chronic health care needs. The reader will also learn there are Standards of Practice for life care planning that have been a long-standing guide for the practitioner and its core components will be discussed. There are qualifications of professionals who perform the specialty practice of life care planning which will be reviewed, and in conclusion there are special considerations for individuals coordinating life care plans with individuals who have sustained an acquired brain injury will also be discussed.

  8. [Advanced nursing practice: a must for the quality of care and mental health services].

    PubMed

    Ricard, Nicole; Page, Claire; Laflamme, France

    2014-01-01

    supported the development of new models of advanced practice in mental health. These developments have been particularly significant in the United States and Australia. In United States, during the 1990s, at least four models of advanced practice in mental health nursing have been developed leading to wide variations in the roles, education, job titles, scope of practice and legal authorizations. Consequently, a consensus model of uniform standards of practice, accreditation and education has been proposed. This LACE model (Licensure, Accreditation, Certification, Education) will be in effect in 2015. Australia has adopted a more systematic approach, unified and progressive to facilitate the development of advanced mental health nursing practice. Australia who, through their many publications, retains more attention since a clear definition of the role of the nurse practitioner in mental health and a legal framework has been adopted at the national level. The Australian experience and the finding from studies suggest that mental health nurse practitioners and nurses who are specialized in mental health have the potential to make a significant contribution to enhancing access to and quality of mental health care through flexible an innovative approaches. So there are more and more evidence and indications that Quebec should invest in enhancing the skills of mental health nurses through the development of advanced nursing practice and integration of this new model in primary care. In addition, researches, funded by the Canadian Services Research Foundation (CHSRF, 2010), shows that the contribution of advanced nursing practice has never been stronger and there is a broad consensus to its value for the Canadian health care system (Dicenso.et Lukosius-Briant, 2010). The implementation of advanced practice nursing role in mental health is part of best practices required to improve care and mental health services and should be taken into account in future Action Plan 2014-2020.

  9. [Advanced nursing practice: a must for the quality of care and mental health services].

    PubMed

    Ricard, Nicole; Page, Claire; Laflamme, France

    2014-01-01

    supported the development of new models of advanced practice in mental health. These developments have been particularly significant in the United States and Australia. In United States, during the 1990s, at least four models of advanced practice in mental health nursing have been developed leading to wide variations in the roles, education, job titles, scope of practice and legal authorizations. Consequently, a consensus model of uniform standards of practice, accreditation and education has been proposed. This LACE model (Licensure, Accreditation, Certification, Education) will be in effect in 2015. Australia has adopted a more systematic approach, unified and progressive to facilitate the development of advanced mental health nursing practice. Australia who, through their many publications, retains more attention since a clear definition of the role of the nurse practitioner in mental health and a legal framework has been adopted at the national level. The Australian experience and the finding from studies suggest that mental health nurse practitioners and nurses who are specialized in mental health have the potential to make a significant contribution to enhancing access to and quality of mental health care through flexible an innovative approaches. So there are more and more evidence and indications that Quebec should invest in enhancing the skills of mental health nurses through the development of advanced nursing practice and integration of this new model in primary care. In addition, researches, funded by the Canadian Services Research Foundation (CHSRF, 2010), shows that the contribution of advanced nursing practice has never been stronger and there is a broad consensus to its value for the Canadian health care system (Dicenso.et Lukosius-Briant, 2010). The implementation of advanced practice nursing role in mental health is part of best practices required to improve care and mental health services and should be taken into account in future Action Plan 2014

  10. Clinical Workflow Observations to Identify Opportunities for Nurse, Physicians and Patients to Share a Patient-centered Plan of Care

    PubMed Central

    Collins, Sarah A.; Gazarian, Priscilla; Stade, Diana; McNally, Kelly; Morrison, Conny; Ohashi, Kumiko; Lehmann, Lisa; Dalal, Anuj; Bates, David W.; Dykes, Patricia C.

    2014-01-01

    Patient- and Family-Centered Care (PFCC) is essential for high quality care in the critical and acute-specialty care hospital setting. Effective PFCC requires clinicians to form an integrated interprofessional team to collaboratively engage with the patient/family and contribute to a shared patient-centered plan of care. We conducted observations on a critical care and specialty unit to understand the plan of care activities and workflow documentation requirements for nurses and physicians to inform the development of a shared patient-centered plan of care to support patient engagement. We identified siloed plan of care documentation, with workflow opportunities to converge the nurses plan of care with the physician planned To-do lists and quality and safety checklists. Integration of nurses and physicians plan of care activities into a shared plan of care is a feasible and valuable step toward interprofessional teams that effectively engage patients in plan of care activities. PMID:25954345

  11. Transition Planning for Adolescents with Special Health Care Needs and Disabilities: A Guide for Health Care Providers.

    ERIC Educational Resources Information Center

    Porter, Stephanie; Freeman, Linda; Griffin, Lynne Reeves

    Designed for Massachusetts health care providers, this booklet provides information on transition planning for adolescents with special health care needs and disabilities. It includes resources and strategies to guide interventions with families and to focus their attention on four key facets of adulthood: health care, education, employment, and…

  12. 42 CFR 414.39 - Special rules for payment of care plan oversight.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... limited to a single medical condition rather than multi-disciplinary coordination of care; and (iii) The... 42 Public Health 3 2010-10-01 2010-10-01 false Special rules for payment of care plan oversight... Physicians and Other Practitioners § 414.39 Special rules for payment of care plan oversight. (a)...

  13. Determinants of survivorship care plan use in US cancer programs.

    PubMed

    Birken, Sarah A; Deal, Allison M; Mayer, Deborah K; Weiner, Bryan J

    2014-12-01

    Cancer programs are increasingly required to use survivorship care plans (SCPs). Compliance with SCP use requirements will be evaluated at the cancer program level. Cancer program-level determinants of SCP use may suggest strategies for compliance. The objective of this study was to describe SCP use and identify its cancer program-level determinants. We surveyed employees knowledgeable about survivorship practices in cancer programs throughout the USA with a wide range of annual incident cancers, program types, and cancer care quality improvement organization memberships (81/100 response rate). We used descriptive statistics to describe SCP use and bivariate statistics to identify its cancer program-level determinants. Most respondents (56 %) reported that SCPs were not used. In programs reporting use, SCP use is restricted primarily to breast (82 %) and colorectal (55 %) cancer survivors, and few providers use SCPs. When developed, SCPs seldom reach survivors and their primary care providers. Most respondents (78 %) reported beginning to use SCPs because of requirements. Frequently cited barriers included insufficient resources (76 %), perceived difficulty using SCPs (29 %), and lack of advocacy for SCP use from influential people (24 %). SCP use was positively associated with academic program type (p = .009) and membership in the National Cancer Institute's Community Cancer Centers Program (p = .009) and negatively associated with freestanding program type (p = .02). SCP use in the US cancer programs is highly inconsistent. Many cancer programs plan to implement SCPs to comply with SCP use requirements. Support specifically intended to facilitate SCP use may be more effective than non-specific resources.

  14. Advances in paper-based point-of-care diagnostics.

    PubMed

    Hu, Jie; Wang, ShuQi; Wang, Lin; Li, Fei; Pingguan-Murphy, Belinda; Lu, Tian Jian; Xu, Feng

    2014-04-15

    Advanced diagnostic technologies, such as polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA), have been widely used in well-equipped laboratories. However, they are not affordable or accessible in resource-limited settings due to the lack of basic infrastructure and/or trained operators. Paper-based diagnostic technologies are affordable, user-friendly, rapid, robust, and scalable for manufacturing, thus holding great potential to deliver point-of-care (POC) diagnostics to resource-limited settings. In this review, we present the working principles and reaction mechanism of paper-based diagnostics, including dipstick assays, lateral flow assays (LFAs), and microfluidic paper-based analytical devices (μPADs), as well as the selection of substrates and fabrication methods. Further, we report the advances in improving detection sensitivity, quantification readout, procedure simplification and multi-functionalization of paper-based diagnostics, and discuss the disadvantages of paper-based diagnostics. We envision that miniaturized and integrated paper-based diagnostic devices with the sample-in-answer-out capability will meet the diverse requirements for diagnosis and treatment monitoring at the POC.

  15. Health-related quality of life and quality of care in specialized medicare-managed care plans.

    PubMed

    Grace, Susan C; Elliott, Marc N; Giordano, Laura A; Burroughs, James N; Malinoff, Rochelle L

    2013-01-01

    Special needs plans (SNPs) were created under the Medicare Modernization Act of 2003 to focus on Medicare beneficiaries who required more coordination of care than most beneficiaries served through the Medicare Advantage program. This research indicates that beneficiaries in 3 types of SNPs show evidence of worse health-related quality of life. Special needs plans demonstrated worse plan performance on the HEDIS osteoporosis testing in older women measure compared with non-SNP Medicare Advantage beneficiaries, but better plan performance on the HEDIS fall risk management measure. Future research should consider broader measures of plan performance, quality of care, and cost.

  16. What's the Plan? Needing Assistance with Plan of Care Is Associated with In-Hospital Death for ICU Patients Referred for Palliative Care Consultation.

    PubMed

    Kiyota, Ayano; Bell, Christina L; Masaki, Kamal; Fischberg, Daniel J

    2016-08-01

    To inform earlier identification of intensive care unit (ICU) patients needing palliative care, we examined factors associated with in-hospital death among ICU patients (N=260) receiving palliative care consultations at a 542-bed tertiary care hospital (2005-2009). High pre-consultation length of stay (LOS, ≥7 days) (adjusted odds ratio (aOR)=5.0, 95% confidence interval (95% CI)=2.5-9.9, P<.01) and consultations for assistance with plan of care (aOR=11.6, 95% CI=5.6-23.9, P<.01) were independently associated with in-hospital death. Patients with both consultation for plan of care and high pre-consult LOS had the highest odds of in-hospital death (aOR=36.3, 95% CI=14.9-88.5, P<.001), followed by patients with consultation for plan of care and shorter pre-consult LOS (aOR=9.8, 95% CI=4.3-22.1, P<.001), and patients with long pre-consult LOS but no consultation for plan of care (aOR=4.7, 95% CI=1.8-12.4, P=.002). Our findings suggest that ICU patients who require assistance with plan of care need to be identified early to optimize end-of-life care and avoid in-hospital death.

  17. What's the Plan? Needing Assistance with Plan of Care Is Associated with In-Hospital Death for ICU Patients Referred for Palliative Care Consultation

    PubMed Central

    Kiyota, Ayano; Bell, Christina L; Masaki, Kamal

    2016-01-01

    To inform earlier identification of intensive care unit (ICU) patients needing palliative care, we examined factors associated with in-hospital death among ICU patients (N=260) receiving palliative care consultations at a 542-bed tertiary care hospital (2005–2009). High pre-consultation length of stay (LOS, ≥7 days) (adjusted odds ratio (aOR)=5.0, 95% confidence interval (95% CI)=2.5–9.9, P<.01) and consultations for assistance with plan of care (aOR=11.6, 95% CI=5.6–23.9, P<.01) were independently associated with in-hospital death. Patients with both consultation for plan of care and high pre-consult LOS had the highest odds of in-hospital death (aOR=36.3, 95% CI=14.9–88.5, P<.001), followed by patients with consultation for plan of care and shorter pre-consult LOS (aOR=9.8, 95% CI=4.3–22.1, P<.001), and patients with long pre-consult LOS but no consultation for plan of care (aOR=4.7, 95% CI=1.8–12.4, P=.002). Our findings suggest that ICU patients who require assistance with plan of care need to be identified early to optimize end-of-life care and avoid in-hospital death. PMID:27563500

  18. What's the Plan? Needing Assistance with Plan of Care Is Associated with In-Hospital Death for ICU Patients Referred for Palliative Care Consultation.

    PubMed

    Kiyota, Ayano; Bell, Christina L; Masaki, Kamal; Fischberg, Daniel J

    2016-08-01

    To inform earlier identification of intensive care unit (ICU) patients needing palliative care, we examined factors associated with in-hospital death among ICU patients (N=260) receiving palliative care consultations at a 542-bed tertiary care hospital (2005-2009). High pre-consultation length of stay (LOS, ≥7 days) (adjusted odds ratio (aOR)=5.0, 95% confidence interval (95% CI)=2.5-9.9, P<.01) and consultations for assistance with plan of care (aOR=11.6, 95% CI=5.6-23.9, P<.01) were independently associated with in-hospital death. Patients with both consultation for plan of care and high pre-consult LOS had the highest odds of in-hospital death (aOR=36.3, 95% CI=14.9-88.5, P<.001), followed by patients with consultation for plan of care and shorter pre-consult LOS (aOR=9.8, 95% CI=4.3-22.1, P<.001), and patients with long pre-consult LOS but no consultation for plan of care (aOR=4.7, 95% CI=1.8-12.4, P=.002). Our findings suggest that ICU patients who require assistance with plan of care need to be identified early to optimize end-of-life care and avoid in-hospital death. PMID:27563500

  19. Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care

    Cancer.gov

    Cancer Pharmacogenomics: Integrating Discoveries in Basic, Clinical and Population Sciences to Advance Predictive Cancer Care, a 2010 workshop sponsored by the Epidemiology and Genomics Research Program.

  20. Employer strategies to combat health care plan fraud.

    PubMed

    Pflaum, B B; Rivers, J S

    1991-01-01

    Each year health care fraud drains millions of dollars from employer-sponsored health plans. Historically, employers have taken a rather tolerant view of fraud. As the pressure to manage health plan costs increases, however, many employers are beginning to see the detection and prosecution of fraud as an appropriate part of a cost management program. Fraud in medical insurance covers a wide range of activities in terms of cost and sophistication--from misrepresenting information on a claim, to billing for services never rendered, to falsifying the existence of an entire medical organization. To complicate matters, fraudulent activities can emanate from many, many sources. Perpetrators can include employees, dependents or associates of employees, providers and employees of providers--virtually anyone able to make a claim against a plan. This article addresses actions that employers can take to reduce losses from fraud. The first section suggests policy statements and administrative procedures and guidelines that can be used to discourage employee fraud. Section two addresses the most prevalent form of fraud--provider fraud. To combat provider fraud, employers should set corporate guidelines and should enlist the assistance of employees in identifying fraudulent provider activities. Section three suggests ways to improve fraud detection through the claims payment system--often the first line of defense against fraud. Finally, section four discusses the possibility of civil and criminal remedies and reviews the legal theories under which an increasing number of fraud cases have been prosecuted.

  1. Syntactic flexibility and planning scope: the effect of verb bias on advance planning during sentence recall.

    PubMed

    van de Velde, Maartje; Meyer, Antje S

    2014-01-01

    In sentence production, grammatical advance planning scope depends on contextual factors (e.g., time pressure), linguistic factors (e.g., ease of structural processing), and cognitive factors (e.g., production speed). The present study tests the influence of the availability of multiple syntactic alternatives (i.e., syntactic flexibility) on the scope of advance planning during the recall of Dutch dative phrases. We manipulated syntactic flexibility by using verbs with a strong bias or a weak bias toward one structural alternative in sentence frames accepting both verbs (e.g., strong/weak bias: De ober schotelt/serveert de klant de maaltijd [voor] "The waiter dishes out/serves the customer the meal"). To assess lexical planning scope, we varied the frequency of the first post-verbal noun (N1, Experiment 1) or the second post-verbal noun (N2, Experiment 2). In each experiment, 36 speakers produced the verb phrases in a rapid serial visual presentation (RSVP) paradigm. On each trial, they read a sentence presented one word at a time, performed a short distractor task, and then saw a sentence preamble (e.g., De ober…) which they had to complete to form the presented sentence. Onset latencies were compared using linear mixed effects models. N1 frequency did not produce any effects. N2 frequency only affected sentence onsets in the weak verb bias condition and especially in slow speakers. These findings highlight the dependency of planning scope during sentence recall on the grammatical properties of the verb and the frequency of post-verbal nouns. Implications for utterance planning in everyday speech are discussed.

  2. Syntactic flexibility and planning scope: the effect of verb bias on advance planning during sentence recall.

    PubMed

    van de Velde, Maartje; Meyer, Antje S

    2014-01-01

    In sentence production, grammatical advance planning scope depends on contextual factors (e.g., time pressure), linguistic factors (e.g., ease of structural processing), and cognitive factors (e.g., production speed). The present study tests the influence of the availability of multiple syntactic alternatives (i.e., syntactic flexibility) on the scope of advance planning during the recall of Dutch dative phrases. We manipulated syntactic flexibility by using verbs with a strong bias or a weak bias toward one structural alternative in sentence frames accepting both verbs (e.g., strong/weak bias: De ober schotelt/serveert de klant de maaltijd [voor] "The waiter dishes out/serves the customer the meal"). To assess lexical planning scope, we varied the frequency of the first post-verbal noun (N1, Experiment 1) or the second post-verbal noun (N2, Experiment 2). In each experiment, 36 speakers produced the verb phrases in a rapid serial visual presentation (RSVP) paradigm. On each trial, they read a sentence presented one word at a time, performed a short distractor task, and then saw a sentence preamble (e.g., De ober…) which they had to complete to form the presented sentence. Onset latencies were compared using linear mixed effects models. N1 frequency did not produce any effects. N2 frequency only affected sentence onsets in the weak verb bias condition and especially in slow speakers. These findings highlight the dependency of planning scope during sentence recall on the grammatical properties of the verb and the frequency of post-verbal nouns. Implications for utterance planning in everyday speech are discussed. PMID:25368592

  3. 42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... care facility services. (a) The State plan must provide that— (1) UR is performed for each ICF that furnishes inpatient services under the plan; (2) Each ICF has on file a written UR plan that provides for review of each beneficiary's need for the services that the ICF furnishes him; and (3) Each written...

  4. 42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... care facility services. (a) The State plan must provide that— (1) UR is performed for each ICF that furnishes inpatient services under the plan; (2) Each ICF has on file a written UR plan that provides for review of each beneficiary's need for the services that the ICF furnishes him; and (3) Each written...

  5. 42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... care facility services. (a) The State plan must provide that— (1) UR is performed for each ICF that furnishes inpatient services under the plan; (2) Each ICF has on file a written UR plan that provides for review of each recipient's need for the services that the ICF furnishes him; and (3) Each written ICF...

  6. 42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... care facility services. (a) The State plan must provide that— (1) UR is performed for each ICF that furnishes inpatient services under the plan; (2) Each ICF has on file a written UR plan that provides for review of each recipient's need for the services that the ICF furnishes him; and (3) Each written ICF...

  7. 42 CFR 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... care facility services. (a) The State plan must provide that— (1) UR is performed for each ICF that furnishes inpatient services under the plan; (2) Each ICF has on file a written UR plan that provides for review of each beneficiary's need for the services that the ICF furnishes him; and (3) Each written...

  8. Space Station Freedom advanced photovoltaics and battery technology development planning

    NASA Technical Reports Server (NTRS)

    Brender, Karen D.; Cox, Spruce M.; Gates, Mark T.; Verzwyvelt, Scott A.

    1993-01-01

    Space Station Freedom (SSF) usable electrical power is planned to be built up incrementally during assembly phase to a peak of 75 kW end-of-life (EOL) shortly after Permanently Manned Capability (PMC) is achieved in 1999. This power will be provided by planar silicon (Si) arrays and nickel-hydrogen (NiH2) batteries. The need for power is expected to grow from 75 kW to as much as 150 kW EOL during the evolutionary phase of SSF, with initial increases beginning as early as 2002. Providing this additional power with current technology may not be as cost effective as using advanced technology arrays and batteries expected to develop prior to this evolutionary phase. A six-month study sponsored by NASA Langley Research Center and conducted by Boeing Defense and Space Group was initiated in Aug. 1991. The purpose of the study was to prepare technology development plans for cost effective advanced photovoltaic (PV) and battery technologies with application to SSF growth, SSF upgrade after its arrays and batteries reach the end of their design lives, and other low Earth orbit (LEO) platforms. Study scope was limited to information available in the literature, informal industry contacts, and key representatives from NASA and Boeing involved in PV and battery research and development. Ten battery and 32 PV technologies were examined and their performance estimated for SSF application. Promising technologies were identified based on performance and development risk. Rough order of magnitude cost estimates were prepared for development, fabrication, launch, and operation. Roadmaps were generated describing key issues and development paths for maturing these technologies with focus on SSF application.

  9. Advanced Platform Systems Technology study. Volume 4: Technology advancement program plan

    NASA Technical Reports Server (NTRS)

    1983-01-01

    An overview study of the major technology definition tasks and subtasks along with their interfaces and interrelationships is presented. Although not specifically indicated in the diagram, iterations were required at many steps to finalize the results. The development of the integrated technology advancement plan was initiated by using the results of the previous two tasks, i.e., the trade studies and the preliminary cost and schedule estimates for the selected technologies. Descriptions for the development of each viable technology advancement was drawn from the trade studies. Additionally, a logic flow diagram depicting the steps in developing each technology element was developed along with descriptions for each of the major elements. Next, major elements of the logic flow diagrams were time phased, and that allowed the definition of a technology development schedule that was consistent with the space station program schedule when possible. Schedules show the major milestone including tests required as described in the logic flow diagrams.

  10. Written and computerized care plans. Organizational processes and effect on patient outcomes.

    PubMed

    Daly, Jeanette M; Buckwalter, Kathleen; Maas, Meridean

    2002-09-01

    The purpose of this study was to determine how use of a standardized nomenclature for nursing diagnosis and intervention statements on the computerized nursing care plan in a long-term care (LTC) facility would affect patient outcomes, as well as organizational processes and outcomes. An experimental design was used to compare the effects of two methods of documentation: Computer care plan and paper care plan. Twenty participants (10 in each group) were randomly assigned to either group. No statistically significant differences were found by group for demographic data. Repeated measures ANOVA was computed for each of the study variables with type of care plan, written or computerized, as the independent variable. There were no statistically significant differences between participants, group (care plan), within subjects (across time), or interaction (group and time) effects for the dependent variables: Level of care, activities of daily living, perception of pain, cognitive abilities, number of medications, number of bowel medications, number of constipation episodes, weight, percent of meals eaten, and incidence of alteration in skin integrity. There were significantly more nursing interventions and activities on the computerized care plan, although this care plan took longer to develop at each of the three time periods. Results from this study suggest that use of a computerized plan of care increases the number of documented nursing activities and interventions, but further research is warranted to determine if this potential advantage can be translated into improved patient and organizational outcomes in the long-term care setting.

  11. Fuel qualification plan for the Advanced Neutron Source Reactor

    SciTech Connect

    Copeland, G.L.

    1995-07-01

    This report describes the development and qualification plan for the fuel for the Advanced Neutron Source. The reference fuel is U{sub 3}Si{sub 2}, dispersed in aluminum and clad in 6061 aluminum. This report was prepared in May 1994, at which time the reference design was for a two-element core containing highly enriched uranium (93% {sup 235}U) . The reactor was in the process of being redesigned to accommodate lowered uranium enrichment and became a three-element core containing a higher volume fraction of uranium enriched to 50% {sup 235}U. Consequently, this report was not issued at that time and would have been revised to reflect the possibly different requirements of the lower-enrichment, higher-volume fraction fuel. Because the reactor is now being canceled, this unrevised report is being issued for archival purposes. The report describes the fabrication and inspection development plan, the irradiation tests and performance modeling to qualify performance, the transient testing that is part of the safety program, and the interactions and interfaces of the fuel development with other tasks.

  12. Development of Advanced Multi-Modality Radiation Treatment Planning Software

    SciTech Connect

    Nigg, D W; Hartmann Siantar, C

    2002-02-19

    The Idaho National Engineering and Environmental Laboratory (INEEL) has long been active in development of advanced Monte-Carlo based computational dosimetry and treatment planning methods and software for advanced radiotherapy, with a particular focus on Neutron Capture Therapy (NCT) and, to a somewhat lesser extent, Fast-Neutron Therapy. The most recent INEEL software product system of this type is known as SERA, Simulation Environment for Radiotherapy Applications. SERA is at a mature level in its life cycle, it has been licensed for research use worldwide, and it has become well established as a computational tool for research. However, along with its strengths, SERA also has some limitations in its structure and computational methodologies. More specifically, it is optimized only for neutron-based applications. Although photon transport can be computed with SERA, the simplified model that is used is designed primarily for photons produced in the neutron transport process. Thus SERA is not appropriate for applications to, for example, standard external-beam photon radiotherapy, which is by far more commonly used in the clinic than neutron based therapy.

  13. Advanced Stirling Convertor Durability Testing: Plans and Interim Results

    NASA Technical Reports Server (NTRS)

    Meer, David W.; Oriti, Salvatore M.

    2012-01-01

    The U.S. Department of Energy (DOE), Lockheed Martin Corporation (LM), and NASA Glenn Research Center (GRC) have been developing the Advanced Stirling Radioisotope Generator (ASRG) for use as a power system for space science missions. In support of this program, GRC has been involved in testing Stirling convertors, including the Advanced Stirling Convertor (ASC), for use in the ASRG. This testing includes electromagnetic interference/compatibility (EMI/EMC), structural dynamics, advanced materials, organics, and unattended extended operation. The purpose of the durability tests is to experimentally demonstrate the margins in the ASC design. Due to the high value of the hardware, previous ASC tests focused on establishing baseline performance of the convertors within the nominal operating conditions. The durability tests present the first planned extension of the operating conditions into regions beyond those intended to meet the product spec, where the possibility exists of lateral contact, overstroke, or over-temperature events. These tests are not intended to cause damage that would shorten the life of the convertors, so they can transition into extended operation at the conclusion of the tests. This paper describes the four tests included in the durability test sequence: 1) start/stop cycling, 2) exposure to constant acceleration in the lateral and axial directions, 3) random vibration at increased piston amplitude to induce contact events, and 4) overstroke testing to simulate potential failures during processing or during the mission life where contact events could occur. The paper also summarizes the analysis and simulation used to predict the results of each of these tests.

  14. Advanced Stirling Convertor Durability Testing: Plans and Interim Results

    NASA Technical Reports Server (NTRS)

    Meer, Dave; Oriti, Sal

    2012-01-01

    The U.S. Department of Energy (DOE), Lockheed Martin Corporation (LM), and NASA Glenn Research Center (GRC) have been developing the Advanced Stirling Radioisotope Generator (ASRG) for use as a power system for space science missions. In support of this program, NASA?s Glenn Research Center (GRC) has been involved in testing Stirling convertors, including the Advanced Stirling Convertor (ASC), for use in the ASRG. This testing includes electromagnetic interference/compatibility (EMI/EMC), structural dynamics, advanced materials, organics, and unattended extended operation. The purpose of the durability tests is to experimentally demonstrate the margins in the ASC design. Due to the high value of the hardware, previous ASC tests focused on establishing baseline performance of the convertors within the nominal operating conditions. The durability tests present the first planned extension of the operating conditions into regions beyond those intended to meet the product spec, where the possibility exists of lateral contact, overstroke, or over-temperature events. These tests are not intended to cause damage that would shorten the life of the convertors, so they can transition into extended operation at the conclusion of the tests. This paper describes the four tests included in the durability test sequence: 1) start/stop cycling, 2) exposure to constant acceleration in the lateral and axial directions, 3) random vibration at increased piston amplitude to induce contact events, and 4) overstroke testing to simulate potential failures during processing or during the mission life where contact events could occur. The paper also summarizes the analysis and simulation used to predict the results of each of these tests.

  15. 15 CFR 713.4 - Advance declaration requirements for additionally planned production, processing, or consumption...

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 2 CHEMICALS § 713.4 Advance declaration requirements for additionally planned production... additionally planned production, processing, or consumption of Schedule 2 chemicals. 713.4 Section...

  16. 15 CFR 713.4 - Advance declaration requirements for additionally planned production, processing, or consumption...

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 2 CHEMICALS § 713.4 Advance declaration requirements for additionally planned production... additionally planned production, processing, or consumption of Schedule 2 chemicals. 713.4 Section...

  17. 15 CFR 713.4 - Advance declaration requirements for additionally planned production, processing, or consumption...

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 2 CHEMICALS § 713.4 Advance declaration requirements for additionally planned production... additionally planned production, processing, or consumption of Schedule 2 chemicals. 713.4 Section...

  18. [Specific care plan in different stages of Alzheimer's disease].

    PubMed

    Hein, Christophe; Villars, Hélène; Nourhashemi, Fati

    2011-09-01

    The management and follow-up of patients with Alzheimers disease have stage-specific characteristics. In the mild stage, the key challenges are above all to improve the early diagnosis and the communication of the diagnosis. With the patient's agreement, a follow-up should be scheduled to assess, at each stage of the disease, cognitive and functional decline, and detect psycho-behavioral, nutritional or mobility complications. In the moderate or severe stages, prevention and treatment of caregiver burnout should be included in the follow-up. Finally, in the very severe stage, end of life and ethical issues should be considered. The followup and the intervention plan should be adapted to each patient, and require coordination between health care professionals and social workers. However, the practical aspects of the follow-up and the ways in which those can be improved are yet to be defined.

  19. Theory of Planned Behavior, Self-Care Motivation, and Blood Pressure Self-Care

    PubMed Central

    Peters, Rosalind M.; Templin, Thomas N.

    2013-01-01

    The theory of planned behavior (TPB) was integrated within the theory of self-care (SCT) to explore the predictive value of extending TPB to measure attitudes and beliefs regarding a behavioral goal, and determine the ability of goal beliefs to predict engagement in the combined, multiple behaviors necessary to control BP. The hypothesized model was evaluated in a sample of 306 community-dwelling African Americans between 21 and 65 years of age. Scales developed for the study achieved acceptable reliability (α=.68–95). Structural equation modeling analysis resulted in a second-order factor structure with attitude, subjective norm, perceived behavioral control, and intention modeled as indicators of a construct representing goal beliefs related to keeping BP within normal limits. This latent construct was conceptualized within the theory of self-care as “self-care motivation,” and predicted 18% of the variance in self-care behaviors necessary for BP control. The model achieved acceptable fit (CMIN/df = 2.32; CFI = .95; RMSEA = .066). Final assessment of fit was done using multi-group SEM and bootstrapping techniques. In this extension of the TPB attitudes and beliefs regarding the goal of keeping BP within normal limits were found to determine one's motivation to engage in the multiple behaviors necessary for BP control. PMID:20949834

  20. Theory of planned behavior, self-care motivation, and blood pressure self-care.

    PubMed

    Peters, Rosalind M; Templin, Thomas N

    2010-01-01

    The theory of planned behavior (TPB) was integrated within the theory of self-care (SCT) to explore the predictive value of extending TPB to measure attitudes and beliefs regarding a behavioral goal, and determine the ability of goal beliefs to predict engagement in the combined, multiple behaviors necessary to control BP. The hypothesized model was evaluated in a sample of 306 community-dwelling African Americans between 21 and 65 years of age. Scales developed for the study achieved acceptable reliability (alpha = .68-.95). Structural equation modeling analysis resulted in a second-order factor structure with attitude, subjective norm, perceived behavioral control, and intention modeled as indicators of a construct representing goal beliefs related to keeping BP within normal limits. This latent construct was conceptualized within the theory of self-care as "self-care motivation," and predicted 18% of the variance in self-care behaviors necessary for BP control. The model achieved acceptable fit (CMIN/df = 2.32; CFI = .95; RMSEA = .066). Final assessment of fit was done using multi-group SEM and bootstrapping techniques. In this extension of the TPB attitudes and beliefs regarding the goal of keeping BP within normal limits were found to determine one's motivation to engage in the multiple behaviors necessary for BP control.

  1. Advance Planning and Compassionate Care Act of 2009

    THOMAS, 111th Congress

    Sen. Rockefeller, John D., IV [D-WV

    2009-05-21

    05/21/2009 Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S5863-5872) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  2. The Planning and Operation of an Intensive Care Unit

    PubMed Central

    Grundy, Eric C.

    1964-01-01

    It is desirable that every hospital of 100 beds or more should have an intensive care unit. An attempt is made to outline the more important features to be considered, including the physical aspects, when planning and establishing such a unit. The unit should contain 2-4% of the total number of hospital beds. It should be separate, centrally located and self-contained. Direct observation of all patients must be possible at all times. Efficient and specially trained personnel using modern and special equipment are required. Orientation lectures and demonstrations must be carried out frequently and regularly. The types of patients to be admitted to the unit are discussed, as well as the governing rules and regulations. All doctors should have a right to admit and look after their own patients in the unit; an Intensive Care Unit Committee made up of representatives of the major services is suggested as a means of controlling admissions and discharges and for general administration. ImagesFig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7 PMID:14175876

  3. CARES: Carbonaceous Aerosol and Radiative Effects Study Operations Plan

    SciTech Connect

    Zaveri, RA; Shaw, WJ; Cziczo, DJ

    2010-07-12

    The CARES field campaign is motivated by the scientific issues described in the CARES Science Plan. The primary objectives of this field campaign are to investigate the evolution and aging of carbonaceous aerosols and their climate-affecting properties in the urban plume of Sacramento, California, a mid-size, mid-latitude city that is located upwind of a biogenic volatile organic compound (VOC) emission region. Our basic observational strategy is to make comprehensive gas, aerosol, and meteorological measurements upwind, within, and downwind of the urban area with the DOE G-1 aircraft and at strategically located ground sites so as to study the evolution of urban aerosols as they age and mix with biogenic SOA precursors. The NASA B-200 aircraft, equipped with the High Spectral Resolution Lidar (HSRL), digital camera, and the Research Scanning Polarimeter (RSP), will be flown in coordination with the G-1 to characterize the vertical and horizontal distribution of aerosols and aerosol optical properties, and to provide the vertical context for the G-1 and ground in situ measurements.

  4. Economic Impact of an Advanced Illness Consultation Program within a Medicare Advantage Plan Population

    PubMed Central

    Colaberdino, Vincent; Marshall, Colleen; DuBose, Paul; Daitz, Mitchell

    2016-01-01

    Abstract Background: In the United States the quality and cost associated with medical treatment for individuals experiencing an advanced illness is highly variable and is often misaligned with the patient's and family's quality of life values and priorities. Many of the obstacles that stand in the way of aligning the care that an individual receives with their priorities are well understood in the context of behavioral science. Through employing behavioral based approaches to improve the quality of communication and shared decision making processes among patients, providers and families it is possible to enhance the efficiency of delivering care which is also more highly aligned with the individual's preferences. Objectives: The study objectives were to measure the economic impact of a proprietary advanced illness behavioral consultation program, the Vital Decisions Living Well Consultation Program (LWCP), on the cost of care delivered during the last six and three months of life for enrolled members in a Medicare Advantage plan. Study design: Retrospective matched case control analysis examined medical, pharmaceutical, and capitation expenses after an offset by premium revenue. Methods: The treatment population consisted of participating members of the LWCP who died between October 1, 2011 and March 31, 2013 (N = 1755). The control population consisted of plan members who died between July 1, 2008 and June 1, 2011, prior to the introduction of the LWCP (N = 5560). Criteria used to match treatment subjects with one or more control subjects were diagnosis, age at death, and health care costs incurred prior to the time under examination. A paired t-test evaluated the significance of differences between the matched treatment and control members. Results: The mean cost reduction during the last six months of life for treatment members compared to matched control group members was $13,956 (p < 0.001) during the last six months of life and $9,285 (p < 0

  5. The Attending Nurse Caring Model: integrating theory, evidence and advanced caring-healing therapeutics for transforming professional practice.

    PubMed

    Watson, Jean; Foster, Roxie

    2003-05-01

    This paper presents a proposed model: The Attending Nursing Caring Model (ANCM) as an exemplar for advancing and transforming nursing practice within a reflective, theoretical and evidence-based context. Watson's theory of human caring is used as a guide for integrating theory, evidence and advanced therapeutics in the area of children's pain. The ANCM is offered as a programme for renewing the profession and its professional practices of caring-healing arts and science, during an era of decline, shortages, and crises in care, safety, and hospital and health reform. The ANCM elevates contemporary nursing's caring values, relationships, therapeutics and responsibilities to a higher/deeper order of caring science and professionalism, intersecting with other professions, while sustaining the finest of its heritage and traditions of healing.

  6. In place of fear: aligning health care planning with system objectives to achieve financial sustainability.

    PubMed

    Birch, Stephen; Murphy, Gail Tomblin; MacKenzie, Adrian; Cumming, Jackie

    2015-04-01

    The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase.

  7. Advancing Design-for-Assembly: The Next Generation in Assembly Planning

    SciTech Connect

    Calton, T.L.

    1998-12-09

    At the 1995 IEEE Symposium on Assembly and Task Planning, Sandia National Laboratories introduced the Archimedes 2 Software Tool [2]. The system was described as a second-generation assembly planning system that allowed preliminmy application of awembly planning for industry, while solidly supporting further research in planning techniques. Sandia has worked closely with indust~ and academia over the last four years. The results of these working relationships have bridged a gap for the next generation in assembly planning. Zke goal of this paper is to share Sandia 's technological advancements in assembly planning over the last four years and the impact these advancements have made on the manufacturing communip.

  8. Consensus statement on advancing research in emergency department operations and its impact on patient care.

    PubMed

    Yiadom, Maame Yaa A B; Ward, Michael J; Chang, Anna Marie; Pines, Jesse M; Jouriles, Nick; Yealy, Donald M

    2015-06-01

    The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications.

  9. Consensus statement on advancing research in emergency department operations and its impact on patient care.

    PubMed

    Yiadom, Maame Yaa A B; Ward, Michael J; Chang, Anna Marie; Pines, Jesse M; Jouriles, Nick; Yealy, Donald M

    2015-06-01

    The consensus conference on "Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care," hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but understudied area. The EDOSG is a research consortium dedicated to promoting evidence-based clinical practice in emergency medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we call for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multisite clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence-based research; 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system, including observation units, fast tracks, waiting rooms, laboratories, and radiology subunits; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research, and nontraditional publications. PMID:26014365

  10. Incorporating Age-Specific Plans of Care to Achieve Optimal Perioperative Outcomes.

    PubMed

    Mower, Juliana

    2015-10-01

    When developing a nursing plan of care, a perioperative nurse identifies nursing diagnoses during the preoperative patient assessment. The ability to identify age-specific outcomes (ie, infant/child, adolescent, adult, elderly adult) in addition to those that are universally applicable is a major responsibility of the perioperative RN. Having an individualized plan of care is one of the best ways to determine whether desired patient outcomes have been successfully attained. Nursing care plans address intraoperative and postoperative risks and allow for a smooth transfer of care throughout the perioperative experience. A good nursing care plan also includes education for the patient and his or her caregiver. Within an overall plan of care, the use of methods such as a concept or mind map can visually demonstrate the relationships between systems, nursing diagnoses, nursing interventions, and desirable outcomes.

  11. The positive attitudes and perceptions of care managers about advance directives.

    PubMed

    Golden, Adam G; Tewary, Sweta; Qadri, Syeda; Zaw, Khin; Ruiz, Jorge G; Roos, Bernard A

    2011-03-01

    In a previous intervention, we found that reminders from care managers failed to increase the number of their homebound older adult clients with advance directives. Thus, in the current study, we looked at the perceptions and attitudes of care managers about the need to discuss advance directives with their clients. Ninety-five care managers serving community-based nursing home-eligible older adults completed an 18-question survey, which found that care managers overwhelmingly believe it is important to address advance directives. Only 3.2% reported that discussing advance directives is time consuming. No attitudinal barriers were identified. Given their positive attitudes about advance directives, care managers need educational interventions that will provide the knowledge and skills to interact effectively with clients who are resistant to addressing end-of-life issues.

  12. Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation

    PubMed Central

    Baker, Adrian; Leak, Paul; Ritchie, Lewis D; Lee, Amanda J; Fielding, Shona

    2012-01-01

    Background Anticipatory care for older patients who are frail involves both case identification and proactive intervention to reduce hospitalisation. Aim To identify a population who were at risk of admission to hospital and to provide an anticipatory care plan (ACP) for them and to ascertain whether using primary and secondary care data to identify this population and then applying an ACP can help to reduce hospital admission rates. Design and setting Cohort study of a service intervention in a general practice and a primary care team in Scotland. Method The ACP sets out patients’ wishes in the event of a sudden deterioration in health. If admitted, a proactive approach was taken to transfer and discharge patients into the community. Cohorts were selected using the Nairn Case Finder, which matched patients in two practices for age, sex, multiple morbidity indexes, and secondary care outpatient and inpatient activity; 96 patients in each practice were studied for admission rate, occupied bed days and survival. Results Survivors from the ACP cohort (n = 80) had 510 fewer days in hospital than in the 12 months pre-intervention: a significant reduction of 52.0% (P = 0.020). There were 37 fewer admissions of the survivors from that cohort post-intervention than in the preceding 12 months, with a significant reduction of 42.5% (P = 0.002). Mortality rates in the two cohorts were similar, but the number of patients who died in hospital and the hospital bed days used in the last 3 months of life were significantly lower for the decedents with an ACP than for the controls who had died (P = 0.007 and P = 0.045 respectively). Conclusion This approach produced statistically significant reductions in unplanned hospitalisation for a cohort of patients with multiple morbidities. It demonstrates the potential for providing better care for patients as well as better value for health and social care services. It is of particular benefit in managing end-of-life care. PMID:22520788

  13. Plan for advanced microelectronics processing technology application. Final report

    SciTech Connect

    Goland, A.N.

    1990-10-01

    The ultimate objective of the tasks described in the research agreement was to identify resources primarily, but not exclusively, within New York State that are available for the development of a Center for Advanced Microelectronics Processing (CAMP). Identification of those resources would enable Brookhaven National Laboratory to prepare a program plan for the CAMP. In order to achieve the stated goal, the principal investigators undertook to meet the key personnel in relevant NYS industrial and academic organizations to discuss the potential for economic development that could accompany such a Center and to gauge the extent of participation that could be expected from each interested party. Integrated of these discussions was to be achieved through a workshop convened in the summer of 1990. The culmination of this workshop was to be a report (the final report) outlining a plan for implementing a Center in the state. As events unfolded, it became possible to identify the elements of a major center for x-ray lithography on Lone Island at Brookhaven National Laboratory. The principal investigators were than advised to substitute a working document based upon that concept in place of a report based upon the more general CAMP workshop originally envisioned. Following that suggestion from the New York State Science and Technology Foundation, the principals established a working group consisting of representatives of the Grumman Corporation, Columbia University, the State University of New York at Stony Brook, and Brookhaven National Laboratory. Regular meetings and additional communications between these collaborators have produced a preproposal that constitutes the main body of the final report required by the contract. Other components of this final report include the interim report and a brief description of the activities which followed the establishment of the X-ray Lithography Center working group.

  14. Care planning at home: a way to increase the influence of older people?

    PubMed Central

    Berglund, Helene; Dunér, Anna; Blomberg, Staffan; Kjellgren, Karin

    2012-01-01

    Introduction: Care-planning meetings represent a common method of needs assessment and decision-making practices in elderly care. Older people’s influence is an important and required aspect of these practices. This study’s objective was to describe and analyse older people’s influence on care-planning meetings at home and in hospital. Methods: Ten care-planning meetings were audio-recorded in the older people’s homes and nine were recorded in hospital. The study is part of a project including a comprehensive continuum-of-care model. A qualitative content analysis was performed. Results: Care-planning meetings at home appeared to enable older people’s involvement in the discussions. Fewer people participated in the meetings at home and there was less parallel talking. Unrelated to the place of the care-planning meeting, the older people were able to influence concerns relating to the amount of care/service and the choice of provider. However, they were not able to influence the way the help should be provided or organised. Conclusion: Planning care at home indicated an increase in involvement on the part of the older people, but this does not appear to be enough to obtain any real influence. Our findings call for attention to be paid to older people’s opportunities to receive care and services according to their individual needs and their potential for influencing their day-to-day provision of care and service. PMID:23593048

  15. The role of Advanced Practice Providers in interdisciplinary oncology care in the United States.

    PubMed

    Reynolds, Rae Brana; McCoy, Kimberly

    2016-06-01

    Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs), generally referred to as Advanced Practice Providers (APPs), are fundamental to interdisciplinary oncology care. As the projected demand for oncology services is anticipated to outpace the supply of oncologists, APPs will become increasingly vital in the delivery of oncology care and services. The training, education, and scope of practice for APPs gives the interdisciplinary care team professionals that deliver high-quality clinical services and provide valuable contributions and leadership to health care quality improvement initiatives. Optimizing the integration of APPs in oncology care offers immense advantages towards improvement of clinical outcomes. PMID:27197514

  16. 14 CFR 151.123 - Procedures: Offer; amendment; acceptance; advance planning agreement.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Procedures: Offer; amendment; acceptance; advance planning agreement. 151.123 Section 151.123 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION... Planning and Engineering Proposals § 151.123 Procedures: Offer; amendment; acceptance; advance...

  17. 14 CFR 151.123 - Procedures: Offer; amendment; acceptance; advance planning agreement.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Procedures: Offer; amendment; acceptance; advance planning agreement. 151.123 Section 151.123 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION... Planning and Engineering Proposals § 151.123 Procedures: Offer; amendment; acceptance; advance...

  18. 42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the Medicaid Program § 495.338 Health information technology implementation advance planning document... 42 Public Health 5 2012-10-01 2012-10-01 false Health information technology implementation advance planning document requirements (HIT IAPD). 495.338 Section 495.338 Public Health CENTERS...

  19. 42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... the Medicaid Program § 495.338 Health information technology implementation advance planning document... 42 Public Health 5 2014-10-01 2014-10-01 false Health information technology implementation advance planning document requirements (HIT IAPD). 495.338 Section 495.338 Public Health CENTERS...

  20. 42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... the Medicaid Program § 495.338 Health information technology implementation advance planning document... 42 Public Health 5 2011-10-01 2011-10-01 false Health information technology implementation advance planning document requirements (HIT IAPD). 495.338 Section 495.338 Public Health CENTERS...

  1. 42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... the Medicaid Program § 495.338 Health information technology implementation advance planning document... 42 Public Health 5 2013-10-01 2013-10-01 false Health information technology implementation advance planning document requirements (HIT IAPD). 495.338 Section 495.338 Public Health CENTERS...

  2. Advanced Test Reactor Capabilities and Future Irradiation Plans

    SciTech Connect

    Frances M. Marshall

    2006-10-01

    The Advanced Test Reactor (ATR), located at the Idaho National Laboratory (INL), is one of the most versatile operating research reactors in the Untied States. The ATR has a long history of supporting reactor fuel and material research for the US government and other test sponsors. The INL is owned by the US Department of Energy (DOE) and currently operated by Battelle Energy Alliance (BEA). The ATR is the third generation of test reactors built at the Test Reactor Area, now named the Reactor Technology Complex (RTC), whose mission is to study the effects of intense neutron and gamma radiation on reactor materials and fuels. The current experiments in the ATR are for a variety of customers--US DOE, foreign governments and private researchers, and commercial companies that need neutrons. The ATR has several unique features that enable the reactor to perform diverse simultaneous tests for multiple test sponsors. The ATR has been operating since 1967, and is expected to continue operating for several more decades. The remainder of this paper discusses the ATR design features, testing options, previous experiment programs, future plans for the ATR capabilities and experiments, and some introduction to the INL and DOE's expectations for nuclear research in the future.

  3. Advanced Coal Conversion Process Demonstration Project. Environmental Monitoring Plan

    SciTech Connect

    Not Available

    1992-04-01

    Western Energy Company (WECO) was selected by the Department of Energy (DOE) to demonstrate the Advanced Coal Conversion Process (ACCP) which upgrades low rank coals into high Btu, low sulfur, synthetic bituminous coal. As specified in the Corporate Agreement, RSCP is required to develop an Environmental Monitoring Plan (EMP) which describes in detail the environmental monitoring activities to be performed during the project execution. The purpose of the EMP is to: (1) identify monitoring activities that will be undertaken to show compliance to applicable regulations, (2) confirm the specific environmental impacts predicted in the National Environmental Policy Act documentation, and (3) establish an information base of the assessment of the environmental performance of the technology demonstrated by the project. The EMP specifies the streams to be monitored (e.g. gaseous, aqueous, and solid waste), the parameters to be measured (e.g. temperature, pressure, flow rate), and the species to be analyzed (e.g. sulfur compounds, nitrogen compounds, trace elements) as well as human health and safety exposure levels. The operation and frequency of the monitoring activities is specified, as well as the timing for the monitoring activities related to project phase (e.g. preconstruction, construction, commissioning, operational, post-operational). The EMP is designed to assess the environmental impacts and the environmental improvements resulting from construction and operation of the project.

  4. Bioinformatics Methods and Tools to Advance Clinical Care

    PubMed Central

    Lecroq, T.

    2015-01-01

    Summary Objectives To summarize excellent current research in the field of Bioinformatics and Translational Informatics with application in the health domain and clinical care. Method We provide a synopsis of the articles selected for the IMIA Yearbook 2015, from which we attempt to derive a synthetic overview of current and future activities in the field. As last year, a first step of selection was performed by querying MEDLINE with a list of MeSH descriptors completed by a list of terms adapted to the section. Each section editor has evaluated separately the set of 1,594 articles and the evaluation results were merged for retaining 15 articles for peer-review. Results The selection and evaluation process of this Yearbook’s section on Bioinformatics and Translational Informatics yielded four excellent articles regarding data management and genome medicine that are mainly tool-based papers. In the first article, the authors present PPISURV a tool for uncovering the role of specific genes in cancer survival outcome. The second article describes the classifier PredictSNP which combines six performing tools for predicting disease-related mutations. In the third article, by presenting a high-coverage map of the human proteome using high resolution mass spectrometry, the authors highlight the need for using mass spectrometry to complement genome annotation. The fourth article is also related to patient survival and decision support. The authors present datamining methods of large-scale datasets of past transplants. The objective is to identify chances of survival. Conclusions The current research activities still attest the continuous convergence of Bioinformatics and Medical Informatics, with a focus this year on dedicated tools and methods to advance clinical care. Indeed, there is a need for powerful tools for managing and interpreting complex, large-scale genomic and biological datasets, but also a need for user-friendly tools developed for the clinicians in their

  5. Type of Plan and Provider Network (Affordable Care Act)

    MedlinePlus

    ... health insurance plan Email Print Health insurance plan & network types: HMOs, PPOs, and more 3 things to ... deductible & out-of-pocket costs Health insurance plan & network types: HMOs, PPOs, and more START HERE See ...

  6. 42 CFR 414.39 - Special rules for payment of care plan oversight.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... this section a nonphysician practitioner (NPP) is a nurse practitioner, clinical nurse specialist or... the NPP is a nurse practitioner or clinical nurse specialist, the physician signing the plan of care... SERVICES Physicians and Other Practitioners § 414.39 Special rules for payment of care plan oversight....

  7. 42 CFR 414.39 - Special rules for payment of care plan oversight.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... this section a nonphysician practitioner (NPP) is a nurse practitioner, clinical nurse specialist or... the NPP is a nurse practitioner or clinical nurse specialist, the physician signing the plan of care... SERVICES Physicians and Other Practitioners § 414.39 Special rules for payment of care plan oversight....

  8. 42 CFR 414.39 - Special rules for payment of care plan oversight.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... this section a nonphysician practitioner (NPP) is a nurse practitioner, clinical nurse specialist or... the NPP is a nurse practitioner or clinical nurse specialist, the physician signing the plan of care... SERVICES Physicians and Other Practitioners § 414.39 Special rules for payment of care plan oversight....

  9. 42 CFR 414.39 - Special rules for payment of care plan oversight.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... this section a nonphysician practitioner (NPP) is a nurse practitioner, clinical nurse specialist or... the NPP is a nurse practitioner or clinical nurse specialist, the physician signing the plan of care... Physicians and Other Practitioners § 414.39 Special rules for payment of care plan oversight. (a)...

  10. Professional perspectives on service user and carer involvement in mental health care planning: A qualitative study

    PubMed Central

    Bee, Penny; Brooks, Helen; Fraser, Claire; Lovell, Karina

    2015-01-01

    Background Involving users/carers in mental health care-planning is central to international policy initiatives yet users frequently report feeling excluded from the care planning process. Rigorous explorations of mental health professionals’ experiences of care planning are lacking, limiting our understanding of this important translational gap. Objectives To explore professional perceptions of delivering collaborative mental health care-planning and involving service users and carers in their care. Design Qualitative interviews and focus groups with data combined and subjected to framework analysis. Setting UK secondary care mental health services. Participants 51 multi-disciplinary professionals involved in care planning and recruited via study advertisements. Results Emergent themes identified care-planning as a meaningful platform for user/carer involvement but revealed philosophical tensions between user involvement and professional accountability. Professionals emphasised their individual, relational skills as a core facilitator of involvement, highlighting some important deficiencies in conventional staff training programmes. Conclusions Although internationally accepted on philosophical grounds, user-involved care-planning is poorly defined and lacks effective implementation support. Its full realisation demands greater recognition of both the historical and contemporary contexts in which statutory mental healthcare occurs. PMID:26253574

  11. [The combination of "Careworks" insurance plan integrated with medical and long-term care insurance].

    PubMed

    Sumii, Hiroshi

    2006-11-01

    The social security system in Japan was greatly revolutionized when the long-term care insurance plan began in April 2000. Thus, Japan began the 21st century with two great social insurance plans, that is, medical care insurance and long-term care insurance. Each delivery system is divided: the medical care insurance plan is for the acute stage, and the long-term care is for the chronic stage. Both systems can be intended to cooperate to provide continuous care throughout life. The public health and welfare system has been trying hard to efficiently integrate the medical and long-term care insurance plans. However, it is necessary to establish a new insurance plan for ensuring the integrated adequacy of both insurance systems. One's life is destined to shift from medical care to long-term care at some point. As one ages or becomes disabled, it becomes difficult to lead an independent life with self-decision, and social support become necessary from third parties, instead of from the family or from one's own means. The society imposes the responsibility of payment of the medical and long-term care plan premiums on the individual throughout life. However, the structure of these insurance foundations should be combined under an integrated system, "Careworks", in order to also combine the concepts of length of life from the medicine and the respect of living from the long-term case to improve the social security of the life.

  12. Medicaid beneficiaries in california reported less positive experiences when assigned to a managed care plan.

    PubMed

    McDonnell, Diana D; Graham, Carrie L

    2015-03-01

    In 2011 California began transitioning approximately 340,000 seniors and people with disabilities from Medicaid fee-for-service (FFS) to Medicaid managed care plans. When beneficiaries did not actively choose a managed care plan, the state assigned them to one using an algorithm based on their previous FFS primary and specialty care use. When no clear link could be established, beneficiaries were assigned by default to a managed care plan based on weighted randomization. In this article we report the results of a telephone survey of 1,521 seniors and people with disabilities enrolled in Medi-Cal (California Medicaid) and who were recently transitioned to a managed care plan. We found that 48 percent chose their own plan, 11 percent were assigned to a plan by algorithm, and 41 percent were assigned to a plan by default. People in the latter two categories reported being similarly less positive about their experiences compared to beneficiaries who actively chose a plan. Many states in addition to California are implementing mandatory transitions of Medicaid-only beneficiaries to managed care plans. Our results highlight the importance of encouraging beneficiaries to actively choose their health plan; when beneficiaries do not choose, states should employ robust intelligent assignment algorithms.

  13. Social Work Discharge Planning in Acute Care Hospitals in Israel: Clients' Evaluation of the Discharge Planning Process and Adequacy

    ERIC Educational Resources Information Center

    Soskolne, Varda; Kaplan, Giora; Ben-Shahar, Ilana; Stanger, Varda; Auslander, Gail. K.

    2010-01-01

    Objective: To examine the associations of patients' characteristics, hospitalization factors, and the patients' or family assessment of the discharge planning process, with their evaluation of adequacy of the discharge plan. Method: A prospective study. Social workers from 11 acute care hospitals in Israel provided data on 1426 discharged…

  14. Manager's leadership is the main skill for ambulatory health care plan success.

    PubMed

    Marin, Gustavo Horacio; Silberman, Martin; Colombo, Maria Virginia; Ozaeta, Belen; Henen, Jaime

    2015-01-01

    To demonstrate effectiveness of ambulatory health care plan implementation among institutions and variables associated with the differences observed. Randomized selection of primary health care (PHC) centers was done. Leadership ability of the plan manager was explored. Univariate/bivariate analyses were performed to observe correlation between variables. Two groups of PHC centers were established according to the efficacy of plan implementation: high and low performance. Differences between groups were observed (592%-1023% more efficacy in controls and practices; P < .001). Leadership was responsible for the main differences observed. Leadership of manager for implementation of the health care plan was the major important variable to reach the best efficacy standards.

  15. Transition Planning for Youth With Special Health Care Needs (YSHCN) in Illinois Schools.

    PubMed

    Bargeron, Jodie; Contri, Darcy; Gibbons, Linda J; Ruch-Ross, Holly S; Sanabria, Kathy

    2015-08-01

    "Transition Planning for Youth with Special Health Care Needs (YSHCN)" chronicles the research and work completed by agencies in Illinois to provide examples of best practice in transition planning. Increasing numbers of YSHCN survive into adulthood creating a need for focus on the transition to adult life for these young people, including meeting health care needs. As a part of the Transitions project, the Illinois Chapter of the American Academy of Pediatrics and the University of Illinois at Chicago Division of Specialized Care for Children surveyed Illinois public high schools to identify transition planning efforts, staff training needs and used those results to develop and implement training. A natural way to organize health services is by integration with school transition services. The credentialed school nurse would be the ideal person to contribute to the development of the health care transition plans based on the student's heath care provider's medical management plan.

  16. Planning the acoustic environment of a neonatal intensive care unit.

    PubMed

    Philbin, M Kathleen

    2004-06-01

    This article addresses general principles of designing a quiet neonatal intensive care unit (NICU) and describes basic aspects of room acoustics as these apply to the NICU. Recommended acoustical criteria for walls, background noise, vibration, and reverberation are included as appendices. Crowding in open, multiple-bed NICUs is the major factor in designs that inevitably produce noisy nurseries with limited space for parents. Quiet infant spaces with appropriate sound sources rely on isolation of the infant from facility and operational noise sources (eg, adult work spaces, supply delivery, and travel paths) and extended contact with family members.However, crowding has been an important influence on the clinical practice and social context of neonatology. It allows clinicians to rely on wide visual and auditory access to many patients for monitoring their well-being. It also allows immediate social contact with other adults, both staff and families. Giving up this wide access and relying on other forms of communication in order to provide for increased quiet and privacy for staff, infants, and parents is a challenge for some design teams. Studies of the effects of various nursery designs on infants, parents, clinicians, and the delivery of services are proposed as a means of advancing the field of design.

  17. The Clintons stump for health care reform plan as details slowly emerge.

    PubMed

    1993-10-01

    In September 1993, in the US, Hillary Rodham Clinton, testified before 5 key congressional committees on President Clinton's plan to reform health care. Most of the money needed to finance the plan would come from elimination of waste in the current system. The administration has not yet formally sent the proposal to Congress. Family planning services are part of the proposed mandated benefit package, but the draft document does not provide details on family planning coverage while it discusses other mandated services in detail. Further, the draft document mentions neither family planning supplies (e.g., pills, IUDs, or diaphragms) nor whether family planning services will be considered preventive care, thereby exempting them from copayments or deductibles. It specifies prenatal care, periodic examinations, and screening test for children and adults (e.g., well-baby care and immunizations) as preventive services. The plan covers pregnancy-related care, but, other than exclusion of in vitro fertilization, this is not defined. The plan has a conscientious exemption option, but it is not clear as to whether the administration plans to continue the standing policy granting conscientious exemption to individuals and medical facilities or to expand it to include entire health plans. The administration emphasizes that, even though the plan covers abortion. The Health Insurance Association of America opposes the plan while the American Medical Association (AMA) neither supports nor opposes it. The AMA does object, however, to the plans provisions on malpractice and limits on annual premium increases. Families USA strongly favors the plan. The Congressional Caucus on Women's Issues asks the President to include all reproductive health services. The National Black Women's Health Project appreciates the Administration's commitment and the plan's coverage of preventive care and reproductive health, but stresses that it must improve access to poor women, most of whom are black.

  18. The Clintons stump for health care reform plan as details slowly emerge.

    PubMed

    1993-10-01

    In September 1993, in the US, Hillary Rodham Clinton, testified before 5 key congressional committees on President Clinton's plan to reform health care. Most of the money needed to finance the plan would come from elimination of waste in the current system. The administration has not yet formally sent the proposal to Congress. Family planning services are part of the proposed mandated benefit package, but the draft document does not provide details on family planning coverage while it discusses other mandated services in detail. Further, the draft document mentions neither family planning supplies (e.g., pills, IUDs, or diaphragms) nor whether family planning services will be considered preventive care, thereby exempting them from copayments or deductibles. It specifies prenatal care, periodic examinations, and screening test for children and adults (e.g., well-baby care and immunizations) as preventive services. The plan covers pregnancy-related care, but, other than exclusion of in vitro fertilization, this is not defined. The plan has a conscientious exemption option, but it is not clear as to whether the administration plans to continue the standing policy granting conscientious exemption to individuals and medical facilities or to expand it to include entire health plans. The administration emphasizes that, even though the plan covers abortion. The Health Insurance Association of America opposes the plan while the American Medical Association (AMA) neither supports nor opposes it. The AMA does object, however, to the plans provisions on malpractice and limits on annual premium increases. Families USA strongly favors the plan. The Congressional Caucus on Women's Issues asks the President to include all reproductive health services. The National Black Women's Health Project appreciates the Administration's commitment and the plan's coverage of preventive care and reproductive health, but stresses that it must improve access to poor women, most of whom are black

  19. Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases

    PubMed Central

    Harirah, Hassan M.; Smith, J. Michael; Dixon, C. Luke; Hankins, Gary D. V.

    2016-01-01

    Advanced abdominal pregnancy is an extremely rare condition that poses diagnostic and management challenges. A high index of suspicion and careful assessment of the patient's symptoms, supplemented with obstetric ultrasound, and magnetic resonance imaging, are crucial for timely diagnosis and management to prevent life-threatening complications. The presence of periviable fetuses in advanced abdominal pregnancies increases the challenge to achieve a balance between maternal and fetal benefits and risks. Early diagnosis and management decisions via a multidisciplinary approach and planned delivery are of paramount importance to minimize complications and achieve favorable maternal and fetal outcomes. Even in the setting of oligohydramnios and suspected preterm premature rupture of membranes, in-patient conservative management and an individualized planned surgical approach that includes removing or leaving the placenta in place are appropriate for managing the periviable abdominal pregnancy. PMID:27595049

  20. Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases.

    PubMed

    Harirah, Hassan M; Smith, J Michael; Dixon, C Luke; Hankins, Gary D V

    2016-07-01

    Advanced abdominal pregnancy is an extremely rare condition that poses diagnostic and management challenges. A high index of suspicion and careful assessment of the patient's symptoms, supplemented with obstetric ultrasound, and magnetic resonance imaging, are crucial for timely diagnosis and management to prevent life-threatening complications. The presence of periviable fetuses in advanced abdominal pregnancies increases the challenge to achieve a balance between maternal and fetal benefits and risks. Early diagnosis and management decisions via a multidisciplinary approach and planned delivery are of paramount importance to minimize complications and achieve favorable maternal and fetal outcomes. Even in the setting of oligohydramnios and suspected preterm premature rupture of membranes, in-patient conservative management and an individualized planned surgical approach that includes removing or leaving the placenta in place are appropriate for managing the periviable abdominal pregnancy.

  1. Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases

    PubMed Central

    Harirah, Hassan M.; Smith, J. Michael; Dixon, C. Luke; Hankins, Gary D. V.

    2016-01-01

    Advanced abdominal pregnancy is an extremely rare condition that poses diagnostic and management challenges. A high index of suspicion and careful assessment of the patient's symptoms, supplemented with obstetric ultrasound, and magnetic resonance imaging, are crucial for timely diagnosis and management to prevent life-threatening complications. The presence of periviable fetuses in advanced abdominal pregnancies increases the challenge to achieve a balance between maternal and fetal benefits and risks. Early diagnosis and management decisions via a multidisciplinary approach and planned delivery are of paramount importance to minimize complications and achieve favorable maternal and fetal outcomes. Even in the setting of oligohydramnios and suspected preterm premature rupture of membranes, in-patient conservative management and an individualized planned surgical approach that includes removing or leaving the placenta in place are appropriate for managing the periviable abdominal pregnancy.

  2. Conservative Management and Planned Surgery for Periviable Advanced Extrauterine Abdominal Pregnancy with Favorable Outcome: Report of Two Cases.

    PubMed

    Harirah, Hassan M; Smith, J Michael; Dixon, C Luke; Hankins, Gary D V

    2016-07-01

    Advanced abdominal pregnancy is an extremely rare condition that poses diagnostic and management challenges. A high index of suspicion and careful assessment of the patient's symptoms, supplemented with obstetric ultrasound, and magnetic resonance imaging, are crucial for timely diagnosis and management to prevent life-threatening complications. The presence of periviable fetuses in advanced abdominal pregnancies increases the challenge to achieve a balance between maternal and fetal benefits and risks. Early diagnosis and management decisions via a multidisciplinary approach and planned delivery are of paramount importance to minimize complications and achieve favorable maternal and fetal outcomes. Even in the setting of oligohydramnios and suspected preterm premature rupture of membranes, in-patient conservative management and an individualized planned surgical approach that includes removing or leaving the placenta in place are appropriate for managing the periviable abdominal pregnancy. PMID:27595049

  3. Ladies' Letters: Rx for Eighteenth-Century Health Care. Lesson Plan.

    ERIC Educational Resources Information Center

    Koman, Rita G.

    1994-01-01

    Asserts that, at the time of the American Revolution, most people handled their own health care. Presents a lesson plan on illness and health care in colonial America that uses Martha Washington as a case study. Includes a reproduction of a colonial era herbal manual and excerpts from letters discussing health care. (CFR)

  4. Nutrition and Meal Planning in Child-Care Programs: A Practical Guide.

    ERIC Educational Resources Information Center

    Edelstein, Sari

    Designed to assist child care center managers in planning nutritious meals for children in centers or licensed home day care programs, this guide presents information on the nutritional requirements of infants and children, sample menus for child care centers, and resources for further information. The first part of the guide details the…

  5. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., care planning, and coordination of services. 418.56 Section 418.56 Public Health CENTERS FOR MEDICARE... interdisciplinary group to provide coordination of care and to ensure continuous assessment of each patient's and... care. (e) Standard: Coordination of services. The hospice must develop and maintain a system...

  6. Planning Manual for School-Age Child Care in New Mexico.

    ERIC Educational Resources Information Center

    Rainhart, Dolly

    This manual was designed to assist concerned individuals and organizations within communities in New Mexico to develop and plan effective school-age child care programs. Emphasized are the first steps in initiating and implementing school-age child care in a community. Chapter I discusses the need for school-age child care programs and the…

  7. Advanced Education and Technology Business Plan, 2010-13. Highlights

    ERIC Educational Resources Information Center

    Alberta Advanced Education and Technology, 2010

    2010-01-01

    The Ministry of Advanced Education and Technology envisions Alberta's prosperity through innovation and lifelong learning. Advanced Education and Technology's mission is to lead the development of a knowledge-driven future through a dynamic and integrated advanced learning and innovation system. This paper presents the highlights of the business…

  8. [Necessary changes for advancing nursing as caring science].

    PubMed

    de Pires, Denise Elvira Pires

    2013-09-01

    The article aimed to reflect upon the challenges involved in strengthening Nursing as a caring science. It is founded on the sociological theory, connecting three approaches: the historical-dialectic materialism perspective about the working process in health care and nursing; the sociology of professions from a critical perspective; and the philosophy of science. The discussion is organized considering the aspects of Nursing as a discipline, work and health care profession. It sustains that knowledge production should be driven both by the purpose of Nursing work which is providing care to human beings with health needs and to advocate for the indispensable work conditions to a safe and responsible practice. It concludes that to strengthening Nursing it is necessary to produce knowledge to support nursing care and the political actions defending safe work conditions, the universal right to health as well safe and high quality care. PMID:24092308

  9. Integrated care through disease-oriented clinical care pathways: experience from Japan’s regional health planning initiatives

    PubMed Central

    Okamoto, Etsuji; Miyamoto, Masaki; Hara, Kazuhiro; Yoshida, Jun; Muto, Masaki; Hirai, Aizan; Tatsumi, Haruyuki; Mizuno, Masaaki; Nagata, Hiroshi; Yamakata, Daisuke; Tanaka, Hiroshi

    2011-01-01

    Introduction In April 2008, Japan launched a radical reform in regional health planning that emphasized the development of disease-oriented clinical care pathways. These ‘inter-provider critical paths’ have sought to ensure effective integration of various providers ranging among primary care practitioners, acute care hospitals, rehabilitation hospitals, long-term care facilities and home care. Description of policy practice All 47 prefectures in Japan developed their Regional Health Plans pursuant to the guideline requiring that these should include at least four diseases: diabetes, acute myocardial infarction, cerebrovascular accident and cancer. To illustrate the care pathways developed, this paper describes the guideline referring to strokes and provides examples of the new Regional Health Plans as well as examples of disease-oriented inter-provider clinical paths. In particular, the paper examines the development of information sharing through electronic health records (EHR) to enhance effective integration among providers is discussed. Discussion and conclusion Japan’s reform in 2008 is unique in that the concept of ‘disease-oriented regional inter-provider critical paths’ was adopted as a national policy and all 47 prefectures developed their Regional Health Plans simultaneously. How much the new regional health planning policy has improved the quality and outcome of care remains to be seen and will be evaluated in 2013 after the five-year planned period of implementation has concluded. Whilst electronic health records appear to be a useful tool in supporting care integration they do not guarantee success in the application of an inter-provider critical path. PMID:22128281

  10. Mental health care reforms in Asia: the regional health care strategic plan: the growing impact of mental disorders in Japan.

    PubMed

    Ito, Hiroto; Frank, Richard G; Nakatani, Yukiko; Fukuda, Yusuke

    2013-07-01

    In April 2013 Japan designated mental disorders as the fifth "priority disease" for national medical services, after cancer, stroke, acute myocardial infarction, and diabetes. All prefectures will be required to assess local mental health needs and develop necessary service components. This column provides an overview of the Regional Health Care Strategic Plan in the context of mental health and welfare reforms. The goals of the plan are to alter the balance between institutional and community-based care for patients with severe and persistent mental disorders, integrate general medical and mental health care, and support greater independence for people with mental disorders. It is a political challenge for Japan to reallocate resources to rebalance care services while maintaining free access to care.

  11. Health care infrastructure post-Katrina: disaster planning to return health care workers to their home communities.

    PubMed

    Griffies, W Scott

    2010-01-01

    One of the greatest challenges of restoring the New Orleans health care infrastructure since the post-Katrina disaster has been shortages of health care providers. Many providers had prolonged displacements or did not return to their practices, depleting the city of valuable resources. This Open Forum chronicles the displacement of Louisiana State University's Department of Psychiatry and discusses barriers to returning health care providers to their communities expeditiously. Predisaster planning and policy changes are proposed to facilitate a quicker return and decrease the attrition of health care providers after future disasters. A community's predisaster plans should include a mechanism to allow funds to follow patients instead of hospitals, to provide bridge funding that pays local health care providers to work as first responders and serve uninsured patients while these providers rebuild their practices, and to provide funds to quickly expand services and usable space in undamaged clinics and hospitals and to shore up reparable structures.

  12. Anesthesia and Intensive care implications for pituitary surgery: Recent trends and advancements

    PubMed Central

    Bajwa, Sukhminderjit Singh; Bajwa, Sukhwinder Kaur

    2011-01-01

    The advancements in neuro-endocrine surgical interventions have been well supported by similar advancements in anesthesiology and intensive care. Surgery of the pituitary tumor poses unique challenges to the anesthesiologists and the intensivists as it involves the principles and practices of both endocrine and neurosurgical management. A multidisciplinary approach involving the endocrine surgeon, neurosurgeon, anesthesiologist, endocrinologist and intensivist is mandatory for a successful surgical outcome. The focus of pre-anesthetic checkup is mainly directed at the endocrinological manifestations of pituitary hypo or hyper-secretion as it secretes a variety of essential hormones, and also any pathological state that can cause imbalance of pituitary secretions. The pathophysiological aspects associated with pituitary tumors mandate a thorough airway, cardiovascular, neurologic and endocrinological assessment. A meticulous preoperative preparation and definite plans for the intra-operative period are the important clinical components of the anesthetic strategy. Various anesthetic modalities and drugs can be useful to provide a smooth intra-operative period by countering any complication and thus providing an uneventful recovery period. PMID:22029028

  13. Democratic Citizenship and Service Learning: Advancing the Caring Self.

    ERIC Educational Resources Information Center

    Rhoads, Robert A.

    2000-01-01

    Discusses how service learning can promote the development of a "caring self" in college students by drawing on the ideas of John Dewey, George Herbert Mead, and contemporary critical theorists. Links this caring self to democratic citizenship and uses students' narratives to illustrate how it develops through service learning contexts. (DB)

  14. [A study on the development of standardized nursing care plans for computerized nursing service].

    PubMed

    Kim, C J; Chun, C Y; Lim, Y S; Park, J W

    1990-12-01

    A central issue in the development of nursing practice is to describe the phenomenon with which nursing is concerned. To identify the health problems which can be diagnosed and managed by the nurse is the first step to organize and ensure the development of nursing science. Therefore the academic world has been discussing the application of the nursing diagnosis in nursing practice as a means of improving quality of care. The objectives of this study were to develop a standardized nursing care plan for ten selected nursing diagnoses to form a database for computerized nursing service. The research approach used in the study was (1) the selection of the ten nursing diagnoses which occur most frequently on medical-surgical wards, (2) the development of a standardized nursing care plan for the ten selected nursing diagnoses, (3) application of the plan to hospitalized patients and evaluation of the content validity by the nurses, and (4) evaluation of the clinical effects after the use of the standardized nursing care plans. The subjects were 56 nurses and 395 hospitalized patients on two medical and two surgical unit. The results of this study were as follows: 1) The ten selected nursing diagnoses for the development of the standardized nursing care plans were "PAIN, SLEEP DISTURBANCE, ALTERED HEALTH MAINTENANCE, ALTERATION IN NUTRITION, ANXIETY, CONSTIPATION, ALTERED PATTERNS OF URINARY ELIMINATION, DISTURBANCE IN BODY IMAGE, POTENTIAL FOR ACTIVITY INTOLERANCE AND ACTIVITY INTOLERANCE". 2. The developed standardized nursing care plans included the nursing diagnosis, definition, defining characteristics, etiologic or related factors that contribute to the condition, recording pattern, desired outcomes and nursing orders (nursing interventions). 3. The plan was used with hospitalized patients on medical-surgical wards to test for content validity. The patient's satisfaction with the nursing care and nurses' job satisfaction were investigated to evaluate the clinical

  15. Family planning education as an integral part of day care services in Korea.

    PubMed

    Sung, K T

    1978-04-01

    The Integrated Day Care Program (IDCP) in Korea provices family planning classes as an integral part of comprehensive day care services for low-income families. The program was initiated by CARE in 1973, with support from the Korean government, and has received important inputs from national family planning agencies. A review of the first two years' accomplishments shows that mothers participating in the IDCP knew more about, were more favorable toward, and were more likely to practice family planning than mothers using day care centers that were not a part of the program. Findings also demonstrate the potential for program expansion: the substantial numbers of friends and relatives brought by mothers to the classes, and the number of IDCP and non-IDCP mothers indicating a willingness to use family planning clinic services in the day care setting. PMID:663990

  16. Financial Performance of Health Plans in Medicaid Managed Care

    PubMed Central

    McCue, Mike

    2012-01-01

    Objective This study assesses the financial performance of health plans that enroll Medicaid members across the key plan traits, specifically Medicaid dominant, publicly traded, and provider-sponsored. Data and Methods National Association of Insurance Commissioners (NAIC) financial data, coupled with selected state financial data, were analyzed for 170 Medicaid health plans for 2009. A mean test compared the mean values for medical loss, administrative cost, and operating margin ratios across these plan traits. Medicaid dominant plans are plans with 75 percent of their total enrollment in the Medicaid line of business. Findings Plans that are Medicaid dominant and publicly traded incurred a lower medical loss ratio and higher administrative cost ratio than multi-product and non-publicly traded plans. Medicaid dominant plans also earned a higher operating profit margin. Plans offering commercial and Medicare products are operating at a loss for their Medicaid line of business. Policy Implications Health plans that do not specialize in Medicaid are losing money. Higher medical cost rather than administrative cost is the underlying reason for this financial loss. Since Medicaid enrollees do not account for their primary book of business, these plans may not have invested in the medical management programs to reduce inappropriate emergency room use and avoid costly hospitalization. PMID:24800142

  17. African Cultural Concept of Death and the Idea of Advance Care Directives

    PubMed Central

    Ekore, Rabi Ilemona; Lanre-Abass, Bolatito

    2016-01-01

    An advance care directive is a person's oral or written instructions about his or her future medical care, if he or she becomes unable to communicate. It may be in written or oral form. Africans ordinarily do not encourage the contemplation of death or any discussion about their own or their loved ones’ death. According to the African belief system, life does not end with death, but continues in another realm. Becoming an ancestor after death is a desirable goal of every individual, a feat which cannot be achieved if an individual asks for an unnatural death by attempting to utilize advance care directives. Advance care directives are considered to be too individualistic for communitarian societies such as Africa. Coupled with the communitarian nature of African societies are issues such as lack of awareness of advance directives, fear of death and grief, and the African cultural belief system, which are potential barriers to the utilization of advance care directives in the African setting. Hence, the need for culture sensitivity which makes it imperative that patient's family and loved ones are carried along as far as possible, without compromising the autonomy of the patient in question when utilizing advance care directives. PMID:27803556

  18. Consensus Statement on Advancing Research in Emergency Department Operations and Its Impact on Patient Care

    PubMed Central

    Ward, Michael J.; Chang, Anna Marie; Pines, Jesse M.; Jouriles, Nick; Yealy, Donald M.

    2016-01-01

    The Consensus Conference on “Advancing Research in Emergency Department (ED) Operations and Its Impact on Patient Care,” hosted by The ED Operations Study Group (EDOSG), convened to craft a framework for future investigations in this important but underserved area. The EDOSG is a research consortium dedicated to promoting evidence based clinical practice in Emergency Medicine. The consensus process format was a modified version of the NIH Model for Consensus Conference Development. Recommendations provide an action plan for how to improve ED operations study design, create a facilitating research environment, identify data measures of value for process and outcomes research, and disseminate new knowledge in this area. Specifically, we called for eight key initiatives: 1) the development of universal measures for ED patient care processes; 2) attention to patient outcomes, in addition to process efficiency and best practice compliance; 3) the promotion of multi-site clinical operations studies to create more generalizable knowledge; 4) encouraging the use of mixed methods to understand the social community and human behavior factors that influence ED operations; 5) the creation of robust ED operations research registries to drive stronger evidence based research, 6) prioritizing key clinical questions with the input of patients, clinicians, medical leadership, emergency medicine organizations, payers, and other government stakeholders; 7) more consistently defining the functional components of the ED care system including observation units, fast tracks, waiting rooms, laboratories and radiology sub-units; and 8) maximizing multidisciplinary knowledge dissemination via emergency medicine, public health, general medicine, operations research and nontraditional publications. PMID:26014365

  19. Maternity care in developing countries: relevance of new technological advances.

    PubMed

    Faundes, A; Rosenfield, A; Pinotti, J A

    1988-06-01

    It is suggested that improved maternity care in the developing world depends primarily on the increased provision of cost-effective, basic, easily accessible maternity care services. Expensive new technologies should be judged by their effectiveness, safety, technical feasibility, cost (including operating and maintenance expenses) and local need. After identifying the major causes of morbidity and mortality, priority should be given to interventions applicable at the local level and which do not require highly or specially trained educated personnel. PMID:2900161

  20. Maternity care in developing countries: relevance of new technological advances.

    PubMed

    Faundes, A; Rosenfield, A; Pinotti, J A

    1988-06-01

    It is suggested that improved maternity care in the developing world depends primarily on the increased provision of cost-effective, basic, easily accessible maternity care services. Expensive new technologies should be judged by their effectiveness, safety, technical feasibility, cost (including operating and maintenance expenses) and local need. After identifying the major causes of morbidity and mortality, priority should be given to interventions applicable at the local level and which do not require highly or specially trained educated personnel.

  1. Benefits of advanced software techniques for mission planning systems

    NASA Technical Reports Server (NTRS)

    Gasquet, A.; Parrod, Y.; Desaintvincent, A.

    1994-01-01

    The increasing complexity of modern spacecraft, and the stringent requirement for maximizing their mission return, call for a new generation of Mission Planning Systems (MPS). In this paper, we discuss the requirements for the Space Mission Planning and the benefits which can be expected from Artificial Intelligence techniques through examples of applications developed by Matra Marconi Space.

  2. Time Pressure and Phonological Advance Planning in Spoken Production

    ERIC Educational Resources Information Center

    Damian, Markus F.; Dumay, Nicolas

    2007-01-01

    Current accounts of spoken production debate the extent to which speakers plan ahead. Here, we investigated whether the scope of phonological planning is influenced by changes in time pressure constraints. The first experiment used a picture-word interference task and showed that picture naming latencies were shorter when word distractors shared…

  3. Advanced Education and Technology Business Plan, 2009-12

    ERIC Educational Resources Information Center

    Alberta Advanced Education and Technology, 2009

    2009-01-01

    The Ministry of Advanced Education and Technology consists of the following entities for budget purposes: Department of Advanced Education and Technology, the Access to the Future Fund, Alberta Enterprise Corporation, Alberta Research Council Inc., and iCORE Inc. Achieving the Ministry's goals involves the work and coordination of many…

  4. Advanced Education and Technology Business Plan, 2011-14

    ERIC Educational Resources Information Center

    Alberta Advanced Education and Technology, 2011

    2011-01-01

    Advanced Education and Technology's mission is to lead the development of a knowledge-driven future through a dynamic and integrated advanced learning and innovation system. Its core businesses are to: (1) provide strategic leadership for Campus Alberta and Alberta Innovates; and (2) engage learners, industry and the community in learning…

  5. Family-centered care for children with cerebral palsy: conceptual and practical considerations to advance care and practice.

    PubMed

    King, Gillian; Chiarello, Lisa

    2014-08-01

    This article focuses on conceptual and practical considerations in family-centered care for children with cerebral palsy and their families. In the last 5 years, there have been important advances in our understanding of the components of family-centered care, and initial attempts to understand the client change processes at play. Recent research elaborates on family-centered care by delving into aspects of family-provider partnership, and applying family-centered principles to organizational service delivery to bring about organizational cultures of family-centered care. Recent research has also begun to consider mediators of client change, and new practice models have been proposed that embrace family-centered principles and illustrate the "art" of practice. Future research directions are discussed, including explorations of causal relationships between family-centered care principles, elements of caregiving practice, client change processes, and child and family outcomes. The meaning of the recent literature for pediatric neurology practice is considered. PMID:24810084

  6. Educating advanced practice nurses in using social media in rural health care.

    PubMed

    Rutledge, Carolyn M; Renaud, Michelle; Shepherd, Laurel; Bordelon, Michele; Haney, Tina; Gregory, Donna; Ayers, Paula

    2011-01-01

    Health care in the United States is facing a crisis in providing access to quality care for those in underserved and rural regions. Advanced practice nurses are at the forefront of addressing such issues, through modalities such as health care technology. Many nursing education programs are seeking strategies for better educating students on technology utilization. Health care technology includes electronic health records, telemedicine, and clinical decision support systems. However, little focus has been placed on the role of social media in health care. This paper describes an educational workshop using standardized patients and hands-on experiences to introduce advanced practice nurses in a Doctor of Nursing Practice program to the role of social media in addressing issues inherent in the delivery of rural health care. The students explore innovative approaches for utilizing social media for patient and caregiver support as well as identify online resources that assist providers in a rural setting. PMID:22718665

  7. Advanced practice in neurocritical care: an innovative orientation and competency model.

    PubMed

    Vicari-Christensen, Michele

    2014-02-01

    The advanced registered nurse practitioner (ARNP) began in the 1960s as an alternative provider to meet the demands of an escalating healthcare resource deficit. As the role evolved and ARNPs demonstrated safe and effective care, these providers began to appear in critical care settings. It is believed that in the specialty of Neurocritical Care, about half the providers are ARNPs. Hiring and training practitioners for this complex environment is daunting. At the University of Florida & Shands Jacksonville, an innovative orientation and competency model for ARNPs hired for the newly opened Neurocritical Care unit was developed and implemented. The program contains a roadmap for knowledge base and skill acquisition as well as competency training and maintenance. Experience with appropriate hiring and screening standards, internally developed training tools, and identification of necessary advanced classes are discussed. This model may be used as a guideline for Neurocritical Care ARNP training as well as adapted for all other critical care settings. PMID:24399169

  8. Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901

    PubMed Central

    Luta, Gheorghe; Sheppard, Vanessa; Isaacs, Claudine; Cohen, Harvey J.; Muss, Hyman B.; Yung, Rachel; Clapp, Jonathan D.; Winer, Eric; Hudis, Clifford; Tallarico, Michelle; Wang, Julhy; Barry, William T.; Mandelblatt, Jeanne S.

    2015-01-01

    Purpose Survivorship care plans (SCP) are recommended for all cancer patients and could be especially useful to survivors 65 years and over (“older”). This study examined receipt of SCPs among older breast cancer survivors and whether SCPs were associated with improved patient-reported outcomes. Methods Three hundred and twenty-eight older women diagnosed with invasive, nonmetastatic breast cancer between 2007–2011 were recruited from 78 cooperative-group sites. Participants completed telephone interviews at baseline and 1-year posttreatment. Regression analyses examined SCP receipt (yes/no) and functioning (EORTC-QLQ-C30), cancer worry, and experiences of survivorship care (care coordination, knowledge). Results Only 35 % of women received SCPs. For each 1-year increase in age, there was a 5 % lower odds of receiving an SCP (odds ratio (OR)=0.94, 95 % confidence interval (CI) 0.91–0.98, p=0.007). Besides age, no other factor predicted SCPs. SCP receipt was associated with greater knowledge and understanding of requisite follow-up care (p<0.05); however, functioning was not significantly different among those with vs. without SCPs. Conclusions Receipt of care plans was limited. SCPs improved understanding of breast cancer follow-up care among older survivors, but did not impact functioning one year post-treatment. Implications for Cancer Survivors To impact functioning and salient needs of the growing cohort of older survivors, survivorship care plans likely should be tailored to geriatric-specific issues. To improve functioning, SCP content should expand to include exercise, nutrition, polypharmacy, social support and management of symptom burden from cancer, and other comorbid conditions. To improve follow-up care for cancer survivors, SCPs should delineate shared care roles between oncology and primary care in managing recurrence surveillance, screening, and cancer sequelae. PMID:24917307

  9. Health Care Professionals' Death Attitudes, Experiences, and Advance Directive Communication Behavior

    ERIC Educational Resources Information Center

    Black, Kathy

    2007-01-01

    The study surveyed 135 health care professionals (74 nurses, 32 physicians, and 29 social workers) to examine their personal death attitudes and experiences in relation to their reported advance directive communication practice behavior. Negative correlations were found between collaborating with other health care professionals regarding the…

  10. The Care Needs of Community-Dwelling Seniors Suffering from Advanced Chronic Obstructive Pulmonary Disease

    ERIC Educational Resources Information Center

    Wilson, Donna M.; Ross, Carolyn; Goodridge, Donna; Davis, Penny; Landreville, Alison; Roebuck, Kim

    2008-01-01

    Aim: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD). Background: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out…

  11. The Role and Timing of Palliative Care in Supporting Persons with Intellectual Disability and Advanced Dementia

    ERIC Educational Resources Information Center

    McCarron, Mary; McCallion, Philip; Fahey-McCarthy, Elizabeth; Connaire, Kevin

    2011-01-01

    Aim: To better describe the role and timing of palliative care in supporting persons with intellectual disabilities and advanced dementia (AD). Background: Specialist palliative care providers have focused mostly on people with cancers. Working with persons with intellectual disabilities and AD offers opportunities to expand such palliative care…

  12. Integrating Compassionate, Collaborative Care (the "Triple C") Into Health Professional Education to Advance the Triple Aim of Health Care.

    PubMed

    Lown, Beth A; McIntosh, Sharrie; Gaines, Martha E; McGuinn, Kathy; Hatem, David S

    2016-03-01

    Empathy and compassion provide an important foundation for effective collaboration in health care. Compassion (the recognition of and response to the distress and suffering of others) should be consistently offered by health care professionals to patients, families, staff, and one another. However, compassion without collaboration may result in uncoordinated care, while collaboration without compassion may result in technically correct but depersonalized care that fails to meet the unique emotional and psychosocial needs of all involved. Providing compassionate, collaborative care (CCC) is critical to achieving the "triple aim" of improving patients' health and experiences of care while reducing costs. Yet, values and skills related to CCC (or the "Triple C") are not routinely taught, modeled, and assessed across the continuum of learning and practice. To change this paradigm, an interprofessional group of experts recently recommended approaches and a framework for integrating CCC into health professional education and postgraduate training as well as clinical care. In this Perspective, the authors describe how the Triple C framework can be integrated and enhance existing competency standards to advance CCC across the learning and practice continuum. They also discuss strategies for partnering with patients and families to improve health professional education and health care design and delivery through quality improvement projects. They emphasize that compassion and collaboration are important sources of professional, patient, and family satisfaction as well as critical aspects of professionalism and person-centered, relationship-based high-quality care. PMID:26717505

  13. Integrating Compassionate, Collaborative Care (the "Triple C") Into Health Professional Education to Advance the Triple Aim of Health Care.

    PubMed

    Lown, Beth A; McIntosh, Sharrie; Gaines, Martha E; McGuinn, Kathy; Hatem, David S

    2016-03-01

    Empathy and compassion provide an important foundation for effective collaboration in health care. Compassion (the recognition of and response to the distress and suffering of others) should be consistently offered by health care professionals to patients, families, staff, and one another. However, compassion without collaboration may result in uncoordinated care, while collaboration without compassion may result in technically correct but depersonalized care that fails to meet the unique emotional and psychosocial needs of all involved. Providing compassionate, collaborative care (CCC) is critical to achieving the "triple aim" of improving patients' health and experiences of care while reducing costs. Yet, values and skills related to CCC (or the "Triple C") are not routinely taught, modeled, and assessed across the continuum of learning and practice. To change this paradigm, an interprofessional group of experts recently recommended approaches and a framework for integrating CCC into health professional education and postgraduate training as well as clinical care. In this Perspective, the authors describe how the Triple C framework can be integrated and enhance existing competency standards to advance CCC across the learning and practice continuum. They also discuss strategies for partnering with patients and families to improve health professional education and health care design and delivery through quality improvement projects. They emphasize that compassion and collaboration are important sources of professional, patient, and family satisfaction as well as critical aspects of professionalism and person-centered, relationship-based high-quality care.

  14. Developing a Patient Care Co-ordination Centre in Trafford, England: lessons from the International Foundation for Integrated Care (IFIC)/Advancing Quality Alliance integrated care fellowship experience.

    PubMed

    Gregory, Michael

    2015-01-01

    The NHS and Social Care in England are facing one of the biggest financial challenges for a generation. Commissioners and providers need to work on collaborative schemes to manage the increasing demand on health and social care within a period of financial constraint. Different forms of care co-ordination have been developed at different levels across the world. In the north-west of England, the Trafford health and social care economy have been working through a competitive dialogue process with industry to develop an innovative and dynamic solution to deliver seamless co-ordination for all patients and service users. The strategy is to develop a new Patient Care Co-ordination Centre, which will be responsible for the delivery of co-ordinated, quality care. The Patient Care Co-ordination Centre will work at clinical, service, functional and community levels across multiple providers covering risk stratification, preventative, elective and unscheduled care. I am the clinical lead for the Patient Care Co-ordination Centre and during my year as an Advancing Quality Alliance Integrated Care Fellow, I have had the opportunity to study examples of care coordination from UK and international sites. The learning from these visits has been assimilated into the design process of the Patient Care Co-ordination Centre.

  15. Effectiveness of Advanced Illness Care Teams for Nursing Home Residents with Dementia

    ERIC Educational Resources Information Center

    Chapman, Dennis G.; Toseland, Ronald W.

    2007-01-01

    This study evaluated the effectiveness of advanced illness care teams (AICTs) for nursing home residents with advanced dementia. The AICTs used a holistic approach that focused on four domains: (1) medical, (2) meaningful activities, (3) psychological, and (4) behavioral. The authors recruited 118 residents in two nursing homes for this study and…

  16. As health care technology advances: benefits and risks.

    PubMed

    Funk, Marjorie

    2011-07-01

    Technology permeates every dimension of critical care. Bedside technology is integral to the assessment and monitoring of patients and to the provision of treatment. It also helps with access to vital information and can enhance communication. Although it offers extraordinary benefits to patients and clinicians, technology may also create problems. Our research addresses the wise use of technology in the care of critically ill patients. It examines the appropriate and safe use of technology, its equitable distribution, and the human-machine interface. Given that some devices are more effective and safe than others, it is important to assess the appropriateness of a specific technology in a specific situation. Just because a particular device is available, is it necessary to use it in every possible situation? Do we use it just because it is there? Do we employ "heroic" measures sometimes when it would be kinder not to? Studies on the safe use of technology in patient care lead to a consideration of the risk-benefit ratio. Our research on gender and racial differences in the use of cardiac procedures in patients with acute myocardial infarction focused on the equitable distribution of technology. The results of this line of research, along with those of numerous other studies, suggest possible racism in our health care practices. The human-machine interface, or how clinicians and patients interact with health care technology, is a crucial focus of research. Technology is at the heart of critical care. It allows clinicians to perform miracles, but is also a seductive and self-perpetuating force that needs careful monitoring by those who use it.

  17. Strategic plan for geriatrics and extended care in the veterans health administration: background, plan, and progress to date.

    PubMed

    Shay, Kenneth; Hyduke, Barbara; Burris, James F

    2013-04-01

    The leaders of Geriatrics and Extended Care (GEC) in the Veterans Health Administration (VHA) undertook a strategic planning process that led to approval in 2009 of a multidisciplinary, evidence-guided strategic plan. This article reviews the four goals contained in that plan and describes VHA's progress in addressing them. The goals included transforming the healthcare system to a veteran-centric approach, achieving universal access to a panel of services, ensuring that the Veterans Affair's (VA) healthcare workforce was adequately prepared to manage the needs of the growing elderly veteran population, and integrating continuous improvement into all care enhancements. There has been substantial progress in addressing all four goals. All VHA health care has undergone an extensive transformation to patient-centered care, has enriched the services it can offer caregivers of dependent veterans, and has instituted models to better integrate VA and non-VA cares and services. A range of successful models of geriatric care described in the professional literature has been adapted to VA environments to gauge suitability for broader implementation. An executive-level task force developed a three-pronged approach for enhancing the VA's geriatric workforce. The VHA's performance measurement approaches increasingly include incentives to enhance the quality of management of vulnerable elderly adults in primary care. The GEC strategic plan was intended to serve as a road map for keeping VHA aligned with an ambitious but important long-term vision for GEC services. Although no discrete set of resources was appropriated for fulfillment of the plan's recommendations, this initial report reflects substantial progress in addressing most of its goals.

  18. Perceptions of palliative care among patients with advanced cancer and their caregivers

    PubMed Central

    Zimmermann, Camilla; Swami, Nadia; Krzyzanowska, Monika; Leighl, Natasha; Rydall, Anne; Rodin, Gary; Tannock, Ian; Hannon, Breffni

    2016-01-01

    Background: Early palliative care is increasingly recommended but seldom practised. We sought to examine perceptions of palliative care among patients with advanced cancer and their caregivers. Methods: After conducting a cluster randomized controlled trial of early palliative care versus standard care for patients with advanced cancer, we approached patients and their caregivers to participate in semistructured interviews seeking to assess, qualitatively, their attitudes and perceptions about palliative care. We used the grounded theory method for data collection and analysis. Results: A total of 48 patients (26 intervention, 22 control) and 23 caregivers (14 intervention, 9 control) completed interviews. Participants’ initial perceptions of palliative care in both trial arms were of death, hopelessness, dependency and end-of-life comfort care for inpatients. These perceptions provoked fear and avoidance, and often originated from interactions with health care professionals. During the trial, those in the intervention arm developed a broader concept of palliative care as “ongoing care” that improved their “quality of living” but still felt that the term itself carried a stigma. Participants in the intervention group emphasized the need for palliative care to be reframed and better explained by health care professionals. Participants in the control group generally considered it pointless to rename palliative care, but many in the intervention group stated emphatically that a different name was necessary in the early outpatient setting. Interpretation: There is a strong stigma attached to palliative care, which may persist even after positive experiences with an early palliative care intervention. Education of the public, patients and health care providers is paramount if early integration of palliative care is to be successful. PMID:27091801

  19. 42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... a doctor of medicine, osteopathy, or podiatric medicine. (a) Standard: Plan of care. The plan of..., plan of care, and medical supervision. 484.18 Section 484.18 Public Health CENTERS FOR MEDICARE... HEALTH SERVICES Administration § 484.18 Condition of participation: Acceptance of patients, plan of...

  20. Advancing nursing leadership in long-term care.

    PubMed

    O'Brien, Jennifer; Ringland, Margaret; Wilson, Susan

    2010-05-01

    Nurses working in the long-term care (LTC) sector face unique workplace stresses, demands and circumstances. Designing approaches to leadership training and other supportive human-resource strategies that reflect the demands of the LTC setting fosters a positive work life for nurses by providing them with the skills and knowledge necessary to lead the care team and to address resident and family issues. Through the St. Joseph's Health Centre Guelph demonstration site project, funded by the Nursing Secretariat of Ontario's Ministry of Health and Long-Term Care, the Excelling as a Nurse Leader in Long Term Care training program and the Mentor Team program were developed to address these needs. Evaluation results show that not only have individual nurses benefitted from taking part in these programs, but also that the positive effects were felt in other parts of the LTC home (as reported by Directors of Care). By creating a generally healthier work environment, it is anticipated that these programs will also have a positive effect on recruitment and retention. PMID:20463447

  1. 45 CFR 1355.54 - Submittal of advance planning documents.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON CHILDREN, YOUTH AND FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL... statewide automated child welfare information system, signed by the appropriate State official,...

  2. Teaching Comprehensive Treatment Planning within a Patient-Centered Care Model.

    ERIC Educational Resources Information Center

    Ford, Richard T.; And Others

    1988-01-01

    A group of patient-centered comprehensive-care clinics revised its treatment planning system to better accommodate patient needs for information while still serving student needs for instruction and support. (MSE)

  3. Web-based collaboration in individual care planning challenges the user and the provider roles – toward a power transition in caring relationships

    PubMed Central

    Bjerkan, Jorunn; Vatne, Solfrid; Hollingen, Anne

    2014-01-01

    Background and objective The Individual Care Plan (ICP) was introduced in Norway to meet new statutory requirements for user participation in health care planning, incorporating multidisciplinary and cross-sector collaboration. A web-based solution (electronic ICP [e-ICP]) was used to support the planning and documentation. The aim of this study was to investigate how web-based collaboration challenged user and professional roles. Methods Data were obtained from 15 semistructured interviews with users and eight with care professionals, and from two focus-group interviews with eight care professionals in total. The data were analyzed using systematic text condensation in a stepwise analysis model. Results Users and care professionals took either a proactive or a reluctant role in e-ICP collaboration. Where both user and care professionals were proactive, the pairing helped to ensure that the planning worked well; so did pairings of proactive care professionals and reluctant users. Proactive users paired with reluctant care professionals also made care planning work, thanks to the availability of information and the users’ own capacity or willingness to conduct the planning. Where both parties were reluctant, no planning activities occurred. Conclusion Use of the e-ICP challenged the user–professional relationship. In some cases, a power transition took place in the care process, which led to patient empowerment. This knowledge might be used to develop a new understanding of how role function can be challenged when users and care professionals have equal access to health care documentation and planning tools. PMID:25525367

  4. Neglecting the Importance of the Decision Making and Care Regimes of Personal Support Workers: A Critique of Standardization of Care Planning through the RAI/MDS

    ERIC Educational Resources Information Center

    Kontos, Pia C.; Miller, Karen-Lee; Mitchell, Gail J.

    2010-01-01

    Purpose: The Resident Assessment Instrument-Minimum Data Set (RAI/MDS) is an interdisciplinary standardized process that informs care plan development in nursing homes. This standardized process has failed to consistently result in individualized care planning, which may suggest problems with content and planning integrity. We examined the…

  5. What is Family-Centered Care for Nursing Home Residents With Advanced Dementia?

    PubMed Central

    Lopez, Ruth Palan; Mazor, Kathleen M.; Mitchell, Susan L.; Givens, Jane L.

    2014-01-01

    To understand family members’ perspectives on person- and family-centered end-of-life care provided to nursing home (NH) residents with advanced dementia, we conducted a qualitative follow-up interview with 16 respondents who had participated in an earlier prospective study, Choices, Attitudes, and Strategies for Care of Advance Dementia at End of Life (CASCADE). Family members of NH residents (N = 16) with advanced dementia participated in semistructured qualitative interviews that inquired about overall NH experience, communication, surrogate decision making, emotional reaction, and recommendations for improvement. Analysis identified 5 areas considered important by family members: (1) providing basic care; (2) ensuring safety and security; (3) creating a sense of belonging and attachment; (4) fostering self-esteem and self-efficacy; and (5) coming to terms with the experience. These themes can provide a framework for creating and testing strategies to meet the goal of person- and family-centered care. PMID:24085250

  6. A Strategic Action Plan for Advancing Math and Science Education in New Mexico 2007-2010

    ERIC Educational Resources Information Center

    New Mexico Public Education Department, 2007

    2007-01-01

    This Strategic Action Plan for Advancing Math and Science Education is an initial outline of strategies, actions, measures of progress, resources needed, timelines, and responsible parties. The Plan focuses on these three main goals: (1) increasing student interest, participation, and achievement in math and science; (2) raising public support and…

  7. Goals of care in advanced dementia: quality of life, dignity and comfort.

    PubMed

    Volicer, L

    2007-01-01

    Prolongation of human lifespan is increasing the number of individuals suffering from Alzheimer's disease and other progressive dementia worldwide. There are about 5 million of these individuals in both United States and European Union and many more in other countries of the world (1). Because there is no curative treatment for these diseases, most individuals with dementia survive to an advanced stage of dementia at which time many of them require institutional care. Home care for individuals with advanced dementia and especially institutional care are very expensive and are becoming major public health problems. The cost of care for advanced dementia is often increased by the use of aggressive medical interventions that may not be in the best interest of the patient. Because advanced dementia is currently incurable, it should be considered a terminal illness, similar to terminal cancer. Therefore, palliative care may be the most appropriate strategy for management of advanced dementia (2). The goals of palliative care are maintenance of quality of life, dignity and comfort and the four articles in this special issue are addressing these goals. Enhancement of quality of life in dementia requires attention to three main domains: provision of meaningful activities, appropriate medical care, and treatment of behavioral symptoms (3). Individuals with advanced dementia may not be able to participate in many activity programs but they still may maintain some quality of life if they are provided care in a pleasant environment with constant presence of a caregiver. Simard describes a program, Namaste Care, which is specifically tailored for individuals with advanced dementia. This program requires neither major expenditure nor increased staffing and should be instituted in all facilities that care for individuals with advanced dementia. Maintaining functional status of individuals with advanced dementia is important because it improves their self esteem and facilitates

  8. Advances in migraine management: implications for managed care organizations.

    PubMed

    Dodick, David W; Lipsy, Robert J

    2004-05-01

    Migraine headache is a disabling disease that poses a significant societal burden. Stratified care and early intervention are current strategies for migraine management. It has been shown that early treatment with triptans in select patients can improve treatment outcomes. Triptans are selective 5-HT receptor agonists that are specific and effective treatments in the management of migraine, and they meet the acute treatment goal of rapid relief with minimal side effects. Triptans are associated with improved quality of life. Factors such as speed of onset, need for a second triptan dose, and patient satisfaction should be considered in the selection of a specific triptan treatment. Appropriate treatment can decrease costs. The patient's migraine history and response to prior therapy should be considered when selecting acute treatment. Cost-effectiveness models can be used to understand the effect of treatment choices on health care budgets. The direct cost per migraine episode, driven primarily by the need for rescue medications, is important to include in economic models. All aspects of effectiveness (efficacy, tolerability, and cost) should be considered to reduce overall managed care expenditures for migraine treatment. The improved clinical profiles of the triptans provide substantial value to managed care organizations.

  9. Systematic synthesis of barriers and facilitators to service user-led care planning

    PubMed Central

    Bee, Penny; Price, Owen; Baker, John; Lovell, Karina

    2015-01-01

    Background Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice. Aims To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur. Method Systematic evidence synthesis. Results Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes. Conclusions Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs. PMID:26243762

  10. Palliative care and policy in England: a review of health improvement plans for 1999-2003.

    PubMed

    Seymour, J; Clark, D; Marples, R

    2002-01-01

    Since 1987 health authorities in England have been required to make plans for palliative care provision, but their record in doing so has been patchy. The production of health improvement plans (HlmPs), in which each health authority must set out its priorities and actions designed to improve the health and well-being of its local population, provides an opportunity to examine the extent to which palliative care provision in the NHS is regarded as a priority by policy makers in England. This paper reports on a structured documentary review of the HlmPs published by the 99 health authorities in England. The review indicates that at the moment, in spite of the longstanding duty placed on health authorities to develop strategic plans for palliative care and to assess the level of local palliative care needs, not all have made significant progress in this direction. Among those that do have plans for palliative care, the vast majority of these plans are for people with cancer. What emerges most clearly is a sense in which specialist palliative care, especially for non-cancer patients, is perceived as an 'optional extra' by many health authorities rather than an integral and essential part of the overall supportive care strategy which they clearly are at pains to develop.

  11. Comparison of planned menus and centre characteristics with foods and beverages served in New York City child-care centres

    PubMed Central

    Breck, Andrew; Dixon, L Beth; Khan, Laura Kettel

    2016-01-01

    Objective The present study evaluated the extent to which child-care centre menus prepared in advance correspond with food and beverage items served to children. The authors identified centre and staff characteristics that were associated with matches between menus and what was served. Design Menus were collected from ninety-five centres in New York City (NYC). Direct observation of foods and beverages served to children were conducted during 524 meal and snack times at these centres between April and June 2010, as part of a larger study designed to determine compliance of child-care centres with city health department regulations for nutrition. Setting Child-care centres were located in low-income neighbourhoods in NYC. Results Overall, 87% of the foods and beverages listed on the menus or allowed as substitutions were served. Menu items matched with foods and beverages served for all major food groups by > 60%. Sweets and water had lower match percentages (40 and 32%, respectively), but water was served 68% of the time when it was not listed on the menu. The staff person making the food and purchasing decisions predicted the match between the planned or substituted items on the menus and the foods and beverages served. Conclusions In the present study, child-care centre menus included most foods and beverages served to children. Menus planned in advance have potential to be used to inform parents about which child-care centre to send their child or what foods and beverages their enrolled children will be offered throughout the day. PMID:27280341

  12. Advanced nursing roles in critical care--a natural or forced evolution?

    PubMed

    Coombs, Maureen; Chaboyer, Wendy; Sole, Mary Lou

    2007-01-01

    Meeting the expectation of delivering safe, effective, and timely health care services within current financial and workforce envelopes requires all health care clinicians to refine and adapt to their clinical roles. The arena of critical care is currently receiving increasing scrutiny regarding developing dedicated advanced practice roles. This is challenging to critical care nurses who historically neither have been exposed to nor have chosen to engage in such specific role developments. The critical care nursing community has, on the whole, embraced previous role expansions within the limits of existing group practices rather than an evolution of new subspecialties. International comparisons demonstrate that critical care nurses in the United States, the United Kingdom, and Australia are all facing common health policy drivers. Although there are some similarities in addressing these challenges, the solutions remain at various stages of development. The natural history framework of Bucher [Work and Occupations 1988;15:131-147] provides a useful and supportive tool to understand how it is necessary and natural for specialties within occupational groups to emerge to meet changing health care needs. A shared concern providing challenges at national and international levels involves the coordination of educational standards as well as competencies and clear articulation of the leadership component of advanced practice roles. These areas must be addressed to enable the international critical care community to naturally transform and evolve into fully established and legitimate advanced practitioners. PMID:17383600

  13. Child Care and Development Fund: Report of State and Territory Plans, FY 2010-2011

    ERIC Educational Resources Information Center

    Child Care Bureau, 2011

    2011-01-01

    This report was prepared by the National Child Care Information and Technical Assistance Center (NCCIC) in partnership with staff from the Child Care Bureau. NCCIC compiled data reported in approved CCDF Plans and relevant attachments submitted by Lead Agencies for a selected number of questions. The information presented reflects some of the…

  14. Eight Steps to Future Care Planning for a Loved One with Special Needs

    ERIC Educational Resources Information Center

    Ehlert, Mary Anne

    2008-01-01

    This article presents an eight-step process to future care planning for a loved one with special needs. The first big step in starting to recognize the work is to make an honest assessment of future care needs in light of the entire family's make-up and financial situation. Then, identify all life needs for a loved one with a developmental…

  15. Two Models of Managed Long-Term Care: Comparing Pace with a Medicaid-Only Plan

    ERIC Educational Resources Information Center

    Nadash, Pamela

    2004-01-01

    Purpose: In this study an attempt is made to understand how a Medicaid-only managed long-term-care (MMLTC) plan for elders differs from the Program of All-Inclusive Care for the Elderly (PACE), a fully integrated model, in terms of structure, operations, patient population, and service utilization. Design and Methods: With the use of information…

  16. Investing in Our Children: A Plan to Expand Access to Preschool and Child Care

    ERIC Educational Resources Information Center

    Brown, Cynthia G.; Cooper, Donna; Herman, Juliana; Lazarín, Melissa; Linden, Michael; Post, Sasha; Tanden, Neera

    2013-01-01

    This issue brief presents a plan to expand educational opportunities and care for children ages 0-5 years old by investing significant federal dollars to: (1) Make high-quality preschool universally accessible to all 3- and 4-year-old children; and (2) Enable more lower-income families to afford child care for children ages 0-3 years old. These…

  17. [Russian Federation implementation of WHO global efforts plan on workers health care].

    PubMed

    Izmerov, N F; Bukhtiyarov, I V; Prokopenko, L V; Shigan, E E

    2015-01-01

    The article deals with problems of implementing global WHO efforts plan on workers health care, Target program of World Labor Organization on work and occupational environment safety "For safe labor", some WLO conventions. The authors justify priority directions of governmental policy on health care for working population in Russia.

  18. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... interdisciplinary group to establish policies governing the day-to-day provision of hospice care and services. (b...'s own policies, in the clinical record. (d) Standard: Review of the plan of care. The hospice... communication and integration, in accordance with the hospice's own policies and procedures, to— (1) Ensure...

  19. Health Care Assisting Lesson Planning Guide for Long-Term Care Aide Certification. South Carolina Health Occupations Education.

    ERIC Educational Resources Information Center

    South Carolina State Dept. of Education, Columbia. Office of Occupational Education.

    This document consists of 13 competency outlines/lesson plans that have been developed for use in preparing students for certification as long-term care aides through South Carolina's health occupations education program. The following competencies are covered in the individual lessons: identify the function and responsibilities of nurses aides;…

  20. Planning and Decision Making about the Future Care of Older Group Home Residents and Transition to Residential Aged Care

    ERIC Educational Resources Information Center

    Bigby, C.; Bowers, B.; Webber, R.

    2011-01-01

    Background: Planning for future care after the death of parental caregivers and adapting disability support systems to achieve the best possible quality of life for people with intellectual disability as they age have been important issues for more than two decades. This study examined perceptions held by family members, group home staff and…

  1. Transition Planning for Youth with Special Health Care Needs (YSHCN) in Illinois Schools

    ERIC Educational Resources Information Center

    Bargeron, Jodie; Contri, Darcy; Gibbons, Linda J.; Ruch-Ross, Holly S.; Sanabria, Kathy

    2015-01-01

    "Transition Planning for Youth with Special Health Care Needs (YSHCN)" chronicles the research and work completed by agencies in Illinois to provide examples of best practice in transition planning. Increasing numbers of YSHCN survive into adulthood creating a need for focus on the transition to adult life for these young people,…

  2. Boost your bargaining clout in contract negotiations with Medicare managed care plans.

    PubMed

    1999-06-01

    Boost your clout in negotiations with Medicare plans. Find out what Desert Physicians Association in Mesa, AZ, has learned in its dispute over reimbursement rates with CIGNA, and get some advice from a Medicare managed care consultant on how to negotiate contracts with Medicare plans. PMID:10538679

  3. Investigating What Second Language Learners Do and Monitor under Careful Online Planning Conditions

    ERIC Educational Resources Information Center

    Ahmadian, Mohammad Javad; Tavakoli, Mansoor

    2014-01-01

    This study used quantitative analyses complemented by the retrospective data obtained through a stimulated recall procedure to address three interrelated issues: (a) whether second language learners use online planning opportunities to carefully plan their speech to enhance the quality of the language they produce, (b) what kinds of self-repair…

  4. Concurrent Planning and beyond: Family-Centered Services for Children in Foster Care

    ERIC Educational Resources Information Center

    Hudson, Lucy; Almeida, Connie; Bentley, Dawn; Brown, Josie; Harlin, Daria; Norris, Judy

    2008-01-01

    Family reunification is not always possible for children who have been removed from the care of their biological parents because of abuse or neglect. Concurrent planning puts into place a secondary plan for a permanent home should family reunification prove to be impossible. Working in four diverse communities around the country in an innovative…

  5. Individualized Health Care Plans: Supporting Children With Chronic Conditions in the Classroom

    ERIC Educational Resources Information Center

    Hopkins, Amanda F.; Hughes, Mary-alayne

    2016-01-01

    Due to the major advances in technology and the sciences, advances in the medical treatment options for children with chronic conditions are being made at an astonishing rate. In the health care field, "children with chronic conditions" is a generic phrase that typically refers to children with physical, developmental, behavioral, or…

  6. Understanding the motivations of long-term care insurance owners: the importance of retirement planning.

    PubMed

    Yakoboski, Paul J

    2002-01-01

    This article is based on two recent reports by the American Council of Life Insurers (ACLI) that illuminate the reasons why individuals purchase private long-term care insurance in both the group and individual markets. This information suggests that a younger and more diverse group of individuals are becoming increasingly interested in private long-term care insurance and that workplace education linkage the purchase of long-term care insurance to retirement planning may promote coverage.

  7. Advanced practice in emergency care: the paediatric flow nurse.

    PubMed

    Gray, Constance; Hutch, Michelle; Christensen, Martin

    2016-05-01

    Children admitted to emergency departments (EDs) in Australia are often placed in an environment better suited to the treatment of adult patients. This can lead to problems because ED staff are unfamiliar with specialist paediatric care and children often find adult EDs frightening. The development of the paediatric flow nurse (PFN) role at Caboolture Hospital has meant children are treated and supported by a trained paediatric nurse and triaged and treated quickly and effectively. The PFN team collaborates with ED nursing and medical staff to start treating patients and to help move children from the ED to the paediatric emergency short stay unit or inpatient paediatric beds. Each week, the PFN team sees about 30-50 children, many of whom are cared for and discharged directly from the ED.

  8. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... which clearly state the purpose and objectives of the project to be accomplished and the necessity for the project. (b) A project management plan which addresses the following: (1) The planning project... project procurement activities and schedule. (c) A specific budget for the planning of the project. (d)...

  9. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... which clearly state the purpose and objectives of the project to be accomplished and the necessity for the project. (b) A project management plan which addresses the following: (1) The planning project... project procurement activities and schedule. (c) A specific budget for the planning of the project. (d)...

  10. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... which clearly state the purpose and objectives of the project to be accomplished and the necessity for the project. (b) A project management plan which addresses the following: (1) The planning project... project procurement activities and schedule. (c) A specific budget for the planning of the project. (d)...

  11. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... which clearly state the purpose and objectives of the project to be accomplished and the necessity for the project. (b) A project management plan which addresses the following: (1) The planning project... project procurement activities and schedule. (c) A specific budget for the planning of the project. (d)...

  12. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... which clearly state the purpose and objectives of the project to be accomplished and the necessity for the project. (b) A project management plan which addresses the following: (1) The planning project... project procurement activities and schedule. (c) A specific budget for the planning of the project. (d)...

  13. Development of Advanced Multi-Modality Radiation Treatment Planning Software for Neutron Radiotherapy and Beyond

    SciTech Connect

    Nigg, D; Wessol, D; Wemple, C; Harkin, G; Hartmann-Siantar, C

    2002-08-20

    The Idaho National Engineering and Environmental Laboratory (INEEL) has long been active in development of advanced Monte-Carlo based computational dosimetry and treatment planning methods and software for advanced radiotherapy, with a particular focus on Neutron Capture Therapy (NCT) and, to a somewhat lesser extent, Fast-Neutron Therapy. The most recent INEEL software system of this type is known as SERA, Simulation Environment for Radiotherapy Applications. As a logical next step in the development of modern radiotherapy planning tools to support the most advanced research, INEEL and Lawrence Livermore National Laboratory (LLNL), the developers of the PEREGRTNE computational engine for radiotherapy treatment planning applications, have recently launched a new project to collaborate in the development of a ''next-generation'' multi-modality treatment planning software system that will be useful for all modern forms of radiotherapy.

  14. Plan of advanced satellite communication experiments using ETS-6

    NASA Technical Reports Server (NTRS)

    Ikegami, Tetsushi

    1989-01-01

    In 1992, an Engineering Test Satellite 6 is scheduled to be launched by an H-2 rocket. The missions of ETS-6 are to establish basic technologies of inter-satellite communications using S-band, millimeter waves and optical beams and of fixed and mobile satellite communications using multibeam antenna on board the satellite. A plan of the experiments is introduced.

  15. Chemical release and radiation effects experiment advanced planned

    NASA Technical Reports Server (NTRS)

    Vaughan, William W.; Alzmann, Melanie

    1990-01-01

    A summary of the efforts conducted to provide assessments and planning support for the Chemical Release and Radiation Experiment Satellite (CRRES) is reported. Included are activities regarding scientific working group and workshop development including the preparation of descriptive information on the CRRES project.

  16. Chemical release and radiation effects experiment advanced planning and coordination

    NASA Technical Reports Server (NTRS)

    Vaughan, William W.; Alzmann, Melanie

    1991-01-01

    The efforts conducted to provide assessments and planning support for the Chemical Release and Radiation Effects Satellite (CRRES) Experiments are summarized. Included are activities regarding scientific working group and workshop development including the preparation of descriptive information on the CRRES Project.

  17. Early Education and Care, and Reconceptualizing Play. Advances in Early Education and Day Care.

    ERIC Educational Resources Information Center

    Reifel, Stuart, Ed.; Brown, Mac H., Ed.

    Providing a forum for current thought about the field of early education and care, this book reviews efforts worldwide to educate young children. The book examines child care quality, presents a cultural feminist perspective on caregiving, discusses curricular issues, and considers the role of play in early childhood practice. The chapters are:…

  18. Ontario's primary care reforms have transformed the local care landscape, but a plan is needed for ongoing improvement.

    PubMed

    Hutchison, Brian; Glazier, Richard

    2013-04-01

    Primary care in Ontario, Canada, has undergone a series of reforms designed to improve access to care, patient and provider satisfaction, care quality, and health system efficiency and sustainability. We highlight key features of the reforms, which included patient enrollment with a primary care provider; funding for interprofessional primary care organizations; and physician reimbursement based on varying blends of fee-for-service, capitation, and pay-for-performance. With nearly 75 percent of Ontario's population now enrolled in these new models, total payments to primary care physicians increased by 32 percent between 2006 and 2010, and the proportion of Ontario primary care physicians who reported overall satisfaction with the practice of medicine rose from 76 percent in 2009 to 84 percent in 2012. However, primary care in Ontario also faces challenges. There is no meaningful performance measurement system that tracks the impact of these innovations, for example. A better system of risk adjustment is also needed in capitated plans so that groups have the incentive to take on high-need patients. Ongoing investment in these models is required despite fiscal constraints. We recommend a clearly articulated policy road map to continue the transformation. PMID:23569049

  19. Protocolized Care for Early Septic Shock (ProCESS) statistical analysis plan

    PubMed Central

    Pike, Francis; Yealy, Donald M; Kellum, John A; Huang, David T; Barnato, Amber E; Eaton, Tammy L; Angus, Derek C; Weissfeld, Lisa A

    2014-01-01

    Background The Protocolized Care for Early Septic Shock study is a randomised, multicentre, prospective, three-arm, parallel-group trial of alternative resuscitation strategies for early septic shock. Objective To state our analysis plan for trial data. Methods Our plan is to guide data collection and analysis using pre-existing definitions and testing, with local consensus-based efforts where needed. We examine protocolised care (two experimental approaches) and compare this to usual “wild type” care. Results Our plan is to address three aims (clinical efficacy, biology of illness and recovery, and costs and cost-effectiveness) and four hypotheses, and we specify rules for handling data and determining outcomes. Conclusion By using measures to maintain study conduct and analysis rigour, we hope to improve understanding of early septic shock resuscitation and care of patients. PMID:24289512

  20. Pittsburgh as a High Risk Population: The Potential Savings of a Personalized Dental Care Plan.

    PubMed

    Ng, Andrew J; Vieira, Alexandre R

    2016-01-01

    Objectives. Little evidence exists for the current standard of two annual preventative care visits. The purpose of this study was investigate this claim by modeling the potential savings of implementing a personalized care plan for high risk individuals in the Pittsburgh region. Methods. Using radiographs from 39 patients in the University of Pittsburgh Dental Registry and DNA Repository database, two models were created to analyse the direct savings of implementing a more aggressive preventative treatment plan and to view the longitudinal cost of increased annual yearly visits. Results. There is a significant decrease (p < 0.001) between original and modeled treatment cost when treatment severity is reduced. In addition, there is a significant decrease in adult lifetime treatment cost (p < 0.001) for up to four annual visits. Conclusions. Patients in high risk populations may see significant cost benefits in treatment cost when a personalized care plan, or higher annual preventative care visits, is implemented. PMID:27006657