The business process management software for successful quality management and organization: A case study from the University of Split School of Medicine.

PubMed

Sapunar, Damir; Grković, Ivica; Lukšić, Davor; Marušić, Matko

2016-05-01

Our aim was to describe a comprehensive model of internal quality management (QM) at a medical school founded on the business process analysis (BPA) software tool. BPA software tool was used as the core element for description of all working processes in our medical school, and subsequently the system served as the comprehensive model of internal QM. The quality management system at the University of Split School of Medicine included the documentation and analysis of all business processes within the School. The analysis revealed 80 weak points related to one or several business processes. A precise analysis of medical school business processes allows identification of unfinished, unclear and inadequate points in these processes, and subsequently the respective improvements and increase of the QM level and ultimately a rationalization of the institution's work. Our approach offers a potential reference model for development of common QM framework allowing a continuous quality control, i.e. the adjustments and adaptation to contemporary educational needs of medical students. Copyright © 2016 by Academy of Sciences and Arts of Bosnia and Herzegovina.

[Development of medical supplies management system].

PubMed

Zhong, Jianping; Shen, Beijun; Zhu, Huili

2012-11-01

This paper adopts advanced information technology to manage medical supplies, in order to improve the medical supplies management level and reduce material cost. It develops a Medical Supplies Management System with B/S and C/S mixed structure, optimizing material management process, building large equipment performance evaluation model, providing interface solution with HIS, and realizing real-time information briefing of high value material's consumption. The medical materials are managed during its full life-cycle. The material consumption of the clinical departments is monitored real-timely. Through the closed-loop management with pre-event budget, mid-event control and after-event analysis, it realizes the final purpose of management yielding benefit.

Improving medical stores management through automation and effective communication

PubMed Central

Kumar, Ashok; Cariappa, M.P.; Marwaha, Vishal; Sharma, Mukti; Arora, Manu

2016-01-01

Background Medical stores management in hospitals is a tedious and time consuming chore with limited resources tasked for the purpose and poor penetration of Information Technology. The process of automation is slow paced due to various inherent factors and is being challenged by the increasing inventory loads and escalating budgets for procurement of drugs. Methods We carried out an indepth case study at the Medical Stores of a tertiary care health care facility. An iterative six step Quality Improvement (QI) process was implemented based on the Plan–Do–Study–Act (PDSA) cycle. The QI process was modified as per requirement to fit the medical stores management model. The results were evaluated after six months. Results After the implementation of QI process, 55 drugs of the medical store inventory which had expired since 2009 onwards were replaced with fresh stock by the suppliers as a result of effective communication through upgraded database management. Various pending audit objections were dropped due to the streamlined documentation and processes. Inventory management improved drastically due to automation, with disposal orders being initiated four months prior to the expiry of drugs and correct demands being generated two months prior to depletion of stocks. The monthly expense summary of drugs was now being done within ten days of the closing month. Conclusion Improving communication systems within the hospital with vendor database management and reaching out to clinicians is important. Automation of inventory management requires to be simple and user-friendly, utilizing existing hardware. Physical stores monitoring is indispensable, especially due to the scattered nature of stores. Staff training and standardized documentation protocols are the other keystones for optimal medical store management. PMID:26900225

Process Reengineering for Quality Improvement in ICU Based on Taylor's Management Theory.

PubMed

Tao, Ziqi

2015-06-01

Using methods including questionnaire-based surveys and control analysis, we analyzed the improvements in the efficiency of ICU rescue, service quality, and patients' satisfaction, in Xuzhou Central Hospital after the implementation of fine management, with an attempt to further introduce the concept of fine management and implement the brand construction. Originating in Taylor's "Theory of Scientific Management" (1982), fine management uses programmed, standardized, digitalized, and informational approaches to ensure each unit of an organization is running with great accuracy, high efficiency, strong coordination, and at sustained duration (Wang et al., Fine Management, 2007). The nature of fine management is a process that breaks up the strategy and goal, and executes it. Strategic planning takes place at every part of the process. Fine management demonstrates that everybody has a role to play in the management process, every area must be examined through the management process, and everything has to be managed (Zhang et al., The Experience of Hospital Nursing Precise Management, 2006). In other words, this kind of management theory demands all people to be involved in the entire process (Liu and Chen, Med Inf, 2007). As public hospital reform is becoming more widespread, it becomes imperative to "build a unified and efficient public hospital management system" and "improve the quality of medical services" (Guidelines on the Pilot Reform of Public Hospitals, 2010). The execution of fine management is of importance in optimizing the medical process, improving medical services and building a prestigious hospital brand.

Management of medical care, a fundamental tool for resident doctors.

PubMed

Fajardo-Ortiz, Guillermo; Robledo, Héctor

2018-01-01

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly poses knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important. Copyright: © 2018 Permanyer.

Exploring Factors that Influence Informal Caregiving in Medication Management for Home Hospice Patients

PubMed Central

Berman, Rebecca; Halpern, Leslie; Pickard, A. Simon; Schrauf, Robert; Witt, Whitney

2010-01-01

Abstract Objective To explore factors that influence how informal caregivers manage medications as part of caring for hospice patients. Methods : Semistructured, open-ended interviews were conducted with 23 informal caregivers and 22 hospice providers from 4 hospice programs in the Chicago metropolitan areas. Qualitative analysis was conducted consistent with the grounded theory approach. Results : In general, informal caregivers and hospice providers identified similar key factors that facilitated or impeded caregivers' process in managing medications. Caregivers' life experience and self-confidence were considered assets that facilitated medication management. Limitations impeding the process included caregivers' negative emotional states, cognitive and physical impairments, low literacy, other competing responsibilities, as well as patients' negative emotional states and complex medication needs. Furthermore, the social context of medication management emerged as a salient theme: caregivers' good interpersonal relations with patients facilitated medication management, whereas poor communication/relations among caregivers within a support network impeded the process. While both study groups discussed the positive attributes of good caregiver–patient relations and support from multiple caregivers, hospice providers were cautious about the potential adverse influence of close relations with patients on caregivers' decision making about medications and discussed poor communication/relations among informal and privately hired caregivers that often resulted from family conflicts and/or a lack of long-standing leadership. Conclusion Our findings suggest additional intervention points, beyond knowledge and skill building, that could be addressed to support caregivers in executing medication responsibilities at home for hospice patients. PMID:20836633

Pain medication management processes used by oncology outpatients and family caregivers part I: health systems contexts.

PubMed

Schumacher, Karen L; Plano Clark, Vicki L; West, Claudia M; Dodd, Marylin J; Rabow, Michael W; Miaskowski, Christine

2014-11-01

Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. The aim was to describe day-to-day pain medication management from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management by patients and family caregivers in the context of multiple complex health systems. We qualitatively analyzed audio-recorded intervention sessions that included extensive dialogue between patients, family caregivers, and nurses about pain medication management during the 10-week intervention. The health systems context for pain medication management included multiple complex systems for clinical care, reimbursement, and regulation of analgesic prescriptions. Pain medication management processes particularly relevant to this context were getting prescriptions and obtaining medications. Responsibilities that fell primarily to patients and family caregivers included facilitating communication and coordination among multiple clinicians, overcoming barriers to access, and serving as a final safety checkpoint. Significant effort was required of patients and family caregivers to insure safe and effective pain medication management. Health systems issues related to access to needed analgesics, medication safety in outpatient settings, and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Identifying Medication Management Smartphone App Features Suitable for Young Adults With Developmental Disabilities: Delphi Consensus Study

PubMed Central

Salgado, Teresa M; Fedrigon, Alexa; Riccio Omichinski, Donna; Meade, Michelle A

2018-01-01

Background Smartphone apps can be a tool to facilitate independent medication management among persons with developmental disabilities. At present, multiple medication management apps exist in the market, but only 1 has been specifically designed for persons with developmental disabilities. Before initiating further app development targeting this population, input from stakeholders including persons with developmental disabilities, caregivers, and professionals regarding the most preferred features should be obtained. Objective The aim of this study was to identify medication management app features that are suitable to promote independence in the medication management process by young adults with developmental disabilities using a Delphi consensus method. Methods A compilation of medication management app features was performed by searching the iTunes App Store, United States, in February 2016, using the following terms: adherence, medication, medication management, medication list, and medication reminder. After identifying features within the retrieved apps, a final list of 42 features grouped into 4 modules (medication list, medication reminder, medication administration record, and additional features) was included in a questionnaire for expert consensus rating. A total of 52 experts in developmental disabilities, including persons with developmental disabilities, caregivers, and professionals, were invited to participate in a 3-round Delphi technique. The purpose was to obtain consensus on features that are preferred and suitable to promote independence in the medication management process among persons with developmental disabilities. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively. Results A total of 75 responses were received over the 3 Delphi rounds—30 in the first round, 24 in the second round, and 21 in the third round. At the end of the third round, cumulative consensus was achieved for 60% (12/20) items in the medication list module, 100% (3/3) in the medication reminder module, 67% (2/3) in the medication administration record module, and 63% (10/16) in the additional features module. In addition to the medication list, medication reminder, and medication administration record features, experts selected the following top 3 most important additional features: automatic refills through pharmacies; ability to share medication information from the app with providers; and ability to share medication information from the app with family, friends, and caregivers. The top 3 least important features included a link to an official drug information source, privacy settings and password protection, and prescription refill reminders. Conclusions Although several mobile apps for medication management exist, few are specifically designed to support persons with developmental disabilities in the complex medication management process. Of the 42 different features assessed, 64% (27/42) achieved consensus for inclusion in a future medication management app. This study provides information on the features of a medication management app that are most important to persons with developmental disabilities, caregivers, and professionals. PMID:29792292

[Development of a medical equipment support information system based on PDF portable document].

PubMed

Cheng, Jiangbo; Wang, Weidong

2010-07-01

According to the organizational structure and management system of the hospital medical engineering support, integrate medical engineering support workflow to ensure the medical engineering data effectively, accurately and comprehensively collected and kept in electronic archives. Analyse workflow of the medical, equipment support work and record all work processes by the portable electronic document. Using XML middleware technology and SQL Server database, complete process management, data calculation, submission, storage and other functions. The practical application shows that the medical equipment support information system optimizes the existing work process, standardized and digital, automatic and efficient orderly and controllable. The medical equipment support information system based on portable electronic document can effectively optimize and improve hospital medical engineering support work, improve performance, reduce costs, and provide full and accurate digital data

A qualitative study exploring issues related to medication management in residential aged care facilities

PubMed Central

Ahmad Nizaruddin, Mariani; Omar, Marhanis-Salihah; Mhd-Ali, Adliah; Makmor-Bakry, Mohd

2017-01-01

Background Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs). Participants and methods A total of 11 stakeholders comprising health care providers, administrators, caretakers and residents were recruited from a list of registered government, nongovernmental organization and private RACFs in Malaysia from September 2016 to April 2017. An exploratory qualitative study adhering to Consolidated Criteria for Reporting Qualitative Studies was conducted. In-depth interview was conducted with consent of all participants, and the interviews were audio recorded for later verbatim transcription. Observational analysis was also conducted in a noninterfering manner. Results and discussion Three themes, namely medication use process, personnel handling medications and culture, emerged in this study. Medication use process highlighted an unclaimed liability for residents’ medication by the RACFs, whereas personnel handling medications were found to lack sufficient training in medication management. Culture of the organization did affect the medication safety and quality improvement. The empowerment of the residents in their medication management was limited. There were unclear roles and responsibility of who manages the medication in the nongovernment-funded RACFs, although they were well structured in the private nursing homes. Conclusion There are important issues related to medication management in RACFs which require a need to establish policy and guidelines. PMID:29138540

Team Regulation in a Simulated Medical Emergency: An In-Depth Analysis of Cognitive, Metacognitive, and Affective Processes

ERIC Educational Resources Information Center

Duffy, Melissa C.; Azevedo, Roger; Sun, Ning-Zi; Griscom, Sophia E.; Stead, Victoria; Crelinsten, Linda; Wiseman, Jeffrey; Maniatis, Thomas; Lachapelle, Kevin

2015-01-01

This study examined the nature of cognitive, metacognitive, and affective processes among a medical team experiencing difficulty managing a challenging simulated medical emergency case by conducting in-depth analysis of process data. Medical residents participated in a simulation exercise designed to help trainees to develop medical expertise,…

[A Medical Devices Management Information System Supporting Full Life-Cycle Process Management].

PubMed

Tang, Guoping; Hu, Liang

2015-07-01

Medical equipments are essential supplies to carry out medical work. How to ensure the safety and reliability of the medical equipments in diagnosis, and reduce procurement and maintenance costs is a topic of concern to everyone. In this paper, product lifecycle management (PLM) and enterprise resource planning (ERP) are cited to establish a lifecycle management information system. Through integrative and analysis of the various stages of the relevant data in life-cycle, it can ensure safety and reliability of medical equipments in the operation and provide the convincing data for meticulous management.

Real association of factors with inappropriate hospital days.

PubMed

Huet, Bernard; Cauterman, Maxime

2005-01-01

Several studies of inappropriate (in the sense of the AEP) hospital days highlighted associations between two factors (rate of inappropriateness and reasons for inappropriateness, rate of inappropriateness and appropriate setting of care,..). The aim of this communication is to present a study on real associations, at constant factor, between five factors associated with hospital inappropriate days: medical management process, reason for inappropriateness, scheduled admission, rate of inappropriateness, length of stay. We used the European version of Appropriateness Evaluation Protocol for evaluation of inappropriate days and the French protocol ;for analysis of inappropriate days. The study set in three Parisian hospitals, four clinical departments, three specialities. 523 patients were included in the study, 5663 days were evaluated on a wide variety of pathologies: 27 Medical Management Processes. Results show that there are real associations (elimination of transitive associations) between five factors : medical management process and discharge processes, reason for inappropriateness, scheduled admission, rate of inappropriate days, length of stay. Multiple Correspondence Analysis on all "groups of contiguous days related with the same reason for inappropriateness" shows five profiles of queues integrating various medical management processes.

Task analysis of information technology-mediated medication management in outpatient care.

PubMed

van Stiphout, F; Zwart-van Rijkom, J E F; Maggio, L A; Aarts, J E C M; Bates, D W; van Gelder, T; Jansen, P A F; Schraagen, J M C; Egberts, A C G; ter Braak, E W M T

2015-09-01

Educating physicians in the procedural as well as cognitive skills of information technology (IT)-mediated medication management could be one of the missing links for the improvement of patient safety. We aimed to compose a framework of tasks that need to be addressed to optimize medication management in outpatient care. Formal task analysis: decomposition of a complex task into a set of subtasks. First, we obtained a general description of the medication management process from exploratory interviews. Secondly, we interviewed experts in-depth to further define tasks and subtasks. Outpatient care in different fields of medicine in six teaching and academic medical centres in the Netherlands and the United States. 20 experts. Tasks were divided up into procedural, cognitive and macrocognitive tasks and categorized into the three components of dynamic decision making. The medication management process consists of three components: (i) reviewing the medication situation; (ii) composing a treatment plan; and (iii) accomplishing and communicating a treatment and surveillance plan. Subtasks include multiple cognitive tasks such as composing a list of current medications and evaluating the reliability of sources, and procedural tasks such as documenting current medication. The identified macrocognitive tasks were: planning, integration of IT in workflow, managing uncertainties and responsibilities, and problem detection. All identified procedural, cognitive and macrocognitive skills should be included when designing education for IT-mediated medication management. The resulting framework supports the design of educational interventions to improve IT-mediated medication management in outpatient care. © 2015 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of The British Pharmacological Society.

Medical Management: Process Analysis Study Report

DTIC Science & Technology

2011-10-28

in Medical Management (care coordinator, case manager, PCM, clinic nurses , referral management shop, utilization management?, etc). The goal is to...Enterprise Nursing Procedure Manual, revealed that fact from the Navy’s perspective. An OASD(HA) TRICARE Management Activity (TMA) Senior...Requirements Analyst, Clinical Information Management (IM) and retired Army Colonel Nurse , Patricia Kinder, essentially told us no single application suite

Optimizing medication safety in the home.

PubMed

LeBlanc, Raeanne Genevieve; Choi, Jeungok

2015-06-01

Medication safety among community-dwelling older adults in the United States is an ongoing health issue impacting health outcomes, chronic disease management, and aging in place at home. This article describes a medication safety improvement project that aimed to: (1) Increase the ability of participants to manage medications, (2) Identify and make necessary medication changes, (3) Create an accurate up-to-date medication list to be available in the home, and (4) Provide communication between the primary care provider, participant, and case manager. An in-home medication assessment was completed for 25 participants using an evidence-based medication management software system. This process was used to review medications; identify medication-related problems; create a shared medication list; and convey this information to the primary care provider, case manager, and client while addressing needed medication changes. Educational interventions on management and understanding of medications were provided to participants to emphasize the correct use of medications and use of a personal medication record. Outcome improvements included provision of an accurate medication list, early identification of medication-related problems, identification of drug duplication, and identification of medication self-management challenges that can be useful for optimizing medication safety-related home healthcare and inform future interventions.

American Medical Association

MedlinePlus

... the Payment Process Physician Payment Resource Center Reinventing Medical Practice Managing Your Practice CPT® (Current Procedural Terminology) Medicare & Medicaid Private Payer Reform Claims Processing & Practice ...

Choosing Your Medical Specialty

MedlinePlus

... the Payment Process Physician Payment Resource Center Reinventing Medical Practice Managing Your Practice CPT® (Current Procedural Terminology) Medicare & Medicaid Private Payer Reform Claims Processing & Practice ...

Rethinking the outpatient medication list: increasing patient activation and education while architecting for centralization and improved medication reconciliation.

PubMed

Pandolfe, Frank; Wright, Adam; Slack, Warner V; Safran, Charles

2018-05-17

Identify barriers impacting the time consuming and error fraught process of medication reconciliation. Design and implement an electronic medication management system where patient and trusted healthcare proxies can participate in establishing and maintaining an inclusive and up-to-date list of medications. A patient-facing electronic medication manager was deployed within an existing research project focused on elder care management funded by the AHRQ, InfoSAGE, allowing patients and patients' proxies the ability to build and maintain an accurate and up-to-date medication list. Free and open-source tools available from the U.S. government were used to embed the tenets of centralization, interoperability, data federation, and patient activation into the design. Using patient-centered design and free, open-source tools, we implemented a web and mobile enabled patient-facing medication manager for complex medication management. Patient and caregiver participation are essential to improve medication safety. Our medication manager is an early step towards a patient-facing medication manager that has been designed with data federation and interoperability in mind.

[Medical record management and risk management processes. State of the art and new normative guidelines about the organization and the management of the sanitary documentation in the National Health System or Hospital Trusts].

PubMed

Spolaore, P; Murolo, G; Sommavilla, M

2003-01-01

Recent health care reforms, the start of accreditation processes of health institutions, and the introduction also in the health system of risk management concepts and instruments, borrowed from the enterprise culture and the emphasis put on the protection of privacy, render evident the need and the urgency to define and to implement improvement processes of the organization and management of the medical documentation in the hospital with the aim of facilitation in fulfilment of regional and local health authorities policies about protection of the safety and improvement of quality of care. Currently the normative context that disciplines the management of medical records inside the hospital appears somewhat fragmentary, incomplete and however not able to clearly orientate health operators with the aim of a correct application of the enforced norms in the respect of the interests of the user and of local health authority. In this job we individuate the critical steps in the various phases of management process of the clinical folder and propose a new model of regulations, with the purpose to improve and to simplify the management processes and the modalities of compilation, conservation and release to entitled people of all clinical documentation.

SPD-based Logistics Management Model of Medical Consumables in Hospitals.

PubMed

Liu, Tongzhu; Shen, Aizong; Hu, Xiaojian; Tong, Guixian; Gu, Wei; Yang, Shanlin

2016-10-01

With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China.

Enabling Healthcare IT Governance: Human Task Management Service for Administering Emergency Department's Resources for Efficient Patient Flow.

PubMed

Rodriguez, Salvador; Aziz, Ayesha; Chatwin, Chris

2014-01-01

The use of Health Information Technology (HIT) to improve healthcare service delivery is constantly increasing due to research advances in medical science and information systems. Having a fully automated process solution for a Healthcare Organization (HCO) requires a combination of organizational strategies along with a selection of technologies that facilitate the goal of improving clinical outcomes. HCOs, requires dynamic management of care capability to realize the full potential of HIT. Business Process Management (BPM) is being increasingly adopted to streamline the healthcare service delivery and management processes. Emergency Departments (EDs) provide a case in point, which require multidisciplinary resources and services to deliver effective clinical outcomes. Managed care involves the coordination of a range of services in an ED. Although fully automated processes in emergency care provide a cutting edge example of service delivery, there are many situations that require human interactions with the computerized systems; e.g. Medication Approvals, care transfer, acute patient care. This requires a coordination mechanism for all the resources, computer and human, to work side by side to provide the best care. To ensure evidence-based medical practice in ED, we have designed a Human Task Management service to model the process of coordination of ED resources based on the UK's NICE Clinical guideline for managing the care of acutely ill patients. This functionality is implemented using Java Business process Management (jBPM).

Medical Waste Management in Community Health Centers.

PubMed

Tabrizi, Jafar Sadegh; Rezapour, Ramin; Saadati, Mohammad; Seifi, Samira; Amini, Behnam; Varmazyar, Farahnaz

2018-02-01

Non-standard management of medical waste leads to irreparable side effects. This issue is of double importance in health care centers in a city which are the most extensive system for providing Primary Health Care (PHC) across Iran cities. This study investigated the medical waste management standards observation in Tabriz community health care centers, northwestern Iran. In this triangulated cross-sectional study (qualitative-quantitative), data collecting tool was a valid checklist of waste management process developed based on Iranian medical waste management standards. The data were collected in 2015 through process observation and interviews with the health center's staff. The average rate of waste management standards observance in Tabriz community health centers, Tabriz, Iran was 29.8%. This case was 22.8% in dimension of management and training, 27.3% in separating and collecting, 31.2% in transport and temporary storage, and 42.9% in sterilization and disposal. Lack of principal separation of wastes, inappropriate collecting and disposal cycle of waste and disregarding safety tips (fertilizer device performance monitoring, microbial cultures and so on) were among the observed defects in health care centers supported by quantitative data. Medical waste management was not in a desirable situation in Tabriz community health centers. The expansion of community health centers in different regions and non-observance of standards could predispose to incidence the risks resulted from medical wastes. So it is necessary to adopt appropriate policies to promote waste management situation.

The association between effectiveness of the management processes and quality of health services from the perspective of the managers in the university hospitals of Ahvaz, Iran

PubMed Central

Faraji-Khiavi, F; Ghobadian, S; Moradi-Joo, E

2015-01-01

Background and Objective: Knowledge management is introduced as a key element of quality improvement in organizations. There was no such research in university hospitals of Ahvaz. This study aimed to determine the association between the effectiveness of the processes of knowledge management and the health services quality from the managers’ view in the educational hospitals of Ahvaz city. Materials and Methods: in this correlational and research, the research population consisted of 120 managers from hospitals in University of Medical Sciences Ahvaz. Due to the limited population, the census was run. Three questionnaires were used for data collection: Demographic characteristics, the effectiveness of knowledge management processes and the quality of medical services. To analyze the data, the Spearman association analysis, The Kruskal-Wallis, the Mann–Whitney U test, were used in SPSS. Results: estimation of average scoring of the effectiveness of knowledge management processes and its components were relatively appropriate. Quality of medical services was estimated as relatively appropriate. Relationship of quality of health services with the effectiveness of knowledge management processes showed a medium and positive correlation (p < 0.001). Managers with different genders showed significant differences in knowledge development and transfer (P = 0.003). Conclusion: a significant and positive association was observed between the effectiveness of knowledge management processes and health care quality. To improve the health care quality in university hospitals, managers should pay more attention to develop the cultures of innovation, encourage teamwork, and improve communication and creative thinking in the knowledge management context PMID:28316735

Utilization of a Clinical Trial Management System for the Whole Clinical Trial Process as an Integrated Database: System Development

PubMed Central

Park, Yu Rang; Yoon, Young Jo; Koo, HaYeong; Yoo, Soyoung; Choi, Chang-Min; Beck, Sung-Ho

2018-01-01

Background Clinical trials pose potential risks in both communications and management due to the various stakeholders involved when performing clinical trials. The academic medical center has a responsibility and obligation to conduct and manage clinical trials while maintaining a sufficiently high level of quality, therefore it is necessary to build an information technology system to support standardized clinical trial processes and comply with relevant regulations. Objective The objective of the study was to address the challenges identified while performing clinical trials at an academic medical center, Asan Medical Center (AMC) in Korea, by developing and utilizing a clinical trial management system (CTMS) that complies with standardized processes from multiple departments or units, controlled vocabularies, security, and privacy regulations. Methods This study describes the methods, considerations, and recommendations for the development and utilization of the CTMS as a consolidated research database in an academic medical center. A task force was formed to define and standardize the clinical trial performance process at the site level. On the basis of the agreed standardized process, the CTMS was designed and developed as an all-in-one system complying with privacy and security regulations. Results In this study, the processes and standard mapped vocabularies of a clinical trial were established at the academic medical center. On the basis of these processes and vocabularies, a CTMS was built which interfaces with the existing trial systems such as the electronic institutional review board health information system, enterprise resource planning, and the barcode system. To protect patient data, the CTMS implements data governance and access rules, and excludes 21 personal health identifiers according to the Health Insurance Portability and Accountability Act (HIPAA) privacy rule and Korean privacy laws. Since December 2014, the CTMS has been successfully implemented and used by 881 internal and external users for managing 11,645 studies and 146,943 subjects. Conclusions The CTMS was introduced in the Asan Medical Center to manage the large amounts of data involved with clinical trial operations. Inter- and intraunit control of data and resources can be easily conducted through the CTMS system. To our knowledge, this is the first CTMS developed in-house at an academic medical center side which can enhance the efficiency of clinical trial management in compliance with privacy and security laws. PMID:29691212

A Faculty Development Program can result in an improvement of the quality and output in medical education, basic sciences and clinical research and patient care.

PubMed

Dieter, Peter Erich

2009-07-01

The Carl Gustav Carus Faculty of Medicine, University of Technology Dresden, Germany, was founded in 1993 after the reunification of Germany. In 1999, a reform process of medical education was started together with Harvard Medical International.The traditional teacher- and discipline-centred curriculum was displaced by a student-centred, interdisciplinary and integrative curriculum, which has been named Dresden Integrative Patient/Problem-Oriented Learning (DIPOL). The reform process was accompanied and supported by a parallel-ongoing Faculty Development Program. In 2004, a Quality Management Program in medical education was implemented, and in 2005 medical education received DIN EN ISO 9001:2000 certification. Quality Management Program and DIN EN ISO 9001:2000 certification were/are unique for the 34 medical schools in Germany.The students play a very important strategic role in all processes. They are members in all committees like the Faculty Board, the Board of Study Affairs (with equal representation) and the ongoing audits in the Quality Management Program. The Faculty Development program, including a reform in medical education, the establishment of the Quality Management program and the certification, resulted in an improvement of the quality and output of medical education and was accompanied in an improvement of the quality and output of basic sciences and clinical research and interdisciplinary patient care.

From A to Z: Medication Cost-Management Strategies for Disproportionate Share Hospitals

PubMed Central

Henry, Andrea; Erowele, Goldina Ikezuagu; Ndefo, Uche Anadu; Milton-Brown, Jackie; Anassi, Enock; Green, Wendy; Alvidrez, Adriana; Okpara, Alphonsus U.

2011-01-01

Background Harris County Hospital District, Houston, TX, is a publicly funded hospital system that provides care to residents of Harris County with a need-based payment system. The Harris County Hospital District pharmacy department, with a drug budget of more than $75 million in fiscal year 2010, utilizes a closed formulary system that is managed by the Formulary Management and Pharmacoeconomics Service, along with the medical staff. This service is comprised of clinical pharmacists whose goal is to provide a comprehensive, safe, and cost-effective formulary. Objective To describe the unique formulary management process at a county hospital system and what makes this process cost-effective, which may benefit pharmacy departments in institutions serving an indigent patient population. Summary The Harris County Hospital District drug formulary is overseen by the Pharmacy & Therapeutics committee, which is supported by 5 therapeutic subcommittees, including antimicrobials, cardiovascular, general formulary, central nervous system, and oncology. The Pharmacy & Therapeutics Committee consists of a medical staff committee that is supported by clinical pharmacists, who serve as the facilitators of these 5 subcommittees. Their responsibilities include the provision of drug information for formulary decisions, providing parameters to govern the use of certain medications, communicating changes to the formulary, conducting class reviews and medication utilization evaluations, coordinating annual pharmaceutical bids, reviewing and writing medication use policies and procedures, facilitating the use of cost-effective medications, and monitoring the use of medications in the hospital system. Conclusion The processes incorporated by Harris County Hospital District in its formulary management are cost-effective and may be beneficial to other pharmacy departments, especially those institutions that serve an indigent patient population and are interested in cost-effective management strategies. PMID:25126349

Utilization of a Clinical Trial Management System for the Whole Clinical Trial Process as an Integrated Database: System Development.

PubMed

Park, Yu Rang; Yoon, Young Jo; Koo, HaYeong; Yoo, Soyoung; Choi, Chang-Min; Beck, Sung-Ho; Kim, Tae Won

2018-04-24

Clinical trials pose potential risks in both communications and management due to the various stakeholders involved when performing clinical trials. The academic medical center has a responsibility and obligation to conduct and manage clinical trials while maintaining a sufficiently high level of quality, therefore it is necessary to build an information technology system to support standardized clinical trial processes and comply with relevant regulations. The objective of the study was to address the challenges identified while performing clinical trials at an academic medical center, Asan Medical Center (AMC) in Korea, by developing and utilizing a clinical trial management system (CTMS) that complies with standardized processes from multiple departments or units, controlled vocabularies, security, and privacy regulations. This study describes the methods, considerations, and recommendations for the development and utilization of the CTMS as a consolidated research database in an academic medical center. A task force was formed to define and standardize the clinical trial performance process at the site level. On the basis of the agreed standardized process, the CTMS was designed and developed as an all-in-one system complying with privacy and security regulations. In this study, the processes and standard mapped vocabularies of a clinical trial were established at the academic medical center. On the basis of these processes and vocabularies, a CTMS was built which interfaces with the existing trial systems such as the electronic institutional review board health information system, enterprise resource planning, and the barcode system. To protect patient data, the CTMS implements data governance and access rules, and excludes 21 personal health identifiers according to the Health Insurance Portability and Accountability Act (HIPAA) privacy rule and Korean privacy laws. Since December 2014, the CTMS has been successfully implemented and used by 881 internal and external users for managing 11,645 studies and 146,943 subjects. The CTMS was introduced in the Asan Medical Center to manage the large amounts of data involved with clinical trial operations. Inter- and intraunit control of data and resources can be easily conducted through the CTMS system. To our knowledge, this is the first CTMS developed in-house at an academic medical center side which can enhance the efficiency of clinical trial management in compliance with privacy and security laws. ©Yu Rang Park, Young Jo Yoon, HaYeong Koo, Soyoung Yoo, Chang-Min Choi, Sung-Ho Beck, Tae Won Kim. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 24.04.2018.

Initial development of the Systems Approach to Home Medication Management (SAHMM) model.

PubMed

Doucette, William R; Vinel, Shanrae'l; Pennathur, Priyadarshini

Adverse drug events and medication nonadherence are two problems associated with prescription medication use for chronic conditions. These issues often develop because patients have difficulty managing their medications at home. To guide patients and providers for achieving safe and effective medication use at home, the Systems Approach to Home Medication Management (SAHMM) model was derived from a systems engineering model for health care workplace safety. To explore how well concepts from the SAHMM model can represent home medication management by using patient descriptions of how they take prescription medications at home. Twelve patients were interviewed about home medication management using an interview guide based on the factors of the SAHMM model. Each interview was audio-taped and then transcribed verbatim. Interviews were coded to identify themes for home medication management using MAXQDA for Windows. SAHMM concepts extracted from the coded interview transcripts included work system components of person, tasks, tools & technology, internal environment, external environment, and household. Concepts also addressed work processes and work outcomes for home medication management. Using the SAHMM model for studying patients' home medication management is a promising approach to improving our understanding of the factors that influence patient adherence to medication and the development of adverse drug events. Copyright © 2016 Elsevier Inc. All rights reserved.

The role of paediatric nurses in medication safety prior to the implementation of electronic prescribing: a qualitative case study.

PubMed

Farre, Albert; Heath, Gemma; Shaw, Karen; Jordan, Teresa; Cummins, Carole

2017-04-01

Objectives To explore paediatric nurses' experiences and perspectives of their role in the medication process and how this role is enacted in everyday practice. Methods A qualitative case study on a general surgical ward of a paediatric hospital in England, one year prior to the planned implementation of ePrescribing. Three focus groups and six individual semi-structured interviews were conducted, involving 24 nurses. Focus groups and interviews were audio-recorded, transcribed, anonymized and subjected to thematic analysis. Results Two overarching analytical themes were identified: the centrality of risk management in nurses' role in the medication process and the distributed nature of nurses' medication risk management practices. Nurses' contribution to medication safety was seen as an intrinsic feature of a role that extended beyond just preparing and administering medications as prescribed and placed nurses at the heart of a dynamic set of interactions, practices and situations through which medication risks were managed. These findings also illustrate the collective nature of patient safety. Conclusions Both the recognized and the unrecognized contributions of nurses to the management of medications needs to be considered in the design and implementation of ePrescribing systems.

Nurses' role in medication safety.

PubMed

Choo, Janet; Hutchinson, Alison; Bucknall, Tracey

2010-10-01

To explore the nurse's role in the process of medication management and identify the challenges associated with safe medication management in contemporary clinical practice. Medication errors have been a long-standing factor affecting consumer safety. The nursing profession has been identified as essential to the promotion of patient safety. A review of literature on medication errors and the use of electronic prescribing in medication errors. Medication management requires a multidisciplinary approach and interdisciplinary communication is essential to reduce medication errors. Information technologies can help to reduce some medication errors through eradication of transcription and dosing errors. Nurses must play a major role in the design of computerized medication systems to ensure a smooth transition to such as system. The nurses' roles in medication management cannot be over-emphasized. This is particularly true when designing a computerized medication system. The adoption of safety measures during decision making that parallel those of the aviation industry safety procedures can provide some strategies to prevent medication error. Innovations in information technology offer potential mechanisms to avert adverse events in medication management for nurses. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.

PubMed

Sasnett, Bonita; Harris, Susie T; White, Shelly

Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

SPD-based Logistics Management Model of Medical Consumables in Hospitals

PubMed Central

LIU, Tongzhu; SHEN, Aizong; HU, Xiaojian; TONG, Guixian; GU, Wei; YANG, Shanlin

2016-01-01

Background: With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. Methods: We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. Results: We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. Conclusion: The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China. PMID:27957435

A CMMI-based approach for medical software project life cycle study.

PubMed

Chen, Jui-Jen; Su, Wu-Chen; Wang, Pei-Wen; Yen, Hung-Chi

2013-01-01

In terms of medical techniques, Taiwan has gained international recognition in recent years. However, the medical information system industry in Taiwan is still at a developing stage compared with the software industries in other nations. In addition, systematic development processes are indispensable elements of software development. They can help developers increase their productivity and efficiency and also avoid unnecessary risks arising during the development process. Thus, this paper presents an application of Light-Weight Capability Maturity Model Integration (LW-CMMI) to Chang Gung Medical Research Project (CMRP) in the Nuclear medicine field. This application was intended to integrate user requirements, system design and testing of software development processes into three layers (Domain, Concept and Instance) model. Then, expressing in structural System Modeling Language (SysML) diagrams and converts part of the manual effort necessary for project management maintenance into computational effort, for example: (semi-) automatic delivery of traceability management. In this application, it supports establishing artifacts of "requirement specification document", "project execution plan document", "system design document" and "system test document", and can deliver a prototype of lightweight project management tool on the Nuclear Medicine software project. The results of this application can be a reference for other medical institutions in developing medical information systems and support of project management to achieve the aim of patient safety.

Implementing a Swedish regionalized medical program supported by digital technologies: possibilities and challenges from a management perspective.

PubMed

Pettersson, Fanny L M

2013-01-01

In 2011, Umeå University in Sweden was facing its first attempt to transform the existing medical program into a regionalized medical program (RMP), supported by the use of digital technologies. The Swedish RMP means that students are distributed in geographically separated groups while doing their five clinical clerkship semesters. To provide medical students with ways of undertaking their theoretical studies when geographically distributed, digital technologies are used for educational and administrative purposes. In this article, the Swedish RMP will be described and related to previous international research on educating medical students in rural settings. The aim of this article was, from a management perspective, to understand if and how contradictions arise during the implementation process of the Swedish RMP, supported by digital technologies. Based on this analysis, a further aim was to discuss, from a management perspective, the possibilities and challenges for improvement of this medical educational practice, as well as to provide implications for other similar changes in medical programs internationally. To identify possible contradictions during the implementation process, ethnographically inspired observations were made during management work meetings, before and during the first regionalized semester. In addition, in-depth follow-up interviews were held in May and June 2011 with six management executives of the Swedish RMP, concerning their expectations and experiences of the implementation process. The qualitative and activity theory (AT)-inspired analysis resulted in the emergence of two main themes and seven sub-themes. The analysis suggests that a number of contradictions arose during the implementation process of the Swedish RMP. For instance, a contradiction constituted as a conflict between the university management and some teachers concerning how digital technologies and technology enhanced learning (TEL) could and should be used when educating medical students. In addition, due to the use of digital technologies the implementation process helped to reveal existing problems and tensions in educational practice, not previously visible to management. These included contradictions such as a lack of alignment in how course goals, teaching practices, and examinations should be carried out. Further, obsolete course content and overlap between courses and subjects were identified, leading to an overhaul of all semesters, not only those regionalized. This study showed how contradictions in educational practice arose when the Swedish RMP, supported by digital technologies, was implemented. These contradictions involve both possibilities and challenges for management to improve how and with what quality the Swedish RMP is conducted. A challenge for management is to find the most effective way to enhance up-take and use of the more interactive and innovative TEL-solutions. However, a possibility is that the regionalization process and implemented improvements may also influence non-regionalized semesters, with the potential to eventually increase the quality of the entire program.

An ontological knowledge framework for adaptive medical workflow.

PubMed

Dang, Jiangbo; Hedayati, Amir; Hampel, Ken; Toklu, Candemir

2008-10-01

As emerging technologies, semantic Web and SOA (Service-Oriented Architecture) allow BPMS (Business Process Management System) to automate business processes that can be described as services, which in turn can be used to wrap existing enterprise applications. BPMS provides tools and methodologies to compose Web services that can be executed as business processes and monitored by BPM (Business Process Management) consoles. Ontologies are a formal declarative knowledge representation model. It provides a foundation upon which machine understandable knowledge can be obtained, and as a result, it makes machine intelligence possible. Healthcare systems can adopt these technologies to make them ubiquitous, adaptive, and intelligent, and then serve patients better. This paper presents an ontological knowledge framework that covers healthcare domains that a hospital encompasses-from the medical or administrative tasks, to hospital assets, medical insurances, patient records, drugs, and regulations. Therefore, our ontology makes our vision of personalized healthcare possible by capturing all necessary knowledge for a complex personalized healthcare scenario involving patient care, insurance policies, and drug prescriptions, and compliances. For example, our ontology facilitates a workflow management system to allow users, from physicians to administrative assistants, to manage, even create context-aware new medical workflows and execute them on-the-fly.

A practical framework for data management processes and their evaluation in population-based medical registries.

PubMed

Sariyar, M; Borg, A; Heidinger, O; Pommerening, K

2013-03-01

We present a framework for data management processes in population-based medical registries. Existing guidelines lack the concreteness we deem necessary for them to be of practical use, especially concerning the establishment of new registries. Therefore, we propose adjustments and concretisations with regard to data quality, data privacy, data security and registry purposes. First, we separately elaborate on the issues to be included into the framework and present proposals for their improvements. Thereafter, we provide a framework for medical registries based on quasi-standard-operation procedures. The main result is a concise and scientifically based framework that tries to be both broad and concrete. Within that framework, we distinguish between data acquisition, data storage and data presentation as sub-headings. We use the framework to categorise and evaluate the data management processes of a German cancer registry. The standardisation of data management processes in medical registries is important to guarantee high quality of the registered data, to enhance the realisation of purposes, to increase efficiency and to enable comparisons between registries. Our framework is destined to show how one central impediment for such standardisations - lack of practicality - can be addressed on scientific grounds.

How does the knowledge environment shape procurement practices for orthopaedic medical devices in Mexico?

PubMed

Lingg, Myriam; Wyss, Kaspar; Durán-Arenas, Luis

2016-07-08

In organisational theory there is an assumption that knowledge is used effectively in healthcare systems that perform well. Actors in healthcare systems focus on managing knowledge of clinical processes like, for example, clinical decision-making to improve patient care. We know little about connecting that knowledge to administrative processes like high-risk medical device procurement. We analysed knowledge-related factors that influence procurement and clinical procedures for orthopaedic medical devices in Mexico. We based our qualitative study on 48 semi-structured interviews with various stakeholders in Mexico: orthopaedic specialists, government officials, and social security system managers or administrators. We took a knowledge-management related perspective (i) to analyse factors of managing knowledge of clinical procedures, (ii) to assess the role of this knowledge and in relation to procurement of orthopaedic medical devices, and (iii) to determine how to improve the situation. The results of this study are primarily relevant for Mexico but may also give impulsion to other health systems with highly standardized procurement practices. We found that knowledge of clinical procedures in orthopaedics is generated inconsistently and not always efficiently managed. Its support for procuring orthopaedic medical devices is insufficient. Identified deficiencies: leaders who lack guidance and direction and thus use knowledge poorly; failure to share knowledge; insufficiently defined formal structures and processes for collecting information and making it available to actors of health system; lack of strategies to benefit from synergies created by information and knowledge exchange. Many factors are related directly or indirectly to technological aspects, which are insufficiently developed. The content of this manuscript is novel as it analyses knowledge-related factors that influence procurement of orthopaedic medical devices in Mexico. Based on our results we recommend that the procurement mechanism should integrate knowledge from clinical procedures adequately in their decision-making. Without strong guidance, organisational changes, and support by technological solutions to improve the generation and management of knowledge, procurement processes for orthopaedic high-risk medical devices will remain sub-optimal.

Risk management and measuring productivity with POAS--point of act system.

PubMed

Akiyama, Masanori; Kondo, Tatsuya

2007-01-01

The concept of our system is not only to manage material flows, but also to provide an integrated management resource, a means of correcting errors in medical treatment, and applications to EBM through the data mining of medical records. Prior to the development of this system, electronic processing systems in hospitals did a poor job of accurately grasping medical practice and medical material flows. With POAS (Point of Act System), hospital managers can solve the so-called, "man, money, material, and information" issues inherent in the costs of healthcare. The POAS system synchronizes with each department system, from finance and accounting, to pharmacy, to imaging, and allows information exchange. We can manage Man, Material, Money and Information completely by this system. Our analysis has shown that this system has a remarkable investment effect - saving over four million dollars per year - through cost savings in logistics and business process efficiencies. In addition, the quality of care has been improved dramatically while error rates have been reduced - nearly to zero in some cases.

Use of failure mode effect analysis (FMEA) to improve medication management process.

PubMed

Jain, Khushboo

2017-03-13

Purpose Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety. Design/methodology/approach The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored. Findings The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes. Research limitations/implications FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing FMEA but also for implementing the corrective actions. Practical implications FMEA is an effective proactive risk-assessment tool and is a continuous process which can be continued in phases. The corrective actions taken resulted in reduction in RPN, subjected to further evaluation and usage by others depending on the facility type. Originality/value The application of the tool helped the hospital in identifying failures in medication management process, thereby prioritising and correcting them leading to improvement.

Content standards for medical image metadata

NASA Astrophysics Data System (ADS)

d'Ornellas, Marcos C.; da Rocha, Rafael P.

2003-12-01

Medical images are at the heart of the healthcare diagnostic procedures. They have provided not only a noninvasive mean to view anatomical cross-sections of internal organs but also a mean for physicians to evaluate the patient"s diagnosis and monitor the effects of the treatment. For a Medical Center, the emphasis may shift from the generation of image to post processing and data management since the medical staff may generate even more processed images and other data from the original image after various analyses and post processing. A medical image data repository for health care information system is becoming a critical need. This data repository would contain comprehensive patient records, including information such as clinical data and related diagnostic images, and post-processed images. Due to the large volume and complexity of the data as well as the diversified user access requirements, the implementation of the medical image archive system will be a complex and challenging task. This paper discusses content standards for medical image metadata. In addition it also focuses on the image metadata content evaluation and metadata quality management.

Preliminary data on ASP2215: tolerability and efficacy in acute myeloid leukemia patients.

PubMed

Thom, Claire

2015-09-01

Claire Thom speaks to Gemma Westcott, Commissioning Editor: Claire Thom joined Astellas in 2013 as the Therapeutic Area Head for Oncology in Global Development. In that role, she also serves as the STAR leader for Oncology for Astellas. Prior to Astellas, she spent 12 years with Takeda. Her last position was Senior Vice President, Portfolio Management, Drug Development Management and Medical Informatics and Strategic Operations within the Medical Division (the Division within Millennium responsible for oncology clinical drug development within Takeda). During her 4 years at Millennium, at various times, she had responsibility within the Medical Division for leading portfolio management, business operations (medical finance, annual and mid-range financial planning, space planning and operations, headcount resourcing, development goals process), clinical development operations (clinical operations, programming, data management, statistics, medical writing, clinical outsourcing), drug development management (project management), medical informatics (technology support for the division) and the strategic project management office for the division. Prior to joining Millennium, Claire Thom spent 18 months working in Osaka, Japan, during which she was responsible for developing the oncology strategy for Takeda that culminated in the acquisition of Millennium. Before going to Japan, she held positions of varying responsibility within the Takeda US development organization including the management of regulatory affairs, safety, biometrics and data management, clinical research and quality assurance. Claire Thom has particular expertise in organizational design and efficiency; she has successfully worked through integrations across multiple functions and redesigned business processes. She has a PharmD from University of Illinois (IL, USA) and over 20 years of pharmaceutical experience including positions in medical affairs and new product planning (over 11 years at Searle) and drug development (over 12 years at Takeda/Millennium).

[Definition and stabilization of processes I. Management processes and support in a Urology Department].

PubMed

Pascual, Carlos; Luján, Marcos; Mora, José Ramón; Chiva, Vicente; Gamarra, Manuela

2015-01-01

The implantation of total quality management models in clinical departments can better adapt to the 2009 ISO 9004 model. An essential part of implantation of these models is the establishment of processes and their stabilization. There are four types of processes: key, management, support and operative (clinical). Management processes have four parts: process stabilization form, process procedures form, medical activities cost estimation form and, process flow chart. In this paper we will detail the creation of an essential process in a surgical department, such as the process of management of the surgery waiting list.

Medical waste management plan.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lane, Todd W.; VanderNoot, Victoria A.

2004-12-01

This plan describes the process for managing research generated medical waste at Sandia National Laboratories/California. It applies to operations at the Chemical and Radiation Detection Laboratory (CRDL), Building 968, and other biosafety level 1 or 2 activities at the site. It addresses the accumulation, storage, treatment and disposal of medical waste and sharps waste. It also describes the procedures to comply with regulatory requirements and SNL policies applicable to medical waste.

Managerial process improvement: a lean approach to eliminating medication delivery.

PubMed

Hussain, Aftab; Stewart, LaShonda M; Rivers, Patrick A; Munchus, George

2015-01-01

Statistical evidence shows that medication errors are a major cause of injuries that concerns all health care oganizations. Despite all the efforts to improve the quality of care, the lack of understanding and inability of management to design a robust system that will strategically target those factors is a major cause of distress. The paper aims to discuss these issues. Achieving optimum organizational performance requires two key variables; work process factors and human performance factors. The approach is that healthcare administrators must take in account both variables in designing a strategy to reduce medication errors. However, strategies that will combat such phenomena require that managers and administrators understand the key factors that are causing medication delivery errors. The authors recommend that healthcare organizations implement the Toyota Production System (TPS) combined with human performance improvement (HPI) methodologies to eliminate medication delivery errors in hospitals. Despite all the efforts to improve the quality of care, there continues to be a lack of understanding and the ability of management to design a robust system that will strategically target those factors associated with medication errors. This paper proposes a solution to an ambiguous workflow process using the TPS combined with the HPI system.

The association between quality of care and the intensity of diabetes disease management programs.

PubMed

Mangione, Carol M; Gerzoff, Robert B; Williamson, David F; Steers, W Neil; Kerr, Eve A; Brown, Arleen F; Waitzfelder, Beth E; Marrero, David G; Dudley, R Adams; Kim, Catherine; Herman, William; Thompson, Theodore J; Safford, Monika M; Selby, Joe V

2006-07-18

Although disease management programs are widely implemented, little is known about their effectiveness. To determine whether disease management by physician groups is associated with diabetes care processes, control of intermediate outcomes, or the amount of medication used when intermediate outcomes are above target levels. Cross-sectional study. Patients were randomly sampled from 63 physician groups nested in 7 health plans sponsored by Translating Research into Action for Diabetes (87%) and from 4 health plans with individual physician contracts (13%). 8661 adults with diabetes who completed a survey (2000-2001) and had medical record data. Physician group and health plan directors described their organizations' use of physician reminders, performance feedback, and structured care management on a survey; their responses were used to determine measures of intensity of disease management. The current study measured 8 processes of care, including most recent hemoglobin A1c level, systolic blood pressure, serum low-density lipoprotein cholesterol level, and several measures of medication use. Increased use of any of 3 disease management strategies was significantly associated with higher adjusted rates of retinal screening, nephropathy screening, foot examinations, and measurement of hemoglobin A1c levels. Serum lipid level testing and influenza vaccine administration were associated with greater use of structured care management and performance feedback. Greater use of performance feedback correlated with an increased rate of foot examinations (difference, 5 percentage points [95% CI, 1 to 8 percentage points]), and greater use of physician reminders was associated with an increased rate of nephropathy screening (difference, 15 percentage points [CI, 6 to 23 percentage points]). No strategies were associated with intermediate outcome levels or level of medication management. Physician groups were not randomly sampled from population-based listings, and disease management strategies were not randomly allocated across groups. Disease management strategies were associated with better processes of diabetes care but not with improved intermediate outcomes or level of medication management. A greater focus on direct measurement, feedback, and reporting of intermediate outcome levels or of level of medication management may enhance the effectiveness of these programs.

Case management: a case study.

PubMed

Stanton, M P; Walizer, E M; Graham, J I; Keppel, L

2000-01-01

This article describes the implementation of a pilot case management program at Walter Reed Army Medical Center. I, it we discuss obvious pitfalls and problems implementing case management in a large multiservice center and the steps and processes implemented to expedite and move case management forward in its early stages. The insights shared may be useful for those implementing case management in a complex medical center situation. Other models used in similar situations are also reviewed.

Shared decision making and medication management in the recovery process.

PubMed

Deegan, Patricia E; Drake, Robert E

2006-11-01

Mental health professionals commonly conceptualize medication management for people with severe mental illness in terms of strategies to increase compliance or adherence. The authors argue that compliance is an inadequate construct because it fails to capture the dynamic complexity of autonomous clients who must navigate decisional conflicts in learning to manage disorders over the course of years or decades. Compliance is rooted in medical paternalism and is at odds with principles of person-centered care and evidence-based medicine. Using medication is an active process that involves complex decision making and a chance to work through decisional conflicts. It requires a partnership between two experts: the client and the practitioner. Shared decision making provides a model for them to assess a treatment's advantages and disadvantages within the context of recovering a life after a diagnosis of a major mental disorder.

A patient workflow management system built on guidelines.

PubMed Central

Dazzi, L.; Fassino, C.; Saracco, R.; Quaglini, S.; Stefanelli, M.

1997-01-01

To provide high quality, shared, and distributed medical care, clinical and organizational issues need to be integrated. This work describes a methodology for developing a Patient Workflow Management System, based on a detailed model of both the medical work process and the organizational structure. We assume that the medical work process is represented through clinical practice guidelines, and that an ontological description of the organization is available. Thus, we developed tools 1) for acquiring the medical knowledge contained into a guideline, 2) to translate the derived formalized guideline into a computational formalism, precisely a Petri Net, 3) to maintain different representation levels. The high level representation guarantees that the Patient Workflow follows the guideline prescriptions, while the low level takes into account the specific organization characteristics and allow allocating resources for managing a specific patient in daily practice. PMID:9357606

Flexible medical image management using service-oriented architecture.

PubMed

Shaham, Oded; Melament, Alex; Barak-Corren, Yuval; Kostirev, Igor; Shmueli, Noam; Peres, Yardena

2012-01-01

Management of medical images increasingly involves the need for integration with a variety of information systems. To address this need, we developed Content Management Offering (CMO), a platform for medical image management supporting interoperability through compliance with standards. CMO is based on the principles of service-oriented architecture, implemented with emphasis on three areas: clarity of business process definition, consolidation of service configuration management, and system scalability. Owing to the flexibility of this platform, a small team is able to accommodate requirements of customers varying in scale and in business needs. We describe two deployments of CMO, highlighting the platform's value to customers. CMO represents a flexible approach to medical image management, which can be applied to a variety of information technology challenges in healthcare and life sciences organizations.

[Structured medication management in primary care - a tool to promote medication safety].

PubMed

Mahler, Cornelia; Freund, Tobias; Baldauf, Annika; Jank, Susanne; Ludt, Sabine; Peters-Klimm, Frank; Haefeli, Walter Emil; Szecsenyi, Joachim

2014-01-01

Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to check what medicines have been prescribed and what medicines are actually taken by the patient or the structured evaluation of drug-related problems rarely take place in Germany. The process of "medication reconciliation" or "medication review" as developed in the USA and the UK aim at increasing medication safety and therefore represent an instrument of quality assurance. Within the HeiCare(®) project a structured medication management was developed for general practice, with medical assistants playing a major role in the implementation of the process. Both the structured medication management and the tools developed for the medication check and medication counselling will be outlined in this article; also, findings on feasibility and acceptance in various projects and experiences from a total of 200 general practices (56 HeiCare(®), 29 HiCMan,115 PraCMan) will be described. The results were obtained from questionnaires and focus group discussions. The implementation of a structured medication management intervention into daily routine was seen as a challenge. Due to the high relevance of medication reconciliation for daily clinical practice, however, the checklists - once implemented successfully - have been applied even after the end of the project. They have led to the regular review and reconciliation of the physicians' documentation of the medicines prescribed (medication chart) with the medicines actually taken by the patient. Copyright © 2013. Published by Elsevier GmbH.

Processing of intended and unintended strategic issues and integration into the strategic agenda.

PubMed

Ridder, Hans-Gerd; Schrader, Jan Simon

2017-11-01

Strategic change is needed in hospitals due to external and internal pressures. However, research on strategic change, as a combination of management and medical expertise in hospitals, remains scarce. We analyze how intended strategic issues are processed into deliberate strategies and how unintended strategic issues are processed into emergent strategies in the management of strategy formation in hospitals. This study empirically investigates the integration of medical and management expertise in strategy formation. The longitudinal character of the case study enabled us to track patterns of intended and unintended strategic issues over 2 years. We triangulated data from interviews, observations, and documents. In accordance with the quality standards of qualitative research procedures, we analyzed the data by pattern matching and provided analytical generalization regarding strategy formation in hospitals. Our findings suggest that strategic issues are particularly successful within the strategy formation process if interest groups are concerned with the strategic issue, prospective profits are estimated, and relevant decisions makers are involved early on. Structure and interaction processes require clear criteria and transparent procedures for effective strategy formation. There is systematic neglect of medical expertise in processes of generating strategies. Our study reveals that the decentralized structure of medical centers is an adequate template for both the operationalization of intended strategic issues and the development of unintended strategic issues. However, tasks, roles, responsibility, resources, and administrative support are necessary for effective management of strategy formation. Similarly, criteria, procedures, and decision-making are prerequisites for effective strategy formation.

Antecedents of the People and Organizational Aspects of Medical Informatics

PubMed Central

Lorenzi, Nancy M.; Riley, Robert T.; Blyth, Andrew J. C.; Southon, Gray; Dixon, Bradley J.

1997-01-01

Abstract People and organizational issues are critical in both implementing medical informatics systems and in dealing with the altered organizations that new systems often create. The people and organizational issues area—like medical informatics itself—is a blend of many disciplines. The academic disciplines of psychology, sociology, social psychology, social anthropology, organizational behavior and organizational development, management, and cognitive sciences are rich with research with significant potential to ease the introduction and on-going use of information technology in today's complex health systems. These academic areas contribute research data and core information for better understanding of such issues as the importance of and processes for creating future direction; managing a complex change process; effective strategies for involving individuals and groups in the informatics effort; and effectively managing the altered organization. This article reviews the behavioral and business referent disciplines that can potentially contribute to improved implementations and on-going management of change in the medical informatics arena. PMID:9067874

Risk management in medical product development process using traditional FMEA and fuzzy linguistic approach: a case study

NASA Astrophysics Data System (ADS)

Kirkire, Milind Shrikant; Rane, Santosh B.; Jadhav, Jagdish Rajaram

2015-12-01

Medical product development (MPD) process is highly multidisciplinary in nature, which increases the complexity and the associated risks. Managing the risks during MPD process is very crucial. The objective of this research is to explore risks during MPD in a dental product manufacturing company and propose a model for risk mitigation during MPD process to minimize failure events. A case study approach is employed. The existing MPD process is mapped with five phases of the customized phase gate process. The activities during each phase of development and risks associated with each activity are identified and categorized based on the source of occurrence. The risks are analyzed using traditional Failure mode and effect analysis (FMEA) and fuzzy FMEA. The results of two methods when compared show that fuzzy approach avoids the duplication of RPNs and helps more to convert cognition of experts into information to get values of risk factors. The critical, moderate, low level and negligible risks are identified based on criticality; risk treatments and mitigation model are proposed. During initial phases of MPD, the risks are less severe, but as the process progresses the severity of risks goes on increasing. The MPD process should be critically designed and simulated to minimize the number of risk events and their severity. To successfully develop the products/devices within the manufacturing companies, the process risk management is very essential. A systematic approach to manage risks during MPD process will lead to the development of medical products with expected quality and reliability. This is the first research of its kind having focus on MPD process risks and its management. The methodology adopted in this paper will help the developers, managers and researchers to have a competitive edge over the other companies by managing the risks during the development process.

A new leadership role for pharmacists: a prescription for change.

PubMed

Burgess, L Hayley; Cohen, Michael R; Denham, Charles R

2010-03-01

Pharmacists can play an important role as leaders to reduce patient safety risks, optimize the safe function of medication management systems, and align pharmacy services with national initiatives that measure and reward quality performance. The objective of this article is to determine the actions that pharmacists can take to create a visible and sustainable safe medication management structure and system in the health care environment. An evidence-based literature search was performed to determine what actions successful pharmacist leaders have taken to improve patient safety. There is a growing number of quality and patient safety standards, as well as measures that focus specifically on medication use and education. Health care organizations must be made aware of the valuable resources that pharmacists provide and of the complexity of medication management. There are steps that pharmacist leaders can take to achieve these goals. The 10 steps that pharmacist leaders can take to create a visible and sustainable safe medication management structure and system are the following: 1. Identify and mitigate medication management risks and hazards to reduce preventable patient harm. 2. Establish pharmacy leadership structures and systems to ensure organizational awareness of medication safety gaps. 3. Support an organizational culture of safe medication use. 4. Ensure evidence-based medication regimens for all patients. 5. Have daily check-in calls/meetings, with the primary focus on significant safety or quality issues. 6. Establish a medication safety committee. 7. Perform medication safety walk-rounds to evaluate medication processes, and request front-line staff ’s input about medication safe practices. 8. Ensure that pharmacy staff engage in teamwork, skill building, and communication training. 9. Engage in readiness planning for implementation of health information technology (HIT). 10. Include medication history-taking and reviews upon entry into the organization; medication counseling and training during the discharge process; and follow-up after the transition to home.

Designing an architectural style for dynamic medical Cross-Organizational Workflow management system: an approach based on agents and web services.

PubMed

Bouzguenda, Lotfi; Turki, Manel

2014-04-01

This paper shows how the combined use of agent and web services technologies can help to design an architectural style for dynamic medical Cross-Organizational Workflow (COW) management system. Medical COW aims at supporting the collaboration between several autonomous and possibly heterogeneous medical processes, distributed over different organizations (Hospitals, Clinic or laboratories). Dynamic medical COW refers to occasional cooperation between these health organizations, free of structural constraints, where the medical partners involved and their number are not pre-defined. More precisely, this paper proposes a new architecture style based on agents and web services technologies to deal with two key coordination issues of dynamic COW: medical partners finding and negotiation between them. It also proposes how the proposed architecture for dynamic medical COW management system can connect to a multi-agent system coupling the Clinical Decision Support System (CDSS) with Computerized Prescriber Order Entry (CPOE). The idea is to assist the health professionals such as doctors, nurses and pharmacists with decision making tasks, as determining diagnosis or patient data analysis without stopping their clinical processes in order to act in a coherent way and to give care to the patient.

Pharmacists' guide to the management of organ donors after brain death.

PubMed

Korte, Catherine; Garber, Jennifer L; Descourouez, Jillian L; Richards, Katelyn R; Hardinger, Karen

2016-11-15

This article reviews organ donor pathophysiology as it relates to medication use with the goal of maximizing the successful procurement and transplantation of donor organs. The number of patients requiring organ transplantation continues to grow, yet organ donation rates remain flat, making it critical to appropriately manage each organ donor in order to ensure viability of all transplantable organs. The care given to one organ donor is tantamount to the care of several transplant recipients. Aggressive donor management ensures that the largest number of organs can be successfully procured and improves the organs' overall quality. Hospital pharmacists are responsible for processing orders and preparing the medications outlined in donor management algorithms developed by their respective medical systems. It is important that pharmacists understand the details of the medications used in these protocols in order to critically evaluate each medication order and appropriately manage the donor. Typical medications used in organ donors after brain death include medications for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. It is essential to provide optimal pharmacotherapy for each organ donor to ensure organ recovery and donation. Typical medications used in organ donors include agents for blood pressure management and fluid resuscitation, medications necessary for electrolyte management, blood products, vasopressors, hormone replacement therapy, antiinfectives, anticoagulants, paralytics, and organ preservation solutions. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Equine recurrent uveitis: new methods of management.

PubMed

Gilger, Brian C; Michau, Tammy Miller

2004-08-01

Equine recurrent uveitis (ERU) is one of the most common causes of blindness in horses. Until recently, treatment of this condition consisted only of symptomatic therapy, typically with steroidal and nonsteroidal medications. A better understanding of the disease process(es) has permitted new medical and surgical therapies that have recently been described. This article highlights clinical features of ERU, the causes of ERU, and new management and treatment options for horses with ERU.

Medical-School Partnership in Guiding Return to School Following Mild Traumatic Brain Injury in Youth

PubMed Central

Gioia, Gerard A.

2015-01-01

Mild traumatic brain injury (mTBI) is recognized as a prevalent and significant risk concern for youth. Appropriate school return is particularly challenging. The medical and school systems must be prepared partners to support the school return of the student with mTBI. Medical providers must be trained in assessment and management skills with a focused understanding of school demands. Schools must develop policies and procedures to prepare staff to support a gradual return process with the necessary academic accommodations. Ongoing communication between the family, student, school, and medical provider is essential to supporting recovery. A systematic gradual return to school process is proposed including levels of recommended activity and criteria for advancement. Targets for intervention are described with associated strategies for supporting recovery. A ten element PACE model for activity-exertion management is introduced to manage symptom exacerbation. A strong medical-school partnership will maximize outcomes for students with mTBI. PMID:25535055

Construction and Application of a Refined Hospital Management Chain.

PubMed

Lihua, Yi

2016-01-01

Large scale development was quite common in the later period of hospital industrialization in China. Today, Chinese hospital management faces such problems as service inefficiency, high human resources cost, and low rate of capital use. This study analyzes the refined management chain of Wuxi No.2 People's Hospital. This consists of six gears namely, "organizational structure, clinical practice, outpatient service, medical technology, and nursing care and logistics." The gears are based on "flat management system targets, chief of medical staff, centralized outpatient service, intensified medical examinations, vertical nursing management and socialized logistics." The core concepts of refined hospital management are optimizing flow process, reducing waste, improving efficiency, saving costs, and taking good care of patients as most important. Keywords: Hospital, Refined, Management chain

Web-based healthcare hand drawing management system.

PubMed

Hsieh, Sheau-Ling; Weng, Yung-Ching; Chen, Chi-Huang; Hsu, Kai-Ping; Lin, Jeng-Wei; Lai, Feipei

2010-01-01

The paper addresses Medical Hand Drawing Management System architecture and implementation. In the system, we developed four modules: hand drawing management module; patient medical records query module; hand drawing editing and upload module; hand drawing query module. The system adapts windows-based applications and encompasses web pages by ASP.NET hosting mechanism under web services platforms. The hand drawings implemented as files are stored in a FTP server. The file names with associated data, e.g. patient identification, drawing physician, access rights, etc. are reposited in a database. The modules can be conveniently embedded, integrated into any system. Therefore, the system possesses the hand drawing features to support daily medical operations, effectively improve healthcare qualities as well. Moreover, the system includes the printing capability to achieve a complete, computerized medical document process. In summary, the system allows web-based applications to facilitate the graphic processes for healthcare operations.

[Quality assurance of hospital medical records as a risk management tool].

PubMed

Terranova, Giuseppina; Cortesi, Elisabetta; Briani, Silvia; Giannini, Raffaella

2006-01-01

A retrospective analysis of hospital medical records was performed jointly by the Medicolegal department of the Pistoia Local Health Unit N. 3 and by the management of the SS. Cosma and Damiano di Pescia Hospital. Evaluation was based on ANDEM criteria, JCAHO standards, and the 1992 discharge abstract guidelines of the Italian Health Ministry. In the first phase of the study, data were collected and processed for each hospital ward and then discussed with clinicians and audited. After auditing, appropriate actions were agreed upon for correcting identified problems. Approximately one year later a second smaller sample of medical records was evaluated and a higher compliance rate with the established corrective actions was found in all wards for all data categories. In this study the evaluation of medical records can be considered in the wider context of risk management, a multidisciplinary process directed towards identifying and monitoring risk through the use of appropriate quality indicators.

Managing chronic illness: physician practices increased the use of care management and medical home processes.

PubMed

Wiley, James A; Rittenhouse, Diane R; Shortell, Stephen M; Casalino, Lawrence P; Ramsay, Patricia P; Bibi, Salma; Ryan, Andrew M; Copeland, Kennon R; Alexander, Jeffrey A

2015-01-01

The effective management of patients with chronic illnesses is critical to bending the curve of health care spending in the United States and is a crucial test for health care reform. In this article we used data from three national surveys of physician practices between 2006 and 2013 to determine the extent to which practices of all sizes have increased their use of evidence-based care management processes associated with patient-centered medical homes for patients with asthma, congestive heart failure, depression, and diabetes. We found relatively large increases over time in the overall use of these processes for small and medium-size practices as well as for large practices. However, the large practices used fewer than half of the recommended processes, on average. We also identified the individual processes whose use increased the most and show that greater use of care management processes is positively associated with public reporting of patient experience and clinical quality and with pay-for-performance. Project HOPE—The People-to-People Health Foundation, Inc.

Quality assurance in military medical research and medical radiation accident management.

PubMed

Hotz, Mark E; Meineke, Viktor

2012-08-01

The provision of quality radiation-related medical diagnostic and therapeutic treatments cannot occur without the presence of robust quality assurance and standardization programs. Medical laboratory services are essential in patient treatment and must be able to meet the needs of all patients and the clinical personnel responsible for the medical care of these patients. Clinical personnel involved in patient care must embody the quality assurance process in daily work to ensure program sustainability. In conformance with the German Federal Government's concept for modern departmental research, the international standard ISO 9001, one of the relevant standards of the International Organization for Standardization (ISO), is applied in quality assurance in military medical research. By its holistic approach, this internationally accepted standard provides an excellent basis for establishing a modern quality management system in line with international standards. Furthermore, this standard can serve as a sound basis for the further development of an already established quality management system when additional standards shall apply, as for instance in reference laboratories or medical laboratories. Besides quality assurance, a military medical facility must manage additional risk events in the context of early recognition/detection of health risks of military personnel on deployment in order to be able to take appropriate preventive and protective measures; for instance, with medical radiation accident management. The international standard ISO 31000:2009 can serve as a guideline for establishing risk management. Clear organizational structures and defined work processes are required when individual laboratory units seek accreditation according to specific laboratory standards. Furthermore, international efforts to develop health laboratory standards must be reinforced that support sustainable quality assurance, as in the exchange and comparison of test results within the scope of external quality assurance, but also in the exchange of special diagnosis data among international research networks. In summary, the acknowledged standard for a quality management system to ensure quality assurance is the very generic standard ISO 9001.Health Phys. 103(2):221-225; 2012.

Pharmacist-managed inpatient discharge medication reconciliation: a combined onsite and telepharmacy model.

PubMed

Keeys, Christopher; Kalejaiye, Bamidele; Skinner, Michelle; Eimen, Mandana; Neufer, Joann; Sidbury, Gisele; Buster, Norman; Vincent, Joan

2014-12-15

The development, implementation, and pilot testing of a discharge medication reconciliation service managed by pharmacists with offsite telepharmacy support are described. Hospitals' efforts to prepare legible, complete, and accurate medication lists to patients prior to discharge continue to be complicated by staffing and time constraints and suboptimal information technology. To address these challenges, the pharmacy department at a 324-bed community hospital initiated a quality-improvement project to optimize patients' discharge medication lists while addressing problems that often resulted in confusing, incomplete, or inaccurate lists. A subcommittee of the hospital's pharmacy and therapeutics committee led the development of a revised medication reconciliation process designed to streamline and improve the accuracy and utility of discharge medication documents, with subsequent implementation of a new service model encompassing both onsite and remote pharmacists. The new process and service were evaluated on selected patient care units in a 19-month pilot project requiring collaboration by physicians, nurses, case managers, pharmacists, and an outpatient prescription drug database vendor. During the pilot testing period, 6402 comprehensive reconciled discharge medication lists were prepared; 634 documented discrepancies or medication errors were detected. The majority of identified problems were in three categories: unreconciled medication orders (31%), order clarification (25%), and duplicate orders (12%). The most problematic medications were the opioids, cardiovascular agents, and anticoagulants. A pharmacist-managed medication reconciliation service including onsite pharmacists and telepharmacy support was successful in improving the final discharge lists and documentation received by patients. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Reform of the Method for Evaluating the Teaching of Medical Linguistics to Medical Students

ERIC Educational Resources Information Center

Zhang, Hongkui; Wang, Bo; Zhang, Longlu

2014-01-01

Explorating reform of the teaching evaluation method for vocational competency-based education (CBE) curricula for medical students is a very important process in following international medical education standards, intensify ing education and teaching reforms, enhancing teaching management, and improving the quality of medical education. This…

PASTE: patient-centered SMS text tagging in a medication management system.

PubMed

Stenner, Shane P; Johnson, Kevin B; Denny, Joshua C

2012-01-01

To evaluate the performance of a system that extracts medication information and administration-related actions from patient short message service (SMS) messages. Mobile technologies provide a platform for electronic patient-centered medication management. MyMediHealth (MMH) is a medication management system that includes a medication scheduler, a medication administration record, and a reminder engine that sends text messages to cell phones. The object of this work was to extend MMH to allow two-way interaction using mobile phone-based SMS technology. Unprompted text-message communication with patients using natural language could engage patients in their healthcare, but presents unique natural language processing challenges. The authors developed a new functional component of MMH, the Patient-centered Automated SMS Tagging Engine (PASTE). The PASTE web service uses natural language processing methods, custom lexicons, and existing knowledge sources to extract and tag medication information from patient text messages. A pilot evaluation of PASTE was completed using 130 medication messages anonymously submitted by 16 volunteers via a website. System output was compared with manually tagged messages. Verified medication names, medication terms, and action terms reached high F-measures of 91.3%, 94.7%, and 90.4%, respectively. The overall medication name F-measure was 79.8%, and the medication action term F-measure was 90%. Other studies have demonstrated systems that successfully extract medication information from clinical documents using semantic tagging, regular expression-based approaches, or a combination of both approaches. This evaluation demonstrates the feasibility of extracting medication information from patient-generated medication messages.

An accountable fistula management treatment plan.

PubMed

Thompson, Mary Jo; Epanomeritakis, Emanuel

An accountable fistula management treatment plan focuses on combining effective medical and nursing treatment with effective and efficient pouching technique and equipment to ensure patient comfort. Small bowel fistula following abdominal surgery can provide challenges in patients' medical and nursing management. This article describes a case study of the successful medical and nursing management of a patient post-abdominal surgery. Within days of surgery a small bowel fistula formed within an abdominal wound. Medical management involved the use of total parenteral nutrition, electrolyte balance management, nil orally and Sandostatin medication. The nursing interventions comprised accurate intake and output measurement, effective and efficient pouching systems and appropriate psychological care. The medical and nursing interventions provided during the healing process are outlined together with the assessment and evaluation of a new innovative wound management pouch. This system proved invaluable in the successful containment of a high small bowel effluent and skin preservation. In an attempt to share best practice a pictorial guide is provided to demonstrate the correct application of the pouching system and technique. This article provides details of an accountable fistula management treatment plan which resulted in the successful spontaneous closure of the small bowel fistula coupled with excellent cost-effectiveness and patient comfort.

[Medical safety management in the setting of a clinical reference laboratory--risk management efforts in clinical testing].

PubMed

Seki, Akira; Miya, Tetsumasa

2011-03-01

As a result of recurring medical accidents, risk management in the medical setting has been given much attention. The announcement in August, 2000 by the Ministry of Health committee for formulating a standard manual for risk management, of a "Risk management manual formulation guideline" has since been accompanied by the efforts of numerous medical testing facilities to develop such documents. In 2008, ISO/TS 22367:2008 on "Medical laboratories-Reduction of error through risk management and continual improvement" was published. However, at present, risk management within a medical testing facility stresses the implementation of provisional actions in response to a problem after it has occurred. Risk management is basically a planned process and includes "corrective actions" as well as "preventive actions." A corrective action is defined as identifying the root cause of the problem and removing it, and is conducted to prevent the problem from recurring. A preventive action is defined as identifying of the any potential problem and removing it, and is conducted to prevent a problem before it occurs. Presently, I shall report on the experiences of our laboratory regarding corrective and preventive actions taken in response to accidents and incidents, respectively.

Analysis of Closed Claims in the Clinical Management of Rheumatoid Arthritis in Japan

PubMed Central

Otaki, Yasuhiro; Ishida, Makiko DaSilva; Saito, Yuichi; Oyama, Yasuaki; Oiso, Giichiro; Moriyama, Mitsuru

2017-01-01

Background: Despite an increasing awareness of the risk of medical errors, few data sources are available to highlight the characteristics and patterns of medical errors in the clinical management of rheumatoid arthritis (RA). The present study aimed to evaluate medical malpractice claims associated with the management of RA and other autoimmune connective tissue diseases (ACTDs). Methods: We analyzed 38 ACTD-associated closed claims extracted from a total of 8530 claims processed between July 2004 and June 2014 by the Tokyo headquarters office of Sompo Japan Nipponkoa Incorporated, a leading malpractice insurer in Japan. Results: RA was the most common ACTD assessed in this study, accounting for 20 cases. Although the male-to-female ratio among these cases was 5:15, in accordance with the general demographic distribution of RA, the proportion of patients older than 60 years (77.8%) was relatively high as the general range of RA susceptibility is 30–50 years. The analysis of allegation types among RA cases revealed statistically significant differences from non-RA cases (Fisher's exact test) as well as the following key findings: diagnosis-related allegations were absent (P < 0.01), whereas medication-related allegations were distinctively common (P = 0.02). Clinical processes related to the assessment process were most vulnerable to breakdown and leading to negligence identified with subsequent medication-related allegations, particularly among RA cases. Conclusions: The characteristics of malpractice claims associated with RA management, including the high frequency of medication-related allegations, breakdowns in the assessment process, and high claim numbers among patients older than 60 years, suggest the importance of caution exercised by physicians when administering immunosuppressants for the clinical treatment of RA. PMID:28584209

Medical care of type 2 diabetes in German disease management programmes: a population-based evaluation.

PubMed

Stark, Reneé G; Schunk, Michaela V; Meisinger, Christine; Rathmann, Wolfgang; Leidl, Reiner; Holle, Rolf

2011-05-01

Type 2 diabetes disease management programmes (DDMPs) are offered by German social health insurance to promote healthcare consistent with evidence-based medical guidelines. The aim of this study was to compare healthcare quality and medical endpoints between diabetes management programme participants and patients receiving usual care designated as controls. All patients with type 2 diabetes (age range: 36-81) in a cross-sectional survey of a cohort study, performed by the Cooperative Health Research in the Region of Augsburg, received a self-administered questionnaire regarding their diabetes care. Physical examination and laboratory tests were also performed. The analysis only included patients with social health insurance and whose participation status in a diabetes disease management program was validated by the primary physician (n = 166). Regression analyses, adjusting for age, sex, education, diabetes duration, baseline waist circumference and clustering regarding primary physician were conducted. Evaluation of healthcare processes showed that those in diabetes disease management programmes (n = 89) reported medical examination of eyes and feet and medical advice regarding diet [odds ratio (OR): 2.39] and physical activity (OR: 2.87) more frequently, received anti-diabetic medications (OR: 3.77) and diabetes education more often (OR: 2.66) than controls. Both groups had satisfactory HbA(1c) control but poor low-density lipoprotein cholesterol control. Blood pressure goals (<140/90 mmHg) were achieved more frequently by patients in diabetes disease management programmes (OR: 2.21). German diabetes disease management programmes are associated with improved healthcare processes and blood pressure control. Low-density lipoprotein cholesterol control must be improved for all patients with diabetes. Further research will be required to assess the long-term effects of this diabetes disease management programme. Copyright © 2011 John Wiley & Sons, Ltd.

How to convince your manager to invest in an HIS preimplementation methodology for appraisal of material, process and human costs and benefits.

PubMed Central

Bossard, B.; Renard, J. M.; Capelle, P.; Paradis, P.; Beuscart, M. C.

2000-01-01

Investing in information technology has become a crucial process in hospital management today. Medical and administrative managers are faced with difficulties in measuring medical information technology costs and benefits due to the complexity of the domain. This paper proposes a preimplementation methodology for evaluating and appraising material, process and human costs and benefits. Based on the users needs and organizational process analysis, the methodology provides an evaluative set of financial and non financial indicators which can be integrated in a decision making and investment evaluation process. We describe the first results obtained after a few months of operation for the Computer-Based Patient Record (CPR) project. Its full acceptance, in spite of some difficulties, encourages us to diffuse the method for the entire project. PMID:11079851

From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care.

PubMed

Wilf-Miron, R; Lewenhoff, I; Benyamini, Z; Aviram, A

2003-02-01

The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1). errors inevitably occur and usually derive from faulty system design, not from negligence; (2). accident prevention should be an ongoing process based on open and full reporting; (3). major accidents are only the "tip of the iceberg" of processes that indicate possibilities for organisational learning. Reporting physicians were granted immunity, which encouraged open reporting of errors. A telephone "hotline" served the medical staff for direct reporting and receipt of emotional support and medical guidance. Any adverse event which had learning potential was debriefed, while focusing on the human cause of error within a systemic context. Specific recommendations were formulated to rectify processes conducive to error when failures were identified. During the first 5 years of implementation, the aviation safety concept and tools were successfully adapted to ambulatory care, fostering a culture of greater concern for patient safety through risk management while providing support to the medical staff.

From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care

PubMed Central

Wilf-Miron, R; Lewenhoff, I; Benyamini, Z; Aviram, A

2003-01-01



 The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1) errors inevitably occur and usually derive from faulty system design, not from negligence; (2) accident prevention should be an ongoing process based on open and full reporting; (3) major accidents are only the "tip of the iceberg" of processes that indicate possibilities for organisational learning. Reporting physicians were granted immunity, which encouraged open reporting of errors. A telephone "hotline" served the medical staff for direct reporting and receipt of emotional support and medical guidance. Any adverse event which had learning potential was debriefed, while focusing on the human cause of error within a systemic context. Specific recommendations were formulated to rectify processes conducive to error when failures were identified. During the first 5 years of implementation, the aviation safety concept and tools were successfully adapted to ambulatory care, fostering a culture of greater concern for patient safety through risk management while providing support to the medical staff. PMID:12571343

[Independent medical processing enterprises as innovative organizational model for market of medical services].

PubMed

Shevchenko, Iu L; Matveev, S A; Makhnev, D A; Korsun, K Iu

2006-01-01

In Russia, current stage of health care development is characterized by occurrence of various problems. Most of them are related to cooperation between participators of market of medical services. Different options are proposed to resolve cooperation problems embedded into medical services market with emphasis on development of ultimately different medical processing enterprise with brand-new organizational and functional structure. Its functioning is based on process management logistics. The company broad professional experience allows to implement above-mentioned managerial structure and make it function as well as claims positive perspectives of described option.

Medical Big Data Warehouse: Architecture and System Design, a Case Study: Improving Healthcare Resources Distribution.

PubMed

Sebaa, Abderrazak; Chikh, Fatima; Nouicer, Amina; Tari, AbdelKamel

2018-02-19

The huge increases in medical devices and clinical applications which generate enormous data have raised a big issue in managing, processing, and mining this massive amount of data. Indeed, traditional data warehousing frameworks can not be effective when managing the volume, variety, and velocity of current medical applications. As a result, several data warehouses face many issues over medical data and many challenges need to be addressed. New solutions have emerged and Hadoop is one of the best examples, it can be used to process these streams of medical data. However, without an efficient system design and architecture, these performances will not be significant and valuable for medical managers. In this paper, we provide a short review of the literature about research issues of traditional data warehouses and we present some important Hadoop-based data warehouses. In addition, a Hadoop-based architecture and a conceptual data model for designing medical Big Data warehouse are given. In our case study, we provide implementation detail of big data warehouse based on the proposed architecture and data model in the Apache Hadoop platform to ensure an optimal allocation of health resources.

Implementation of an integrated pharmacy supply management strategy.

PubMed

Amerine, Lindsey B; Calvert, Daniel R; Pappas, Ashley L; Lee, Sarah M; Valgus, John M; Savage, Scott W

2017-12-15

Implementation of an integrated pharmacy supply management strategy is described. In 2011, the formulary approval process and supply management for oncology medications were independent of each other at an oncology infusion center. Numerous nonformulary medications were kept on hand and reordered based on inventory levels that were established with inadequate usage information, while some formulary agents did not have on-hand inventory levels and had to be reordered on a patient-specific basis, which required paperwork and then a review by drug information staff per institutional policy. Because there was no true distinction in the ordering of formulary versus nonformulary oncology agents, the medical staff prescribed both in the same manner, leaving the pharmacy staff responsible for ensuring that enough quantities were on hand for many drugs, regardless of formulary status. Using supply chain management principles, a formal analysis of the on-hand inventory was performed. In addition, the formulary process for oncology drugs was restructured to align with how oncology drugs are managed for on-hand inventory levels. The alignment of these processes allowed the operation to have 1 supply strategy for the ambulatory oncology infusion center. As a result, inventory exhaustion rates were reduced by 70% and inventory turn rates improved by 78%. There was also significant time savings in the operational process streamlining, eliminating the rework and inefficiencies caused by an unclear process that was not fully captured in this assessment. Alignment of the formulary review process with inventory analyses that support supply management principles reduced inventory exhaustion while improving inventory turn rates. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Knowledge Management within the Medical University.

PubMed

Rauzina, Svetlana Ye; Tikhonova, Tatiana A; Karpenko, Dmitriy S; Bogopolskiy, Gennady A; Zarubina, Tatiana V

2015-01-01

The aim of the work is studying the possibilities of ontological engineering in managing of medical knowledge. And also practical implementation of knowledge management system (KMS) in medical university. The educational process model is established that allows analyzing learning results within time scale. Glossary sub-system has been developed; ontologies of educational disciplines are constructed; environment for setup and solution of situational cases is established; ontological approach to assess competencies is developed. The possibilities of the system for solving situation tasks have been described. The approach to the evaluation of competence has been developed.

Supporting diagnosis and treatment in medical care based on Big Data processing.

PubMed

Lupşe, Oana-Sorina; Crişan-Vida, Mihaela; Stoicu-Tivadar, Lăcrămioara; Bernard, Elena

2014-01-01

With information and data in all domains growing every day, it is difficult to manage and extract useful knowledge for specific situations. This paper presents an integrated system architecture to support the activity in the Ob-Gin departments with further developments in using new technology to manage Big Data processing - using Google BigQuery - in the medical domain. The data collected and processed with Google BigQuery results from different sources: two Obstetrics & Gynaecology Departments, the TreatSuggest application - an application for suggesting treatments, and a home foetal surveillance system. Data is uploaded in Google BigQuery from Bega Hospital Timişoara, Romania. The analysed data is useful for the medical staff, researchers and statisticians from public health domain. The current work describes the technological architecture and its processing possibilities that in the future will be proved based on quality criteria to lead to a better decision process in diagnosis and public health.

Medical talent management: a model for physician deployment.

PubMed

Brightman, Baird

2007-01-01

This article aims to provide a focused cost-effective method for triaging physicians into appropriate non-clinical roles to benefit both doctors and healthcare organizations. Reviews a validated career-planning process and customize it for medical talent management. A structured career assessment can differentiate between different physician work styles and direct medical talent into best-fit positions. This allows healthcare organizations to create a more finely tuned career ladder than the familiar "in or out" binary choice. PRACTICAL IMPLICATIONS--Healthcare organizations can invest in cost-effective processes for the optimal utilization of their medical talent. Provides a new use for a well-validated career assessment and planning system. The actual value of this approach should be studied using best-practices in ROI research.

[A systemic risk analysis of hospital management processes by medical employees--an effective basis for improving patient safety].

PubMed

Sobottka, Stephan B; Eberlein-Gonska, Maria; Schackert, Gabriele; Töpfer, Armin

2009-01-01

Due to the knowledge gap that exists between patients and health care staff the quality of medical treatment usually cannot be assessed securely by patients. For an optimization of safety in treatment-related processes of medical care, the medical staff needs to be actively involved in preventive and proactive quality management. Using voluntary, confidential and non-punitive systematic employee surveys, vulnerable topics and areas in patient care revealing preventable risks can be identified at an early stage. Preventive measures to continuously optimize treatment quality can be defined by creating a risk portfolio and a priority list of vulnerable topics. Whereas critical incident reporting systems are suitable for continuous risk assessment by detecting safety-relevant single events, employee surveys permit to conduct a systematic risk analysis of all treatment-related processes of patient care at any given point in time.

Winning performance improvement strategies--linking documentation and accounts receivable.

PubMed

Braden, J H; Swadley, D

1996-01-01

When the HIM department at The University of Texas Medical Branch set out to improve documentation and accounts receivable management, it established a plan that encompassed a broad spectrum of data management process changes. The department examined and acknowledged the deficiencies in data management processes and used performance improvement tools to achieve successful results.

[Assessment of financial performance improves the quality of healthcare provided by medical organizations].

PubMed

Afek, Arnon; Meilik, Ahuva; Rotstein, Zeev

2009-01-01

Today, medical organizations have to contend with a highly competitive environment, an atmosphere saturated with a multitude of innovative new technologies and ever-increasing costs. The ability of these organizations to survive and to develop and expand their services mandates adoption of management guidelines based on the world of finance/commerce, adapted to make them relevant to the world of medical service. In this article the authors chose to present a management administration assessment which is a process that ensures that the management will effectively administer the organization's resources, and meet the goals set by the organization. The system demands that hospital "centers of responsibility" be defined, a management information system be set up, activities be priced, budget be defined and the expenses assessed. These processes make it possible to formulate a budget and assess any possible deviation between the budget and the actual running costs. An assessment of deviations will reveal any possible deviation of the most significant factor--efficiency. Medical organization managers, with the cooperation of the directors of the "centers of responsibility", can assess subunit activities and gain an understanding of the significance of management decisions and thus improve the quality of management, and the medical organization. The goal of this management system is not only to Lower costs and to meet the financial goals that were set; it is a tool that ensures quality. Decreasing expenditure is important in this case, but is only secondary in importance and will be a result of reducing the costs incurred by services lacking in quality.

Quality management for the processing of medical devices

PubMed Central

Klosz, Kerstin

2008-01-01

Rules on the reprocessing of medical devices were put into place in Germany in 2001. The present article explains the background situation and the provisions that are currently in force. The implementation of these statutory requirements is described using the example of the quality management system of Germany’s market leader, Vanguard AG. This quality management system was successfully certified pursuant to DIN EN ISO 13485:2003 for the scope "reprocessing of medical devices", including class “critical C”, in accordance with the recommendation of the Commission for Hospital Hygiene and the Prevention of Infection at the Robert-Koch-Institute (RKI) and the German Federal Institute for Drugs and Medical Devices (BfArM) on the “Hygiene requirements for reprocessing of medical devices”. PMID:20204094

U.S. Army Medical Department Journal (May-June 1998)

DTIC Science & Technology

1998-06-01

patients. Dental Management of a Patient with Osteogenesis Imperfecta is a case report on the dental management of molar extraction in a patient with the...bone-forming disease osteogenesis imperfecta . Through a continual process of evaluation and improvement in training, the AMEDD’s combat medics will continue to conserve the fighting strength.

Improving Care Transitions Management: Examining the Role of Accountable Care Organization Participation and Expanded Electronic Health Record Functionality.

PubMed

Huber, Thomas P; Shortell, Stephen M; Rodriguez, Hector P

2017-08-01

Examine the extent to which physician organization participation in an accountable care organization (ACO) and electronic health record (EHR) functionality are associated with greater adoption of care transition management (CTM) processes. A total of 1,398 physician organizations from the third National Study of Physician Organization survey (NSPO3), a nationally representative sample of medical practices in the United States (January 2012-May 2013). We used data from the third National Study of Physician Organization survey (NSPO3) to assess medical practice characteristics, including CTM processes, ACO participation, EHR functionality, practice type, organization size, ownership, public reporting, and pay-for-performance participation. Multivariate linear regression models estimated the extent to which ACO participation and EHR functionality were associated with greater CTM capabilities, controlling for practice size, ownership, public reporting, and pay-for-performance participation. Approximately half (52.4 percent) of medical practices had a formal program for managing care transitions in place. In adjusted analyses, ACO participation (p < .001) and EHR functionality (p < .001) were independently associated with greater use of CTM processes among medical practices. The growth of ACOs and similar provider risk-bearing arrangements across the country may improve the management of care transitions by physician organizations. © Health Research and Educational Trust.

Senior managers' viewpoints toward challenges of implementing clinical governance: a national study in iran.

PubMed

Ravaghi, Hamid; Heidarpour, Peigham; Mohseni, Maryam; Rafiei, Sima

2013-11-01

Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government's intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers' viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers' attitude toward CG and ultimately affected the success of quality improvement activities.

A web-based knowledge management system integrating Western and Traditional Chinese Medicine for relational medical diagnosis.

PubMed

Herrera-Hernandez, Maria C; Lai-Yuen, Susana K; Piegl, Les A; Zhang, Xiao

2016-10-26

This article presents the design of a web-based knowledge management system as a training and research tool for the exploration of key relationships between Western and Traditional Chinese Medicine, in order to facilitate relational medical diagnosis integrating these mainstream healing modalities. The main goal of this system is to facilitate decision-making processes, while developing skills and creating new medical knowledge. Traditional Chinese Medicine can be considered as an ancient relational knowledge-based approach, focusing on balancing interrelated human functions to reach a healthy state. Western Medicine focuses on specialties and body systems and has achieved advanced methods to evaluate the impact of a health disorder on the body functions. Identifying key relationships between Traditional Chinese and Western Medicine opens new approaches for health care practices and can increase the understanding of human medical conditions. Our knowledge management system was designed from initial datasets of symptoms, known diagnosis and treatments, collected from both medicines. The datasets were subjected to process-oriented analysis, hierarchical knowledge representation and relational database interconnection. Web technology was implemented to develop a user-friendly interface, for easy navigation, training and research. Our system was prototyped with a case study on chronic prostatitis. This trial presented the system's capability for users to learn the correlation approach, connecting knowledge in Western and Traditional Chinese Medicine by querying the database, mapping validated medical information, accessing complementary information from official sites, and creating new knowledge as part of the learning process. By addressing the challenging tasks of data acquisition and modeling, organization, storage and transfer, the proposed web-based knowledge management system is presented as a tool for users in medical training and research to explore, learn and update relational information for the practice of integrated medical diagnosis. This proposal in education has the potential to enable further creation of medical knowledge from both Traditional Chinese and Western Medicine for improved care providing. The presented system positively improves the information visualization, learning process and knowledge sharing, for training and development of new skills for diagnosis and treatment, and a better understanding of medical diseases. © IMechE 2016.

Mining level of control in medical organizations.

PubMed

Çalimli, Olgu; Türkeli, Serkan; Eken, Emir Gökberk; Gönen, Halil Emre

2014-01-01

In literature of strategic management, there are three layers of control defined in organizational structures. These layers are strategic, tactical and operational, in which resides senior, medium level and low level managers respectively. In strategic level, institutional strategies are determined according to senior managers' perceived state of organization. In tactical level, this strategy is processed into methods and activities of a business management plan. Operational level embodies actions and functions to sustain specified business management plan. An acknowledged lead organization in Turkish medical area is examined using case study and data mining method in the scope of this paper. The level of decisions regarded in managerial purposes evaluated through chosen organization's business intelligence event logs report. Hence specification of management level importance of medical organizations is made. Case study, data mining and descriptive statistical method of taken case's reports present that positions of "Chief Executive Officer", "Outpatient Center Manager", "General Manager", monitored and analyzed functions of operational level management more frequently than strategic and tactical level. Absence of strategic management decision level research in medical area distinguishes this paper and consequently substantiates its significant contribution.

PASTE: patient-centered SMS text tagging in a medication management system

PubMed Central

Johnson, Kevin B; Denny, Joshua C

2011-01-01

Objective To evaluate the performance of a system that extracts medication information and administration-related actions from patient short message service (SMS) messages. Design Mobile technologies provide a platform for electronic patient-centered medication management. MyMediHealth (MMH) is a medication management system that includes a medication scheduler, a medication administration record, and a reminder engine that sends text messages to cell phones. The object of this work was to extend MMH to allow two-way interaction using mobile phone-based SMS technology. Unprompted text-message communication with patients using natural language could engage patients in their healthcare, but presents unique natural language processing challenges. The authors developed a new functional component of MMH, the Patient-centered Automated SMS Tagging Engine (PASTE). The PASTE web service uses natural language processing methods, custom lexicons, and existing knowledge sources to extract and tag medication information from patient text messages. Measurements A pilot evaluation of PASTE was completed using 130 medication messages anonymously submitted by 16 volunteers via a website. System output was compared with manually tagged messages. Results Verified medication names, medication terms, and action terms reached high F-measures of 91.3%, 94.7%, and 90.4%, respectively. The overall medication name F-measure was 79.8%, and the medication action term F-measure was 90%. Conclusion Other studies have demonstrated systems that successfully extract medication information from clinical documents using semantic tagging, regular expression-based approaches, or a combination of both approaches. This evaluation demonstrates the feasibility of extracting medication information from patient-generated medication messages. PMID:21984605

[Modern aspects of organization of medical support for the Armed Forces].

PubMed

Stavila, A G; Krasavin, K D; Levchenko, V N; Lemeshko, A L; Roenko, A S

2015-09-01

The challenges that medical service of the Armed Forces of the Russian Federation faces cannot be solved without a new qualitative approach to military and medical support. In order to create a complete organizational system of the medical support, consisting of united process of material flow management and management of accompanying elements, the. structure of the medical support and its equipment must correspond to performed tasks. The article describes a set of activities that are performed in the system of military-medical support and offers some promising approaches, which are supposed to solve assigned tasks imposed upon the center of pharmacy and medical technology and its interaction with superior body control, maintainable and third party organizations.

Infectious waste management in Japan: A revised regulation and a management process in medical institutions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miyazaki, M.; Une, H.

In Japan, the waste management practice is carried out in accordance with the Waste Disposal Law of 1970. The first rule of infectious waste management was regulated in 1992, and infectious wastes are defined as the waste materials generated in medical institutions as a result of medical care or research which contain pathogens that have the potential to transmit infectious diseases. Revised criteria for infectious waste management were promulgated by the Ministry of Environment in 2004. Infectious waste materials are divided into three categories: the form of waste; the place of waste generation; the kind of infectious diseases. A reductionmore » of infectious waste is expected. We introduce a summary of the revised regulation of infectious waste management in this article.« less

Framework conditions and requirements to ensure the technical functional safety of reprocessed medical devices.

PubMed

Kraft, Marc

2008-09-03

Testing and restoring technical-functional safety is an essential part of medical device reprocessing. Technical functional tests have to be carried out on the medical device in the course of the validation of reprocessing procedures. These ensure (in addition to the hygiene tests) that the reprocessing procedure is suitable for the medical device. Functional tests are, however, also a part of reprocessing procedures. As a stage in the reprocessing, they ensure for the individual medical device that no damage or other changes limit the performance. When determining which technical-functional tests are to be carried out, the current technological standard has to be taken into account in the form of product-specific and process-oriented norms. Product-specific norms primarily define safety-relevant requirements. The risk management method described in DIN EN ISO 14971 is the basis for recognising hazards; the likelihood of such hazards arising can be minimised through additional technical-functional tests, which may not yet have been standardised. Risk management is part of a quality management system, which must be bindingly certified for manufacturers and processors of critical medical devices with particularly high processing demands by a body accredited by the competent authority.

Framework conditions and requirements to ensure the technical functional safety of reprocessed medical devices

PubMed Central

Kraft, Marc

2008-01-01

Testing and restoring technical-functional safety is an essential part of medical device reprocessing. Technical functional tests have to be carried out on the medical device in the course of the validation of reprocessing procedures. These ensure (in addition to the hygiene tests) that the reprocessing procedure is suitable for the medical device. Functional tests are, however, also a part of reprocessing procedures. As a stage in the reprocessing, they ensure for the individual medical device that no damage or other changes limit the performance. When determining which technical-functional tests are to be carried out, the current technological standard has to be taken into account in the form of product-specific and process-oriented norms. Product-specific norms primarily define safety-relevant requirements. The risk management method described in DIN EN ISO 14971 is the basis for recognising hazards; the likelihood of such hazards arising can be minimised through additional technical-functional tests, which may not yet have been standardised. Risk management is part of a quality management system, which must be bindingly certified for manufacturers and processors of critical medical devices with particularly high processing demands by a body accredited by the competent authority. PMID:20204095

The medical communications officer. A resource for data collection, quality management and medical control.

PubMed

Gunderson, Michael; Barnard, Jeff; McPherson, John; Kearns, Conrad T

2002-08-01

Pinellas County EMS' Medical Communications Officers provide a wide variety of services to patients, field clinicians, managers and their medical director. The concurrent data collection processes used in the MCO program for performance measurement of resuscitation efforts, intubations, submersion incidents and aeromedical transports for trauma cases have been very effective in the integration of data from multiple computer databases and telephone follow-ups with field crews and receiving emergency department staffs. This has facilitated significant improvements in the performance of these and many other aspects of our EMS system.

Medication management strategies used by older adults with heart failure: A systems-based analysis.

PubMed

Mickelson, Robin S; Holden, Richard J

2017-09-01

Older adults with heart failure use strategies to cope with the constraining barriers impeding medication management. Strategies are behavioral adaptations that allow goal achievement despite these constraining conditions. When strategies do not exist, are ineffective or maladaptive, medication performance and health outcomes are at risk. While constraints to medication adherence are described in literature, strategies used by patients to manage medications are less well-described or understood. Guided by cognitive engineering concepts, the aim of this study was to describe and analyze the strategies used by older adults with heart failure to achieve their medication management goals. This mixed methods study employed an empirical strategies analysis method to elicit medication management strategies used by older adults with heart failure. Observation and interview data collected from 61 older adults with heart failure and 31 caregivers were analyzed using qualitative content analysis to derive categories, patterns and themes within and across cases. Data derived thematic sub-categories described planned and ad hoc methods of strategic adaptations. Stable strategies proactively adjusted the medication management process, environment, or the patients themselves. Patients applied situational strategies (planned or ad hoc) to irregular or unexpected situations. Medication non-adherence was a strategy employed when life goals conflicted with medication adherence. The health system was a source of constraints without providing commensurate strategies. Patients strived to control their medication system and achieve goals using adaptive strategies. Future patient self-mangement research can benefit from methods and theories used to study professional work, such as strategies analysis.

Implementing AORN recommended practices for medication safety.

PubMed

Hicks, Rodney W; Wanzer, Linda J; Denholm, Bonnie

2012-12-01

Medication errors in the perioperative setting can result in patient morbidity and mortality. The AORN "Recommended practices for medication safety" provide guidance to perioperative nurses in developing, implementing, and evaluating safe medication use practices. These practices include recognizing risk points in the medication use process, collaborating with pharmacy staff members, conducting preoperative assessments and postoperative evaluations (eg, medication reconciliation), and handling hazardous medications and pharmaceutical waste. Strategies for successful implementation of the recommended practices include promoting a basic understanding of the nurse's role in the medication use process and developing a medication management plan as well as policies and procedures that support medication safety and activities to measure compliance with safe practices. Published by Elsevier Inc.

75 FR 47458 - TRICARE; Diabetic Education

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-06

... counseling for socioeconomic purposes, stress management, lifestyle modification. Services provided by a...: Joy Saly, Medical Benefits and Reimbursement Branch, TRICARE Management Activity, telephone (303) 676... education. Diabetes self-management training (DSMT) is an interactive, collaborative process involving...

Medical Writing Competency Model - Section 1: Functions, Tasks, and Activities.

PubMed

Clemow, David B; Wagner, Bertil; Marshallsay, Christopher; Benau, Dan; L'Heureux, Darryl; Brown, David H; Dasgupta, Devjani Ghosh; Girten, Eileen; Hubbard, Frank; Gawrylewski, Helle-Mai; Ebina, Hiroko; Stoltenborg, Janet; York, J P; Green, Kim; Wood, Linda Fossati; Toth, Lisa; Mihm, Michael; Katz, Nancy R; Vasconcelos, Nina-Maria; Sakiyama, Norihisa; Whitsell, Robin; Gopalakrishnan, Shobha; Bairnsfather, Susan; Wanderer, Tatyana; Schindler, Thomas M; Mikyas, Yeshi; Aoyama, Yumiko

2018-01-01

This article provides Section 1 of the 2017 Edition 2 Medical Writing Competency Model that describes the core work functions and associated tasks and activities related to professional medical writing within the life sciences industry. The functions in the Model are scientific communication strategy; document preparation, development, and finalization; document project management; document template, standard, format, and style development and maintenance; outsourcing, alliance partner, and client management; knowledge, skill, ability, and behavior development and sharing; and process improvement. The full Model also includes Section 2, which covers the knowledge, skills, abilities, and behaviors needed for medical writers to be effective in their roles; Section 2 is presented in a companion article. Regulatory, publication, and other scientific writing as well as management of writing activities are covered. The Model was developed to aid medical writers and managers within the life sciences industry regarding medical writing hiring, training, expectation and goal setting, performance evaluation, career development, retention, and role value sharing to cross-functional partners.

Management information system of medical equipment using mobile devices

NASA Astrophysics Data System (ADS)

Núñez, C.; Castro, D.

2011-09-01

The large numbers of technologies currently incorporated into mobile devices transform them into excellent tools for capture and to manage the information, because of the increasing computing power and storage that allow to add many miscellaneous applications. In order to obtain benefits of these technologies, in the biomedical engineering field, it was developed a mobile information system for medical equipment management. The central platform for the system it's a mobile phone, which by a connection with a web server, it's capable to send and receive information relative to any medical equipment. Decoding a type of barcodes, known as QR-Codes, the management process is simplified and improved. These barcodes identified the medical equipments in a database, when these codes are photographed and decoded with the mobile device, you can access to relevant information about the medical equipment in question. This Project in it's actual state is a basic support tool for the maintenance of medical equipment. It is also a modern alternative, competitive and economic in the actual market.

Issues and challenges of involving users in medical device development.

PubMed

Bridgelal Ram, Mala; Grocott, Patricia R; Weir, Heather C M

2008-03-01

User engagement has become a central tenet of health-care policy. This paper reports on a case study in progress that highlights user engagement in the research process in relation to medical device development. To work with a specific group of medical device users to uncover unmet needs, translating these into design concepts, novel technologies and products. To validate a knowledge transfer model that may be replicated for a range of medical device applications and user groups. In depth qualitative case study to elicit and analyse user needs. The focus is on identifying design concepts for medical device applications from unmet needs, and validating these in an iterative feedback loop to the users. The case study has highlighted three interrelated challenges: ensuring unmet needs drive new design concepts and technology development; managing user expectations and managing the research process. Despite the challenges, active participation of users is crucial to developing usable and clinically effective devices.

Transformation of an academic medical center: lessons learned from restructuring and downsizing.

PubMed

Woodard, B; Fottler, M D; Kilpatrick, A O

1999-01-01

This article reviews management literature on health care transformation and describes the processes, including restructuring, job redesign, and downsizing, involved in one academic medical center's experience. The article concludes with lessons learned at each of the stages of the transformation process: planning, implementation, and process continuation. Managerial implications for similar transformation efforts in other health care organizations are suggested.

[Management of medication errors in general medical practice: Study in a pluriprofessionnal health care center].

PubMed

Pourrain, Laure; Serin, Michel; Dautriche, Anne; Jacquetin, Fréderic; Jarny, Christophe; Ballenecker, Isabelle; Bahous, Mickaël; Sgro, Catherine

2018-06-07

Medication errors are the most frequent medical care adverse events in France. Their management process used in hospital remains poorly applied in primary ambulatory care. The main objective of our study was to assess medication error management in general ambulatory practice. The secondary objectives were the characterization of the errors and the analysis of their root causes in order to implement corrective measures. The study was performed in a pluriprofessionnal health care house, applying the stages and tools validated by the French high health authority, that we previously adapted to ambulatory medical cares. During the 3 months study 4712 medical consultations were performed and we collected 64 medication errors. Most of affected patients were at the extreme ages of life (9,4 % before 9 years and 64 % after 70 years). Medication errors occurred at home in 39,1 % of cases, at pluriprofessionnal health care house (25,0 %) or at drugstore (17,2 %). They led to serious clinical consequences (classified as major, critical or catastrophic) in 17,2 % of cases. Drug induced adverse effects occurred in 5 patients, 3 of them needing hospitalization (1 patient recovered, 1 displayed sequelae and 1 died). In more than half of cases, the errors occurred at prescribing stage. The most frequent type of errors was the use of a wrong drug, different from that indicated for the patient (37,5 %) and poor treatment adherence (18,75 %). The systemic reported causes were a care process dysfunction (in coordination or procedure), the health care action context (patient home, not planned act, professional overwork), human factors such as patient and professional condition. The professional team adherence to the study was excellent. Our study demonstrates, for the first time in France, that medication errors management in ambulatory general medical care can be implemented in a pluriprofessionnal health care house with two conditions: the presence of a trained team coordinator, and the use of validated adapted and simple processes and tools. This study also shows that medications errors in general practice are specific of the care process organization. We identified vulnerable points, as transferring and communication between home and care facilities or conversely, medical coordination and involvement of the patient himself in his care. Copyright © 2018 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.

The usability axiom of medical information systems.

PubMed

Pantazi, Stefan V; Kushniruk, Andre; Moehr, Jochen R

2006-12-01

In this article we begin by connecting the concept of simplicity of user interfaces of information systems with that of usability, and the concept of complexity of the problem-solving in information systems with the concept of usefulness. We continue by stating "the usability axiom" of medical information technology: information systems must be, at the same time, usable and useful. We then try to show why, given existing technology, the axiom is a paradox and we continue with analysing and reformulating it several times, from more fundamental information processing perspectives. We underline the importance of the concept of representation and demonstrate the need for context-dependent representations. By means of thought experiments and examples, we advocate the need for context-dependent information processing and argue for the relevance of algorithmic information theory and case-based reasoning in this context. Further, we introduce the notion of concept spaces and offer a pragmatic perspective on context-dependent representations. We conclude that the efficient management of concept spaces may help with the solution to the medical information technology paradox. Finally, we propose a view of informatics centred on the concepts of context-dependent information processing and management of concept spaces that aligns well with existing knowledge centric definitions of informatics in general and medical informatics in particular. In effect, our view extends M. Musen's proposal and proposes a definition of Medical Informatics as context-dependent medical information processing. The axiom that medical information systems must be, at the same time, useful and usable, is a paradox and its investigation by means of examples and thought experiments leads to the recognition of the crucial importance of context-dependent information processing. On the premise that context-dependent information processing equates to knowledge processing, this view defines Medical Informatics as a context-dependent medical information processing which aligns well with existing knowledge centric definitions of our field.

E-facts: business process management in clinical data repositories.

PubMed

Wattanasin, Nich; Peng, Zhaoping; Raine, Christine; Mitchell, Mariah; Wang, Charles; Murphy, Shawn N

2008-11-06

The Partners Healthcare Research Patient Data Registry (RPDR) is a centralized data repository that gathers clinical data from various hospital systems. The RPDR allows clinical investigators to obtain aggregate numbers of patients with user-defined characteristics such as diagnoses, procedures, medications, and laboratory values. They may then obtain patient identifiers and electronic medical records with prior IRB approval. Moreover, the accurate identification and efficient population of worthwhile and quantifiable facts from doctor's report into the RPDR is a significant process. As part of our ongoing e-Fact project, this work describes a new business process management technology that helps coordinate and simplify this procedure.

[Operational costs and control of performance in surgical clinics between marketing and planning economics. Risk or perhaps quadrature of the circle].

PubMed

Kraus, T W; Weber, W; Mieth, M; Funk, H; Klar, E; Herfarth, C

2000-03-01

Surgical hospitals can be seen as operational or even industrial production systems. Doctors have a major impact on both medical performance and costs. For active participation in the management process, knowledge of industrial controlling mechanisms is required. German hospitals currently receive no procedure-related financial revenues, such as prices or tariffs for defined medical treatment activities. Maximum clinical revenues are, furthermore, limited by principles of planned economy and can be increased only slightly by greater medical performance. Costs are the only target that can be autonomously influenced by the management. Operative controlling in hospitals aims at horizontal and vertical coordination of subunits and decentralization of process regulations. Hospital medical performance is not clearly defined, its quantitative measurement very problematic. Process-orientated clinical activities are not taken into account. A high percentage of hospital costs are fixed and can be influenced only by major structural interventions in the long term. Variable costs are primarily dependent on the quantity of clinical activities, but also heavily influenced by patient structure (comorbidity and risk profile). The various forms of industrial cost calculations, such as internal budgeting, internal markets or flexible plan-cost balancing, cannot be directly applied in hospital management. Based on these analyses, current operational concepts and strategic trends are listed to describe cost-management options in hospitals with focus on the German health reforms.

Doctors or technicians: assessing quality of medical education

PubMed Central

Hasan, Tayyab

2010-01-01

Medical education institutions usually adapt industrial quality management models that measure the quality of the process of a program but not the quality of the product. The purpose of this paper is to analyze the impact of industrial quality management models on medical education and students, and to highlight the importance of introducing a proper educational quality management model. Industrial quality management models can measure the training component in terms of competencies, but they lack the educational component measurement. These models use performance indicators to assess their process improvement efforts. Researchers suggest that the performance indicators used in educational institutions may only measure their fiscal efficiency without measuring the quality of the educational experience of the students. In most of the institutions, where industrial models are used for quality assurance, students are considered as customers and are provided with the maximum services and facilities possible. Institutions are required to fulfill a list of recommendations from the quality control agencies in order to enhance student satisfaction and to guarantee standard services. Quality of medical education should be assessed by measuring the impact of the educational program and quality improvement procedures in terms of knowledge base development, behavioral change, and patient care. Industrial quality models may focus on academic support services and processes, but educational quality models should be introduced in parallel to focus on educational standards and products. PMID:23745059

Doctors or technicians: assessing quality of medical education.

PubMed

Hasan, Tayyab

2010-01-01

Medical education institutions usually adapt industrial quality management models that measure the quality of the process of a program but not the quality of the product. The purpose of this paper is to analyze the impact of industrial quality management models on medical education and students, and to highlight the importance of introducing a proper educational quality management model. Industrial quality management models can measure the training component in terms of competencies, but they lack the educational component measurement. These models use performance indicators to assess their process improvement efforts. Researchers suggest that the performance indicators used in educational institutions may only measure their fiscal efficiency without measuring the quality of the educational experience of the students. In most of the institutions, where industrial models are used for quality assurance, students are considered as customers and are provided with the maximum services and facilities possible. Institutions are required to fulfill a list of recommendations from the quality control agencies in order to enhance student satisfaction and to guarantee standard services. Quality of medical education should be assessed by measuring the impact of the educational program and quality improvement procedures in terms of knowledge base development, behavioral change, and patient care. Industrial quality models may focus on academic support services and processes, but educational quality models should be introduced in parallel to focus on educational standards and products.

Improving the coordination of patients' medication management: a regional Finnish development project.

PubMed

Kivekäs, Eija; Luukkonen, Irmeli; Mykkänen, Juha; Saranto, Kaija

2014-01-01

In this paper, we present an overview of activities and results from a regional development project in Finland. The aim in this project was to analyze how healthcare providers produce and receive information on a patient's medication, and to identify opportunities to improve the quality, effectiveness, availability and collaboration of social and healthcare services in relation to medication information. The project focused on the most important points in patients' medication management such as home care and care transitions. In a regional development project, data was gathered by interviews and a multi professional workshop. The study revealed that medication information reached only some professionals and lay caregivers despite electronic patient record (EPR) systems and tools. Differences in work processes related to medication reconciliation and information management were discussed in the group meeting and were regarded as a considerable risk for patient safety.

A case-based reasoning tool for breast cancer knowledge management with data mining concepts and techniques

NASA Astrophysics Data System (ADS)

Demigha, Souâd.

2016-03-01

The paper presents a Case-Based Reasoning Tool for Breast Cancer Knowledge Management to improve breast cancer screening. To develop this tool, we combine both concepts and techniques of Case-Based Reasoning (CBR) and Data Mining (DM). Physicians and radiologists ground their diagnosis on their expertise (past experience) based on clinical cases. Case-Based Reasoning is the process of solving new problems based on the solutions of similar past problems and structured as cases. CBR is suitable for medical use. On the other hand, existing traditional hospital information systems (HIS), Radiological Information Systems (RIS) and Picture Archiving Information Systems (PACS) don't allow managing efficiently medical information because of its complexity and heterogeneity. Data Mining is the process of mining information from a data set and transform it into an understandable structure for further use. Combining CBR to Data Mining techniques will facilitate diagnosis and decision-making of medical experts.

The Role of Healthcare Technology Management in Facilitating Medical Device Cybersecurity.

PubMed

Busdicker, Mike; Upendra, Priyanka

2017-09-02

This article discusses the role of healthcare technology management (HTM) in medical device cybersecurity and outlines concepts that are applicable to HTM professionals at a healthcare delivery organization or at an integrated delivery network, regardless of size. It provides direction for HTM professionals who are unfamiliar with the security aspects of managing healthcare technologies but are familiar with standards from The Joint Commission (TJC). It provides a useful set of recommendations, including relevant references for incorporating good security practices into HTM practice. Recommendations for policies, procedures, and processes referencing TJC standards are easily applicable to HTM departments with limited resources and to those with no resource concerns. The authors outline processes from their organization as well as best practices learned through information sharing at AAMI, National Health Information Sharing and Analysis Center (NH-ISAC), and Medical Device Innovation, Safety, and Security Consortium (MDISS) conferences and workshops.

Management of behavioral dysfunction: a corporate physician's perspective.

PubMed

Farid, I

1996-01-01

This chapter outlines the processes that engage the corporate physician in the course of the management and disposition of psychiatric problems. It begins with a description of a subprocess in which the physician adapts to working with nonmedical professionals as a member of a team. Much of the work lies outside the scope of medical practice and in the domain of management. Transition from the traditional role to a medical manager is an incremental learning process that prepares the physician to assimilate into his or her calculus organizational structure, dynamics, and culture. The core processes involved in the management of psychiatric problems are presented. These run the gamut on one end from the initial screening for psychiatric disorders at the time of placement to, at the other end, psychiatric disability. The barriers and suggested approaches to the successful resolution of these problems are described. Chronic psychiatric problems such as depression and psychosis along with personality problems and stress are recognized as posing added challenge and are briefly presented with emphasis on recent advances in their management.

The Relationship between Environmental Turbulence, Management Support, Organizational Collaboration, Information Technology Solution Realization, and Process Performance, in Healthcare Provider Organizations

ERIC Educational Resources Information Center

Muglia, Victor O.

2010-01-01

The Problem: The purpose of this study was to investigate relationships between environmental turbulence, management support, organizational collaboration, information technology solution realization, and process performance in healthcare provider organizations. Method: A descriptive/correlational study of Hospital medical services process…

An exercise in controversy. Case study: revising a physician employment agreement.

PubMed

Fitzgerald, Paul E; Burkett, Steven H; Key, Charles M

2003-01-01

The physician employment agreement at a faculty practice plan did not meet the needs of a modern health care employer or its medical staff. This article describes the communication among medical group management, medical leadership and the medical staff during the revision of the agreement, as well as the process used to develop a new document.

Stream processing health card application.

PubMed

Polat, Seda; Gündem, Taflan Imre

2012-10-01

In this paper, we propose a data stream management system embedded to a smart card for handling and storing user specific summaries of streaming data coming from medical sensor measurements and/or other medical measurements. The data stream management system that we propose for a health card can handle the stream data rates of commonly known medical devices and sensors. It incorporates a type of context awareness feature that acts according to user specific information. The proposed system is cheap and provides security for private data by enhancing the capabilities of smart health cards. The stream data management system is tested on a real smart card using both synthetic and real data.

Treating asthma with a self-management model of illness behaviour in an Australian community pharmacy setting.

PubMed

Smith, Lorraine; Bosnic-Anticevich, Sinthia Z; Mitchell, Bernadette; Saini, Bandana; Krass, Ines; Armour, Carol

2007-04-01

Asthma affects a considerable proportion of the population worldwide and presents a significant health problem in Australia. Given its chronic nature, effective asthma self-management approaches are important. However, despite research and interventions targeting its treatment, the management of asthma remains problematic. This study aimed to develop, from a theoretical basis, an asthma self-management model and implement it in an Australian community pharmacy setting in metropolitan Sydney, using a controlled, parallel-groups repeated-measures design. Trained pharmacists delivered a structured, step-wise, patient-focused asthma self-management program to adult participants over a 9-month period focusing on identification of asthma problems, goal setting and strategy development. Data on process- clinical- and psychosocial-outcome measures were gathered. Results showed that participants set an average of four new goals and six repeated goals over the course of the intervention. Most common goal-related themes included asthma triggers, asthma control and medications. An average of nine strategies per participant was developed to achieve the set goals. Common strategies involved visiting a medical practitioner for review of medications, improving adherence to medications and using medications before exercise. Clinical and psychosocial outcomes indicated significant improvements over time in asthma symptom control, asthma-related self-efficacy and quality of life, and negative affect. These results suggest that an asthma self-management model of illness behaviour has the potential to provide patients with a range of process skills for self-management, and deliver improvements in clinical and psychosocial indicators of asthma control. The results also indicate the capacity for the effective delivery of such an intervention by pharmacists in Australian community pharmacy settings.

Improving the medical records department processes by lean management.

PubMed

Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine

2015-01-01

Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. The study represents one of the few attempts trying to eliminate wastes in the MRD.

[Application of supply chain integration management of medical consumables].

PubMed

Zhang, Jian

2013-07-01

This paper introduces the background, the content, the information management system of material supply chain integration management and the consumables management process. The system helps to expand the selection of hospital supplies varieties, to reduce consumables management costs, to improve the efficiency of supplies, to ensure supplies safety, reliability and traceability.

Use of antipsychotic medications for the management of delirium: an audit of current practice in the acute care setting.

PubMed

Tropea, J; Slee, J; Holmes, A C N; Gorelik, A; Brand, C A

2009-02-01

Despite delirium being common in older hospitalized people, little is known about its management. The aims of this study are (1) to describe the pharmacological management of delirium in an acute care setting as a baseline measure prior to the implementation of newly developed Australian guidelines; and (2) to determine what areas of delirium pharmacological management need to be targeted for future practical guideline implementation and quality improvement activities. A medical record audit was conducted using a structured audit form. All patients aged 65 years and over who were admitted to a general medical or orthopaedic unit of the Royal Melbourne Hospital between 1 March 2006 and 28 February 2007 and coded with delirium were included. Data on the use of antipsychotic medications for the management of delirium in relation to best practice recommendations were assessed. Overall 174 episodes of care were included in the analysis. Antipsychotic medications were used for the management of most patients with severe behavioral and or emotional disturbance associated with delirium. There was variation in the prescribing patterns of antipsychotic agents and the documentation of medication management plans. Less than a quarter of patients prescribed antipsychotic medication were started on a low dose and very few were reviewed on a regular basis. A wide range of practice is seen in the use of antipsychotic agents to manage older patients with severe symptoms associated with delirium. The findings highlight the need to implement evidence-based guideline recommendations with a focus on improving the consistency in the pharmacological management and documentation processes.

PACS: acceptance test, quality control, warranty, and maintenance continuum

NASA Astrophysics Data System (ADS)

Romlein, John R.; Norton, Gary S.; Lyche, David K.; Richardson, Ronald R., Jr.

1999-07-01

As PACS gain greater acceptance and use in medical facilities the question of life cycle management must be addressed in terms that relate to the common business practices for medical information system and medical devices. The issues in life cycle management of such a system are relatively new to the industry. Increased use of PACS within the medical community requires that standardized life cycle management practices by developed and implemented. This paper develops a new of life cycle issues as cyclic and related events that are not only manageable, but also predictable in terms, of, frequency, duration data content, data exchange, potential outcomes, staffing requirement, documentation, and staff interaction. This view is presented as a continuum that begins at the acceptance testing of a PACS and continues throughout its life cycle. The continuum incorporates the required relationship between quality control testing and maintenance actions during warranty period and the maintenance years. Interrelated cyclic events are described that bind these processes together and provide a basis for long-term proactive management of PACS in a medical environment.

Medication-taking behaviours in chronic kidney disease with multiple chronic conditions: a meta-ethnographic synthesis of qualitative studies.

PubMed

Bartlett Ellis, Rebecca J; Welch, Janet L

2017-03-01

To identify behaviours associated with taking medications and medication adherence reported in qualitative studies of adults with chronic kidney disease and coexisting multiple chronic conditions. To inform medication adherence interventions, information is needed to clarify the nature of the relationships between behaviours that support medication-taking and medication adherence in multiple chronic conditions. Meta-ethnographic review and synthesis. CINAHL Complete, MEDLINE and PsycINFO databases were searched. Five qualitative studies met the inclusion criteria. A meta-ethnographic approach was used for synthesis. Medication-taking behaviours were abstracted from study findings and synthesised according to the contexts in which they occur and interpreted within a new developing framework named the Medication-taking Across the Care Continuum and Adherence-related Outcomes. Twenty categories of medication-taking behaviours occurred in three main contexts: (1) patient-provider clinical encounters, (2) pharmacy encounters and (3) day-to-day management. These behaviours are distinctly different, multilevel and interrelated. Together they represent a process occurring across a continuum. Future medication adherence research should consider using a multilevel ecological view of medication management. Clinical practice and policy development can benefit from further understanding socio-contextual behaviours that occur across the continuum. Nurses should have greater presence in chronic disease management and be positioned to support the day-to-day home management of patients' medications. Healthcare professionals can partner with patients to elucidate how these behaviours are enacted across the care continuum and in day-to-day management to identify opportunities to intervene on specific behaviours and promote medication adherence. © 2016 John Wiley & Sons Ltd.

Cybersecurity and the Medical Device Product Development Lifecycle.

PubMed

Jones, Richard W; Katzis, Konstantinos

2017-01-01

Protecting connected medical devices from evolving cyber related threats, requires a continuous lifecycle approach whereby cybersecurity is integrated within the product development lifecycle and both complements and re-enforces the safety risk management processes therein. This contribution reviews the guidance relating to medical device cybersecurity within the product development lifecycle.

Architecture for Integrated Medical Model Dynamic Probabilistic Risk Assessment

NASA Technical Reports Server (NTRS)

Jaworske, D. A.; Myers, J. G.; Goodenow, D.; Young, M.; Arellano, J. D.

2016-01-01

Probabilistic Risk Assessment (PRA) is a modeling tool used to predict potential outcomes of a complex system based on a statistical understanding of many initiating events. Utilizing a Monte Carlo method, thousands of instances of the model are considered and outcomes are collected. PRA is considered static, utilizing probabilities alone to calculate outcomes. Dynamic Probabilistic Risk Assessment (dPRA) is an advanced concept where modeling predicts the outcomes of a complex system based not only on the probabilities of many initiating events, but also on a progression of dependencies brought about by progressing down a time line. Events are placed in a single time line, adding each event to a queue, as managed by a planner. Progression down the time line is guided by rules, as managed by a scheduler. The recently developed Integrated Medical Model (IMM) summarizes astronaut health as governed by the probabilities of medical events and mitigation strategies. Managing the software architecture process provides a systematic means of creating, documenting, and communicating a software design early in the development process. The software architecture process begins with establishing requirements and the design is then derived from the requirements.

Relating the Components of the Clinical Reasoning Process to the Construction of Patient Management Problems

PubMed Central

Skakun, Ernest N.

1982-01-01

Patient Management Problems (PMPs) are frequently used to test a physician's ability in conducting a medical work-up. The construction of PMPs has been inhibited because the clinical reasoning process with which these simulations deal has not been described until recently. The clinical reasoning process is reviewed and broad guidelines for constructing PMPs to reflect the components of the process are presented.

Service management: New Zealand's model of resource management.

PubMed

Malcolm, L

1990-12-01

The health system in New Zealand, which in many respects is similar to that of the United Kingdom NHS, is currently undergoing massive change. In 1989 fourteen area health boards were formed, each board being accountable to the minister of health for achieving health goals and providing comprehensive health services for its defined population. This process has been assisted by the promulgation of a set of national health goals and a national health charter. Within area health boards the principle of general management is being implemented. Organisational structures are moving away from hospitals to services in a process which is being called service management which may be defined as the decentralisation of general management to the clinical workface. Similar in many respects to the resource management initiatives in the NHS it brings together medical, nursing and business management at the operational level with one person being accountable for the achievement of quality of care objectives within a budgetary framework. Budgetary restraints in excess of 10% have been achieved in the last 12 months partly through the service management process. Service management is seen to be a major paradigm shift in health services organisation and could be of international significance in its potential for achieving medical accountability for cost containment and quality assurance, and for coordinating care across agency and disciplinary boundaries.

Medical Information Management System

NASA Technical Reports Server (NTRS)

Alterescu, S.; Hipkins, K. R.; Friedman, C. A.

1979-01-01

On-line interactive information processing system easily and rapidly handles all aspects of data management related to patient care. General purpose system is flexible enough to be applied to other data management situations found in areas such as occupational safety data, judicial information, or personnel records.

Quality management of clinical-practical instruction for Practical Year medical students in Germany - proposal for a catalogue of criteria from the German Society of Medical Education.

PubMed

Raes, Patricia; Angstwurm, Matthias; Berberat, Pascal; Kadmon, Martina; Rotgans, Jerome; Streitlein-Böhme, Irmgard; Burckhardt, Gerhard; Fischer, Martin R

2014-01-01

Amended in 2013, the current version of the German Medical Licensure Regulation contains structural specifications that are also required of non-university institutions involved in Practical Year clinical training. The criteria are worded in relatively general terms. Furthermore, not all of the structural specifications can be readily applied to every subject area. In order to ensure commensurability in Practical Year instruction in Germany, not least in light of recently introduced Practical Year mobility, it is necessary to define consistent quality criteria for Practical Year training. The authors therefore propose a catalogue of criteria for the quality management process in Practical Year instruction facilities. In January 2014, the board of directors of the German Society for Medical Education decided to establish a committee comprised of representatives from various German medical faculties. In a process similar to the Delphi methodology, the group developed criteria for structure, process and outcome quality in Practical Year training in Germany. The criteria developed for structure, process and outcome quality apply to Practical Year training in academic teaching hospitals and university medical centres. Furthermore, modalities for review are proposed. The present catalogue of criteria is intended to contribute to the formation of a basis for the most consistent quality standards possible for Practical Year instruction in Germany.

Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings

PubMed Central

Kuntz, Jennifer L.; Safford, Monika M.; Singh, Jasvinder A.; Phansalkar, Shobha; Slight, Sarah P.; Her, Qoua Liang; Lapointe, Nancy Allen; Mathews, Robin; O’Brien, Emily; Brinkman, William B.; Hommel, Kevin; Farmer, Kevin C.; Klinger, Elissa; Maniam, Nivethietha; Sobko, Heather J.; Bailey, Stacy C.; Cho, Insook; Rumptz, Maureen H.; Vandermeer, Meredith L.; Hornbrook, Mark C.

2018-01-01

Objective Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior. Methods We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type. Results We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes. Conclusions We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions. Practice Implications Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate. PMID:25264309

Open source electronic health record and patient data management system for intensive care.

PubMed

Massaut, Jacques; Reper, Pascal

2008-01-01

In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed a PDMS and EHR based on open source software and components. The software was designed as a client-server architecture running on the Linux operating system and powered by the PostgreSQL data base system. The client software was developed in C using GTK interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in February 2004, the PDMS was used to care more than three thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of the Mirth HL7 communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on open source software components was able to respond to the medical needs of the local ICU environment. The use of OSS for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

Characteristics of Interruptions During Medication Administration:An Integrative Review of Direct Observational Studies.

PubMed

Schroers, Ginger

2018-06-26

The purpose of this review was to synthesize and summarize data gathered by direct observation of the characteristics of interruptions in the context of nursing medication administration in hospital settings. Interruptions are prevalent during the medication administration process performed by nurses in hospital settings and have been found to be associated with an increase in frequency and severity of nursing medication administration errors. In addition, interruptions decrease task efficiency, leading to longer medication administration completion times. Integrative review. The electronic databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMED, PsyARTICLES, and Google Scholar were searched using the terms "interruptions" AND "medication administration" AND "direct observation". Nine articles met the inclusion criteria. Interruptions are likely to occur at least once during nursing medication administration processes in hospital settings. This finding applies to medication administered to one patient, termed a medication pass, and medication administered to multiple patients, termed a mediation round. Interruptions are most commonly caused by another nurse, staff member, or are self-initiated, and last approximately one minute in length. A raised awareness among staff of the most common sources of interruptions may encourage changes that lead to a decrease in the occurrence of interruptions. In addition, nurse leaders can apply an understanding of the common characteristics of interruptions to guide research, policies, and educational methods aimed at interruption management strategies. The findings from this review can be used to guide the identification and development of targeted interventions and strategies that would have the most substantial impact to reduce and manage interruptions during medication administration. Interruption management strategies have the potential to lead to a decrease in medication errors and an increase in task efficiency. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Managing the replacement cycle of laser inventory.

PubMed

Davis, C E

1992-01-01

Medical lasers are quickly moving into the replacement phase of technology management. Barnes Hospital (St. Louis, MO) is using its laser team to define a process of planned laser replacement using the experience gained from traditional medical equipment replacement cycles, quality improvement principles and tools, and other formalized interdisciplinary teams. The process described in this paper has six basic steps: (1) A decision is made to request a replacement laser. (2) An appropriation request form is completed and submitted with the clinical and/or technical justifications. (3) Those requests initiated outside of the Clinical Engineering Department are reviewed by the Clinical Engineer/Medical Laser Safety Officer (CE/MLSO). (4) The CE/MLSO presents the requests to the hospital Laser Committee, and (5) then to the Laser Users' Group. (6) Finally, an Expenditure Authorization Committee reviews all capital expense requests, including those for replacement lasers, and allocates funds for the next fiscal year. This paper illustrates and evaluates the process, using an example from the review process for 1993 equipment purchases at Barnes Hospital.

Medical ethics contributes to clinical management: teaching medical students to engage patients as moral agents

PubMed Central

Caldicott, Catherine V; Danis, Marion

2013-01-01

OBJECTIVES In order to teach medical students to engage more fully with patients, we offer ethics education as a tool to assist in the management of patient health issues. METHODS We propose that many dilemmas in clinical medicine would benefit by having the doctor embark on an iterative reasoning process with the patient. Such a process acknowledges and engages the patient as a moral agent. We recommend employing Kant’s ethic of respect and a more inclusive definition of patient autonomy drawn from philosophy and clinical medicine, rather than simply presenting dichotomous choices to patients, which represents a common, but often suboptimal, means of approaching both medical and moral concerns. DISCUSSION We describe how more nuanced teaching about the ethics of the doctor–patient relationship might fit into the medical curriculum and offer practical suggestions for implementing a more respectful, morally engaged relationship with patients that should assist them to achieve meaningful health goals. PMID:19250356

Opinion paper: the role of work in the management of medically unexplained physical symptoms.

PubMed

Tobback, Els; Mariman, An; Clauwaert, Lies; Godderis, Lode; Heytens, Stefan; Ruppol, Patrick; Spooren, Daniel; Tytgat, Rita; De Muynck, Martine; Vogelaers, Dirk

2018-05-04

Patients with medically unexplained physical symptoms suffer from chronic fatigue and/or pain in combination with a variety of other symptoms. A flexible, biopsychosocial approach is needed for diagnostic screening and global management. It is crucial to involve the direct patient environment, including family, friends, colleagues as well as health providers, evaluation, and reintegration sector. The aim of this paper is to review the importance of work in the management of medically unexplained physical symptoms. In this paper, different actors involved explain their views and handling concerning work in the management of MUPS. Symptom severity and lack of understanding from the environment can negatively impact on earning an independent income from labor for years. Work, whether or not paid, is however, an important life domain with positive effects on physical, psychological, and social well-being. Therefore, health actors are pivotal in starting the professional reintegration process as soon as possible and should discuss this item from the early stage onward. Support services can be consulted in mutual interaction as required. A case manager, acting as a central intermediator within this multidisciplinary approach, may promote effective communication and coordination between the patients and their surrounding actors. The professional reintegration process should start as soon as possible within the management of medically unexplained physical symptoms. As such, the care sector, the evaluation sector, and the professional integration sector should collaborate and effectively communicate with each other.

Safe medication management in specialized home healthcare - an observational study.

PubMed

Lindblad, Marléne; Flink, Maria; Ekstedt, Mirjam

2017-08-24

Medication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering. Data were collected during the MMP at three specialized home healthcare units in Sweden using two strategies: observation of workplaces and shadowing RNs in everyday work, including interviews. Transcribed material was analysed using grounded theory. The MMP in home healthcare was dynamic and complex with unclear boundaries of responsibilities, inadequate information systems and fluctuating work conditions. Healthcare professionals adapted their everyday clinical work by sharing responsibility and simultaneously being authoritative and preserving patients' active participation, autonomy and integrity. To promote a safe MMP, healthcare professionals constantly re-prioritized goals, handled gaps in communication and information transmission at a distance by creating new bridging solutions. Trade-offs and workarounds were necessary elements, but also posed a threat to patient safety, as these interim solutions were not systematically evaluated or devised learning strategies. To manage a safe medication process in home healthcare, healthcare professionals need to adapt to fluctuating conditions and create bridging strategies through multiple parallel activities distributed over time, space and actors. The healthcare professionals' strategies could be integrated in continuous learning, while preserving boundaries of safety, instead of being more or less interim solutions. Patients' and family caregivers' as active partners in the MMP may be an underestimated resource for a resilient home healthcare.

The effectiveness of risk management program on pediatric nurses' medication error.

PubMed

Dehghan-Nayeri, Nahid; Bayat, Fariba; Salehi, Tahmineh; Faghihzadeh, Soghrat

2013-09-01

Medication therapy is one of the most complex and high-risk clinical processes that nurses deal with. Medication error is the most common type of error that brings about damage and death to patients, especially pediatric ones. However, these errors are preventable. Identifying and preventing undesirable events leading to medication errors are the main risk management activities. The aim of this study was to investigate the effectiveness of a risk management program on the pediatric nurses' medication error rate. This study is a quasi-experimental one with a comparison group. In this study, 200 nurses were recruited from two main pediatric hospitals in Tehran. In the experimental hospital, we applied the risk management program for a period of 6 months. Nurses of the control hospital did the hospital routine schedule. A pre- and post-test was performed to measure the frequency of the medication error events. SPSS software, t-test, and regression analysis were used for data analysis. After the intervention, the medication error rate of nurses at the experimental hospital was significantly lower (P < 0.001) and the error-reporting rate was higher (P < 0.007) compared to before the intervention and also in comparison to the nurses of the control hospital. Based on the results of this study and taking into account the high-risk nature of the medical environment, applying the quality-control programs such as risk management can effectively prevent the occurrence of the hospital undesirable events. Nursing mangers can reduce the medication error rate by applying risk management programs. However, this program cannot succeed without nurses' cooperation.

Construction and Application of a Refined Hospital Management Chain.

PubMed

Yi, Lihua; Hao, Aimin; Hu, Minmin; Huang, Pei; Yuan, Huikang; Xing, Ming

2015-05-01

Gaining large scale success was quite common in the later period of industrialization for hospitals in China. Today, Chinese hospital management face such problems as service inefficiency, high human resources cost, and low rate of capital use. This study analyzes the refined management chain of the Wuxi No. 2 People's Hospital. This consists of six gears namely "organizational structure, clinical practice, outpatient service, medical technology, and nursing care and logistics" used to achieve maximum scale and benefits. The gears are based on "flat management system targets, chief of medical staff, centralized outpatient service, intensified medical examinations, vertical nursing management and socialized logistics". The hospital took innovative measures. The "one doctor-one patient-one clinic" was well accepted; "one dispensary" shorten the waiting time by 20 min. The 168 rear service hot line "made patients' lives easier; and a red wrist ribbon" for seriously ill patient was implemented to prioritize medical treatment. The core concepts of refined hospital management are optimizing flow process, reducing waste, improving efficiency, saving costs, and taking good care of patients as most important.

Improvement of radiology services based on the process management approach.

PubMed

Amaral, Creusa Sayuri Tahara; Rozenfeld, Henrique; Costa, Janaina Mascarenhas Hornos; Magon, Maria de Fátima de Andrade; Mascarenhas, Yvone Maria

2011-06-01

The health sector requires continuous investments to ensure the improvement of products and services from a technological standpoint, the use of new materials, equipment and tools, and the application of process management methods. Methods associated with the process management approach, such as the development of reference models of business processes, can provide significant innovations in the health sector and respond to the current market trend for modern management in this sector (Gunderman et al. (2008) [4]). This article proposes a process model for diagnostic medical X-ray imaging, from which it derives a primary reference model and describes how this information leads to gains in quality and improvements. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Distance Learning Methodologies. TRANSCOM Regulating and Command & Control Evacuation System (TRAC2ES).

ERIC Educational Resources Information Center

Bloomquist, Carroll R.

The TRANSCOM (Transportation Command) Regulating Command and Control Evacuation System (TRAC2ES), which applies state-of-the-art technology to manage global medical regulating (matching patients to clinical availability) and medical evacuation processes, will be installed at all Department of Defense medical locations globally. A combination of…

Performance evaluation of medical records departments by analytical hierarchy process (AHP) approach in the selected hospitals in Isfahan : medical records dep. & AHP.

PubMed

Ajami, Sima; Ketabi, Saeedeh

2012-06-01

Medical Records Department (MRD) is an important unit for evaluating and planning of care services. The goal of this study is evaluating the performance of the Medical Records Departments (MRDs) of the selected hospitals in Isfahan, Iran by using Analytical Hierarchy Process (AHP). This was an analytic of cross-sectional study that was done in spring 2008 in Isfahan, Iran. The statistical population consisted of MRDs of Alzahra, Kashani and Khorshid Hospitals in Isfahan. Data were collected by forms and through brainstorm technique. To analyze and perform AHP, Expert Choice software was used by researchers. Results were showed archiving unit has received the largest importance weight with respect to information management. However, on customer aspect admission unit has received the largest weight. Ordering weights of Medical Records Departments' Alzahra, Kashani and Khorshid Hospitals in Isfahan were with 0.394, 0.342 and 0.264 respectively. It is useful for managers to allocate and prioritize resources according to AHP technique for ranking at the Medical Records Departments.

Six Sigma Quality Management System and Design of Risk-based Statistical Quality Control.

PubMed

Westgard, James O; Westgard, Sten A

2017-03-01

Six sigma concepts provide a quality management system (QMS) with many useful tools for managing quality in medical laboratories. This Six Sigma QMS is driven by the quality required for the intended use of a test. The most useful form for this quality requirement is the allowable total error. Calculation of a sigma-metric provides the best predictor of risk for an analytical examination process, as well as a design parameter for selecting the statistical quality control (SQC) procedure necessary to detect medically important errors. Simple point estimates of sigma at medical decision concentrations are sufficient for laboratory applications. Copyright © 2016 Elsevier Inc. All rights reserved.

Biometric identity management for standard mobile medical networks.

PubMed

Egner, Alexandru; Soceanu, Alexandru; Moldoveanu, Florica

2012-01-01

The explosion of healthcare costs over the last decade has prompted the ICT industry to respond with solutions for reducing costs while improving healthcare quality. The ISO/IEEE 11073 family of standards recently released is the first step towards interoperability of mobile medical devices used in patient environments. The standards do not, however, tackle security problems, such as identity management, or the secure exchange of medical data. This paper proposes an enhancement of the ISO/IEEE 11073-20601 protocol with an identity management system based on biometry. The paper describes a novel biometric-based authentication process, together with the biometric key generation algorithm. The proposed extension of the ISO/IEEE 11073-20601 is also presented.

Tmproving the Consult Management Process at David Grant Medical Center

DTIC Science & Technology

1998-08-01

and the regional referral facility for the DoD Health Services Region 10 in Northern California. It offers most major medical, surgical , and dental...services (Payne, 1987). The primary components of UM include pre -certification, concurrent and retrospective review, case management, and discharge...6-13. O’Brien, K., McComb, J., Fox, N., Beam, D., & Wright, J. (1996). Do dentists refer orthodontic patients inappropriately. British Dental

Understanding the dispensary workflow at the Birmingham Free Clinic: a proposed framework for an informatics intervention.

PubMed

Fisher, Arielle M; Herbert, Mary I; Douglas, Gerald P

2016-02-19

The Birmingham Free Clinic (BFC) in Pittsburgh, Pennsylvania, USA is a free, walk-in clinic that serves medically uninsured populations through the use of volunteer health care providers and an on-site medication dispensary. The introduction of an electronic medical record (EMR) has improved several aspects of clinic workflow. However, pharmacists' tasks involving medication management and dispensing have become more challenging since EMR implementation due to its inability to support workflows between the medical and pharmaceutical services. To inform the design of a systematic intervention, we conducted a needs assessment study to identify workflow challenges and process inefficiencies in the dispensary. We used contextual inquiry to document the dispensary workflow and facilitate identification of critical aspects of intervention design specific to the user. Pharmacists were observed according to contextual inquiry guidelines. Graphical models were produced to aid data and process visualization. We created a list of themes describing workflow challenges and asked the pharmacists to rank them in order of significance to narrow the scope of intervention design. Three pharmacists were observed at the BFC. Observer notes were documented and analyzed to produce 13 themes outlining the primary challenges pharmacists encounter during dispensation at the BFC. The dispensary workflow is labor intensive, redundant, and inefficient when integrated with the clinical service. Observations identified inefficiencies that may benefit from the introduction of informatics interventions including: medication labeling, insufficient process notification, triple documentation, and inventory control. We propose a system for Prescription Management and General Inventory Control (RxMAGIC). RxMAGIC is a framework designed to mitigate workflow challenges and improve the processes of medication management and inventory control. While RxMAGIC is described in the context of the BFC dispensary, we believe it will be generalizable to pharmacies in other low-resource settings, both domestically and internationally.

A national survey to define a new core curriculum to prepare physicians for managed care practice.

PubMed

Meyer, G S; Potter, A; Gary, N

1997-08-01

All levels of medical education will require modification to address the challenges in health care practice brought about by managed care. Because preparation for practice in a managed care environment has received insufficient attention, and because the need for change is so great, in 1995 the authors sought information from a variety of sources to serve as a basis for identifying the core curricular components and the staging of these components in the medical education process. This research effort consisted of a survey of 125 U.S. medical school curriculum deans (or equivalent school representatives); four focus groups of managed care practitioners, administrators, educators, and residents; and a survey of a national sample of physicians and medical directors. Findings indicate that almost all the 91 responding school representatives recognized the importance of revising their curricula to meet the managed care challenge and that the majority either had or were developing programs to train students for practice in managed care environments. The focus groups identified a core set of competencies for managed care practice, although numbers differed on whether the classroom or a managed care setting was the best place to teach the components of a new curriculum. Although medical directors and staff physicians differed with respect to the relative levels of importance of these competencies, the findings suggest that before medical school, training should focus on communication and interpersonal skills, information systems, and customer relations; during medical school, on clinical epidemiology, quality assurance, risk management, and decision analysis; during residency, on utilization management, managed care essentials, and multidisciplinary team building; and after residency, on a review of customer relations, communication skills, and utilization management. The authors conclude that a core curriculum and its sequencing can be identified, that the majority of curricular components exist but in s some cases needed to be modified to more clearly relate to managed care practice, and that their findings may provide a useful starting point for making decisions about curricular reform.

Meeting the challenges of the digital medical enterprise of the future by reusing enterprise software components

NASA Astrophysics Data System (ADS)

Shani, Uri; Kol, Tomer; Shachor, Gal

2004-04-01

Managing medical digital information objects, and in particular medical images is an enterprise-grade problem. Firstly, there is the sheer amount of digital data that is generated in the proliferation of digital (and film-free) medical imaging. Secondly, the managing software ought to enjoy high availability, recoverability and manageability that are found only in the most business-critical systems. Indeed, such requirements are borrowed from the business enterprise world. Moreover, the solution for the medical information management problem should too employ the same software tools, middlewares and architectures. It is safe to say that all first-line medical PACS products strive to provide a solution for all these challenging requirements. The DICOM standard has been a prime enabler of such solutions. DICOM created the interconnectivity, which made it possible for a PACS service to manage millions of exams consisting of trillions of images. With the more comprehensive IHE architecture, the enterprise is expanded into a multi-facility regional conglomerate, which presents extreme demands from the data management system. HIPPA legislations add considerable challenges per security, privacy and other legal issues, which aggravate the situation. In this paper, we firstly present what in our view should be the general requirements for a first-line medical PACS, taken from an enterprise medical imaging storage and management solution perspective. While these requirements can be met by homegrown implementations, we suggest looking at the existing technologies, which have emerged in the recent years to meet exactly these challenges in the business world. We present an evolutionary process, which led to the design and implementation of a medical object management subsystem. This is indeed an enterprise medical imaging solution that is built upon respective technological components. The system answers all these challenges simply by not reinventing wheels, but rather reusing the best "wheels" for the job. Relying on such middleware components allowed us to concentrate on added value for this specific problem domain.

Colonial scientific-medical documentary films and the legitimization of an ideal state in post-war Spain.

PubMed

Tabernero, Carlos; Jiménez-Lucena, Isabel; Molero-Mesa, Jorge

2017-01-01

This paper explores the role of film and medical-health practices and discourses in the building and legitimating strategies of Franco's fascist regime in Spain. The analysis of five medical-colonial documentary films produced during the 1940s explores the relationship between mass media communication practices and techno-scientific knowledge production, circulation and management processes. These films portray a non-problematic colonial space where social order is articulated through scientific-medical practices and discourses that match the regime's need to consolidate and legitimize itself while asserting the inclusion-exclusion dynamics involved in the definition of social prototypes through processes of medicalization.

AUVA - Augmented Reality Empowers Visual Analytics to explore Medical Curriculum Data.

PubMed

Nifakos, Sokratis; Vaitsis, Christos; Zary, Nabil

2015-01-01

Medical curriculum data play a key role in the structure and the organization of medical programs in Universities around the world. The effective processing and usage of these data may improve the educational environment of medical students. As a consequence, the new generation of health professionals would have improved skills from the previous ones. This study introduces the process of enhancing curriculum data by the use of augmented reality technology as a management and presentation tool. The final goal is to enrich the information presented from a visual analytics approach applied on medical curriculum data and to sustain low levels of complexity of understanding these data.

Medical Staff Involvement in Nursing Homes: Development of a Conceptual Model and Research Agenda

PubMed Central

Shield, Renée; Rosenthal, Marsha; Wetle, Terrie; Tyler, Denise; Clark, Melissa; Intrator, Orna

2013-01-01

Medical staff (physicians, nurse practitioners, physicians’ assistants) involvement in nursing homes (NH) is limited by professional guidelines, government policies, regulations, and reimbursements, creating bureaucratic burden. The conceptual NH Medical Staff Involvement Model, based on our mixed methods research, applies the Donabedian structure-process-outcomes framework to the NH identifying measures for a coordinated research agenda. Quantitative surveys and qualitative interviews conducted with medical directors, administrators and directors of nursing, other experts, residents and family members and Minimum Data Set, the Online Certification and Reporting System and Medicare Part B claims data related to NH structure, process and outcomes were analyzed. NH control of medical staff, or structure, affects medical staff involvement in care processes and is associated with better outcomes (e.g. symptom management, appropriate transitions, satisfaction). The Model identifies measures clarifying the impact of NH medical staff involvement on care processes and resident outcomes and has strong potential to inform regulatory policies. PMID:24652944

[Prospective assessment of medication errors in critically ill patients in a university hospital].

PubMed

Salazar L, Nicole; Jirón A, Marcela; Escobar O, Leslie; Tobar, Eduardo; Romero, Carlos

2011-11-01

Critically ill patients are especially vulnerable to medication errors (ME) due to their severe clinical situation and the complexities of their management. To determine the frequency and characteristics of ME and identify shortcomings in the processes of medication management in an Intensive Care Unit. During a 3 months period, an observational prospective and randomized study was carried out in the ICU of a university hospital. Every step of patient's medication management (prescription, transcription, dispensation, preparation and administration) was evaluated by an external trained professional. Steps with higher frequency of ME and their therapeutic groups involved were identified. Medications errors were classified according to the National Coordinating Council for Medication Error Reporting and Prevention. In 52 of 124 patients evaluated, 66 ME were found in 194 drugs prescribed. In 34% of prescribed drugs, there was at least 1 ME during its use. Half of ME occurred during medication administration, mainly due to problems in infusion rates and schedule times. Antibacterial drugs had the highest rate of ME. We found a 34% rate of ME per drug prescribed, which is in concordance with international reports. The identification of those steps more prone to ME in the ICU, will allow the implementation of an intervention program to improve the quality and security of medication management.

Improving the medical records department processes by lean management

PubMed Central

Ajami, Sima; Ketabi, Saeedeh; Sadeghian, Akram; Saghaeinnejad-Isfahani, Sakine

2015-01-01

Background: Lean management is a process improvement technique to identify waste actions and processes to eliminate them. The benefits of Lean for healthcare organizations are that first, the quality of the outcomes in terms of mistakes and errors improves. The second is that the amount of time taken through the whole process significantly improves. Aims: The purpose of this paper is to improve the Medical Records Department (MRD) processes at Ayatolah-Kashani Hospital in Isfahan, Iran by utilizing Lean management. Materials and Methods: This research was applied and an interventional study. The data have been collected by brainstorming, observation, interview, and workflow review. The study population included MRD staff and other expert staff within the hospital who were stakeholders and users of the MRD. Statistical Analysis Used: The MRD were initially taught the concepts of Lean management and then formed into the MRD Lean team. The team then identified and reviewed the current processes subsequently; they identified wastes and values, and proposed solutions. Results: The findings showed that the MRD units (Archive, Coding, Statistics, and Admission) had 17 current processes, 28 wastes, and 11 values were identified. In addition, they offered 27 comments for eliminating the wastes. Conclusion: The MRD is the critical department for the hospital information system and, therefore, the continuous improvement of its services and processes, through scientific methods such as Lean management, are essential. Originality/Value: The study represents one of the few attempts trying to eliminate wastes in the MRD. PMID:26097862

[Anniversary of the medical department of the Federal Office for Safe Storage and Destruction of Chemical Weapons].

PubMed

Kuz'menko, I E

2013-01-01

The article is devoted to the process of formation and development of CW destruction management system and medical support of professional activities of personnel. Founders of Medical department of the Federal Directorate for Safe Storage and Destruction of Chemical Weapons are presented. Main principles and ways of working of medical department in specific conditions are covered.

Managed medical education?

PubMed

Hafferty, F W

1999-09-01

The forces of rationality and commodification, hallmarks of the managed care revolution, may soon breach the walls of organized medical education. Whispers are beginning to circulate that the cost of educating future physicians is too high. Simultaneously, managed care companies are accusing medical education of turning out trainees unprepared to practice in a managed care environment. Changes evident in other occupational and service delivery sectors of U.S. society as diverse as pre-college education and prisons provide telling insights into what may be in store for medical educators. Returning to academic medicine, the author reflects that because corporate managed care is already established in teaching hospitals, and because managed research (e.g., corporate-sponsored and -run drug trials, for-profit drug-study centers, and contract research organizations) is increasing, managed medical education could become a reality as well. Medical education has made itself vulnerable to the intrusion of corporate rationalizers because it has failed to professionalism at core of its curricula-something only it is able to do--and instead has focused unduly on the transmission of esoteric knowledge and core clinical skills, a process that can be carried out more efficiently, more effectively, and less expensively by other players in the medical education marketplace such as Kaplan, Compass, or the Princeton Review. The author explains why reorganizing medical education around professional values is crucial, why the AAMC's Medical School Objectives Project offers guidance in this area, why making this change will be difficult, and why medical education must lead in establishing how to document the presence and absence of such qualities as altruism and dutifulness and the ways that appropriate medical education can foster these and similar core competencies. "Anything less and organized medicine will acknowledged... that it has abandoned its social contract and entered the temple of those who clamor, 'I can name that tune in four notes.'"

FMEA: a model for reducing medical errors.

PubMed

Chiozza, Maria Laura; Ponzetti, Clemente

2009-06-01

Patient safety is a management issue, in view of the fact that clinical risk management has become an important part of hospital management. Failure Mode and Effect Analysis (FMEA) is a proactive technique for error detection and reduction, firstly introduced within the aerospace industry in the 1960s. Early applications in the health care industry dating back to the 1990s included critical systems in the development and manufacture of drugs and in the prevention of medication errors in hospitals. In 2008, the Technical Committee of the International Organization for Standardization (ISO), licensed a technical specification for medical laboratories suggesting FMEA as a method for prospective risk analysis of high-risk processes. Here we describe the main steps of the FMEA process and review data available on the application of this technique to laboratory medicine. A significant reduction of the risk priority number (RPN) was obtained when applying FMEA to blood cross-matching, to clinical chemistry analytes, as well as to point-of-care testing (POCT).

Innovations in Medication Preparation Safety and Wastage Reduction: Use of a Workflow Management System in a Pediatric Hospital.

PubMed

Davis, Stephen Jerome; Hurtado, Josephine; Nguyen, Rosemary; Huynh, Tran; Lindon, Ivan; Hudnall, Cedric; Bork, Sara

2017-01-01

Background: USP <797> regulatory requirements have mandated that pharmacies improve aseptic techniques and cleanliness of the medication preparation areas. In addition, the Institute for Safe Medication Practices (ISMP) recommends that technology and automation be used as much as possible for preparing and verifying compounded sterile products. Objective: To determine the benefits associated with the implementation of the workflow management system, such as reducing medication preparation and delivery errors, reducing quantity and frequency of medication errors, avoiding costs, and enhancing the organization's decision to move toward positive patient identification (PPID). Methods: At Texas Children's Hospital, data were collected and analyzed from January 2014 through August 2014 in the pharmacy areas in which the workflow management system would be implemented. Data were excluded for September 2014 during the workflow management system oral liquid implementation phase. Data were collected and analyzed from October 2014 through June 2015 to determine whether the implementation of the workflow management system reduced the quantity and frequency of reported medication errors. Data collected and analyzed during the study period included the quantity of doses prepared, number of incorrect medication scans, number of doses discontinued from the workflow management system queue, and the number of doses rejected. Data were collected and analyzed to identify patterns of incorrect medication scans, to determine reasons for rejected medication doses, and to determine the reduction in wasted medications. Results: During the 17-month study period, the pharmacy department dispensed 1,506,220 oral liquid and injectable medication doses. From October 2014 through June 2015, the pharmacy department dispensed 826,220 medication doses that were prepared and checked via the workflow management system. Of those 826,220 medication doses, there were 16 reported incorrect volume errors. The error rate after the implementation of the workflow management system averaged 8.4%, which was a 1.6% reduction. After the implementation of the workflow management system, the average number of reported oral liquid medication and injectable medication errors decreased to 0.4 and 0.2 times per week, respectively. Conclusion: The organization was able to achieve its purpose and goal of improving the provision of quality pharmacy care through optimal medication use and safety by reducing medication preparation errors. Error rates decreased and the workflow processes were streamlined, which has led to seamless operations within the pharmacy department. There has been significant cost avoidance and waste reduction and enhanced interdepartmental satisfaction due to the reduction of reported medication errors.

System review: a method for investigating medical errors in healthcare settings.

PubMed

Alexander, G L; Stone, T T

2000-01-01

System analysis is a process of evaluating objectives, resources, structure, and design of businesses. System analysis can be used by leaders to collaboratively identify breakthrough opportunities to improve system processes. In healthcare systems, system analysis can be used to review medical errors (system occurrences) that may place patients at risk for injury, disability, and/or death. This study utilizes a case management approach to identify medical errors. Utilizing an interdisciplinary approach, a System Review Team was developed to identify trends in system occurrences, facilitate communication, and enhance the quality of patient care by reducing medical errors.

Consensus on current management of endometriosis.

PubMed

Johnson, Neil P; Hummelshoj, Lone

2013-06-01

Is there a global consensus on the management of endometriosis that considers the views of women with endometriosis? It was possible to produce an international consensus statement on the current management of endometriosis through engagement of representatives of national and international, medical and non-medical societies with an interest in endometriosis. Management of endometriosis anywhere in the world has been based partially on evidence-based practices and partially on unsubstantiated therapies and approaches. Several guidelines have been developed by a number of national and international bodies, yet areas of controversy and uncertainty remain, not least due to a paucity of firm evidence. A consensus meeting, in conjunction with a pre- and post-meeting process, was undertaken. A consensus meeting was held on 8 September 2011, in conjunction with the 11th World Congress on Endometriosis in Montpellier, France. A rigorous pre- and post-meeting process, involving 56 representatives of 34 national and international, medical and non-medical organizations from a range of disciplines, led to this consensus statement. A total of 69 consensus statements were developed. Seven statements had unanimous consensus; however, none of the statements were made without expression of a caveat about the strength of the statement or the statement itself. Only two statements failed to achieve majority consensus. The statements covered global considerations, the role of endometriosis organizations, support groups, centres or networks of expertise, the impact of endometriosis throughout a woman's life course, and a full range of treatment options for pain, infertility and other symptoms related to endometriosis. This consensus process differed from that of formal guideline development. A different group of international experts from those participating in this process would likely have yielded subtly different consensus statements. This is the first time that a large, global, consortium, representing 34 major stake-holding organizations from five continents, has convened to systematically evaluate the best available current evidence on the management of endometriosis, and to reach consensus. In addition to 18 international medical organizations, representatives from 16 national endometriosis organizations were involved, including lay support groups, thus generating input from women who suffer from endometriosis.

Responding to the Medical Malpractice Insurance Crisis: A National Risk Management Information System

PubMed Central

Wess, Bernard P.; Jacobson, Gary

1987-01-01

In the process of forming a new medical malpractice reinsurance company, the authors analyzed thousands of medical malpractice cases, settlements, and verdicts. The evidence of those analyses indicated that the medical malpractice crisis is (1)emerging nation- and world-wide, (2)exacerbated by but not primarily a result of “predatory” legal action, (3)statistically determined by a small percentage of physicians and procedures, (4)overburdened with data but poor on information, (5)subject to classic forms of quality control and automation. The management information system developed to address this problem features a tiered data base architecture to accommodate medical, administrative, procedural, statistical, and actuarial analyses necessary to predict claims from untoward events, not merely to report them.

Assessment of the elderly's functional ability to manage their medication: a systematic literature review.

PubMed

Advinha, Ana Margarida; Lopes, Manuel José; de Oliveira-Martins, Sofia

2017-02-01

Background The evaluation of the elderly's ability to manage medication through the use of a validated tool can be a significant step in identifying inabilities and needs, with the objective of increasing their self-care skills, and promoting successful aging. Aim of the review To identify studies assessing the elderly's functional ability to manage their own medication. Method For the search strategy, the PICO method was used: P-Population (elderly), I-Instruments (tools for assessing medication management ability), C-Context (community) and O-Outcomes (functional ability to manage medication). The final search query was run in MEDLINE/PubMed, CINAHL Plus, ISI Web of Science and Scopus. The whole process was developed according to the PRISMA statement. Results The search retrieved 8051 records. In each screening stage, the selection criteria were applied to eliminate records where at least one of the exclusion criteria was verified. At the end of this selection, we obtained a total of 18 papers (17 studies). The results allow the conclusion to be drawn that studies use several different instruments, most of them not validated. The authors agree that medication management abilities decrease as cognitive impairment increases, even if a lot of studies assess only the physical dimension. DRUGS was the instrument most often used. Conclusion Older adults' ability to manage their medication should be assessed using tools specifically built and validate for the purpose. DRUGS (which uses the real regimen taken by the elderly) was the most widely used assessment instrument in the screened studies.

The financial management of research centers and institutes at U.S. medical schools: findings from six institutions.

PubMed

Mallon, William T

2006-06-01

To explore three questions surrounding the financial management of research centers and institutes at U.S. medical schools: How do medical schools allocate institutional funds to centers and institutes? How and by whom are those decisions made? What are the implications of these decision-making models on the future of the academic biomedical research enterprise? Using a qualitative research design, the author and associates interviewed over 150 faculty members and administrators at six medical schools and their parent universities in 2004. Interview data were transcribed, coded, and analyzed using a grounded theory approach. This methodology generated rich descriptions and explanations of the six medical schools, which can produce extrapolations to, but not necessarily generalizable findings to, other institutions and settings. An examination of four dimensions of financial decision-making-funding timing, process, structure, and culture-produces two essential models of how medical schools approach the financial management of research centers. In the first, a "charity" model, center directors make hat-in-hand appeals directly to the dean, the result of which may depend on individual negotiation skills and personal relationships. In the second, a "planned-giving" model, the process for obtaining and renewing funds is institutionalized, agreed upon, and monitored. The ways in which deans, administrators, department chairs, and center directors attend to, decide upon, and carry out financial decisions can influence how people throughout the medical school think about interdisciplinary and collaborative activities marshalled though centers and institutes.

Determining the disease management process for epileptic patients: A qualitative study.

PubMed

Hosseini, Nazafarin; Sharif, Farkhondeh; Ahmadi, Fazlollah; Zare, Mohammad

2016-01-01

Epilepsy exposes patients to many physical, social, and emotional challenges. Thus, it seems to portray a complex picture and needs holistic care. Medical treatment and psychosocial part of epilepsy remain central to managing and improving the patient's qualify of life through team efforts. Some studies have shown the dimensions of self-management, but its management process of epilepsy patients, especially in Iran, is not clear. This study aimed to determine the disease management process in patients with epilepsy in Iran. This qualitative approach and grounded theory study was conducted from January 2009 to February 2012 in Isfahan city (Iran). Thirty-two participants were recruited by the goal-oriented, and snowball sample selection and theoretical sampling methods. After conducting a total of 43 in-depth interviews with the participants, the researchers reached data saturation. Data were analyzed using Strauss and Corbin method. With a focus on disease management process, researchers found three main themes and seven sub-themes as a psychosocial process (PSP). The main themes were: perception of threat to self-identity, effort to preserve self-identity, and burn out. The psychosocial aspect of the disease generated one main variable "the perception of identity loss" and one central variable "searching for self-identity." Participants attributed threat to self-identity and burn out to the way their disease was managed requiring efforts to preserve their identity. Recommendations consist of support programs and strategies to improve the public perception of epilepsy in Iran, help patients accept their condition and preserve self-identity, and most importantly, enhance medical management of epilepsy.

[Success factors in hospital management].

PubMed

Heberer, M

1998-12-01

The hospital environment of most Western countries is currently undergoing dramatic changes. Competition among hospitals is increasing, and economic issues have become decisive factors for the allocation of medical care. Hospitals therefore require management tools to respond to these changes adequately. The balanced scorecard is a method of enabling development and implementation of a business strategy that equally respects the financial requirements, the needs of the customers, process development, and organizational learning. This method was used to derive generally valid success factors for hospital management based on an analysis of an academic hospital in Switzerland. Strategic management, the focus of medical services, customer orientation, and integration of professional groups across the hospital value chain were identified as success factors for hospital management.

Treatment of maladaptive aggression in youth: CERT guidelines II. Treatments and ongoing management.

PubMed

Scotto Rosato, Nancy; Correll, Christoph U; Pappadopulos, Elizabeth; Chait, Alanna; Crystal, Stephen; Jensen, Peter S

2012-06-01

To develop guidelines for management and treatment of maladaptive aggression in youth in the areas of psychosocial interventions, medication treatments, and side-effect management. Evidence was assembled and evaluated in a multistep process, including systematic reviews of published literature; an expert survey of recommended practices; a consensus conference of researchers, policymakers, clinicians, and family advocates; and review by the steering committee of successive drafts of the recommendations. The Center for Education and Research on Mental Health Therapeutics Treatment of Maladaptive Aggression in Youth guidelines reflect a synthesis of the available evidence, based on this multistep process. This article describes the content, rationale, and evidence for 11 recommendations. Key treatment principles include considering psychosocial interventions, such as evidence-based parent and child skills training as the first line of treatment; targeting the underlying disorder first following evidence-based guidelines; considering individual psychosocial and medical factors, including cardiovascular risk in the selection of agents if medication treatment (ideally with the best evidence base) is initiated; avoiding the use of multiple psychotropic medications simultaneously; and careful monitoring of treatment response, by using structured rating scales, as well as close medical monitoring for side effects, including metabolic changes. Treatment of children with maladaptive aggression is a "moving target" requiring ongoing assimilation of new evidence as it emerges. Based on the existing evidence, the Treatment of Maladaptive Aggression in Youth guidelines provide a framework for management of maladaptive aggression in youth, appropriate for use by primary care clinicians and mental health providers.

3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 1: Diagnosis and Medical Management.

PubMed

Gomollón, Fernando; Dignass, Axel; Annese, Vito; Tilg, Herbert; Van Assche, Gert; Lindsay, James O; Peyrin-Biroulet, Laurent; Cullen, Garret J; Daperno, Marco; Kucharzik, Torsten; Rieder, Florian; Almer, Sven; Armuzzi, Alessandro; Harbord, Marcus; Langhorst, Jost; Sans, Miquel; Chowers, Yehuda; Fiorino, Gionata; Juillerat, Pascal; Mantzaris, Gerassimos J; Rizzello, Fernando; Vavricka, Stephan; Gionchetti, Paolo

2017-01-01

This paper is the first in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the methodology of the consensus process, and the classification, diagnosis and medical management of active and quiescent Crohn's disease. Surgical management as well as special situations including management of perianal Crohn's disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016]. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

E-documentation as a process management tool for nursing care in hospitals.

PubMed

Rajkovic, Uros; Sustersic, Olga; Rajkovic, Vladislav

2009-01-01

Appropriate documentation plays a key role in process management in nursing care. It includes holistic data management based on patient's data along the clinical path with regard to nursing care. We developed an e-documentation model that follows the process method of work in nursing care. It assesses the patient's status on the basis of Henderson's theoretical model of 14 basic living activities and is aligned with internationally recognized nursing classifications. E-documentation development requires reengineering of existing documentation and facilitates process reengineering. A prototype solution of an e-nursing documentation, already being in testing process at University medical centres in Ljubljana and Maribor, will be described.

Impact of Capital and Current Costs Changes of the Incineration Process of the Medical Waste on System Management Cost

NASA Astrophysics Data System (ADS)

Jolanta Walery, Maria

2017-12-01

The article describes optimization studies aimed at analysing the impact of capital and current costs changes of medical waste incineration on the cost of the system management and its structure. The study was conducted on the example of an analysis of the system of medical waste management in the Podlaskie Province, in north-eastern Poland. The scope of operational research carried out under the optimization study was divided into two stages of optimization calculations with assumed technical and economic parameters of the system. In the first stage, the lowest cost of functioning of the analysed system was generated, whereas in the second one the influence of the input parameter of the system, i.e. capital and current costs of medical waste incineration on economic efficiency index (E) and the spatial structure of the system was determined. Optimization studies were conducted for the following cases: with a 25% increase in capital and current costs of incineration process, followed by 50%, 75% and 100% increase. As a result of the calculations, the highest cost of system operation was achieved at the level of 3143.70 PLN/t with the assumption of 100% increase in capital and current costs of incineration process. There was an increase in the economic efficiency index (E) by about 97% in relation to run 1.

[The German Disease Management Guideline Asthma: methods and development process].

PubMed

Kopp, Ina; Lelgemann, Monika; Ollenschläger, Günter

2006-01-01

The German National Program for Disease Management Guidelines, which is being operated under the auspices of the German Medical Association (GMA), the Association of the Scientific Medical Societies (AWMF) and the National Association of Statutory Health Insurance Physicians (NASHIP), provides a conceptual basis for the disease management of prioritized healthcare aspects. The main objective of the program is to establish consensus of the medical professions on key recommendations covering all sectors of healthcare provision and facilitating the coordination of care for the individual patient through time and across interfaces. Within the scope of this program, the Scientific Medical Societies concerned with the prevention, diagnosis, treatment and rehabilitation of asthma in children, adolescents and adults have reached consensus on the core contents for a National Disease Management Guideline for Asthma. This consensus was reached by applying formal techniques and on the basis of the adaptation of recommendations from existing guidelines with high quality standards in methodology and reporting, and information from evidence reports.

Ageing Holocaust survivors in Australia.

PubMed

Paratz, Elizabeth D; Katz, Benny

2011-02-21

In recent years, a phenomenon of "late effects of the Holocaust" has emerged, with impacts on the psychological and physical health of ageing Holocaust survivors. As Holocaust survivors age, they may experience heightened anxiety around normal processes of ageing, worsened post-traumatic stress disorder with cognitive decline, and fear of the medical system. Holocaust survivors are at increased risk of osteoporosis, cardiometabolic disease due to hypothalamic-pituitary-adrenal axis dysfunction, cancer, and sequelae of Nazi medical experiments. From existing medical literature on this topic, practical principles of management are derived to create a framework for sensitive medical management of Holocaust survivors in Australia. The issues discussed are also relevant to the wider geriatric refugee or prisoner-of-war experience.

EMPOWER--pathways for supporting the self-management of diabetes patients.

PubMed

Plößnig, Manuela; Kabak, Yildiray; Lamprinos, Ilias; Pabst, Alexander; Hildebrand, Claudia; Mantwill, Sarah

2015-01-01

Diabetes is a serious world-wide medical challenge and there is a recognised need for improved diabetes care outcomes. This paper describes results of the EMPOWER project, to foster the self-management of diabetes patients by integration of existing and new services offered to patients after having been diagnosed with diabetes. The Self-Management Pathway described in this paper helps patients in the specification of personalized activities based on medical recommendations and personal goals, as well as self-monitoring of the results. The whole process is supported by innovative ICT services that motivate patients to change their lifestyle and adhere to defined medication and activity plans. We describe the approach and present the findings of the validation phase in Germany and Turkey.

The integration of the risk management process with the lifecycle of medical device software.

PubMed

Pecoraro, F; Luzi, D

2014-01-01

The application of software in the Medical Device (MD) domain has become central to the improvement of diagnoses and treatments. The new European regulations that specifically address software as an important component of MD, require complex procedures to make software compliant with safety requirements, introducing thereby new challenges in the qualification and classification of MD software as well as in the performance of risk management activities. Under this perspective, the aim of this paper is to propose an integrated framework that combines the activities to be carried out by the manufacturer to develop safe software within the development lifecycle based on the regulatory requirements reported in US and European regulations as well as in the relevant standards and guidelines. A comparative analysis was carried out to identify the main issues related to the application of the current new regulations. In addition, standards and guidelines recently released to harmonise procedures for the validation of MD software have been used to define the risk management activities to be carried out by the manufacturer during the software development process. This paper highlights the main issues related to the qualification and classification of MD software, providing an analysis of the different regulations applied in Europe and the US. A model that integrates the risk management process within the software development lifecycle has been proposed too. It is based on regulatory requirements and considers software risk analysis as a central input to be managed by the manufacturer already at the initial stages of the software design, in order to prevent MD failures. Relevant changes in the process of MD development have been introduced with the recognition of software being an important component of MDs as stated in regulations and standards. This implies the performance of highly iterative processes that have to integrate the risk management in the framework of software development. It also makes it necessary to involve both medical and software engineering competences to safeguard patient and user safety.

Implementation of a Project Management Office (PMO)--experiences from year 1.

PubMed

Isola, Miriam; Polikaitis, Audrius; Laureto, Rose Ann

2006-01-01

Recognized as an early leader in clinical information systems, the University of Illinois Medical Center was challenged to meet the ever-increasing demand for information systems. Interviews with key stakeholders revealed unfavorable attitudes toward the Information Services department. Reasons given were that projects often are not aligned with business strategy, projects are delayed, IS itself is a barrier to progress, and a lack of proactive planning precipitates crises. Under the leadership of a new CIO, IS began developing a Project Management Office, or PMO, to better meet medical center business objectives and to more effectively manage technology projects. Successes during the first year included comprehensive IT strategic planning. Collaborative relationships were established with departmental leaders for planning, prioritizing, budgeting, and executing projects. A formal Web-based process for requesting IS projects was implemented, project management training was provided, and elements of standard project management methodology were implemented. While a framework for effective project management was created, significant effort is still required to firmly root these new processes within the organizational culture. Project management office goals for the second year include implementing a project portfolio management tool, refining the benefits methodology, and continuing the advancement of the project management methodology.

Selection of infectious medical waste disposal firms by using the analytic hierarchy process and sensitivity analysis.

PubMed

Hsu, Pi-Fang; Wu, Cheng-Ru; Li, Ya-Ting

2008-01-01

While Taiwanese hospitals dispose of large amounts of medical waste to ensure sanitation and personal hygiene, doing so inefficiently creates potential environmental hazards and increases operational expenses. However, hospitals lack objective criteria to select the most appropriate waste disposal firm and evaluate its performance, instead relying on their own subjective judgment and previous experiences. Therefore, this work presents an analytic hierarchy process (AHP) method to objectively select medical waste disposal firms based on the results of interviews with experts in the field, thus reducing overhead costs and enhancing medical waste management. An appropriate weight criterion based on AHP is derived to assess the effectiveness of medical waste disposal firms. The proposed AHP-based method offers a more efficient and precise means of selecting medical waste firms than subjective assessment methods do, thus reducing the potential risks for hospitals. Analysis results indicate that the medical sector selects the most appropriate infectious medical waste disposal firm based on the following rank: matching degree, contractor's qualifications, contractor's service capability, contractor's equipment and economic factors. By providing hospitals with an effective means of evaluating medical waste disposal firms, the proposed AHP method can reduce overhead costs and enable medical waste management to understand the market demand in the health sector. Moreover, performed through use of Expert Choice software, sensitivity analysis can survey the criterion weight of the degree of influence with an alternative hierarchy.

Medical practice in organized settings. Redefining medical autonomy.

PubMed

Astrachan, J H; Astrachan, B M

1989-07-01

Physicians are perplexed by the ongoing erosion of their individual professional autonomy. While the economic forces underlying such change have received much attention, the evolution of new organizational forms that modify and often diminish medical autonomy is less well understood. The practice of medicine is becoming more organized and more hierarchical. We emphasize the importance of organized medical groups, including the medical staff organization, as structures for appropriate peer monitoring, and for counterbalancing the burgeoning influence of governance and administrative constraints on practice. There is an ongoing tension within organizations between management, governance, and physicians. Over time one or another of these groups achieves some measure of dominance, but good management requires a balance of power. The role of the medical staff, which is poorly represented in some health care institutions and under threat in others, is considered. In general, we find that medical work is becoming more hierarchical, and that physician "leaders" do not substitute for collegial processes.

Shared decision making for psychiatric medication management: beyond the micro-social.

PubMed

Morant, Nicola; Kaminskiy, Emma; Ramon, Shulamit

2016-10-01

Mental health care has lagged behind other health-care domains in developing and applying shared decision making (SDM) for treatment decisions. This is despite compatibilities with ideals of modern mental health care such as self-management and recovery-oriented practice, and growing policy-level interest. Psychiatric medication is a mainstay of mental health treatment, but there are known problems with prescribing practices, and service users report feeling uninvolved in medication decisions and concerned about adverse effects. SDM has potential to produce better tailoring of psychiatric medication to individuals' needs. This conceptual review argues that several aspects of mental health care that differ from other health-care contexts (e.g. forms of coercion, questions about service users' insight and disempowerment) may impact on processes and possibilities for SDM. It is therefore problematic to uncritically import models of SDM developed in other health-care contexts. We argue that decision making for psychiatric medication is better understood in a broader way that moves beyond the micro-social focus of a medical consultation. Contextualizing specific medication-related consultations within longer term relationships, and broader service systems enables recognition of the multiple processes, actors and agendas that shape how psychiatric medication is prescribed, managed and used, and which may facilitate or impede SDM. A broad conceptualization of decision making for psychiatric medication that moves beyond the micro-social can account for why SDM in this domain remains a rarity. It has both conceptual and practical utility for evaluating research evidence, identifying future research priorities and highlighting fruitful ways of developing and implementing SDM in mental health care. © 2015 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Implementation of a formulary management process.

PubMed

Karel, Lauren I; Delisle, Dennis R; Anagnostis, Ellena A; Wordell, Cindy J

2017-08-15

The application of lean methodology in an initiative to redesign the formulary maintenance process at an academic medical center is described. Maintaining a hospital formulary requires clear communication and coordination among multiple members of the pharmacy department. Using principles of lean methodology, pharmacy department personnel within a multihospital health system launched a multifaceted initiative to optimize formulary management systemwide. The ongoing initiative began with creation of a formulary maintenance redesign committee consisting of pharmacy department personnel with expertise in informatics, automation, purchasing, drug information, and clinical pharmacy services. The committee met regularly and used lean methodology to design a standardized process for management of formulary additions and deletions and changes to medications' formulary status. Through value stream analysis, opportunities for process and performance improvement were identified; staff suggestions on process streamlining were gathered during a series of departmental kaizen events. A standardized template for development and dissemination of monographs associated with formulary additions and status changes was created. In addition, a shared Web-based checklist was developed to facilitate information sharing and timely initiation and completion of tasks involved in formulary status changes, and a permanent formulary maintenance committee was established to monitor and refine the formulary management process. A clearly defined, standardized process within the pharmacy department was developed for tracking necessary steps in enacting formulary changes to encourage safe and efficient workflow. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Chronic Disease Management in Family Practice: Clinical Note.

DTIC Science & Technology

1998-03-01

disease management in the family practice selling. This paper discusses chronic disease management in the family practice selling....Chronic disease management is the process of evaluating and treating a medical condition or disease state which can not be readily cured so as to...minimize it’s negative impact on the individual. Examples of chronic disease management include the treatment of hypertension, diabetes, osteoporosis

[Knowledge management system for laboratory work and clinical decision support].

PubMed

Inada, Masanori; Sato, Mayumi; Yoneyama, Akiko

2011-05-01

This paper discusses a knowledge management system for clinical laboratories. In the clinical laboratory of Toranomon Hospital, we receive about 20 questions relevant to laboratory tests per day from medical doctors or co-medical staff. These questions mostly involve the essence to appropriately accomplish laboratory tests. We have to answer them carefully and suitably because an incorrect answer may cause a medical accident. Up to now, no method has been in place to achieve a rapid response and standardized answers. For this reason, the laboratory staff have responded to various questions based on their individual knowledge. We began to develop a knowledge management system to promote the knowledge of staff working for the laboratory. This system is a type of knowledge base for assisting the work, such as inquiry management, laboratory consultation, process management, and clinical support. It consists of several functions: guiding laboratory test information, managing inquiries from medical staff, reporting results of patient consultation, distributing laboratory staffs notes, and recording guidelines for laboratory medicine. The laboratory test information guide has 2,000 records of medical test information registered in the database with flexible retrieval. The inquiry management tool provides a methos to record all questions, answer easily, and retrieve cases. It helps staff to respond appropriately in a short period of time. The consulting report system treats patients' claims regarding medical tests. The laboratory staffs notes enter a file management system so they can be accessed to aid in clinical support. Knowledge sharing using this function can achieve the transition from individual to organizational learning. Storing guidelines for laboratory medicine will support EBM. Finally, it is expected that this system will support intellectual activity concerning laboratory work and contribute to the practice of knowledge management for clinical work support.

[Possibilities and perspectives of quality management in radiation oncology].

PubMed

Seegenschmiedt, M H; Zehe, M; Fehlauer, F; Barzen, G

2012-11-01

The medical discipline radiation oncology and radiation therapy (treatment with ionizing radiation) has developed rapidly in the last decade due to new technologies (imaging, computer technology, software, organization) and is one of the most important pillars of tumor therapy. Structure and process quality play a decisive role in the quality of outcome results (therapy success, tumor response, avoidance of side effects) in this field. Since 2007 all institutions in the health and social system are committed to introduce and continuously develop a quality management (QM) system. The complex terms of reference, the complicated technical instruments, the highly specialized personnel and the time-consuming processes for planning, implementation and assessment of radiation therapy made it logical to introduce a QM system in radiation oncology, independent of the legal requirements. The Radiation Center Hamburg (SZHH) has functioned as a medical care center under medical leadership and management since 2009. The total QM and organization system implemented for the Radiation Center Hamburg was prepared in 2008 and 2009 and certified in June 2010 by the accreditation body (TÜV-Süd) for DIN EN ISO 9001:2008. The main function of the QM system of the SZHH is to make the basic principles understandable for insiders and outsiders, to have clear structures, to integrate management principles into the routine and therefore to organize the learning processes more effectively both for interior and exterior aspects.

Handheld tools assess medical necessity at the point of care.

PubMed

Pollard, Dan

2002-01-01

An emerging strategy to manage financial risk in clinical practice is to involve the physician at the point of care. Using handheld technology, encounter-specific information along with medical necessity policy can be presented to physicians allowing them to integrate it into their medical decision-making process. Three different strategies are discussed: reference books or paper encounter forms, electronic reference tools, and integrated process tools. The electronic reference tool strategy was evaluated and showed a return on investment exceeding 1200% due to reduced overhead costs associated with rework of claim errors.

Integrating Six Sigma with total quality management: a case example for measuring medication errors.

PubMed

Revere, Lee; Black, Ken

2003-01-01

Six Sigma is a new management philosophy that seeks a nonexistent error rate. It is ripe for healthcare because many healthcare processes require a near-zero tolerance for mistakes. For most organizations, establishing a Six Sigma program requires significant resources and produces considerable stress. However, in healthcare, management can piggyback Six Sigma onto current total quality management (TQM) efforts so that minimal disruption occurs in the organization. Six Sigma is an extension of the Failure Mode and Effects Analysis that is required by JCAHO; it can easily be integrated into existing quality management efforts. Integrating Six Sigma into the existing TQM program facilitates process improvement through detailed data analysis. A drilled-down approach to root-cause analysis greatly enhances the existing TQM approach. Using the Six Sigma metrics, internal project comparisons facilitate resource allocation while external project comparisons allow for benchmarking. Thus, the application of Six Sigma makes TQM efforts more successful. This article presents a framework for including Six Sigma in an organization's TQM plan while providing a concrete example using medication errors. Using the process defined in this article, healthcare executives can integrate Six Sigma into all of their TQM projects.

Retrieval and management of medical information from heterogeneous sources, for its integration in a medical record visualisation tool.

PubMed

Cabarcos, Alba; Sanchez, Tamara; Seoane, Jose A; Aguiar-Pulido, Vanessa; Freire, Ana; Dorado, Julian; Pazos, Alejandro

2010-01-01

Nowadays, medical practice needs, at the patient Point-of-Care (POC), personalised knowledge adjustable in each moment to the clinical needs of each patient, in order to provide support to decision-making processes, taking into account personalised information. To achieve this, adapting the hospital information systems is necessary. Thus, there is a need of computational developments capable of retrieving and integrating the large amount of biomedical information available today, managing the complexity and diversity of these systems. Hence, this paper describes a prototype which retrieves biomedical information from different sources, manages it to improve the results obtained and to reduce response time and, finally, integrates it so that it is useful for the clinician, providing all the information available about the patient at the POC. Moreover, it also uses tools which allow medical staff to communicate and share knowledge.

Medical equipment libraries: implementation, experience and user satisfaction.

PubMed

Keay, S; McCarthy, J P; Carey-Smith, B E

2015-01-01

The hospital-wide pooling and sharing of certain types of medical equipment can lead to both significant improvements in patient safety and financial advantages when compared with a department or ward-level equipment ownership system. In September 2003, a Medical Equipment Loan Service (MELS) was established, focusing initially on infusion pumps. The aims and expected benefits included; improving availability of equipment for both patients and clinical users, managing and reducing clinical risk, reducing equipment diversity, improving equipment management and reducing the overall cost of equipment provision. A user survey was carried out in 2005 and repeated in 2011. The results showed wide and continued satisfaction with the service. The process and difficulties of establishing the service and its development to include additional types of equipment are described. The benefits of managing medical equipment which is in widespread general use, through a MELS as part of a Clinical Engineering Department, are presented.

Can Pharmacotherapists be Too Supportive? A Process Study of Active Medication and Placebo in the Treatment of Depression

PubMed Central

Strunk, Daniel R.; Stewart, Michael O.; Hollon, Steven D.; DeRubeis, Robert J.; Fawcett, Jan; Amsterdam, Jay D.; Shelton, Richard C.

2013-01-01

Background This study examined therapist-patient interactions during clinical management with anti-depressant medication and pill-placebo. Methods The sample consisted of 80 patients on active medication and 40 patients in a pill-placebo condition from a randomized controlled trial for moderate to severe depression. Pharmacotherapist-patient interactions were characterized using observer ratings of the therapeutic alliance, pharmacotherapist-offered facilitative conditions, pharmacotherapist adherence to clinical management treatment guidelines, and pharmacotherapist competence. Patients, therapists, and raters were blind to treatment condition and outcome. Results Provision of greater nonspecific support (facilitative conditions) in early sessions predicted less subsequent improvement in depressive symptoms for patients receiving pill-placebo but not those receiving active medications, for which none of the process ratings predicted subsequent change. Early symptom change predicted later alliance and adherence in both conditions and therapist competence in the active condition. Conclusions Higher levels of support in early sessions predict poorer subsequent response among placebo patients. It remains unclear whether patients who are likely to be refractory elicit greater nonspecific support or whether the provision of such support has a deleterious effect in unmedicated patients. Differences in treatment process variables between conditions late in treatment are likely to be largely a consequence of symptom relief produced by active medications. PMID:19891806

Java-based browsing, visualization and processing of heterogeneous medical data from remote repositories.

PubMed

Masseroli, M; Bonacina, S; Pinciroli, F

2004-01-01

The actual development of distributed information technologies and Java programming enables employing them also in the medical arena to support the retrieval, integration and evaluation of heterogeneous data and multimodal images in a web browser environment. With this aim, we used them to implement a client-server architecture based on software agents. The client side is a Java applet running in a web browser and providing a friendly medical user interface to browse and visualize different patient and medical test data, integrating them properly. The server side manages secure connections and queries to heterogeneous remote databases and file systems containing patient personal and clinical data. Based on the Java Advanced Imaging API, processing and analysis tools were developed to support the evaluation of remotely retrieved bioimages through the quantification of their features in different regions of interest. The Java platform-independence allows the centralized management of the implemented prototype and its deployment to each site where an intranet or internet connection is available. Giving healthcare providers effective support for comprehensively browsing, visualizing and evaluating medical images and records located in different remote repositories, the developed prototype can represent an important aid in providing more efficient diagnoses and medical treatments.

Application of process improvement principles to increase the frequency of complete airway management documentation.

PubMed

McCarty, L Kelsey; Saddawi-Konefka, Daniel; Gargan, Lauren M; Driscoll, William D; Walsh, John L; Peterfreund, Robert A

2014-12-01

Process improvement in healthcare delivery settings can be difficult, even when there is consensus among clinicians about a clinical practice or desired outcome. Airway management is a medical intervention fundamental to the delivery of anesthesia care. Like other medical interventions, a detailed description of the management methods should be documented. Despite this expectation, airway documentation is often insufficient. The authors hypothesized that formal adoption of process improvement methods could be used to increase the rate of "complete" airway management documentation. The authors defined a set of criteria as a local practice standard of "complete" airway management documentation. The authors then employed selected process improvement methodologies over 13 months in three iterative and escalating phases to increase the percentage of records with complete documentation. The criteria were applied retrospectively to determine the baseline frequency of complete records, and prospectively to measure the impact of process improvements efforts over the three phases of implementation. Immediately before the initial intervention, a retrospective review of 23,011 general anesthesia cases over 6 months showed that 13.2% of patient records included complete documentation. At the conclusion of the 13-month improvement effort, documentation improved to a completion rate of 91.6% (P<0.0001). During the subsequent 21 months, the completion rate was sustained at an average of 90.7% (SD, 0.9%) across 82,571 general anesthetic records. Systematic application of process improvement methodologies can improve airway documentation and may be similarly effective in improving other areas of anesthesia clinical practice.

Developing a clinical information system: the role of the chief information officer.

PubMed

Glaser, J

1994-11-01

Chief information officers (CIOs) must play a pivotal role in the formation and implementation of a clinical information system, the subset of an organizational information system that deals specifically with support of clinical care activities. Major elements include the applications software, technology and data architecture, databases, and analysis. The organizational structures and processes that manage the development of improvement activities, including the clinical information system itself, are just as vital to the design of an information system as the hardware and software. To develop, sustain, and advance an information infrastructure, the CIO must help establish certain organizational precursors, such as medical staff involvement, experience with quality improvement, and ability to meet data needs. The CIO must then work with the senior administrative and medical leadership in developing a vision for the information system. The CIO must also create new roles and knowledge for information system and medical staff members. Interaction between information services and medical staff is vitally important to the success of a clinical information system. Organizational committees and structures that Brigham and Women's Hospital in Boston put in place to formalize the relationship between information systems and medical staff include the Clinical Initiative Development Program and the Center for Applied Medical Information Systems Research. Improving the clinical management of care and the efficacy of care processes involves complex changes in organizational culture and processes, medical practice and information system applications, technologies, staff, and data.

Assessment of the quality of medical care among patients with early stage prostate cancer undergoing expectant management in the United States.

PubMed

Ritchey, Jamie; Gay, E Greer; Spencer, Benjamin A; Miller, David C; Wallner, Lauren P; Stewart, Andrew K; Dunn, Rodney L; Litwin, Mark S; Wei, John T

2012-09-01

Given the increased attention to the quality and cost of medical care, the Institute of Medicine and Centers for Medicare and Medicaid Services have called for performance measurement and reporting. The clinical management of prostate cancer has been outlined, yet is not intended to describe quality prostate cancer care. Therefore, RAND researchers developed quality indicators for early stage prostate cancer. The ACoS (American College of Surgeons) used these indicators to perform the first national assessment to our knowledge of the quality of care among men with early stage prostate cancer undergoing expectant management. Information from medical records was abstracted for evidence of compliance with the RAND indicators (structure and process). Weighted and stratified proportions were calculated to assess indicator compliance. Logistic regression models were fit and evaluated by hospital type and patient factors. A weighted and stratified total of 13,876 early stage prostate cancer cases on expectant management in 2000 to 2001 were investigated. Compliance with structural indicators was high (greater than 80%) and compliance with process indicators varied (19% to 87%). Differences in process indicators were observed from models by hospital type and comorbid conditions, but not for age, race or insurance status. Using the RAND quality indicators this study revealed several process areas for quality improvement among men with early stage prostate cancer on expectant management in the United States. Efforts to improve the quality of early stage prostate cancer care need to move beyond the paradigm of age, race and insurance status. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Validating and determining the weight of items used for evaluating clinical governance implementation based on analytic hierarchy process model.

PubMed

Hooshmand, Elaheh; Tourani, Sogand; Ravaghi, Hamid; Vafaee Najar, Ali; Meraji, Marziye; Ebrahimipour, Hossein

2015-04-08

The purpose of implementing a system such as Clinical Governance (CG) is to integrate, establish and globalize distinct policies in order to improve quality through increasing professional knowledge and the accountability of healthcare professional toward providing clinical excellence. Since CG is related to change, and change requires money and time, CG implementation has to be focused on priority areas that are in more dire need of change. The purpose of the present study was to validate and determine the significance of items used for evaluating CG implementation. The present study was descriptive-quantitative in method and design. Items used for evaluating CG implementation were first validated by the Delphi method and then compared with one another and ranked based on the Analytical Hierarchy Process (AHP) model. The items that were validated for evaluating CG implementation in Iran include performance evaluation, training and development, personnel motivation, clinical audit, clinical effectiveness, risk management, resource allocation, policies and strategies, external audit, information system management, research and development, CG structure, implementation prerequisites, the management of patients' non-medical needs, complaints and patients' participation in the treatment process. The most important items based on their degree of significance were training and development, performance evaluation, and risk management. The least important items included the management of patients' non-medical needs, patients' participation in the treatment process and research and development. The fundamental requirements of CG implementation included having an effective policy at national level, avoiding perfectionism, using the expertise and potentials of the entire country and the coordination of this model with other models of quality improvement such as accreditation and patient safety. © 2015 by Kerman University of Medical Sciences.

Quality improvement tools for chronic disease care--more effective processes are less likely to be implemented in developing countries.

PubMed

Hashim, Muhammad Jawad; Prinsloo, Adrianna; Mirza, Deen M

2013-01-01

Chronic disease services may be improved if care management processes (CMPs), such as disease-specific flowsheets and chronic disease registries, are used. The newly industrialized Gulf state health service has underdeveloped primary care but higher diabetes prevalence. This paper's aim is to investigate care management processes in United Arab Emirates (UAE) primary care clinics to explore these issues. A cross-sectional survey using self-administered questionnaires given to family physicians and nurses attending a UAE University workshop was used to collect data. All 38 participants completed the questionnaire: 68 per cent were women and 81 per cent physicians. Care management processes in use included: medical records, 76 per cent; clinical guidelines, 74 per cent; chronic disease care rooms, 74 per cent; disease-specific flowsheets, 61 per cent; medical record audits, 57 per cent; chronic disease nurse-educators, 58 per cent; electronic medical records (EMR), 34 per cent; and incentive plans based on clinical performance, 21 per cent. Only 62 per cent and 48 per cent reported that flowsheets and problem lists, respectively, were completed by physicians. Responses to the open-ended question included using traditional quality improvement (QI) approaches such as continuing education and staff meetings, but not proactive systems such as disease registries and self-management. The study used a small, non-random sample and the survey instrument's psychometric properties were not collected. Chronic disease care CMPs are present in UAE clinics but use is limited. Quality improvement should include disease registries, reminder-tracking systems, patient self-management support and quality incentives. This report highlights the lag regarding adopting more effective CMPs in developing countries.

Build infrastructure in publishing scientific journals to benefit medical scientists

PubMed Central

Dai, Ni; Xu, Dingyao; Zhong, Xiyao; Li, Li; Ling, Qibo

2014-01-01

There is urgent need for medical journals to optimize their publishing processes and strategies to satisfy the huge need for medical scientists to publish their articles, and then obtain better prestige and impact in scientific and research community. These strategies include optimizing the process of peer-review, utilizing open-access publishing models actively, finding ways of saving costs and getting revenue, smartly dealing with research fraud or misconduct, maintaining sound relationship with pharmaceutical companies, and managing to provide relevant and useful information for clinical practitioners and researchers. Scientists, publishers, societies and organizations need to work together to publish internationally renowned medical journals. PMID:24653634

Build infrastructure in publishing scientific journals to benefit medical scientists.

PubMed

Dai, Ni; Xu, Dingyao; Zhong, Xiyao; Li, Li; Ling, Qibo; Bu, Zhaode

2014-02-01

There is urgent need for medical journals to optimize their publishing processes and strategies to satisfy the huge need for medical scientists to publish their articles, and then obtain better prestige and impact in scientific and research community. These strategies include optimizing the process of peer-review, utilizing open-access publishing models actively, finding ways of saving costs and getting revenue, smartly dealing with research fraud or misconduct, maintaining sound relationship with pharmaceutical companies, and managing to provide relevant and useful information for clinical practitioners and researchers. Scientists, publishers, societies and organizations need to work together to publish internationally renowned medical journals.

A qualitative evaluation of medication management services in six Minnesota health systems.

PubMed

Sorensen, Todd D; Pestka, Deborah; Sorge, Lindsay A; Wallace, Margaret L; Schommer, Jon

2016-03-01

The initiation, establishment, and sustainability of medication management programs in six Minnesota health systems are described. Six Minnesota health systems with well-established medication management programs were invited to participate in this study: Essentia Health, Fairview Health Services, HealthPartners, Hennepin County Medical Center, Mayo Clinic, and Park Nicollet Health Services. Qualitative methods were employed by conducting group interviews with key staff from each institution who were influential in the development of medication management services within their organization. Kotter's theory of eight steps for leading organizational change served as the framework for the question guide. The interviews were audio recorded, transcribed, and analyzed for recurring and emergent themes. A total of 13 distinct themes were associated with the successful integration of medication management services across the six healthcare systems. Identified themes clustered within three stages of Kotter's model for leading organizational change: creating a climate for change, engaging and enabling the whole organization, and implementing and sustaining change. The 13 themes included (1) external influences, (2) pharmacists as an untapped resource, (3) principles and professionalism, (4) organizational culture, (5) momentum champions, (6) collaborative relationships, (7) service promotion, (8) team-based care, (9) implementation strategies, (10) overcoming challenges, (11) supportive care model process, (12) measuring and reporting results, and (13) sustainability strategies. A qualitative survey of six health systems that successfully implemented medication management services in ambulatory care clinics revealed that a supportive culture and team-based collaborative care are among the themes identified as necessary for service sustainability. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

[E-Health and reality - what are we facing in patient care?

PubMed

Gehring, H; Rackebrandt, K; Imhoff, M

2018-03-01

The terms e‑Health and digitization are core elements of a change in our time. The main drivers of this change - in addition to a dynamic market - are the serious advantages for the healthcare sector in the processing of tasks and requirements. The large amounts of data, the intensively growing medical knowledge, the rapidly advancing technological developments and the goal of a personalized, customized therapy for the patient, make the application absolutely necessary. While e‑Health describes the use of information and communication technologies in healthcare, the concept of digitization is associated with the underlying processes of change and innovation. Digital technologies include software and hardware based developments. The term clinical data intelligence describes the property of workability and also characterizes the collaboration of clinically relevant systems with which the medical user works. The hierarchy in digital processing maps the levels from pure data management through clinical decision support to automated process flows and autonomously operating units. The combination of patient data management and clinical decision support proves its value in terms of error reduction, prevention, quality and safety, especially in drug therapy. The aim of this overview is the presentation of the existing reality in medical centers with perspectives derived from the point of view of the medical user.

Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship

PubMed Central

Ford, Bradley A.; Klutts, J. Stacey; Jensen, Chris S.; Briggs, Angela S.; Robinson, Robert A.; Bruch, Leslie A.; Karandikar, Nitin J.

2017-01-01

Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output. PMID:28913416

Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship.

PubMed

Krasowski, Matthew D; Ford, Bradley A; Klutts, J Stacey; Jensen, Chris S; Briggs, Angela S; Robinson, Robert A; Bruch, Leslie A; Karandikar, Nitin J

2017-01-01

Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output.

Medical Data Architecture (MDA) Project Status

NASA Technical Reports Server (NTRS)

Krihak, M.; Middour, C.; Gurram, M.; Wolfe, S.; Marker, N.; Winther, S.; Ronzano, K.; Bolles, D.; Toscano, W.; Shaw, T.

2018-01-01

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current in-flight medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are a variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable a more medically autonomous crew than the current paradigm. The medical system requirements are being developed in parallel with the exploration mission architecture and vehicle design. ExMC has recognized that in order to make informed decisions about a medical data architecture framework, current methods for medical data management must not only be understood, but an architecture must also be identified that provides the crew with actionable insight to medical conditions. This medical data architecture will provide the necessary functionality to address the challenges of executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. Hence, the products supported by current prototype development will directly inform exploration medical system requirements.

Medical Data Architecture Project Status

NASA Technical Reports Server (NTRS)

Krihak, M.; Middour, C.; Gurram, M.; Wolfe, S.; Marker, N.; Winther, S.; Ronzano, K.; Bolles, D.; Toscano, W.; Shaw, T.

2018-01-01

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current in-flight medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are a variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable a more medically autonomous crew than the current paradigm. The medical system requirements are being developed in parallel with the exploration mission architecture and vehicle design. ExMC has recognized that in order to make informed decisions about a medical data architecture framework, current methods for medical data management must not only be understood, but an architecture must also be identified that provides the crew with actionable insight to medical conditions. This medical data architecture will provide the necessary functionality to address the challenges of executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. Hence, the products supported by current prototype development will directly inform exploration medical system requirements.

Overall comparative analysis of management and outcomes of cardiac cases reported on board merchant ships.

PubMed

Apostolatos, Charalampos; Andria, Vivian; Licari, Julie

Telemedical assistance has always been the cornerstone of medical care on board. Significant technological progress has provided improved scientific tools and equipment for high-quality communication and prompt management of either minor incidents or major emergencies on board. Med Solutions International is a medical management company, offering services exclusively to the maritime industry. Registered vessels contact the medical team and healthcare professionals provide immediate guidelines for onboard management as well as necessary action thereafter, i.e. examination ashore or urgent medical evacuation. Since cardiac conditions or diseases are potentially the most dangerous when traveling at sea, it is of major importance to analyse and evaluate the overall management and outcomes of cases reporting symptoms of possible heart disease so as to improve telemedical assistance services in future. The study included cases reporting cardiac symptoms from 5 major shipping companies during the year 2016. Data was collected from telecommunication, emails and seafarers' final medical reports. A descriptive analysis of overall management and outcomes was performed. The study showed that the number of confirmed cardiovascular cases on board was very low. Among 551 total cases and 44 cases with reported cardiac symptoms there was only one heart attack, one pulmonary oedema and one suspected myocarditis. In the majority of cases, chest pain was musculoskeletal or due to respiratory infection. Symptoms resulting from issues such as stress or anxiety often present as potential cardiac conditions. Stress may also amplify the severity of symptoms. Language barriers between the seafarer, the master and the doctor often make communication very difficult. According to our findings there are grounds to intensify the prevention process through more efficient pre-employment medical examinations and improve management on board through more intensive training. Communication problems often complicate medical management on board. Effective communication and knowledge of patient's medical history and risk profile is very important to reviewing physician. Effective diagnosis depends on accurate and objective description of symptoms and clinical condition.

The management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust

PubMed Central

Peacock, M

2013-01-01

Management of ultrasound equipment at Sheffield Teaching Hospitals NHS Foundation Trust is described. The organisation and input of various stakeholders and their involvement with ultrasound equipment management and scientific ultrasound is discussed. Two important stakeholders are the Medical Equipment Management Group and the Radiation Safety Steering Committee. The Medical Equipment Management Group has a specific sub-group, the Ultrasound sub-group, and its role is to coordinate the purchase, replacement and quality assurance of ultrasound equipment in the Trust. The Radiation Safety Steering Committee has a non-ionising radiation representative and the role of this committee is to provide corporate assurance that any health and safety issues arising from the use of radiation to either patients, members of the public or staff within the Trust are being effectively managed. The Ultrasound sub-group of the Medical Equipment Management Group has successfully brought together management of all ultrasound equipment within the Trust and is in the process of fulfilling the quality assurance and training milestones set out by the Medical Equipment Management Group. Advice from the Radiation Safety Steering Committee has helped to increase awareness of ultrasound safety and good scanning practice, especially in the case of neonatal ultrasound imaging, within the Trust. In addition, the RSSC has given advice on clinical pathways for patients undergoing ionising radiation imaging while being treated by extra-corporeal shockwave lithotripsy. PMID:27433195

Integrated billing and accounts receivable management system needed to maximize payments and cope with managed care.

PubMed

Sanders, J; Wold, D; Sullivan, T

1999-01-01

The billing and accounts receivable management process in medical practices today has evolved into a multidisciplinary function. This function requires efficient, coordinated performance by physicians and all staff members, from the point of initial patient contact through aggressive follow-up on delinquent payments for services rendered. Offices with deficient or nonexistent billing and accounts receivable management systems typically experience collection ratios that are less than industry norms. They also experience poor cash flow and unnecessary overhead costs. To avoid costly inefficiencies and ensure that it maximizes payments from third-party payors and patients, a medical practice must have an integrated billing and accounts receivable management system that includes components outlined in this article.

Finance issue brief: HMO medical directors: year end report-2002.

PubMed

Morgan, Rachel; MacEachern, Lillian

2002-12-31

Medical directors of managed care organizations have the ultimate responsibility of deciding the treatments for which a health plan will pay. Cognizant of consumer concerns over the power inherent in the position, states are seeking to inject more accountability into the decision-making process. Lawmakers have begun to grapple with whether medical directors should be required to hold a medical license from the state in which they work and, by extension, whether they should be under the jurisdiction of the state medical board.

Finance issue brief: HMO medical directors: year end report-2003.

PubMed

MacEachern, Lillian

2003-12-31

Medical directors of managed care organizations have the ultimate responsibility of deciding the treatments for which a health plan will pay. Cognizant of consumer concerns over the power inherent in the position, states are seeking to inject more accountability into the decision-making process. Lawmakers have begun to grapple with whether medical directors should be required to hold a medical license from the state in which they work and, by extension, whether they should be under the jurisdiction of the state medical board.

Determining the disease management process for epileptic patients: A qualitative study

PubMed Central

Hosseini, Nazafarin; Sharif, Farkhondeh; Ahmadi, Fazlollah; Zare, Mohammad

2016-01-01

Background: Epilepsy exposes patients to many physical, social, and emotional challenges. Thus, it seems to portray a complex picture and needs holistic care. Medical treatment and psychosocial part of epilepsy remain central to managing and improving the patient's qualify of life through team efforts. Some studies have shown the dimensions of self-management, but its management process of epilepsy patients, especially in Iran, is not clear. This study aimed to determine the disease management process in patients with epilepsy in Iran. Materials and Methods: This qualitative approach and grounded theory study was conducted from January 2009 to February 2012 in Isfahan city (Iran). Thirty-two participants were recruited by the goal-oriented, and snowball sample selection and theoretical sampling methods. After conducting a total of 43 in-depth interviews with the participants, the researchers reached data saturation. Data were analyzed using Strauss and Corbin method. Results: With a focus on disease management process, researchers found three main themes and seven sub-themes as a psychosocial process (PSP). The main themes were: perception of threat to self-identity, effort to preserve self-identity, and burn out. The psychosocial aspect of the disease generated one main variable “the perception of identity loss” and one central variable “searching for self-identity.” Conclusions: Participants attributed threat to self-identity and burn out to the way their disease was managed requiring efforts to preserve their identity. Recommendations consist of support programs and strategies to improve the public perception of epilepsy in Iran, help patients accept their condition and preserve self-identity, and most importantly, enhance medical management of epilepsy. PMID:26985223

Factors associated with medication information in diabetes care: differences in perceptions between patients and health care professionals

PubMed Central

Längst, Gerda; Seidling, Hanna Marita; Stützle, Marion; Ose, Dominik; Baudendistel, Ines; Szecsenyi, Joachim; Wensing, Michel; Mahler, Cornelia

2015-01-01

Purpose This qualitative study in patients with type 2 diabetes and health care professionals (HCPs) aimed to investigate which factors they perceive to enhance or impede medication information provision in primary care. Similarities and differences in perspectives were explored. Methods Eight semistructured focus groups were conducted, four with type 2 diabetes patients (n=25) and four with both general practitioners (n=13) and health care assistants (n=10). Sessions were audio and video recorded, transcribed verbatim, and subjected to computer-aided qualitative content analysis. Results Diabetes patients and HCPs broadly highlighted similar factors as enablers for satisfactory medication information delivery. Perceptions substantially differed regarding impeding factors. Both patients and HCPs perceived it to be essential to deliver tailored information, to have a trustful and continuous patient–provider relationship, to regularly reconcile medications, and to provide tools for medication management. However, substantial differences in perceptions related to impeding factors included the causes of inadequate information, the detail required for risk-related information, and barriers to medication reconciliation. Medication self-management was a prevalent topic among patients, whereas HCPs’ focus was on fulfilling therapy and medication management responsibilities. Conclusion The findings suggest a noteworthy gap in perceptions between information provision and patients’ needs regarding medication-related communication. Medication safety and adherence may be improved if HCPs collaborate more closely with diabetes patients in managing their medication, in particular by incorporating the patients’ perspective. Health care systems need to be structured in a way that supports this process. PMID:26508840

Communication relating to family members' involvement and understandings about patients' medication management in hospital.

PubMed

Manias, Elizabeth

2015-10-01

Many patients with complex health-care needs are prescribed several medications on a daily basis. With admission to hospital, patients are often placed in a vulnerable position. Family members can therefore play an important role in supporting patients in decision making about managing medications and negotiating communication exchange with health professionals. From the perspective of family members, to explore family members' involvement with health professionals and patients about how patients' medications are managed in hospital. Using an ethnographic design, interviews were conducted with family members of patients admitted to hospital who had at least five medications prescribed in hospital. A purposive sampling approach was used for recruitment. A thematic framework process was used for analysis. Interviews took place in four surgical and four medical wards in each of two Australian hospitals. Forty interviews were conducted with family members in relation to their respective relative's medications. Family members tended to participate in passive, rather than active or shared decision-making activities. Those who demonstrated active or shared decision making were extensively involved in managing medications and in addressing problems relating to continuity of care. Communication with health professionals was generally insufficient, despite family members' keenness to speak with them. Improved communication is needed between family members, health professionals and patients in hospitals. Greater attention should be played by health professionals in initiating communication proactively. Family members possessed valuable, unique information about patients' medications that can be utilized to facilitate patient safety. © 2013 Blackwell Publishing Ltd.

A New Model for the Organizational Structure of Medical Record Departments in Hospitals in Iran

PubMed Central

Moghaddasi, Hamid; Hosseini, Azamossadat; Sheikhtaheri, Abbas

2006-01-01

The organizational structure of medical record departments in Iran is not appropriate for the efficient management of healthcare information. In addition, there is no strong information management division to provide comprehensive information management services in hospitals in Iran. Therefore, a suggested model was designed based on four main axes: 1) specifications of a Health Information Management Division, 2) specifications of a Healthcare Information Management Department, 3) the functions of the Healthcare Information Management Department, and 4) the units of the Healthcare Information Management Department. The validity of the model was determined through use of the Delphi technique. The results of the validation process show that the majority of experts agree with the model and consider it to be appropriate and applicable for hospitals in Iran. The model is therefore recommended for hospitals in Iran. PMID:18066362

Applying industrial engineering practices to radiology.

PubMed

Rosen, Len

2004-01-01

Seven hospitals in Oregon and Washington have successfully adopted the Toyota Production System (TPS). Developed by Taiichi Ohno, TPS focuses on finding efficiencies and cost savings in manufacturing processes. A similar effort has occurred in Canada, where Toronto's Hospital for Sick Children has developed a database for its diagnostic imaging department built on the principles of TPS applied to patient encounters. Developed over the last 5 years, the database currently manages all interventional patient procedures for quality assurance, inventory, equipment, and labor. By applying industrial engineering methodology to manufacturing processes, it is possible to manage these constraints, eliminate the obstacles to achieving streamlined processes, and keep the cost of delivering products and services under control. Industrial engineering methodology has encouraged all stakeholders in manufacturing plants to become participants in dealing with constraints. It has empowered those on the shop floor as well as management to become partners in the change process. Using a manufacturing process model to organize patient procedures enables imaging department and imaging centers to generate reports that can help them understand utilization of labor, materials, equipment, and rooms. Administrators can determine the cost of individual procedures as well as the total and average cost of specific procedure types. When Toronto's Hospital for Sick Children first implemented industrial engineering methodology to medical imaging interventional radiology patient encounters, it focused on materials management. Early in the process, the return on investment became apparent as the department improved its management of more than 500,000 dollars of inventory. The calculated accumulated savings over 4 years for 10,000 interventional procedures alone amounted to more than 140,000 dollars. The medical imaging department in this hospital is only now beginning to apply what it has learned to other factors contributing to case cost. It has started to analyze its service contracts with equipment vendors. The department also is accumulating data to measure room, equipment, and labor utilization. The hospital now has a true picture of the real cost associated with each patient encounter in medical imaging. It can now begin to manage case costs, perform better capacity planning, create more effective relationships with its material suppliers, and optimize scheduling of patients and staff.

Innovative medical devices and hospital decision making: a study comparing the views of hospital pharmacists and physicians.

PubMed

Billaux, Mathilde; Borget, Isabelle; Prognon, Patrice; Pineau, Judith; Martelli, Nicolas

2016-06-01

Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders' perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as 'new', 'safe' and 'effective', whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital-based health technology assessment has been developed to support decisions. However, little is known about the different perceptions of innovative medical devices among practitioners and how different perceptions may affect decision making. What does this paper add? This paper compares and understands the perceptions of two groups of health professionals concerning innovative devices in the university hospital environment. What are the implications for practitioners? Such a comparison of viewpoints could facilitate improvements in current practices and decision-making processes in local health technology assessment for these medical products.

Definition of information technology architectures for continuous data management and medical device integration in diabetes.

PubMed

Hernando, M Elena; Pascual, Mario; Salvador, Carlos H; García-Sáez, Gema; Rodríguez-Herrero, Agustín; Martínez-Sarriegui, Iñaki; Gómez, Enrique J

2008-09-01

The growing availability of continuous data from medical devices in diabetes management makes it crucial to define novel information technology architectures for efficient data storage, data transmission, and data visualization. The new paradigm of care demands the sharing of information in interoperable systems as the only way to support patient care in a continuum of care scenario. The technological platforms should support all the services required by the actors involved in the care process, located in different scenarios and managing diverse information for different purposes. This article presents basic criteria for defining flexible and adaptive architectures that are capable of interoperating with external systems, and integrating medical devices and decision support tools to extract all the relevant knowledge to support diabetes care.

How do United Kingdom (UK) medical schools identify and support undergraduate medical students who ‘fail’ communication assessments? A national survey

PubMed Central

2013-01-01

Background The doctor’s ability to communicate effectively (with patients, relatives, advocates and healthcare colleagues) relates directly to health outcomes, and so is core to clinical practice. The remediation of medical students’ clinical communication ability is rarely addressed in medical education literature. There is nothing in the current literature reporting a contemporary national picture of how communication difficulties are managed, and the level of consequence (progression implications) for students of performing poorly. This survey aimed to consolidate practices for identifying and processes for managing students who ‘fail’ communication assessments across all UK medical schools. Methods Data were collected via an email survey to all leads for clinical communication in all UK Medical Schools for the UK Council for Clinical Communication in Undergraduate Medical Education. Results All but two participating Schools reported some means of support and/or remediation in communication. There was diversity of approach, and variance in the level of systemisation adopted. Variables such as individuality of curricula, resourcing issues, student cohort size and methodological preferences were implicated as explaining diversity. Support is relatively ad hoc, and often in the hands of a particular dedicated individual or team with an interest in communication delivery with few Schools reporting robust, centralised, school level processes. Conclusions This survey has demonstrated that few Medical Schools have no identifiable system of managing their students’ clinical communication difficulties. However, some Schools reported ad hoc approaches and only a small number had a centralised programme. There is scope for discussion and benchmarking of best practice across all Schools with allocation of appropriate resources to support this. PMID:23834990

Medical image informatics infrastructure design and applications.

PubMed

Huang, H K; Wong, S T; Pietka, E

1997-01-01

Picture archiving and communication systems (PACS) is a system integration of multimodality images and health information systems designed for improving the operation of a radiology department. As it evolves, PACS becomes a hospital image document management system with a voluminous image and related data file repository. A medical image informatics infrastructure can be designed to take advantage of existing data, providing PACS with add-on value for health care service, research, and education. A medical image informatics infrastructure (MIII) consists of the following components: medical images and associated data (including PACS database), image processing, data/knowledge base management, visualization, graphic user interface, communication networking, and application oriented software. This paper describes these components and their logical connection, and illustrates some applications based on the concept of the MIII.

WE-E-218-01: Writing and Reviewing Papers in Medical Physics.

PubMed

Hendee, W; Slattery, P; Rogers, D; Karellas, A

2012-06-01

There is an art to writing a scientific paper so that it communicates accurately, succinctly, and comprehensively. Developing this art comes with experience, and sharing that experience with younger physicists is an obligation of senior scientists, especially those with editorial responsibilities for the journal. In this workshop, the preparation of a scientific manuscript will be dissected so participants can appreciate how each part is developed and then assembled into a complete paper. Then the review process for the paper will be discussed, including how to examine a paper and write an insightful and constructive review. Finally, we will consider the challenge of accommodating the concerns and recommendations of a reviewer in preparing a revision of the paper. A second feature of the workshop will be a discussion of the process of electronic submission of a paper for consideration by Medical Physics. The web-based PeerX-Press engine for manuscript submission and management will be examined, with attention to special features such as epaps and line-referencing. Finally, new features of Medical Physics will be explained, such as Vision 20/20 manuscripts, Physics Letters and the standardized formatting of book reviews. 1. Improve the participants' abilities to write a scientific manuscript. 2. Understand the review process for Medical Physics manuscripts and how to participate in and benefit from it. 3. Appreciate the many features of the PeerX-Press electronic management process for Medical Physics manuscripts. 4. Develop a knowledge of new features of Medical Physics. © 2012 American Association of Physicists in Medicine.

Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting.

PubMed

Liu, Wei; Gerdtz, Marie; Manias, Elizabeth

2016-10-01

This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication management in an acute hospital setting. Language discourses shaped and were shaped by complex power relations between patients and clinicians and among clinicians themselves. Clinicians need to be encouraged to have regular conversations to talk about and challenge each other's practices. More emphasis should be placed on ensuring that patients are given opportunities to voice their concerns about how their medications are managed. © 2016 John Wiley & Sons Ltd.

Medical device innovation and the value analysis process.

PubMed

Krantz, Heidi; Strain, Barbara; Torzewski, Jane

2017-09-01

Heidi A. Krantz, RN, BSN is the Director of Value Analysis at Johns Hopkins Bayview Medical Center in the Johns Hopkins Health System. Barbara Strain, MA, CVAHP is the Director of Value Management at the University of Virginia Health System. Jane Torzewski RN, MAN, MBA is a Senior Category Manager for the Mayo Clinic Physician Preference Contracting team. She previously was a Senior Clinical Value Analyst on the Mayo Clinic Value Analysis team. Copyright © 2018. Published by Elsevier Inc.

[The medical technologist as a key professional in medical care in the 21st century].

PubMed

Iwatani, Yoshinori

2008-10-01

The dynamic healthcare environment of Japan, including the rapidly aging population and the requirement of highly sophisticated and diverse medical care, induces strict financial conditions and increases the number of those seeking medical care. Therefore, medical professionals are now required to provide safe and effective medical care with limited medical resources. Recently, Japanese medical institutions have introduced the total quality management system, which was developed for better business management, to promote safe and effective management. However, there are two major drawbacks with the introduction of this system in the sector of medical care in Japan. First, the standardization of medical skills of medical professionals is greatly affected due to the presence of different education systems for the same medical profession except for medical doctors and pharmacologists. The education system for major medical professionals, such as nurses and medical and radiological technologists, must be standardized based on the university norms. Second, the knowledge-creating process among the medical professionals has been associated with many problems. The specialized fields are quite different among medical professionals. Therefore, common specialized fields must be established among major medical professions based on the specialization of medical doctors to promote their communication and better understanding. Considering the roles of medical professionals in medical care, medical doctors and nurses are the most responsible for monitoring, assessing, and guaranteeing the safety of medical care, and medical and radiological technologists are the most responsible for effective medical care. The current medical technologists are not only required to carry out clinical laboratory tests, but also be proactive and positive as well as have marked problem-solving abilities. They are expected to improve the diagnostic test systems in medical institutes for medical doctors and patients, resulting in the highest level of management efficiency. For the development of such medical technologists, university education, specialist capabilities in medical technology and clinical laboratory diagnostics, and a research capability are essential. Thus, it is crucial for clinical laboratory physicians and the Japanese medical care system of the 21st century to urgently develop such an education system.

Electronic SSKIN pathway: reducing device-related pressure ulcers.

PubMed

Campbell, Natalie

2016-08-11

This article describes how an interprofessional project in a London NHS Foundation Trust was undertaken to develop an intranet-based medical device-related pressure ulcer prevention and management pathway for clinical staff working across an adult critical care directorate, where life-threatening events require interventions using medical devices. The aim of this project was to improve working policies and processes to define key prevention strategies and provide clinicians with a clear, standardised approach to risk and skin assessment, equipment use, documentation and reporting clinical data using the Trust's CareVue (electronic medical records), Datix (incident reporting and risk-management tool) and eTRACE (online clinical protocol ordering) systems. The process included the development, trial and local implementation of the pathway using collaborative teamwork and the SSKIN care bundle tool. The experience of identifying issues, overcoming challenges, defining best practice and cascading SSKIN awareness training is shared.

Assessment of medical waste management in seven hospitals in Lagos, Nigeria.

PubMed

Awodele, Olufunsho; Adewoye, Aishat Abiodun; Oparah, Azuka Cyril

2016-03-15

Medical waste (MW) can be generated in hospitals, clinics and places where diagnosis and treatment are conducted. The management of these wastes is an issue of great concern and importance in view of potential public health risks associated with such wastes. The study assessed the medical waste management practices in selected hospitals and also determined the impact of Lagos Waste Management Authority (LAWMA) intervention programs. A descriptive cross-sectional survey method was used. Data were collected using three instrument (questionnaire, site visitation and in -depth interview). Two public (hospital A, B) and five private (hospital C, D, E, F and G) which provide services for low, middle and high income earners were used. Data analysis was done with SPSS version 20. Chi-squared test was used to determine level of significance at p < 0.05. The majority 56 (53.3%) of the respondents were females with mean age of 35.46 (±1.66) years. The hospital surveyed, except hospital D, disposes both general and medical waste separately. All the facilities have the same process of managing their waste which is segregation, collection/on-site transportation, on-site storage and off-site transportation. Staff responsible for collecting medical waste uses mainly hand gloves as personal protective equipment. The intervention programs helped to ensure compliance and safety of the processes; all the hospitals employ the services of LAWMA for final waste disposal and treatment. Only hospital B offered on-site treatment of its waste (sharps only) with an incinerator while LAWMA uses hydroclave to treat its wastes. There are no policies or guidelines in all investigated hospitals for managing waste. An awareness of proper waste management amongst health workers has been created in most hospitals through the initiative of LAWMA. However, hospital D still mixes municipal and hazardous wastes. The treatment of waste is generally done by LAWMA using hydroclave, to prevent environmental hazards except hospital B that treats its sharp with an incinerator. In order to enhance uniform and appropriate waste management practices in the entire State, there is need for capacity building at all levels and also policies and guidelines formulations.

Medical Data Architecture Project Status

NASA Technical Reports Server (NTRS)

Krihak, M.; Middour, C.; Lindsey, A.; Marker, N.; Wolfe, S.; Winther, S.; Ronzano, K.; Bolles, D.; Toscano, W.; Shaw, T.

2017-01-01

The Medical Data Architecture (MDA) project supports the Exploration Medical Capability (ExMC) risk to minimize or reduce the risk of adverse health outcomes and decrements in performance due to in-flight medical capabilities on human exploration missions. To mitigate this risk, the ExMC MDA project addresses the technical limitations identified in ExMC Gap Med 07: We do not have the capability to comprehensively process medically-relevant information to support medical operations during exploration missions. This gap identifies that the current International Space Station (ISS) medical data management includes a combination of data collection and distribution methods that are minimally integrated with on-board medical devices and systems. Furthermore, there are variety of data sources and methods of data collection. For an exploration mission, the seamless management of such data will enable an increasingly autonomous crew than the current ISS paradigm. The MDA will develop capabilities that support automated data collection, and the necessary functionality and challenges in executing a self-contained medical system that approaches crew health care delivery without assistance from ground support. To attain this goal, the first year of the MDA project focused on reducing technical risk, developing documentation and instituting iterative development processes that established the basis for the first version of MDA software (or Test Bed 1). Test Bed 1 is based on a nominal operations scenario authored by the ExMC Element Scientist. This narrative was decomposed into a Concept of Operations that formed the basis for Test Bed 1 requirements. These requirements were successfully vetted through the MDA Test Bed 1 System Requirements Review, which permitted the MDA project to begin software code development and component integration. This paper highlights the MDA objectives, development processes, and accomplishments, and identifies the fiscal year 2017 milestones and deliverables in the upcoming year.

Applying the cognitive theory of multimedia learning: an analysis of medical animations.

PubMed

Yue, Carole; Kim, Jessie; Ogawa, Rikke; Stark, Elena; Kim, Sara

2013-04-01

Instructional animations play a prominent role in medical education, but the degree to which these teaching tools follow empirically established learning principles, such as those outlined in the cognitive theory of multimedia learning (CTML), is unknown. These principles provide guidelines for designing animations in a way that promotes optimal cognitive processing and facilitates learning, but the application of these learning principles in current animations has not yet been investigated. A large-scale review of existing educational tools in the context of this theoretical framework is necessary to examine if and how instructional medical animations adhere to these principles and where improvements can be made. We conducted a comprehensive review of instructional animations in the health sciences domain and examined whether these animations met the three main goals of CTML: managing essential processing; minimising extraneous processing, and facilitating generative processing. We also identified areas for pedagogical improvement. Through Google keyword searches, we identified 4455 medical animations for review. After the application of exclusion criteria, 860 animations from 20 developers were retained. We randomly sampled and reviewed 50% of the identified animations. Many animations did not follow the recommended multimedia learning principles, particularly those that support the management of essential processing. We also noted an excess of extraneous visual and auditory elements and few opportunities for learner interactivity. Many unrealised opportunities exist for improving the efficacy of animations as learning tools in medical education; instructors can look to effective examples to select or design animations that incorporate the established principles of CTML. © Blackwell Publishing Ltd 2013.

Implementation of behavioral health interventions in real world scenarios: Managing complex change.

PubMed

Clark, Khaya D; Miller, Benjamin F; Green, Larry A; de Gruy, Frank V; Davis, Melinda; Cohen, Deborah J

2017-03-01

A practice embarks on a radical reformulation of how care is designed and delivered when it decides to integrate medical and behavioral health care for its patients and success depends on managing complex change in a complex system. We examined the ways change is managed when integrating behavioral health and medical care. Observational cross-case comparative study of 19 primary care and community mental health practices. We collected mixed methods data through practice surveys, observation, and semistructured interviews. We analyzed data using a data-driven, emergent approach. The change management strategies that leadership employed to manage the changes of integrating behavioral health and medical care included: (a) advocating for a mission and vision focused on integrated care; (b) fostering collaboration, with a focus on population care and a team-based approaches; (c) attending to learning, which includes viewing the change process as continuous, and creating a culture that promoted reflection and continual improvement; (d) using data to manage change, and (e) developing approaches to finance integration. This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. We offer an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[Safety management in pathology laboratory: from specimen handling to confirmation of reports].

PubMed

Minato, Hiroshi; Nojima, Takayuki; Nakano, Mariko; Yamazaki, Michiko

2011-03-01

Medical errors in pathological diagnosis give a huge amount of physical and psychological damage to patients as well as medical staffs. We discussed here how to avoid medical errors in surgical pathology laboratory through our experience. Handling of surgical specimens and diagnosing process requires intensive labor and involves many steps. Each hospital reports many kinds of accidents or incidents, however, many laboratories share common problems and each process has its specific risk for the certain error. We analyzed the problems in each process and concentrated on avoiding misaccessioning, mislabeling, and misreporting. We have made several changes in our system, such as barcode labels, digital images of all specimens, putting specimens in embedding cassettes directly on the endoscopic biopsied specimens, and using a multitissue control block as controls in immunohistochemistry. Some problems are still left behind, but we have reduced the errors by decreasing the number of artificial operation as much as possible. A pathological system recognizing the status of read or unread the pathological reports by clinician are now underconstruction. We also discussed about quality assurance of diagnosis, cooperation with clinicians and other comedical staffs, and organization and method. In order to operate riskless work, it is important for all the medical staffs to have common awareness of the problems, keeping careful observations, and sharing all the information in common. Incorporation of an organizational management tool such as ISO 15189 and utilizing PDCA cycle is also helpful for safety management and quality improvement of the laboratory.

The economics of health information technology in medication management: a systematic review of economic evaluations.

PubMed

O'Reilly, Daria; Tarride, Jean-Eric; Goeree, Ron; Lokker, Cynthia; McKibbon, K Ann

2012-01-01

To conduct a systematic review and synthesis of the evidence surrounding the cost-effectiveness of health information technology (HIT) in the medication process. Peer-reviewed electronic databases and gray literature were searched to identify studies on HIT used to assist in the medication management process. Articles including an economic component were reviewed for further screening. For this review, full cost-effectiveness analyses, cost-utility analyses and cost-benefit analyses, as well as cost analyses, were eligible for inclusion and synthesis. The 31 studies included were heterogeneous with respect to the HIT evaluated, setting, and economic methods used. Thus the data could not be synthesized, and a narrative review was conducted. Most studies evaluated computer decision support systems in hospital settings in the USA, and only five of the studied performed full economic evaluations. Most studies merely provided cost data; however, useful economic data involves far more input. A full economic evaluation includes a full enumeration of the costs, synthesized with the outcomes of the intervention. The quality of the economic literature in this area is poor. A few studies found that HIT may offer cost advantages despite their increased acquisition costs. However, given the uncertainty that surrounds the costs and outcomes data, and limited study designs, it is difficult to reach any definitive conclusion as to whether the additional costs and benefits represent value for money. Sophisticated concurrent prospective economic evaluations need to be conducted to address whether HIT interventions in the medication management process are cost-effective.

[Designing a software for drug management in special situations at a hospital's drug administration service].

PubMed

Sánchez Cuervo, Marina; Muñoz García, María; Gómez de Salazar López de Silanes, María Esther; Bermejo Vicedo, Teresa

2015-03-01

to describe the features of a computer program for management of drugs in special situations (off-label and compassionate use) in a Department of Hospital Pharmacy (PD). To describe the methodology followed for its implementation in the Medical Services. To evaluate their use after 2 years of practice. the design was carried out by pharmacists of the PD. The stages of the process were: selection of a software development company, establishment of a working group, selection of a development platform, design of an interactive Viewer, definition of functionality and data processing, creation of databases, connection, installation and configuration, application testing and improvements development. A directed sequential strategy was used for implementation in the Medical Services. The program's utility and experience of use were evaluated after 2 years. a multidisciplinary working group was formed and developed Pk_Usos®. The program works in web environment with a common viewer for all users enabling real time checking of the request files' status and that adapts to the management of medications in special situations procedure. Pk_Usos® was introduced first in the Oncology Department, with 15 oncologists as users of the program. 343 patients had 384 treatment requests managed, of which 363 are authorized throughout two years. PK_Usos® is the first software designed for the management of drugs in special situations in the PD. It is a dynamic and efficient tool for all professionals involved in the process by optimization of times. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Disclosing medical mistakes: a communication management plan for physicians.

PubMed

Petronio, Sandra; Torke, Alexia; Bosslet, Gabriel; Isenberg, Steven; Wocial, Lucia; Helft, Paul R

2013-01-01

There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians' own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. The steps are 1) physician preparation, such as talking about the physician's emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested.

Selection of infectious medical waste disposal firms by using the analytic hierarchy process and sensitivity analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hsu, P.-F.; Wu, C.-R.; Li, Y.-T.

2008-07-01

While Taiwanese hospitals dispose of large amounts of medical waste to ensure sanitation and personal hygiene, doing so inefficiently creates potential environmental hazards and increases operational expenses. However, hospitals lack objective criteria to select the most appropriate waste disposal firm and evaluate its performance, instead relying on their own subjective judgment and previous experiences. Therefore, this work presents an analytic hierarchy process (AHP) method to objectively select medical waste disposal firms based on the results of interviews with experts in the field, thus reducing overhead costs and enhancing medical waste management. An appropriate weight criterion based on AHP is derivedmore » to assess the effectiveness of medical waste disposal firms. The proposed AHP-based method offers a more efficient and precise means of selecting medical waste firms than subjective assessment methods do, thus reducing the potential risks for hospitals. Analysis results indicate that the medical sector selects the most appropriate infectious medical waste disposal firm based on the following rank: matching degree, contractor's qualifications, contractor's service capability, contractor's equipment and economic factors. By providing hospitals with an effective means of evaluating medical waste disposal firms, the proposed AHP method can reduce overhead costs and enable medical waste management to understand the market demand in the health sector. Moreover, performed through use of Expert Choice software, sensitivity analysis can survey the criterion weight of the degree of influence with an alternative hierarchy.« less

Development of national competency-based learning objectives "Medical Informatics" for undergraduate medical education.

PubMed

Röhrig, R; Stausberg, J; Dugas, M

2013-01-01

The aim of this project is to develop a catalogue of competency-based learning objectives "Medical Informatics" for undergraduate medical education (abbreviated NKLM-MI in German). The development followed a multi-level annotation and consensus process. For each learning objective a reason why a physician needs this competence was required. In addition, each objective was categorized according to the competence context (A = covered by medical informatics, B = core subject of medical informatics, C = optional subject of medical informatics), the competence level (1 = referenced knowledge, 2 = applied knowledge, 3 = routine knowledge) and a CanMEDS competence role (medical expert, communicator, collaborator, manager, health advocate, professional, scholar). Overall 42 objectives in seven areas (medical documentation and information processing, medical classifications and terminologies, information systems in healthcare, health telematics and telemedicine, data protection and security, access to medical knowledge and medical signal-/image processing) were identified, defined and consented. With the NKLM-MI the competences in the field of medical informatics vital to a first year resident physician are identified, defined and operationalized. These competencies are consistent with the recommendations of the International Medical Informatics Association (IMIA). The NKLM-MI will be submitted to the National Competence-Based Learning Objectives for Undergraduate Medical Education. The next step is implementation of these objectives by the faculties.

Developing a medication communication framework across continuums of care using the Circle of Care Modeling approach.

PubMed

Kitson, Nicole A; Price, Morgan; Lau, Francis Y; Showler, Grey

2013-10-17

Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication management involves key recurrent activities (determine need, prescribe, dispense, administer, and monitor/evaluate) with information communicated within and between each. Despite its importance, there is a lack of conceptual models that explore medication communication specifically across roles and settings. This research seeks to address that gap. The Circle of Care Modeling (CCM) approach was used to build a model of medication communication activities across the circle of care. CCM positions the patient in the centre of his or her own healthcare system; providers and other roles are then modeled around the patient as a web of relationships. Recurrent medication communication activities were mapped to the medication management framework. The research occurred in three iterations, to test and revise the model: Iteration 1 consisted of a literature review and internal team discussion, Iteration 2 consisted of interviews, observation, and a discussion group at a Community Health Centre, and Iteration 3 consisted of interviews and a discussion group in the larger community. Each iteration provided further detail to the Circle of Care medication communication model. Specific medication communication activities were mapped along each communication pathway between roles and to the medication management framework. We could not map all medication communication activities to the medication management framework; we added Coordinate as a separate and distinct recurrent activity. We saw many examples of coordination activities, for instance, Medical Office Assistants acting as a liaison between pharmacists and family physicians to clarify prescription details. Through the use of CCM we were able to unearth tacitly held knowledge to expand our understanding of medication communication. Drawing out the coordination activities could be a missing piece for us to better understand how to streamline and improve multi-step communication processes with a goal of improving patient safety.

Developing a medication communication framework across continuums of care using the Circle of Care Modeling approach

PubMed Central

2013-01-01

Background Medication errors are a common type of preventable errors in health care causing unnecessary patient harm, hospitalization, and even fatality. Improving communication between providers and between providers and patients is a key aspect of decreasing medication errors and improving patient safety. Medication management requires extensive collaboration and communication across roles and care settings, which can reduce (or contribute to) medication-related errors. Medication management involves key recurrent activities (determine need, prescribe, dispense, administer, and monitor/evaluate) with information communicated within and between each. Despite its importance, there is a lack of conceptual models that explore medication communication specifically across roles and settings. This research seeks to address that gap. Methods The Circle of Care Modeling (CCM) approach was used to build a model of medication communication activities across the circle of care. CCM positions the patient in the centre of his or her own healthcare system; providers and other roles are then modeled around the patient as a web of relationships. Recurrent medication communication activities were mapped to the medication management framework. The research occurred in three iterations, to test and revise the model: Iteration 1 consisted of a literature review and internal team discussion, Iteration 2 consisted of interviews, observation, and a discussion group at a Community Health Centre, and Iteration 3 consisted of interviews and a discussion group in the larger community. Results Each iteration provided further detail to the Circle of Care medication communication model. Specific medication communication activities were mapped along each communication pathway between roles and to the medication management framework. We could not map all medication communication activities to the medication management framework; we added Coordinate as a separate and distinct recurrent activity. We saw many examples of coordination activities, for instance, Medical Office Assistants acting as a liaison between pharmacists and family physicians to clarify prescription details. Conclusions Through the use of CCM we were able to unearth tacitly held knowledge to expand our understanding of medication communication. Drawing out the coordination activities could be a missing piece for us to better understand how to streamline and improve multi-step communication processes with a goal of improving patient safety. PMID:24134454

JSC Pharmacy Services for Remote Operations

NASA Technical Reports Server (NTRS)

Stoner, Paul S.; Bayuse, Tina

2005-01-01

The Johnson Space Center Pharmacy began operating in March of 2003. The pharmacy serves in two main capacities: to directly provide medications and services in support of the medical clinics at the Johnson Space Center, physician travel kits for NASA flight surgeon staff, and remote operations, such as the clinics in Devon Island, Star City and Moscow; and indirectly provide medications and services for the International Space Station and Space Shuttle medical kits. Process changes that occurred and continued to evolve in the advent of the installation of the new JSC Pharmacy, and the process of stocking medications for each of these aforementioned areas will be discussed. Methods: The incorporation of pharmacy involvement to provide services for remote operations and supplying medical kits was evaluated. The first step was to review the current processes and work the JSC Pharmacy into the existing system. The second step was to provide medications to these areas. Considerations for the timeline of expiring medications for shipment are reviewed with each request. The third step was the development of a process to provide accountability for the medications. Results: The JSC Pharmacy utilizes a pharmacy management system to document all medications leaving the pharmacy. Challenges inherent to providing medications to remote areas were encountered. A process has been designed to incorporate usage into the electronic medical record upon return of the information from these remote areas. This is an evolving program and several areas have been identified for further improvement.

Nurses' reported thinking during medication administration.

PubMed

Eisenhauer, Laurel A; Hurley, Ann C; Dolan, Nancy

2007-01-01

To document nurses' reported thinking processes during medication administration before and after implementation of point-of-care technology. Semistructured interviews and real-time tape recordings were used to document the thinking processes of 40 nurses practicing in inpatient care units in a large tertiary care teaching hospital in the northeastern US. Content analysis resulted in identification of 10 descriptive categories of nurses' thinking: communication, dose-time, checking, assessment, evaluation, teaching, side effects, work arounds, anticipating problem solving, and drug administration. Situations requiring judgment in dosage, timing, or selection of specific medications (e.g., pain management, titration of antihypertensives) provided the most explicit data about nurses' use of critical thinking and clinical judgment. A key element was nurses' constant professional vigilance to ensure that patients received their appropriate medications. Nurses' thinking processes extended beyond rules and procedures and were based on patient data and interdisciplinary professional knowledge to provide safe and effective care. Identification of thinking processes can help nurses to explain the professional expertise inherent in medication administration beyond the technical application of the "5 rights."

The implementation and evaluation of an evidence-based statewide prehospital pain management protocol developed using the national prehospital evidence-based guideline model process for emergency medical services.

PubMed

Brown, Kathleen M; Hirshon, Jon Mark; Alcorta, Richard; Weik, Tasmeen S; Lawner, Ben; Ho, Shiu; Wright, Joseph L

2014-01-01

In 2008, the National Highway Traffic Safety Administration funded the development of a model process for the development and implementation of evidence-based guidelines (EBGs) for emergency medical services (EMS). We report on the implementation and evaluation of an evidence-based prehospital pain management protocol developed using this model process. An evidence-based protocol for prehospital management of pain resulting from injuries and burns was reviewed by the Protocol Review Committee (PRC) of the Maryland Institute for Emergency Medical Services Systems (MIEMSS). The PRC recommended revisions to the Maryland protocol that reflected recommendations in the EBG: weight-based dosing and repeat dosing of morphine. A training curriculum was developed and implemented using Maryland's online Learning Management System and successfully accessed by 3,941 paramedics and 15,969 BLS providers. Field providers submitted electronic patient care reports to the MIEMSS statewide prehospital database. Inclusion criteria were injured or burned patients transported by Maryland ambulances to Maryland hospitals whose electronic patient care records included data for level of EMS provider training during a 12-month preimplementation period and a 12-month postimplementation period from September 2010 through March 2012. We compared the percentage of patients receiving pain scale assessments and morphine, as well as the dose of morphine administered and the use of naloxone as a rescue medication for opiate use, before and after the protocol change. No differences were seen in the percentage of patients who had a pain score documented or the percent of patients receiving morphine before and after the protocol change, but there was a significant increase in the total dose and dose in mg/kg administered per patient. During the postintervention phase, patients received an 18% higher total morphine dose and a 14.9% greater mg/kg dose. We demonstrated that the implementation of a revised statewide prehospital pain management protocol based on an EBG developed using the National Prehospital Evidence-based Guideline Model Process was associated with an increase in dosing of narcotic pain medication consistent with that recommended by the EBG. No differences were seen in the percentage of patients receiving opiate analgesia or in the documentation of pain scores.

Representing the work of medical protocols for organizational simulation.

PubMed Central

Fridsma, D. B.

1998-01-01

Developing and implementing patient care protocols within a specific organizational setting requires knowledge of the protocol, the organization, and the way in which the organization does its work. Computer-based simulation tools have been used in many industries to provide managers with prospective insight into problems of work process and organization design mismatch. Many of these simulation tools are designed for well-understood routine work processes in which there are few contingent tasks. In this paper, we describe theoretic that make it possible to simulate medical protocols using an information-processing theory framework. These simulations will allow medical administrators to test different protocol and organizational designs before actually using them within a particular clinical setting. PMID:9929231

How does pharmacogenetic testing alter the treatment course and patient response for chronic-pain patients in comparison with the current "trial-and-error" standard of care?

PubMed

DeFeo, Kelly; Sykora, Kristen; Eley, Susan; Vincent, Debra

2014-10-01

To evaluate if pharmacogenetic testing (PT) holds value for pain-management practitioners by identifying the potential applications of pharmacogenetic research as well as applications in practice. A review of the literature was conducted utilizing the databases EBSCOhost, Biomedical Reference Collection, CINAHL, Health Business: Full Text, Health Source: Nursing/Academic Edition, and MEDLINE with the keywords, personalized medicine, cytochrome P450, and phamacogenetics. Chronic-pain patients present some of the most challenging patients to manage medically. Often paired with persistent, life-altering pain, they might also have oncologic and psychological comorbidities that can further complicate their management. One-step in-office PT is now widely available to optimize management of complicated patients and affectively remove the "trial-and-error" process of medication therapy. Practitioners must be familiar with the genetic determinants that affect a patient's response to medications in order to decrease preventable morbidity and mortality associated with drug-drug and patient-drug interactions, and to provide cost-effective care through avoidance of inappropriate medications. Improved pain managements will impove patient outcomes and satisfaction. ©2014 American Association of Nurse Practitioners.

Experienced and potential medical tourists' service quality expectations.

PubMed

Guiry, Michael; Scott, Jeannie J; Vequist, David G

2013-01-01

The paper's aim is to compare experienced and potential US medical tourists' foreign health service-quality expectations. Data were collected via an online survey involving 1,588 US consumers engaging or expressing an interest in medical tourism. The sample included 219 experienced and 1,369 potential medical tourists. Respondents completed a SERVQUAL questionnaire. Mann-Whitney U-tests were used to determine significant differences between experienced and potential US medical tourists' service-quality expectations. For all five service-quality dimensions (tangibles, reliability, responsiveness, assurance and empathy) experienced medical tourists had significantly lower expectations than potential medical tourists. Experienced medical tourists also had significantly lower service-quality expectations than potential medical tourists for 11 individual SERVQUAL items. Results suggest using experience level to segment medical tourists. The study also has implications for managing medical tourist service-quality expectations at service delivery point and via external marketing communications. Managing medical tourists' service quality expectations is important since expectations can significantly influence choice processes, their experience and post-consumption behavior. This study is the first to compare experienced and potential US medical tourist service-quality expectations. The study establishes a foundation for future service-quality expectations research in the rapidly growing medical tourism industry.

Medication management policy, practice and research in Australian residential aged care: Current and future directions.

PubMed

Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon

2017-02-01

Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

Hospital cost structure in the USA: what's behind the costs? A business case.

PubMed

Chandra, Charu; Kumar, Sameer; Ghildayal, Neha S

2011-01-01

Hospital costs in the USA are a large part of the national GDP. Medical billing and supplies processes are significant and growing contributors to hospital operations costs in the USA. This article aims to identify cost drivers associated with these processes and to suggest improvements to reduce hospital costs. A Monte Carlo simulation model that uses @Risk software facilitates cost analysis and captures variability associated with the medical billing process (administrative) and medical supplies process (variable). The model produces estimated savings for implementing new processes. Significant waste exists across the entire medical supply process that needs to be eliminated. Annual savings, by implementing the improved process, have the potential to save several billion dollars annually in US hospitals. The other analysis in this study is related to hospital billing processes. Increased spending on hospital billing processes is not entirely due to hospital inefficiency. The study lacks concrete data for accurately measuring cost savings, but there is obviously room for improvement in the two US healthcare processes. This article only looks at two specific costs associated with medical supply and medical billing processes, respectively. This study facilitates awareness of escalating US hospital expenditures. Cost categories, namely, fixed, variable and administrative, are presented to identify the greatest areas for improvement. The study will be valuable to US Congress policy makers and US healthcare industry decision makers. Medical billing process, part of a hospital's administrative costs, and hospital supplies management processes are part of variable costs. These are the two major cost drivers of US hospitals' expenditures that were examined and analyzed.

'Act on oncology' as a new comprehensive approach to assess prostate cancer centres--method description and results of a pilot study.

PubMed

Voigt, Wieland; Hoellthaler, Josef; Magnani, Tiziana; Corrao, Vito; Valdagni, Riccardo

2014-01-01

Multidisciplinary care of prostate cancer is increasingly offered in specialised cancer centres. It requires the optimisation of medical and operational processes and the integration of the different medical and non-medical stakeholders. To develop a standardised operational process assessment tool basing on the capability maturity model integration (CMMI) able to implement multidisciplinary care and improve process quality and efficiency. Information for model development was derived from medical experts, clinical guidelines, best practice elements of renowned cancer centres, and scientific literature. Data were organised in a hierarchically structured model, consisting of 5 categories, 30 key process areas, 172 requirements, and more than 1500 criteria. Compliance with requirements was assessed through structured on-site surveys covering all relevant clinical and management processes. Comparison with best practice standards allowed to recommend improvements. 'Act On Oncology'(AoO) was applied in a pilot study on a prostate cancer unit in Europe. Several best practice elements such as multidisciplinary clinics or advanced organisational measures for patient scheduling were observed. Substantial opportunities were found in other areas such as centre management and infrastructure. As first improvements the evaluated centre administration described and formalised the organisation of the prostate cancer unit with defined personnel assignments and clinical activities and a formal agreement is being worked on to have structured access to First-Aid Posts. In the pilot study, the AoO approach was feasible to identify opportunities for process improvements. Measures were derived that might increase the operational process quality and efficiency.

Medical Imaging System

NASA Technical Reports Server (NTRS)

1991-01-01

The MD Image System, a true-color image processing system that serves as a diagnostic aid and tool for storage and distribution of images, was developed by Medical Image Management Systems, Huntsville, AL, as a "spinoff from a spinoff." The original spinoff, Geostar 8800, developed by Crystal Image Technologies, Huntsville, incorporates advanced UNIX versions of ELAS (developed by NASA's Earth Resources Laboratory for analysis of Landsat images) for general purpose image processing. The MD Image System is an application of this technology to a medical system that aids in the diagnosis of cancer, and can accept, store and analyze images from other sources such as Magnetic Resonance Imaging.

Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

PubMed

Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B

Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

Optimal Medical Equipment Maintenance Service Proposal Decision Support System combining Activity Based Costing (ABC) and the Analytic Hierarchy Process (AHP).

PubMed

da Rocha, Leticia; Sloane, Elliot; M Bassani, Jose

2005-01-01

This study describes a framework to support the choice of the maintenance service (in-house or third party contract) for each category of medical equipment based on: a) the real medical equipment maintenance management system currently used by the biomedical engineering group of the public health system of the Universidade Estadual de Campinas located in Brazil to control the medical equipment maintenance service, b) the Activity Based Costing (ABC) method, and c) the Analytic Hierarchy Process (AHP) method. Results show the cost and performance related to each type of maintenance service. Decision-makers can use these results to evaluate possible strategies for the categories of equipment.

Risk Information Management Resource (RIMR): modeling an approach to defending against military medical information assurance brain drain

NASA Astrophysics Data System (ADS)

Wright, Willie E.

2003-05-01

As Military Medical Information Assurance organizations face off with modern pressures to downsize and outsource, they battle with losing knowledgeable people who leave and take with them what they know. This knowledge is increasingly being recognized as an important resource and organizations are now taking steps to manage it. In addition, as the pressures for globalization (Castells, 1998) increase, collaboration and cooperation are becoming more distributed and international. Knowledge sharing in a distributed international environment is becoming an essential part of Knowledge Management. This is a major shortfall in the current approach to capturing and sharing knowledge in Military Medical Information Assurance. This paper addresses this challenge by exploring Risk Information Management Resource (RIMR) as a tool for sharing knowledge using the concept of Communities of Practice. RIMR is based no the framework of sharing and using knowledge. This concept is done through three major components - people, process and technology. The people aspect enables remote collaboration, support communities of practice, reward and recognize knowledge sharing while encouraging storytelling. The process aspect enhances knowledge capture and manages information. While the technology aspect enhance system integration and data mining, it also utilizes intelligent agents and exploits expert systems. These coupled with supporting activities of education and training, technology infrastructure and information security enables effective information assurance collaboration.

Patients’ management of type 2 diabetes in Middle Eastern countries: review of studies

PubMed Central

Alsairafi, Zahra Khalil; Taylor, Kevin Michael Geoffrey; Smith, Felicity J; Alattar, Abdulnabi T

2016-01-01

The increased prevalence of diabetes in Middle Eastern countries is a health policy priority. Important risk factors for diabetes have been identified. Lifestyle interventions and adherence to medications are central to disease prevention and management. This review focuses on the management of type 2 diabetes mellitus in Middle Eastern countries. The aim is to identify the ways in which knowledge, health beliefs, and social and cultural factors influence adherence to medication and lifestyle measures. Thirty-four studies were identified following a systematic search of the literature. The studies describe the influence of knowledge, health beliefs, culture, and lifestyle on the management of type 2 diabetes mellitus in the Middle East. Findings indicate a lack of health knowledge about diabetes among populations, which has implications for health behaviors, medication adherence, and treatment outcomes. Many identified health beliefs and cultural lifestyle factors, such as religious beliefs, beliefs about fasting during Ramadan, and sedentary lifestyles played a role in patients’ decisions. For better management of this disease, a collaborative approach between patients, their families, health care professionals, and governments should be adopted. Implementing behavioral strategies and psychological interventions that incorporate all health care professionals in the management process have been shown to be effective methods. Such services help patients change their behavior. However, the utilization of such services and interventions is still limited in Arabian countries. Physicians in the Middle East are the health care professionals most involved in the care process. PMID:27354775

Patients' management of type 2 diabetes in Middle Eastern countries: review of studies.

PubMed

Alsairafi, Zahra Khalil; Taylor, Kevin Michael Geoffrey; Smith, Felicity J; Alattar, Abdulnabi T

2016-01-01

The increased prevalence of diabetes in Middle Eastern countries is a health policy priority. Important risk factors for diabetes have been identified. Lifestyle interventions and adherence to medications are central to disease prevention and management. This review focuses on the management of type 2 diabetes mellitus in Middle Eastern countries. The aim is to identify the ways in which knowledge, health beliefs, and social and cultural factors influence adherence to medication and lifestyle measures. Thirty-four studies were identified following a systematic search of the literature. The studies describe the influence of knowledge, health beliefs, culture, and lifestyle on the management of type 2 diabetes mellitus in the Middle East. Findings indicate a lack of health knowledge about diabetes among populations, which has implications for health behaviors, medication adherence, and treatment outcomes. Many identified health beliefs and cultural lifestyle factors, such as religious beliefs, beliefs about fasting during Ramadan, and sedentary lifestyles played a role in patients' decisions. For better management of this disease, a collaborative approach between patients, their families, health care professionals, and governments should be adopted. Implementing behavioral strategies and psychological interventions that incorporate all health care professionals in the management process have been shown to be effective methods. Such services help patients change their behavior. However, the utilization of such services and interventions is still limited in Arabian countries. Physicians in the Middle East are the health care professionals most involved in the care process.

The impact of medical tourism on Thai private hospital management: informing hospital policy.

PubMed

James, Paul T J

2012-01-01

The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital medical services provision. Develops a qualitative model that attempts to conceptualize the findings from a diverse range of management views into a framework of main (8) - Hospital Management; Hospital Processes; Hospital Technology; Quality Related; Communications; Personnel; Financial; and Patients; and consequent sub-themes (22). Outcomes from small-scale qualitative inquiries cannot by design be taken outside of its topical arena. This inevitably indicates that more research of this kind needs to be carried out to understand this field more effectively. The evidence suggests that Private Thai hospital management have established views about what constitutes the impact of medical tourism on hospital policies and practices when hospital staff interact with international patients. As the private health service sector in Thailand continues to grow, future research is needed to help hospitals provide appropriate service patterns and appropriate medical products/services that meet international patient needs and aspirations. Highlights the increasing importance of the international consumer in Thailand's health industry. This study provides insights of private health service providers in Bangkok by helping to understand more effectively health service quality environments, subsequent service provision, and the integrated development and impacts of new medical technology.

The Impact of Medical Tourism on Thai Private Hospital Management: Informing Hospital Policy

PubMed Central

James, Paul TJ

2012-01-01

Background: The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. Methods: The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital medical services provision. Develops a qualitative model that attempts to conceptualise the findings from a diverse range of management views into a framework of main (8) - Hospital Management; Hospital Processes; Hospital Technology; Quality Related; Communications; Personnel; Financial; and Patients; and consequent sub-themes (22). Results: Outcomes from small-scale qualitative inquiries cannot by design be taken outside of its topical arena. This inevitably indicates that more research of this kind needs to be carried out to understand this field more effectively. The evidence suggests that Private Thai hospital management have established views about what constitutes the impact of medical tourism on hospital policies and practices when hospital staff interact with international patients. Conclusions: As the private health service sector in Thailand continues to grow, future research is needed to help hospitals provide appropriate service patterns and appropriate medical products/services that meet international patient needs and aspirations. Highlights the increasing importance of the international consumer in Thailand’s health industry. This study provides insights of private health service providers in Bangkok by helping to understand more effectively health service quality environments, subsequent service provision, and the integrated development and impacts of new medical technology. PMID:22980119

Building quality into medical product software design.

PubMed

Mallory, S R

1993-01-01

The software engineering and quality assurance disciplines are a requisite to the design of safe and effective software-based medical devices. It is in the areas of software methodology and process that the most beneficial application of these disciplines to software development can be made. Software is a product of complex operations and methodologies and is not amenable to the traditional electromechanical quality assurance processes. Software quality must be built in by the developers, with the software verification and validation engineers acting as the independent instruments for ensuring compliance with performance objectives and with development and maintenance standards. The implementation of a software quality assurance program is a complex process involving management support, organizational changes, and new skill sets, but the benefits are profound. Its rewards provide safe, reliable, cost-effective, maintainable, and manageable software, which may significantly speed the regulatory review process and therefore potentially shorten the overall time to market. The use of a trial project can greatly facilitate the learning process associated with the first-time application of a software quality assurance program.

Design and Evaluation of a Medication Adherence Application with Communication for Seniors in Independent Living Communities.

PubMed

Dasgupta, Dipanwita; Johnson, Reid A; Chaudhry, Beenish; Reeves, Kimberly G; Willaert, Patty; Chawla, Nitesh V

2016-01-01

Medication non-adherence is a pressing concern among seniors, leading to a lower quality of life and higher healthcare costs. While mobile applications provide a viable medium for medication management, their utility can be limited without tackling the specific needs of seniors and facilitating the active involvement of care providers. To address these limitations, we are developing a tablet-based application designed specifically for seniors to track their medications and a web portal for their care providers to track medication adherence. In collaboration with a local Aging in Place program, we conducted a three-month study with sixteen participants from an independent living facility. Our study found that the application helped participants to effectively track their medications and improved their sense of wellbeing. Our findings highlight the importance of catering to the needs of seniors and of involving care providers in this process, with specific recommendations for the development of future medication management applications.

Medical and psychological aspects of irritable bowel syndrome.

PubMed

Kim, E C; Dundon, M

1998-01-01

Irritable bowel syndrome is a disease process commonly encountered by primary care providers. Although the cause of this illness is unknown, much is known about the pathophysiology and strong psychosocial influences. Medical practitioners often are aware of the medical aspects of managing irritable bowel syndrome but are not familiar with specific psychologic options. Long-term care of these patients may be aided by collaboration with mental health professionals.

Bridging the Engineering and Medicine Gap

NASA Technical Reports Server (NTRS)

Walton, M.; Antonsen, E.

2018-01-01

A primary challenge NASA faces is communication between the disparate entities of engineers and human system experts in life sciences. Clear communication is critical for exploration mission success from the perspective of both risk analysis and data handling. The engineering community uses probabilistic risk assessment (PRA) models to inform their own risk analysis and has extensive experience managing mission data, but does not always fully consider human systems integration (HSI). The medical community, as a part of HSI, has been working 1) to develop a suite of tools to express medical risk in quantitative terms that are relatable to the engineering approaches commonly in use, and 2) to manage and integrate HSI data with engineering data. This talk will review the development of the Integrated Medical Model as an early attempt to bridge the communication gap between the medical and engineering communities in the language of PRA. This will also address data communication between the two entities in the context of data management considerations of the Medical Data Architecture. Lessons learned from these processes will help identify important elements to consider in future communication and integration of these two groups.

A Codasyl-Type Schema for Natural Language Medical Records

PubMed Central

Sager, N.; Tick, L.; Story, G.; Hirschman, L.

1980-01-01

This paper describes a CODASYL (network) database schema for information derived from narrative clinical reports. The goal of this work is to create an automated process that accepts natural language documents as input and maps this information into a database of a type managed by existing database management systems. The schema described here represents the medical events and facts identified through the natural language processing. This processing decomposes each narrative into a set of elementary assertions, represented as MEDFACT records in the database. Each assertion in turn consists of a subject and a predicate classed according to a limited number of medical event types, e.g., signs/symptoms, laboratory tests, etc. The subject and predicate are represented by EVENT records which are owned by the MEDFACT record associated with the assertion. The CODASYL-type network structure was found to be suitable for expressing most of the relations needed to represent the natural language information. However, special mechanisms were developed for storing the time relations between EVENT records and for recording connections (such as causality) between certain MEDFACT records. This schema has been implemented using the UNIVAC DMS-1100 DBMS.

Challenges for data storage in medical imaging research.

PubMed

Langer, Steve G

2011-04-01

Researchers in medical imaging have multiple challenges for storing, indexing, maintaining viability, and sharing their data. Addressing all these concerns requires a constellation of tools, but not all of them need to be local to the site. In particular, the data storage challenges faced by researchers can begin to require professional information technology skills. With limited human resources and funds, the medical imaging researcher may be better served with an outsourcing strategy for some management aspects. This paper outlines an approach to manage the main objectives faced by medical imaging scientists whose work includes processing and data mining on non-standard file formats, and relating those files to the their DICOM standard descendents. The capacity of the approach scales as the researcher's need grows by leveraging the on-demand provisioning ability of cloud computing.

Electronic health information system at an opioid treatment programme: roadblocks to implementation

PubMed Central

Louie, Ben; Kritz, Steven; Brown, Lawrence S.; Chu, Melissa; Madray, Charles; Zavala, Roberto

2012-01-01

Rationale Electronic health systems are commonly included in health care reform discussions. However, their embrace by the health care community has been slow. Methods At Addiction Research and Treatment Corporation, a methadone maintenance programme that also provides primary medical care, HIV medical care and case management, substance abuse counselling and vocational services, we describe our experience in implementing an electronic health information system that encompasses all of these areas. Results We describe the challenges and opportunities of this process in terms of change management, hierarchy of corporate objectives, process mastering, training issues, information technology governance, electronic security, and communication and collaboration. Conclusion This description may provide practical insights to other institutions seeking to pursue this technology. PMID:21414111

Electronic health information system at an opioid treatment programme: roadblocks to implementation.

PubMed

Louie, Ben; Kritz, Steven; Brown, Lawrence S; Chu, Melissa; Madray, Charles; Zavala, Roberto

2012-08-01

Electronic health systems are commonly included in health care reform discussions. However, their embrace by the health care community has been slow. At Addiction Research and Treatment Corporation, a methadone maintenance programme that also provides primary medical care, HIV medical care and case management, substance abuse counselling and vocational services, we describe our experience in implementing an electronic health information system that encompasses all of these areas. We describe the challenges and opportunities of this process in terms of change management, hierarchy of corporate objectives, process mastering, training issues, information technology governance, electronic security, and communication and collaboration. This description may provide practical insights to other institutions seeking to pursue this technology. © 2011 Blackwell Publishing Ltd.

Medical Students' Understanding of Directed Questioning by Their Clinical Preceptors.

PubMed

Lo, Lawrence; Regehr, Glenn

2017-01-01

Phenomenon: Throughout clerkship, preceptors ask medical students questions for both assessment and teaching purposes. However, the cognitive and strategic aspects of students' approaches to managing this situation have not been explored. Without an understanding of how students approach the question and answer activity, medical educators are unable to appreciate how effectively this activity fulfills their purposes of assessment or determine the activity's associated educational effects. A convenience sample of nine 4th-year medical students participated in semistructured one-on-one interviews exploring their approaches to managing situations in which they have been challenged with questions from preceptors to which they do not know the answer. Through an iterative and recursive analytic reading of the interview transcripts, data were coded and organized to identify themes relevant to the students' considerations in answering such questions. Students articulated deliberate strategies for managing the directed questioning activity, which at times focused on the optimization of their learning but always included considerations of image management. Managing image involved projecting not only being knowledgeable but also being teachable. The students indicated that their considerations in selecting an appropriate strategy in a given situation involved their perceptions of their preceptors' intentions and preferences as well as several contextual factors. Insights: The medical students we interviewed were quite sophisticated in their understanding of the social nuances of the directed questioning process and described a variety of contextually invoked strategies to manage the situation and maintain a positive image.

Understanding medical practice team roles.

PubMed

Hills, Laura

2015-01-01

Do you believe that the roles your employees play on your medical practice team are identical to their job titles or job descriptions? Do you believe that team roles are determined by personality type? This article suggests that a more effective way to build and manage your medical practice team is to define team roles through employee behaviors. It provides 10 rules of behavioral team roles that can help practice managers to select and build high-performing teams, build more productive team relationships, improve the employee recruitment process, build greater team trust and understanding; and increase their own effectiveness. This article describes in detail Belbin's highly regarded and widely used team role theory and summarizes four additional behavioral team role theories and systems. It offers lessons learned when applying team role theory to practice. Finally, this article offers an easy-to-implement method for assessing current team roles. It provides a simple four-question checklist that will help practice managers balance an imbalanced medical practice team.

Extraterritorial reach of the FCPA: recommendations for U.S. medical device companies with activities in Europe.

PubMed

Vollebregt, Erik

2010-01-01

Traditionally medical devices companies manage business compliance with anti-corruption and anti-fraud rules in a document-oriented way that does not always yield optimal results for the company. As a result, compliance issues are not optimally managed by the companies. Now that medical devices companies become ever more internationally active, they must also take into account the international dimensions of business compliance. This article intends to provide U.S. medical devices companies with activities in Europe with an insight in business compliance risks in the European Union (EU) and the risks related to U.S. statutes that may be applicable to a U.S. company's activities overseas. The article proposes a process-oriented and IT-supported way of structuring an international business compliance program, resulting in increased effectiveness of the program and increased competitiveness and risk management of the company as well as a high degree of acceptance of the procedures by the company's employees.

Medical technology management: from planning to application.

PubMed

David, Y; Jahnke, E

2005-01-01

Appropriate deployment of technological innovation contributes to improvement in the quality of healthcare delivered, the containment of cost, and access to the healthcare system. Hospitals have been allocating a significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new medical equipment and are asked to manage existing inventory for which they are not well prepared. To objectively manage their investment, hospitals are developing medical technology management programs that need pertinent information and planning methodology for integrating new equipment into existing operations as well as for optimizing costs of ownership of all equipment. Clinical engineers can identify technological solutions based on the matching of new medical equipment with hospital's objectives. They can review their institution's overall technological position, determine strengths and weaknesses, develop equipment-selection criteria, supervise installations, train users and monitor post procurement performance to assure meeting of goals. This program, together with cost accounting analysis, will objectively guide the capital assets decision-making process. Cost accounting analysis is a multivariate function that includes determining the amount, based upon a strategic plan and financial resources, of funding to be allocated annually for medical equipment acquisition and replacement. Often this function works closely with clinical engineering to establish equipment useful life and prioritization of acquisition, upgrade, and replacement of inventory within budget confines and without conducting time consuming, individual financial capital project evaluations.

EMR management system for patient pulse data.

PubMed

Lee, Junyoung

2012-10-01

The purpose of this study is to build an integrated medical information system for effective database management of clinical information and to improve the existing Electronic Medical Record (EMR)-based system that is currently being used in hospitals. The integrated medical information system of hospitals consists of an Order Communication System (OCS), Picture Archiving Communication System (PACS), and Laboratory Information System (LIS), as well as Electronic Medical Record (EMR). It is designed so that remote health screening and patient data search can be accessed through a high speed network-even in remote areas-in order to effectively manage data on medical treatment that patients received at their respective hospitals. The existing oriental treatment system is one in which the doctor requires the patient to visit the hospital in person, so as to be able to check the patient's pulse and measure it with his hand for proper diagnosis and treatment. However, due to the recent development of digitalized medical measurement equipment, not only can doctors now check a patient's pulse without touching it directly, but the measured data are computerized and stored into the database as the electronic obligation record. Thus, even if a patient cannot visit the hospital, proper medical treatment is available by analyzing the patient's medical history and diagnosis process in the remote area. Furthermore, when a comprehensive medical testing center system including the people medical examination and diverse physical examination is established, the quality of medical service is expected to be improved than now.

A Study of the Readiness of Hospitals for Implementation of High Reliability Organizations Model in Tehran University of Medical Sciences.

PubMed

Mousavi, Seyed Mohammad Hadi; Dargahi, Hossein; Mohammadi, Sara

2016-10-01

Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers' point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals' accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it seems there are a lot of challenges in this way. Therefore, it is suggested that a detailed audit is conducted among hospitals' current status regarding different characteristics of HROs, and workshops are held for medical and non-medical employees and managers of hospitals as an influencing factor; and a re-assessment process afterward, can help moving the hospitals from their current position towards an HROs culture.

Explaining process orientation failure and success in health care--three case studies.

PubMed

Hellman, Stefan; Kastberg, Gustaf; Siverbo, Sven

2015-01-01

In order to improve cooperation and collaboration between units, clinics and departments, many health care organizations (HCOs) have introduced process orientation. Several studies indicate problems in realizing these ambitions. The purpose of this paper is to explain and understand the success and failure of process orientation in HCOs. The authors conducted three case studies and applied Actor-Network Theory as an analytic lens. The realization of process orientation is hindered by neglect or resistance from physicians, who find the process targets to be of low medical priority. However, the authors also see that medical priorities are no stable entities but are susceptible to negotiations. Over time, process organization, process mapping, process measurement activities and the acting of enroled actors may have impact on medical priorities. Contrary to previous research, the findings indicate that New Public Management may not be the main obstacle against processes, that accounting figures may not be hard to disregard and that the role of leadership is not paramount.

Medication administration and interruptions in nursing homes: A qualitative observational study.

PubMed

Odberg, Kristian Ringsby; Hansen, Britt Saetre; Aase, Karina; Wangensteen, Sigrid

2018-03-01

To contribute in-depth knowledge of the characteristics of medication administration and interruptions in nursing homes. The following research questions guided the study: How can the medication administration process in nursing homes be described? How can interruptions during the medication administration process in nursing homes be characterized? Medication administration is a vital process across healthcare settings, and earlier research in nursing homes is sparse. The medication administration process is prone to interruptions that may lead to adverse drug events. On the other hand, interruptions may also have positive effects on patient safety. A qualitative observational study design was applied. Data were collected using partial participant observations. An inductive content analysis was performed. Factors that contributed to the observed complexity of medication administration in nursing homes were the high number of single tasks, varying degree of linearity, the variability of technological solutions, demands regarding documentation and staff's apparent freedom as to how and where to perform medication-related activities. Interruptions during medication administration are prevalent and can be characterised as passive (e.g., alarm and background noises), active (e.g., discussions) or technological interruptions (e.g., use of mobile applications). Most interruptions have negative outcomes, while some have positive outcomes. A process of normalisation has taken place whereby staff put up with second-rate technological solutions, noise and interruptions when they are performing medication-related tasks. Before seeking to minimise interruptions during the medication administration process, it is important to understand the interconnectivity of the elements using a systems approach. Staff and management need to be aware of the normalisation of interruptions. Knowledge of the complexity of medication administration may raise awareness and highlight the importance of maintaining and enhancing staff competence. © 2017 John Wiley & Sons Ltd.

42 CFR 423.128 - Dissemination of Part D plan information.

Code of Federal Regulations, 2010 CFR

2010-10-01

... tiered formulary structure and utilization management procedures used) functions; (iii) The process for... under § 423.564 et. seq. (8) Quality assurance policies and procedures. A description of the quality assurance policies and procedures required under § 423.153(c), as well as the medication therapy management...

A Model of Process-Based Automation: Cost and Quality Implications in the Medication Management Process

ERIC Educational Resources Information Center

Spaulding, Trent Joseph

2011-01-01

The objective of this research is to understand how a set of systems, as defined by the business process, creates value. The three studies contained in this work develop the model of process-based automation. The model states that complementarities among systems are specified by handoffs in the business process. The model also provides theory to…

Multimodal medical information retrieval with unsupervised rank fusion.

PubMed

Mourão, André; Martins, Flávio; Magalhães, João

2015-01-01

Modern medical information retrieval systems are paramount to manage the insurmountable quantities of clinical data. These systems empower health care experts in the diagnosis of patients and play an important role in the clinical decision process. However, the ever-growing heterogeneous information generated in medical environments poses several challenges for retrieval systems. We propose a medical information retrieval system with support for multimodal medical case-based retrieval. The system supports medical information discovery by providing multimodal search, through a novel data fusion algorithm, and term suggestions from a medical thesaurus. Our search system compared favorably to other systems in 2013 ImageCLEFMedical. Copyright © 2014 Elsevier Ltd. All rights reserved.

Hybrid management, organizational configuration, and medical professionalism: evidence from the establishment of a clinical directorate in Portugal.

PubMed

Correia, T; Denis, J L

2016-05-24

The need of improving the governance of healthcare services has brought health professionals into management positions. However, both the processes and outcomes of this policy change highlight differences among the European countries. This article provides in-depth evidence that neither quantitative data nor cross-country comparisons have been able to provide regarding the influence of hybrids in the functioning of hospital organizations and impact on clinicians' autonomy and exposure to hybridization. The study was designed to witness the process of institutional change from the inside and while that process was underway. It reports a case study carried out in a public hospital in Portugal when the establishment of a clinical directorate was being negotiated. Data collection comprises semi-structured interviews with general managers and surgeons complemented with observations. The clinical directorate under study illustrates a divisionalized professional bureaucracy model that combines features of professional bureaucracies and divisionalized forms. The hybrid manager is key to understand the extent to which practising clinicians are more accountable and to whom given that managerial tools of control have not been strengthened, and trust-based relations allow them to keep professional autonomy untouched. In sum, clinicians are allowed to profit from their activity and to perform autonomously from the hospital's board of directors. The advantageous conditions enjoyed by the clinical directorate intensify internal re-stratification in medicine, thus suggesting forms of divisionalized medical professionalism grounded in organizational dynamics. It is discussed the extent to which policy change to the governance of health organizations regarding the relationship between medicine and management is subject to specific constraints at the workplace level, thus conditioning the expected outcomes of policy setting. The study also highlights the role of hybrid managers in determining the extent to which practising professionals are more accountable to managerial criteria. The overall conclusion is that although medical and managerial values link to each other, clinicians reconfigure managerial criteria according to specific interests. Ultimately, medical autonomy and authority may be reinforced in organizational settings subject to NPM-driven reforms.

Practice management/role of the medical director.

PubMed

Merrill, Douglas G

2014-06-01

Although the nature of ambulatory surgery has changed over the years, the ideal role of the medical director mirrors its earliest iterations, focusing on excellent customer service and high quality of care. These efforts are supported by 3 modern methods of quality management borrowed from industry: intentional process improvement, standard care pathways, and monitoring outcomes to determine the efficacy of each. These methods are critical to master in order to lead the facility and providers to the highest quality of care and service. Copyright © 2014 Elsevier Inc. All rights reserved.

Supply chain optimization at an academic medical center.

PubMed

Labuhn, Jonathan; Almeter, Philip; McLaughlin, Christopher; Fields, Philip; Turner, Benjamin

2017-08-01

A successful supply chain optimization project that leveraged technology, engineering principles, and a technician workflow redesign in the setting of a growing health system is described. With continued rises in medication costs, medication inventory management is increasingly important. Proper management of central pharmacy inventory and floor-stock inventory in automated dispensing cabinets (ADCs) can be challenging. In an effort to improve control of inventory costs in the central pharmacy of a large academic medical center, the pharmacy department implemented a supply chain optimization project in collaboration with the medical center's inhouse team of experts on process improvement and industrial engineering. The project had 2 main components: (1) upgrading and reconfiguring carousel technology within an expanded central pharmacy footprint to generate accurate floor-stock inventory replenishment reports, which resulted in efficiencies within the medication-use system, and (2) implementing a technician workflow redesign and algorithm to right-size the ADC inventory, which decreased inventory stockouts (i.e., incidents of depletion of medication stock) and improved ADC user satisfaction. Through a multifaceted approach to inventory management, the number of stockouts per month was decreased and ADC inventory was optimized, resulting in a one-time inventory cost savings of $220,500. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Benefits of information technology-enabled diabetes management.

PubMed

Bu, Davis; Pan, Eric; Walker, Janice; Adler-Milstein, Julia; Kendrick, David; Hook, Julie M; Cusack, Caitlin M; Bates, David W; Middleton, Blackford

2007-05-01

To determine the financial and clinical benefits of implementing information technology (IT)-enabled disease management systems. A computer model was created to project the impact of IT-enabled disease management on care processes, clinical outcomes, and medical costs for patients with type 2 diabetes aged >25 years in the U.S. Several ITs were modeled (e.g., diabetes registries, computerized decision support, remote monitoring, patient self-management systems, and payer-based systems). Estimates of care process improvements were derived from published literature. Simulations projected outcomes for both payer and provider organizations, scaled to the national level. The primary outcome was medical cost savings, in 2004 U.S. dollars discounted at 5%. Secondary measures include reduction of cardiovascular, cerebrovascular, neuropathy, nephropathy, and retinopathy clinical outcomes. All forms of IT-enabled disease management improved the health of patients with diabetes and reduced health care expenditures. Over 10 years, diabetes registries saved $14.5 billion, computerized decision support saved $10.7 billion, payer-centered technologies saved $7.10 billion, remote monitoring saved $326 million, self-management saved $285 million, and integrated provider-patient systems saved $16.9 billion. IT-enabled diabetes management has the potential to improve care processes, delay diabetes complications, and save health care dollars. Of existing systems, provider-centered technologies such as diabetes registries currently show the most potential for benefit. Fully integrated provider-patient systems would have even greater potential for benefit. These benefits must be weighed against the implementation costs.

Analysis of the medication-use process in North American hospital systems: underlining key points for adoption to improve patient safety in French hospitals.

PubMed

Brouard, Agnes; Fagon, Jean Yves; Daniels, Charles E

2011-01-01

This project was designed to underline any actions relative to medication error prevention and patient safety improvement setting up in North American hospitals which could be implemented in French Parisian hospitals. A literature research and analysis of medication-use process in the North American hospitals and a validation survey of hospital pharmacist managers in the San Diego area was performed to assess main points of hospital medication-use process. Literature analysis, survey analysis of respondents highlighted main differences between the two countries at three levels: nationwide, hospital level and pharmaceutical service level. According to this, proposal development to optimize medication-use process in the French system includes the following topics: implementation of an expanded use of information technology and robotics; increase pharmaceutical human resources allowing expansion of clinical pharmacy activities; focus on high-risk medications and high-risk patient populations; develop a collective sense of responsibility for medication error prevention in hospital settings, involving medical, pharmaceutical and administrative teams. Along with a strong emphasis that should be put on the identified topics to improve the quality and safety of hospital care in France, consideration of patient safety as a priority at a nationwide level needs to be reinforced.

Understanding patient portal use: implications for medication management.

PubMed

Osborn, Chandra Y; Mayberry, Lindsay Satterwhite; Wallston, Kenneth A; Johnson, Kevin B; Elasy, Tom A

2013-07-03

The Internet can be leveraged to provide disease management support, including medication adherence promotion that, when tailored, can effectively improve adherence to medications. The growing adoption of patient portals represents an opportunity to support medication management and adherence more broadly, but virtually no data exist about the real and potential impact of existing portals on these outcomes. We sought to (1) understand who uses an existing patient portal and reasons for use and nonuse, (2) understand how portal users are using a portal to manage their medications, and (3) explore participants' ideas for improving portal functionality for medication management and adherence support. A total of 75 adults with type 2 diabetes participated in a mixed-methods study involving focus groups, a survey, and a medical chart review. We used quantitative data to identify differences between portal users and nonusers, and to test the relationship between the frequency of portal use and glycemic control among users. We used qualitative methods to understand how and why participants use a portal and their ideas for improving its medication management functionality. Of the enrolled participants, 81% (61/75) attended a focus group and/or completed a survey; portal users were more likely than nonusers to participate in that capacity (Fisher exact test; P=.01). Users were also more likely than nonusers to be Caucasian/white (Fisher exact test; P<.001), have higher incomes (Fisher exact test; P=.005), and be privately insured (Fisher exact test; P<.001). Users also tended to have more education than nonusers (Mann-Whitney U; P=.05), although this relationship was not significant at P<.05. Among users, more frequent use of a portal was associated with better A1C (Spearman rho =-0.30; P=.02). Reasons for nonuse included not knowing about the portal (n=3), not having access to a computer (n=3), or having a family member serve as an online delegate (n=1). Users reported using the portal to request prescription refills/reauthorizations and to view their medication list, and they were enthusiastic about the idea of added refill reminder functionality. They were also interested in added functionality that could streamline the refill/reauthorization process, alert providers to fill/refill nonadherence, and provide information about medication side effects and interactions. Although there are disparities in patient portal use, patients use portals to manage their medications, are enthusiastic about further leveraging portals to support medication management and adherence, and those who use a portal more frequently have better glycemic control. However, more features and functionality within a portal platform is needed to maximize medication management and adherence promotion.

Disclosing Medical Mistakes: A Communication Management Plan for Physicians

PubMed Central

Petronio, Sandra; Torke, Alexia; Bosslet, Gabriel; Isenberg, Steven; Wocial, Lucia; Helft, Paul R

2013-01-01

Introduction: There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians’ own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. Methods: This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. Results: The steps are 1) physician preparation, such as talking about the physician’s emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. Conclusion: This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested. PMID:23704848

Electronic Health Record for Intensive Care based on Usual Windows Based Software.

PubMed

Reper, Arnaud; Reper, Pascal

2015-08-01

In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed an EHR based on usual software and components. The software was designed as a client-server architecture running on the Windows operating system and powered by the access data base system. The client software was developed using Visual Basic interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in September 2004, the EHR was used to care more than five thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of basic functionalities communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on usual software components was able to respond to the medical needs of the local ICU environment. The use of Windows for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

Position statement: a clinical approach to the management of adult non-neurogenic overactive bladder.

PubMed

Chung, Eric; Lee, Dominic; Gani, Johan; Gillman, Michael; Maher, Christopher; Brennan, Janelle; Johns Putra, Lydia; Ahmad, Laura; Chan, Lewis Lw

2018-01-15

Overactive bladder (OAB) is a highly prevalent medical condition that has an adverse impact on various health-related quality-of-life domains, including a significant psychosocial and financial burden. This position statement, formulated by members of the Urological Society of Australia and New Zealand and the UroGynaecological Society of Australasia, summarises the current recommendations for clinical diagnosis and treatment strategies in patients with non-neurogenic OAB, and guides clinicians in the decision-making process for managing the condition using evidence-based medicine. Main recommendations: Diagnosis and initial management should be based on thorough clinical history, examination and basic investigations to exclude underlying treatable causes such as urinary tract infection and urological malignancy. Initial treatment strategies for OAB involve conservative management with behavioural modification and bladder retraining. Second-line management involves medical therapy using anticholinergic or β3 agonist drugs provided there is adequate assessment of bladder emptying. If medical therapy is unsuccessful, further investigations with urodynamic studies and cystourethroscopy are recommended to guide further treatment. Intravesical botulinum toxin and sacral neuromodulation should be considered in medical refractory OAB. Changes in management as a result of this statement: OAB is a constellation of urinary symptoms and is a chronic condition with a low likelihood of cure; managing patient expectations is essential because OAB is challenging to treat. At present, the exact pathogenesis of OAB remains unclear and it is likely that there are multiple factors involved in this disease complex. Current medical treatment remains far from ideal, although minimally invasive surgery can be effective. Further research into the pathophysiology of this common condition will hopefully guide future developments in disease management.

Managed approaches to multiple sclerosis in special populations.

PubMed

Sperandeo, Kara; Nogrady, Lisa; Moreo, Kathleen; Prostko, Chris R

2011-01-01

Multiple sclerosis (MS) is a chronic demyelinating disorder of the central nervous system that is classified as an immune-mediated inflammatory disease. In managed care, patients with MS can be managed through care coordination that engages an interprofessional approach to a comprehensive spectrum of preventive, medical, rehabilitative, cognitive, and long-term health care services. In addition, the management paradigm for MS is currently in a stage of rapid evolution, with a number of new agents, including more oral drugs, expected to become available in the near future. Pharmacy and therapeutic committees may soon be faced with evaluating a hierarchy of new scientific data to differentiate the safety and efficacy of these new agents. Decisions will need to be made regarding the utility of these potential new agents among existing therapies with longer-term safety and efficacy data available in the scientific literature. For those MS patients managed under Medicaid, formulary and medication management decisions may be further impacted by psychosocial, cultural, educational, attitudinal, and/or economic factors that may be unique to the Medicaid population. The need to maximize immediate and long-term resource utilization is usually an important consideration when managing a Medicaid population. There is also an increasing focus on quality measures and quality outcomes by the Centers for Medicare and Medicaid Services. Many managed care professionals can be involved in establishing quality measures and quality improvement processes to effectively appropriate and manage the resources required for Medicaid patients with MS. As a result, medication and medical management of this special population can involve a comprehensive approach by managed care professionals. For purposes of this article, the term "special populations" applies to patients with MS who are managed under Medicaid plans. To review (a) particular challenges managed care organizations (MCOs) encounter when managing special populations of Medicaid patients with MS, (b) recent efficacy and safety data for oral therapies for relapsing forms of MS, (c) costs of current MS therapies, and (d) potential strategies for managed care to improve care of their MS patient population and optimize clinical and economic outcomes. Review of recent published literature, abstracts related to MS presented at major medical conferences, and recommendations from key organizations including the U.S. Department of Health and Human Services and the National Multiple Sclerosis Society. The health economics of MS are a central issue for MCOs managing Medicaid patient populations. Additional challenges include the anticipated expansion of the marketplace to include several new oral agents and the lack of consensus guidelines for management of patients with MS. The benefit-risk profile of new agents will need to be considered in the context of established first-line parenteral drugs. Management of patients with MS should include an individualized approach for each patient as part of a shared decision-making process. In the overall management of special patient populations, case management and collaborative practice models in managed care may help to ensure that critical benchmarks are achieved.

The economics of health information technology in medication management: a systematic review of economic evaluations

PubMed Central

Tarride, Jean-Eric; Goeree, Ron; Lokker, Cynthia; McKibbon, K Ann

2011-01-01

Objective To conduct a systematic review and synthesis of the evidence surrounding the cost-effectiveness of health information technology (HIT) in the medication process. Materials and methods Peer-reviewed electronic databases and gray literature were searched to identify studies on HIT used to assist in the medication management process. Articles including an economic component were reviewed for further screening. For this review, full cost-effectiveness analyses, cost-utility analyses and cost-benefit analyses, as well as cost analyses, were eligible for inclusion and synthesis. Results The 31 studies included were heterogeneous with respect to the HIT evaluated, setting, and economic methods used. Thus the data could not be synthesized, and a narrative review was conducted. Most studies evaluated computer decision support systems in hospital settings in the USA, and only five of the studied performed full economic evaluations. Discussion Most studies merely provided cost data; however, useful economic data involves far more input. A full economic evaluation includes a full enumeration of the costs, synthesized with the outcomes of the intervention. Conclusion The quality of the economic literature in this area is poor. A few studies found that HIT may offer cost advantages despite their increased acquisition costs. However, given the uncertainty that surrounds the costs and outcomes data, and limited study designs, it is difficult to reach any definitive conclusion as to whether the additional costs and benefits represent value for money. Sophisticated concurrent prospective economic evaluations need to be conducted to address whether HIT interventions in the medication management process are cost-effective. PMID:21984590

A combined intervention to reduce interruptions during medication preparation and double-checking: a pilot-study evaluating the impact of staff training and safety vests.

PubMed

Huckels-Baumgart, Saskia; Niederberger, Milena; Manser, Tanja; Meier, Christoph R; Meyer-Massetti, Carla

2017-10-01

The aim was to evaluate the impact of staff training and wearing safety vests as a combined intervention on interruptions during medication preparation and double-checking. Interruptions and errors during the medication process are common and an important issue for patient safety in the hospital setting. We performed a pre- and post-intervention pilot-study using direct structured observation of 26 nurses preparing and double-checking 431 medication doses (225 pre-intervention and 206 post-intervention) for 36 patients (21 pre-intervention and 15 post-intervention). With staff training and the introduction of safety vests, the interruption rate during medication preparation was reduced from 36.8 to 28.3 interruptions per hour and during double-checking from 27.5 to 15 interruptions per hour. This pilot-study showed that the frequency of interruptions decreased during the critical tasks of medication preparation and double-checking after the introduction of staff training and wearing safety vests as part of a quality improvement process. Nursing management should acknowledge interruptions as an important factor potentially influencing medication safety. Unnecessary interruptions can be successfully reduced by considering human and system factors and increasing both staff and nursing managers' awareness of 'interruptive communication practices' and implementing physical barriers. This is the first pilot-study specifically evaluating the impact of staff training and wearing safety vests on the reduction of interruptions during medication preparation and double-checking. © 2017 John Wiley & Sons Ltd.

Managing the three 'P's to improve patient safety: nursing administration's role in managing information technology.

PubMed

Simpson, Roy L

2004-08-01

The Institute of Medicine's landmark report asserted that medical error is seldom the fault of individuals, but the result of faulty healthcare policy/procedure systems. Numerous studies have shown that information technology (IT) can shore up weak systems. For nursing, IT plays a key role in eliminating nursing mistakes. However, managing IT is a function of managing the people who use it. For nursing administrators, successful IT implementations depend on adroit management of the three 'P's: People, processes and (computer) programs. This paper examines critical issues for managing each entity. It discusses the importance of developing trusting organizations, the requirements of process change, how to implement technology in harmony with the organization and the significance of vision.

Correlation Research of Medical Security Management System Network Platform in Medical Practice

NASA Astrophysics Data System (ADS)

Jie, Wang; Fan, Zhang; Jian, Hao; Li-nong, Yu; Jun, Fei; Ping, Hao; Ya-wei, Shen; Yue-jin, Chang

Objective-The related research of medical security management system network in medical practice. Methods-Establishing network platform of medical safety management system, medical security network host station, medical security management system(C/S), medical security management system of departments and sections, comprehensive query, medical security disposal and examination system. Results-In medical safety management, medical security management system can reflect the hospital medical security problem, and can achieve real-time detection and improve the medical security incident detection rate. Conclusion-The application of the research in the hospital management implementation, can find hospital medical security hidden danger and the problems of medical disputes, and can help in resolving medical disputes in time and achieve good work efficiency, which is worth applying in the hospital practice.

Situation-Dependent Medical Device Risk Estimation: Design and Evaluation of an Equipment Management Center For Vendor-Independent Integrated Operating Rooms.

PubMed

Maktabi, Marianne; Neumuth, Thomas

2017-12-22

The complexity of surgical interventions and the number of technologies involved are constantly rising. Hospital staff has to learn how to handle new medical devices efficiently. However, if medical device-related incidents occur, the patient treatment is delayed. Patient safety could therefore be supported by an optimized assistance system that helps improve the management of technical equipment by nonmedical hospital staff. We developed a system for the optimal monitoring of networked medical device activity and maintenance requirements, which works in conjunction with a vendor-independent integrated operating room and an accurate surgical intervention Time And Resource Management System. An integrated situation-dependent risk assessment system gives the medical engineers optimal awareness of the medical devices in the operating room. A qualitative and quantitative survey among ten medical engineers from three different hospitals was performed to evaluate the approach. A series of 25 questions was used to evaluate various aspects of our system as well as the system currently used. Moreover, the respondents were asked to perform five tasks related to system supervision and incident handling. Our system received a very positive feedback. The evaluation studies showed that the integration of information, the structured presentation of information, and the assistance modules provide valuable support to medical engineers. An automated operating room monitoring system with an integrated risk assessment and Time And Resource Management System module is a new way to assist the staff being outside of a vendor-independent integrated operating room, who are nevertheless involved in processes in the operating room.

Cognitive Support During High-Consequence Episodes of Care in Cardiovascular Surgery.

PubMed

Conboy, Heather M; Avrunin, George S; Clarke, Lori A; Osterweil, Leon J; Christov, Stefan C; Goldman, Julian M; Yule, Steven J; Zenati, Marco A

2017-03-01

Despite significant efforts to reduce preventable adverse events in medical processes, such events continue to occur at unacceptable rates. This paper describes a computer science approach that uses formal process modeling to provide situationally aware monitoring and management support to medical professionals performing complex processes. These process models represent both normative and non-normative situations, and are validated by rigorous automated techniques such as model checking and fault tree analysis, in addition to careful review by experts. Context-aware Smart Checklists are then generated from the models, providing cognitive support during high-consequence surgical episodes. The approach is illustrated with a case study in cardiovascular surgery.

[Establishing self-management for chronic spinal cord injury patients: a qualitative investigation].

PubMed

Okochi, Ayako; Tadaka, Etsuko

2015-01-01

Self-management is essential for individuals with chronic cervical spinal cord injury, but some cases of self-neglect have been reported. The objective of this study was to examine the establishment of self-management in order to help inform community care practice. This was a qualitative study applying a grounded theory approach with semi-structured home interviews. We interviewed 29 individuals with cervical spinal cord injuries (aged 26-77 years) who were members of each of the three branches of the nationwide self-help group, or the clients of a home-visit nursing care station. Qualitative analysis was implemented from a time transition perspective consisting of the faint awareness period, the seeking period, and the adaptation period. The analysis included the perceptions and methods of self-management. The process of establishing self-management was abstracted into a core category of "continuous adaptation to minimize the extent to which the individual's life was disrupted and to allow them to continue to live within the community". This in turn consisted of seven categories. In the faint awareness period, subjects perceived that they "hardly recognized health maintenance needs", that they had difficulties in acknowledging the necessity of controlling physical conditions, and that they were dependent on caregivers. In the seeking period, they were "driven by handling uncontrollable changes" and they coped with those changes in their own way and sometimes did not consider it necessary to see a doctor. In this period, a process of "searching for the methods of being healthy somehow" begun and they started to understand the degree to which they could cope without medication, together with their own responsibilities, and searched for the best coping methods and acted on advice. In the adaptation period, individuals were "struggling to continue the established health methods"; "managing stress"; "prioritizing their own beliefs over medical regimens"; and "confidently modifying the established self-management methods". They employed self-monitoring, preventative measures for secondary difficulties, and stress management techniques. However, they also avoided medication through self-determination and they prioritized their established lifestyle over medically ideal behavior. Subjects learned sustainable self-management methods through trial and error, although in each period of adaptation, they sometimes failed to acknowledge the necessity of health maintenance and medical care, and they coped with their health care needs in their own way. Future research is essential to develop self-management programs that include the patient's own perspectives, to teach health maintenance methods that enable patients to balance social participation and self-management, and to establish cooperative networks among professionals who support the patient's home care.

‘Act on Oncology’ as a New Comprehensive Approach to Assess Prostate Cancer Centres – Method Description and Results of a Pilot Study

PubMed Central

Voigt, Wieland; Hoellthaler, Josef; Magnani, Tiziana; Corrao, Vito; Valdagni, Riccardo

2014-01-01

Background Multidisciplinary care of prostate cancer is increasingly offered in specialised cancer centres. It requires the optimisation of medical and operational processes and the integration of the different medical and non-medical stakeholders. Objective To develop a standardised operational process assessment tool basing on the capability maturity model integration (CMMI) able to implement multidisciplinary care and improve process quality and efficiency. Design, Setting, and Participants Information for model development was derived from medical experts, clinical guidelines, best practice elements of renowned cancer centres, and scientific literature. Data were organised in a hierarchically structured model, consisting of 5 categories, 30 key process areas, 172 requirements, and more than 1500 criteria. Compliance with requirements was assessed through structured on-site surveys covering all relevant clinical and management processes. Comparison with best practice standards allowed to recommend improvements. ‘Act On Oncology’(AoO) was applied in a pilot study on a prostate cancer unit in Europe. Results and Limitations Several best practice elements such as multidisciplinary clinics or advanced organisational measures for patient scheduling were observed. Substantial opportunities were found in other areas such as centre management and infrastructure. As first improvements the evaluated centre administration described and formalised the organisation of the prostate cancer unit with defined personnel assignments and clinical activities and a formal agreement is being worked on to have structured access to First-Aid Posts. Conclusions In the pilot study, the AoO approach was feasible to identify opportunities for process improvements. Measures were derived that might increase the operational process quality and efficiency. PMID:25192213

A medical home: value and implications of knowledge management.

PubMed

Orzano, A John; McInerney, Claire R; McDaniel, Reuben R; Meese, Abigail; Alajmi, Bibi; Mohr, Stewart M; Tallia, Alfred F

2009-01-01

Central to the "medical home" concept is the premise that the delivery of effective primary care requires a fundamental shift in relationships among practice members and between practice members and patients. Primary care practices can potentially increase their capacity to deliver effective care through knowledge management (KM), a process of sharing and making existing knowledge available or by developing new knowledge among practice members and patients. KM affects performance by influencing work relationships to enhance learning, decision making, and task execution. We extend our previous work to further characterize, describe, and contrast how primary care practices exhibit KM and explain why KM deserves attention in medical home redesign initiatives. Case studies were conducted, drawn from two higher and lower performing practices, which were purposely selected based on disease management, prevention, and productivity measures from an improvement trial. Observations of operations, clinical encounters, meetings, and interviews with office members and patients were transcribed and coded independently using a KM template developed from a previous secondary analysis. Face-to-face discussions resolved coding differences among research team members. Confirmation of findings was sought from practice participants. Practices manifested varying degrees of KM effectiveness through six interdependent processes and multiple overlapping tools. Social tools, such as face-to-face-communication for sharing and developing knowledge, were often more effective than were expensive technical tools such as an electronic medical record. Tool use was tailored for specific outcomes, interacted with each other, and leveraged by other organizational capacities. Practices with effective KM were more open to adopting and sustaining new ways of functioning, ways reflecting attributes of a medical home. Knowledge management differences occur within and between practices and can explain differences in performance. By relying more on social tools rather than costly, high-tech investment, KM leverages primary care's relationship-centered strength, facilitating practice redesign as a medical home.

Senior Managers’ Viewpoints Toward Challenges of Implementing Clinical Governance: A National Study in Iran

PubMed Central

Ravaghi, Hamid; Heidarpour, Peigham; Mohseni, Maryam; Rafiei, Sima

2013-01-01

Background: Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government’s intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. Methods: A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Results: Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers’ viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Conclusion: Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers’ attitude toward CG and ultimately affected the success of quality improvement activities. PMID:24596887

[The medical community's perceptions of management of the layoff process].

PubMed

Monreal-Bosch, Pilar; Perera, Santiago; González, Maite Martínez; Selva, Clara

2017-08-21

The definition and process of layoff are evolving rapidly. This study focuses on the perceptions of physicians in Catalonia, Spain, concerning layoff and the identification of strategies and proposals that allow more satisfactory adjustment to the process. A qualitative approach was used with 16 in-depth interviews with key persons in the healthcare setting (phase 1) and 6 focus groups with 72 persons, according to sampling criteria (phase 2). The analysis was interpretative, based on Grounded Theory. Comparison and triangulation of the results generated by the different techniques and researchers revealed the social representation of the current healthcare organization (immersed in a new public management model) on the medical community and the layoff process. In this sense, retirement is seen as a personal issue, separate from human resources policies, which are more interested in staff turnover at a lower "cost". Given this situation, the article proposes alternatives that value physicians' experience and expertise before they leave the healthcare organization.

Epilepsy: habilitation and rehabilitation.

PubMed

Marks, Warren A; Hernandez, Angel; Gabriel, Marsha

2003-06-01

Rehabilitation represents not only a distinct field of medicine, but also a philosophical and practical treatment approach that can be applied to a variety of chronic disorders. Neurology encompasses many chronic disorders, making it ideal for the application of rehabilitation principles in daily practice. Epilepsy offers a unique opportunity to incorporate rehabilitation principles into the management of a complex medical disorder. Epilepsy is an evolving disease process that changes with the maturation of the central nervous system. The rehabilitative model provides the framework for a dynamic treatment plan to meet the changing needs of the child with epilepsy through the social and developmental changes of childhood, adolescence, and adulthood. The development of epilepsy may complicate the recovery from many acute and chronic conditions that affect the central nervous system. The rehabilitation process must address these many aspects of the disease process and its sequelae. This makes neurologists uniquely qualified to manage the rehabilitation team. The impact of the therapeutic milieu on the recovery process may be as important as any specific medical or surgical intervention.

Finance issue brief: direct access: year end report-2002.

PubMed

Morgan, Rachel; MacEachern, Lillian

2002-12-31

Consumer demand for a less restrictive referral system has urged legislators, as well as the managed care industry and those in the medical field, to seek the best solution to the problem. The point of service (POS) plan was an early attempt by managed care plans to provide more freedom for enrollees. But POS plans are not always available or cost effective. Several of the larger managed care organizations, in an effort to improve enrollee and provider satisfaction, have eliminated or streamlined their referral processes. The American Medical Association has recommended that primary care and other medical specialty organizations collaborate in developing guidelines for specialty referrals, urging health plans to allow direct access in network without financial penalty as long as the access conforms with the established guidelines. In the meantime, legislators have responded to constituents by enacting measures that mandate direct access for specific types of care or standing referrals for ongoing treatment.

Finance issue brief: direct access: year end report-2003.

PubMed

MacEachern, Lillian

2003-12-31

Consumer demand for a less restrictive referral system has urged legislators, as well as the managed care industry and those in the medical field, to seek the best solution to the problem. The point of service (POS) plan was an early attempt by managed care plans to provide more freedom for enrollees. But POS plans are not always available or cost effective. Several of the larger managed care organizations, in an effort to improve enrollee and provider satisfaction, have eliminated or streamlined their referral processes. The American Medical Association has recommended that primary care and other medical specialty organizations collaborate in developing guidelines for specialty referrals, urging health plans to allow direct access in network without financial penalty as long as the access conforms with the established guidelines. In the meantime, legislators have responded to constituents by enacting measures that mandate direct access for specific types of care or standing referrals for ongoing treatment.

Shared decision-making in medication management: development of a training intervention

PubMed Central

Stead, Ute; Morant, Nicola; Ramon, Shulamit

2017-01-01

Shared decision-making is a collaborative process in which clinicians and patients make treatment decisions together. Although it is considered essential to patient-centred care, the adoption of shared decision-making into routine clinical practice has been slow, and there is a need to increase implementation. This paper describes the development and delivery of a training intervention to promote shared decision-making in medication management in mental health as part of the Shared Involvement in Medication Management Education (ShIMME) project. Three stakeholder groups (service users, care coordinators and psychiatrists) received training in shared decision-making, and their feedback was evaluated. The programme was mostly well received, with all groups rating interaction with peers as the best aspect of the training. This small-scale pilot shows that it is feasible to deliver training in shared decision-making to several key stakeholders. Larger studies will be required to assess the effectiveness of such training. PMID:28811918

Shared decision-making in medication management: development of a training intervention.

PubMed

Stead, Ute; Morant, Nicola; Ramon, Shulamit

2017-08-01

Shared decision-making is a collaborative process in which clinicians and patients make treatment decisions together. Although it is considered essential to patient-centred care, the adoption of shared decision-making into routine clinical practice has been slow, and there is a need to increase implementation. This paper describes the development and delivery of a training intervention to promote shared decision-making in medication management in mental health as part of the Shared Involvement in Medication Management Education (ShIMME) project. Three stakeholder groups (service users, care coordinators and psychiatrists) received training in shared decision-making, and their feedback was evaluated. The programme was mostly well received, with all groups rating interaction with peers as the best aspect of the training. This small-scale pilot shows that it is feasible to deliver training in shared decision-making to several key stakeholders. Larger studies will be required to assess the effectiveness of such training.

eMedication Meets eHealth with the Electronic Medication Management Assistant (eMMA).

PubMed

Tschanz, Mauro; Dorner, Tim Lucas; Denecke, Kerstin

2017-01-01

A patient's healthcare team is often missing a complete overview on the prescribed and dispensed medication. This is due to an inconsistent information flow between the different actors of the healthcare system. Often, only the patient himself knows exactly which drugs he is actually taking. Our objective is to exploit different eHealth technologies available or planned in Switzerland to improve the information flow of the medication data among the stakeholder and to support the patient in managing his medication. This work is embedded in the "Hospital of the Future Live" project, involving 16 companies and 6 hospitals in order to develop IT solutions for future optimized health care processes. A comprehensive set of requirements was collected from the different actors and project partners. Further, specifications of the available or planned eHealth infrastructure were reviewed to integrate relevant technologies into a coherent concept. We developed a concept that combines the medication list and an eHealth platform. The resulting electronic medication management assistant (eMMA) designed for the patient provides the current medication plan at any time and supports by providing relevant information through a conversational user interface. In Switzerland, we still need a bridging technology to combine the medication information from the electronic patient record with the medication plan's associated QR-Code. The developed app is intended to provide such bridge and demonstrates the usefulness of the eMediplan. It enables the patient to have all data regarding his medication on his personal mobile phone and he can - if necessary - provide the current medication to the health professional.

Manchester Clinical Placement Index (MCPI). Conditions for Medical Students' Learning in Hospital and Community Placements

ERIC Educational Resources Information Center

Dornan, Tim; Muijtjens, Arno; Graham, Jennifer; Scherpbier, Albert; Boshuizen, Henny

2012-01-01

The drive to quality-manage medical education has created a need for valid measurement instruments. Validity evidence includes the theoretical and contextual origin of items, choice of response processes, internal structure, and interrelationship of a measure's variables. This research set out to explore the validity and potential utility of an…

2009 Mississippi Curriculum Framework: Postsecondary Medical Assisting Technology. (Program CIP-51.0801 - Medical /Clinical Assisting)

ERIC Educational Resources Information Center

Roberson, Kaye; King, Christine

2009-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

Upgrading a ColdFusion-Based Academic Medical Library Staff Intranet

ERIC Educational Resources Information Center

Vander Hart, Robert; Ingrassia, Barbara; Mayotte, Kerry; Palmer, Lisa A.; Powell, Julia

2010-01-01

This article details the process of upgrading and expanding an existing academic medical library intranet to include a wiki, blog, discussion forum, and photo collection manager. The first version of the library's intranet from early 2002 was powered by ColdFusion software and existed primarily to allow staff members to author and store minutes of…

Improving cost-effectiveness of and outcomes from drug therapy in patients with atrial fibrillation in managed care: role of the pharmacist.

PubMed

Johnson, Samuel G

2009-08-01

The medical care costs for procedures, medications, and testing associated with atrial fibrillation (AF) in the United States are high and projected to increase markedly in the future as the number of Americans affected grows. The burden on patient quality of life, the health care system, and society are pharmacoeconomic considerations in managing AF. To identify key pharmacoeconomic considerations in managing AF and describe ways in which managed care pharmacists can improve the cost-effectiveness of and outcomes from drug therapy for AF. The high medical care costs of AF are largely the result of the high cost of hospitalization and inpatient procedures. Recurrence of AF dramatically increases costs, especially for hospital care. Managed care pharmacists have many opportunities to provide cost-effective care to and improve outcomes in patients with AF. Policy and process review, population management, and case management are key strategies for improving outcomes in patients with AF. Pharmacist input into policy and process review, including pharmacy benefits design, formulary management, and the use of information technology, can help ensure that the use of drug therapy for AF is cost-effective. Population management strategies, such as development of clinical pathways and patient registries, seek to improve the quality, consistency, and cost-effectiveness of care and the likelihood that desired therapeutic outcomes are achieved through targeted interventions. Case management strategies focus on longitudinal care for individuals in order to improve quality. Pharmacist-managed anticoagulation services and antiarrhythmic drug monitoring are the 2 most widely known case management strategies for patients with AF. Managed care pharmacists can screen patients with AF for the use of anticoagulation, which is needed to prevent embolic stroke but is under-used, even though recommended by evidence-based guidelines. The clinical efficacy and cost-effectiveness of pharmacist-managed anticoagulation services for patients with AF are well documented. Pharmacist-managed antiarrhythmic drug monitoring is a less well-known case management strategy that facilitates early detection and intervention to minimize toxicity. Managed care pharmacists can play an instrumental role in implementing strategies to improve the cost-effectiveness of and outcomes from drug therapy for AF.

Population-based medical and disease management: an evaluation of cost and quality.

PubMed

Wise, Christopher G; Bahl, Vinita; Mitchell, Rita; West, Brady T; Carli, Thomas

2006-02-01

Reports by the Institute of Medicine and the Health Care Financing Administration have emphasized that the integration of medical care delivery, evidence-based medicine, and chronic care disease management may play a significant role in improving the quality of care and reducing medical care costs. The specific aim of this project is to assess the impact of an integrated set of care coordination tools and chronic disease management interventions on utilization, cost, and quality of care for a population of beneficiaries who have complementary health coverage through a plan designed to apply proactive medical and disease management processes. The utilization of health care services by the study population was compared to another population from the same geographic service area and covered by a traditional fee-for-service indemnity insurance plan that provided few medical or disease management services. Evaluation of the difference in utilization was based on the difference in the cost per-member-per-month (PMPM) in a 1-year measurement period, after adjusting for differences in fee schedules, case-mix and healthcare benefit design. After adjustments for both case-mix and benefit differences, the study group is $63 PMPM less costly than the comparison population for all members. Cost differences are largest in the 55-64 and 65 and above age groups. The study group is $115 PMPM lower than the comparison population for the age category of 65 years and older, after adjustments for case-mix and benefits. Health Plan Employer and Data Information Set (HEDIS)-based quality outcomes are near the 90th percentile for most indications. The cost outcomes of a population served by proactive, population-based disease management and complex care management, compared to an unmanaged population, demonstrates the potential of coordinated medical and disease management programs. Further studies utilizing appropriate methodologies would be beneficial.

Family physicians' professional identity formation: a study protocol to explore impression management processes in institutional academic contexts.

PubMed

Rodríguez, Charo; Pawlikowska, Teresa; Schweyer, Francois-Xavier; López-Roig, Sofia; Bélanger, Emmanuelle; Burns, Jane; Hugé, Sandrine; Pastor-Mira, Maria Ángeles; Tellier, Pierre-Paul; Spencer, Sarah; Fiquet, Laure; Pereiró-Berenguer, Inmaculada

2014-09-06

Despite significant differences in terms of medical training and health care context, the phenomenon of medical students' declining interest in family medicine has been well documented in North America and in many other developed countries as well. As part of a research program on family physicians' professional identity formation initiated in 2007, the purpose of the present investigation is to examine in-depth how family physicians construct their professional image in academic contexts; in other words, this study will allow us to identify and understand the processes whereby family physicians with an academic appointment seek to control the ideas others form about them as a professional group, i.e. impression management. The methodology consists of a multiple case study embedded in the perspective of institutional theory. Four international cases from Canada, France, Ireland and Spain will be conducted; the "case" is the medical school. Four levels of analysis will be considered: individual family physicians, interpersonal relationships, family physician professional group, and organization (medical school). Individual interviews and focus groups with academic family physicians will constitute the main technique for data generation, which will be complemented with a variety of documentary sources. Discourse techniques, more particularly rhetorical analysis, will be used to analyze the data gathered. Within- and cross-case analysis will then be performed. This empirical study is strongly grounded in theory and will contribute to the scant body of literature on family physicians' professional identity formation processes in medical schools. Findings will potentially have important implications for the practice of family medicine, medical education and health and educational policies.

Management of pancreatic trauma: a literature review.

PubMed

Papalois, Vassilios

2017-03-01

The European Union of Medical Specialists, founded in 1958, is the largest and oldest european medical organization. It includes 39 member states (of the European Union and others), and represents a total of 1.600.000 medical specialists. The main objective of the UEMS is to influence european healthcare politics by promoting the interests of the european medical specialists, establishing high standards in practice and training, as well as continuing medical education and professional development, and guaranteeing quality in specialist practice. The UEMS is developing several projects to face current and future challenges related to surgical training, education, acreditation, revalidation and professional development: i.- First, the UEMS is developing homogeneous requisites for European Training (ETRs), ii.- To manage the quality control process of the ETRs and evaluation of the organization, the UEMS has created the Council of european specialized medial evaluations (CESMA), iii.- The UEMS has been greatly involved in the acreditation process of training centres in all of Europe, iv.- in relation to continuing medical education, the European Accreditation Council for Continuing Medical Education (EACCME) is the main project of the UEMS for the accreditation of educational events and v.- the UEMS has established the Network of Accredited Clinical Skills Centres of Europe (UEMS-NASCE), that facilitates the accreditation and cooperation of training centres in Europe. In conclusion, with the great support of National Surgical Societies of the UEMS and the Surgery Section a series of solid projects have been established to support the professional development of the collective in Europe. This process constitutes a continuous effort that is very gratifying, with the aim to set the standards for a brilliant future for surgery students and specialized surgeons. Copyright © 2017. Publicado por Elsevier España, S.L.U.

The use of advanced medical technologies at home: a systematic review of the literature.

PubMed

Ten Haken, Ingrid; Ben Allouch, Somaya; van Harten, Wim H

2018-02-26

The number of medical technologies used in home settings has increased substantially over the last 10-15 years. In order to manage their use and to guarantee quality and safety, data on usage trends and practical experiences are important. This paper presents a literature review on types, trends and experiences with the use of advanced medical technologies at home. The study focused on advanced medical technologies that are part of the technical nursing process and 'hands on' processes by nurses, excluding information technology such as domotica. The systematic review of literature was performed by searching the databases MEDLINE, Scopus and Cinahl. We included papers from 2000 to 2015 and selected articles containing empirical material. The review identified 87 relevant articles, 62% was published in the period 2011-2015. Of the included studies, 45% considered devices for respiratory support, 39% devices for dialysis and 29% devices for oxygen therapy. Most research has been conducted on the topic 'user experiences' (36%), mainly regarding patients or informal caregivers. Results show that nurses have a key role in supporting patients and family caregivers in the process of homecare with advanced medical technologies and in providing information for, and as a member of multi-disciplinary teams. However, relatively low numbers of articles were found studying nurses perspective. Research on medical technologies used at home has increased considerably until 2015. Much is already known on topics, such as user experiences; safety, risks, incidents and complications; and design and technological development. We also identified a lack of research exploring the views of nurses with regard to medical technologies for homecare, such as user experiences of nurses with different technologies, training, instruction and education of nurses and human factors by nurses in risk management and patient safety.

Reorganizing departments of psychiatry, hospitals, and medical centers for the 21st century.

PubMed

Schreter, R K

1998-11-01

Market forces are reshaping health care, transforming it from a public service into a product that is sold in a highly competitive marketplace. This transformation has been particularly disruptive for hospital departments of psychiatry and medical centers that were the early targets for managed care efforts at cost containment. To survive, health care institutions have embarked on a clinical and administrative re-engineering process. The author describes a series of steps for reconfiguring departments, hospitals, and medical centers as they enter the 21st century. The steps include identifying the leadership team, formulating a mission statement and strategic plan, creating a legal entity capable of achieving the organization's goals, drawing up an organizational chart, and developing the provider network. Other steps in the process include enhancing the continuum of services offered, developing administrative capability, dealing with managed care, paying attention to fundamental business practices, integrating psychiatric services into the health care system, and marketing psychiatric services.

Evaluation of an Ongoing Diabetes Group Medical Visit in a Family Medicine Practice.

PubMed

Cunningham, Amy T; Delgado, David J; Jackson, Joseph D; Crawford, Albert G; Jabbour, Serge; Lieberthal, Robert D; Diaz, Victor; LaNoue, Marianna

2018-01-01

Group medical visits (GMVs), which combine 1-on-1 clinical consultations and group self-management education, have emerged as a promising vehicle for supporting type 2 diabetes management in primary care. However, few evaluations exist of ongoing diabetes GMVs embedded in medical practices. This study used a quasi-experimental design to evaluate diabetes GMV at a large family medicine practice. We examined program attendance and attrition, used propensity score matching to create a matched comparison group, and compared participants and the matched group on clinical, process of care, and utilization outcomes. GMV participants (n = 230) attended an average of 1 session. Participants did not differ significantly from the matched comparison group (n = 230) on clinical, process of care or utilization outcomes. The diabetes GMV was not associated with improvements in outcomes. Further studies should examine diabetes GMV implementation challenges to enhance their effectiveness in everyday practice. © Copyright 2018 by the American Board of Family Medicine.

Meeting the challenges--the role of medical informatics in an ageing society.

PubMed

Koch, Sabine

2006-01-01

The objective of this paper is to identify trends and new technological developments that appear due to an ageing society and to relate them to current research in the field of medical informatics. A survey of the current literature reveals that recent technological advances have been made in the fields of "telecare and home-monitoring", "smart homes and robotics" and "health information systems and knowledge management". Innovative technologies such as wearable devices, bio- and environmental sensors and mobile, humanoid robots do already exist and ambient assistant living environments are being created for an ageing society. However, those technologies have to be adapted to older people's self-care processes and coping strategies, and to support new ways of healthcare delivery. Medical informatics can support this process by providing the necessary information infrastructure, contribute to standardisation, interoperability and security issues and provide modelling and simulation techniques for educational purposes. Research fields of increasing importance with regard to an ageing society are, moreover, the fields of knowledge management, ubiquitous computing and human-computer interaction.

Surgical and Resuscitation Capabilities for the "Next War" Based on Lessons Learned From "This War".

PubMed

Freel, David; Warr, Bradley J

2016-01-01

The Army gleaned many lessons regarding the provision of medical care to casualties during the past 14 years of combat. Using these lessons learned in the Joint Capabilities and Integration Development process and through the analysis of an integrated process action team, the Army recently approved 3 changes to medical organizations that are intended to provide trauma management farther forward on the battlefield. These changes include the substitution of an emergency medicine trained physician and emergency medicine physician assistant (PA) in lieu of a general medical officer and primary care PA within the brigade combat team; reorganization of the forward surgical team into a forward surgical and resuscitative team; and the modularization of the traditional 248 bed combat support hospital. The Army anticipates that these changes related to personnel, organizations, doctrine, and materiel will enable Army medicine to provide enhanced trauma management closer to the point of a combatant's injury. These modifications are projected to begin in fiscal year 2016.

Physician’ entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics

PubMed Central

2014-01-01

Background Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers induce physicians to become entrepreneurs by starting a specialty clinic. In addition, we determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics. Methods For our research, we interviewed a total of fifteen physicians and eight managers in four hospitals and twelve physicians and seven managers in twelve specialty clinics. Results We found evidence that in becoming entrepreneurs, physicians are influenced by intra-organizational dynamics, including power dependence, interest dissatisfaction, and value commitments, between physicians and managers as well as among physicians’ groups. The precise motivation for starting a new clinic can vary depending on the medical or business logic in which the entrepreneurs are embedded, but also the presence of an entrepreneurial nature or nurture. Finally we found that the entrepreneurial process of starting a specialty clinic is a process of sedimented change or hybridized professionalism in which elements of the business logic are added to the existing logic of medical professionalism, leading to a hybrid logic. Conclusions These findings have implications for policy at both the national and hospital level. Shared ownership and aligned incentives may provide the additional cement in which the developing entrepreneurial values are ‘glued’ to the central medical logic. PMID:24885912

Physician' entrepreneurship explained: a case study of intra-organizational dynamics in Dutch hospitals and specialty clinics.

PubMed

Koelewijn, Wout T; de Rover, Matthijs; Ehrenhard, Michel L; van Harten, Wim H

2014-05-19

Challenges brought about by developments such as continuing market reforms and budget reductions have strained the relation between managers and physicians in hospitals. By applying neo-institutional theory, we research how intra-organizational dynamics between physicians and managers induce physicians to become entrepreneurs by starting a specialty clinic. In addition, we determine the nature of this change by analyzing the intra-organizational dynamics in both hospitals and clinics. For our research, we interviewed a total of fifteen physicians and eight managers in four hospitals and twelve physicians and seven managers in twelve specialty clinics. We found evidence that in becoming entrepreneurs, physicians are influenced by intra-organizational dynamics, including power dependence, interest dissatisfaction, and value commitments, between physicians and managers as well as among physicians' groups. The precise motivation for starting a new clinic can vary depending on the medical or business logic in which the entrepreneurs are embedded, but also the presence of an entrepreneurial nature or nurture. Finally we found that the entrepreneurial process of starting a specialty clinic is a process of sedimented change or hybridized professionalism in which elements of the business logic are added to the existing logic of medical professionalism, leading to a hybrid logic. These findings have implications for policy at both the national and hospital level. Shared ownership and aligned incentives may provide the additional cement in which the developing entrepreneurial values are 'glued' to the central medical logic.

Simple solution to the medical instrumentation software problem

NASA Astrophysics Data System (ADS)

Leif, Robert C.; Leif, Suzanne B.; Leif, Stephanie H.; Bingue, E.

1995-04-01

Medical devices now include a substantial software component, which is both difficult and expensive to produce and maintain. Medical software must be developed according to `Good Manufacturing Practices', GMP. Good Manufacturing Practices as specified by the FDA and ISO requires the definition and compliance to a software processes which ensures quality products by specifying a detailed method of software construction. The software process should be based on accepted standards. US Department of Defense software standards and technology can both facilitate the development and improve the quality of medical systems. We describe the advantages of employing Mil-Std-498, Software Development and Documentation, and the Ada programming language. Ada provides the very broad range of functionalities, from embedded real-time to management information systems required by many medical devices. It also includes advanced facilities for object oriented programming and software engineering.

Teaching methods in the healthcare management major.

PubMed

Petrova, Gergana G; Popov, Teodor N

2009-01-01

Organisation and management are factors of paramount importance in higher education for achieving higher quality of training, better professional adaptation, and more effective career pursuance of the students. The present study analyses the use of various teaching methods for the students in the major of Healthcare Management as they are employed in two medical universities. We conducted a detailed questionnaire survey which included the students in the Healthcare Management major in the Faculty of Public Health (FPH) at Sofia Medical University (SMU) and the Medical Faculty of Plovdiv Medical University (PMU). The students were surveyed for two consecutive academic years (2004/2005 and 2005/2006). The logical units of study were 198 students completing their baccalaureate programs in Healthcare Management: 145 (73.23+/-3.15%) in the FPH, SMU and 53 (26.77+/-3.15%) in the PMU (the greater number of students from the SMU was due to the greater number of students admitted into the Sofia Medical University). The technical units of study were the Faculty of Public Health in the Medical University in Sofia and the Medical faculty in the Medical University in Plovdiv. The survey was carried out using our own questionnaire form comprising 51 questions (open and closed), some of them allowing more than one answer. The collected sociological data were analysed using SPSS v. 13.0, and the diagrams were made using Microsoft Excel' 97. We used the alternative, non-parametric and graphic analyses to illustrate the processes and events at a level of significance P < 0.05. The most frequently used teaching method in both Medical Universities is the lecture (30.43+/-3.63% for PMU and 26.32+/-1.91% for SMU). This format of teaching is also considered to be the easiest with regard to learning the study material by 22.75+/-3.25% of the PMU graduates and 27.56+/-2.38% of the SMU graduates. The PMU students regard seminars, individual work and discussions as the format that afford the easiest way to acquire knowledge (22.16+/-3.21%, 21.56+/-3.18%, (18.56+/-3.01%, respectively). The most frequently used teaching method is the lecture; for the SMU student, it is used in 91.67+/-5.64% of all cases, while for PMU it is 8.33+/-5.64%. Students prefer the classical teaching methods. They are the most familiar and the most frequently used formats by lecturers, although they do not require a higher level of activity on the part of the students, who in T. Popov's view "...demonstrate passive attitude towards the educational process".

Variation in Formulary Management Practices Within the Department of Veterans Affairs Health Care System.

PubMed

Radomski, Thomas R; Good, Chester B; Thorpe, Carolyn T; Zhao, Xinhua; Marcum, Zachary A; Glassman, Peter A; Lowe, John; Mor, Maria K; Fine, Michael J; Gellad, Walid F

2016-02-01

All Department of Veterans Affairs Medical Centers (VAMCs) operate under a single national drug formulary, yet substantial variation in prescribing and spending exists across facilities. Local management of the national formulary may differ across VAMCs and may be one cause of this variation. To characterize variation in the management of nonformulary medication requests and pharmacy and therapeutics (P&T) committee member perceptions of the formulary environment at VAMCs nationwide. We performed an online survey of the chief of pharmacy and an additional staff pharmacist and physician on the P&T committee at all VAMCs. Respondents were asked questions regarding criteria for use for nonformulary medications, specific procedures for ordering nonformulary medications in general and specific lipid-lowering and diabetes agents, the appeals process, and the formulary environment at their VAMCs. We compared responses across facilities and between chiefs of pharmacy, pharmacists, and physicians. A total of 212 chief pharmacists (n = 80), staff pharmacists (n = 78), and physicians (n = 54) responded, for an overall response rate of 49%. In total, 107/143 (75%) different VAMCs were represented. The majority of VAMCs reported adhering to national criteria for use, with 38 (36%) being very adherent and 69 (65%) being mostly adherent. There was substantial variation between VAMCs regarding how nonformulary drugs were ordered, evaluated, and appealed. The nonformulary lipid-lowering drugs ezetimibe, rosuvastatin, and atorvastatin were viewable to providers in the order entry screen at 67 (63%), 67 (63%), and 64 (60%) VAMCs, respectively. The nonformulary diabetes medication pioglitazone was only viewable at 58 (55%) VAMCs. In the remaining VAMCs, providers could not order these nonformulary drugs through the normal order-entry process. For questions about the formulary environment, physician respondent perceptions differed from those of staff pharmacists and chief pharmacists. Compared with pharmacy chiefs and staff pharmacists, physicians were less likely to agree that providers at their VAMC prescribed too many nonformulary medications (47% and 44% vs. 12%, P < 0.001), more likely to agree that providers must jump through too many hoops to prescribe nonformulary medication (5% and 3% vs. 25%, P < 0.001), and more likely to agree that providers make an effort to convert new patients from nonformulary to formulary lipid-lowering (65% and 73% vs. 94%, P <0.02) and diabetic medications (49% and 50% vs. 88%, P < 0.001). Although the Department of Veterans Affairs (VA) operates under a single national formulary, we found significant differences among VAMCs regarding their management of nonformulary medication requests. We also found differences among formulary leaders regarding their perception of the environment in which their VAMC's formulary is managed. These findings have important implications not just for VA, but for any organization that develops, implements, and manages drug formularies across multiple facilities.

Medical records and issues in negligence

PubMed Central

Thomas, Joseph

2009-01-01

It is very important for the treating doctor to properly document the management of a patient under his care. Medical record keeping has evolved into a science of itself. This will be the only way for the doctor to prove that the treatment was carried out properly. Moreover, it will also be of immense help in the scientific evaluation and review of patient management issues. Medical records form an important part of the management of a patient. It is important for the doctors and medical establishments to properly maintain the records of patients for two important reasons. The first one is that it will help them in the scientific evaluation of their patient profile, helping in analyzing the treatment results, and to plan treatment protocols. It also helps in planning governmental strategies for future medical care. But of equal importance in the present setting is in the issue of alleged medical negligence. The legal system relies mainly on documentary evidence in a situation where medical negligence is alleged by the patient or the relatives. In an accusation of negligence, this is very often the most important evidence deciding on the sentencing or acquittal of the doctor. With the increasing use of medical insurance for treatment, the insurance companies also require proper record keeping to prove the patient's demand for medical expenses. Improper record keeping can result in declining medical claims. It is disheartening to note that inspite of knowing the importance of proper record keeping it is still in a nascent stage in India. It is wise to remember that “Poor records mean poor defense, no records mean no defense”. Medical records include a variety of documentation of patient's history, clinical findings, diagnostic test results, preoperative care, operation notes, post operative care, and daily notes of a patient's progress and medications. A properly obtained consent will go a long way in proving that the procedures were conducted with the concurrence of the patient. A properly written operative note can protect a surgeon in case of alleged negligence due to operative complications. It is important that the prescription for drugs should be legible with the name of the patient, date, and the signature of the doctor. An undated prescription can land a doctor in trouble if the patient misuses it. There are also many records that are indirectly related to patient management such as accounts records, service records of the staff, and administrative records, which are also useful as evidences for litigation purposes. Medical recording needs the concerted effort of a number of people involved in patient care. The doctor is the prime person who has to oversee this process and is primarily responsible for history, physical examination, treatment plans, operative records, consent forms, medications used, referral papers, discharge records, and medical certificates. There should be proper recording of nursing care, laboratory data, reports of diagnostic evaluations, pharmacy records, and billing processes. This means that the paramedical and nursing staff also should be trained in proper maintenance of patient records. The medical scene in India extends from smaller clinics to large hospitals. Medical record keeping is a specialized area in bigger teaching and corporate hospitals with separate medical records officers handling these issues. However, it is yet to develop into a proper process in the large number of smaller clinics and hospitals that cater to a large section of the people in India. PMID:19881136

A Multi Agent Based Approach for Prehospital Emergency Management.

PubMed

Safdari, Reza; Shoshtarian Malak, Jaleh; Mohammadzadeh, Niloofar; Danesh Shahraki, Azimeh

2017-07-01

To demonstrate an architecture to automate the prehospital emergency process to categorize the specialized care according to the situation at the right time for reducing the patient mortality and morbidity. Prehospital emergency process were analyzed using existing prehospital management systems, frameworks and the extracted process were modeled using sequence diagram in Rational Rose software. System main agents were identified and modeled via component diagram, considering the main system actors and by logically dividing business functionalities, finally the conceptual architecture for prehospital emergency management was proposed. The proposed architecture was simulated using Anylogic simulation software. Anylogic Agent Model, State Chart and Process Model were used to model the system. Multi agent systems (MAS) had a great success in distributed, complex and dynamic problem solving environments, and utilizing autonomous agents provides intelligent decision making capabilities.  The proposed architecture presents prehospital management operations. The main identified agents are: EMS Center, Ambulance, Traffic Station, Healthcare Provider, Patient, Consultation Center, National Medical Record System and quality of service monitoring agent. In a critical condition like prehospital emergency we are coping with sophisticated processes like ambulance navigation health care provider and service assignment, consultation, recalling patients past medical history through a centralized EHR system and monitoring healthcare quality in a real-time manner. The main advantage of our work has been the multi agent system utilization. Our Future work will include proposed architecture implementation and evaluation of its impact on patient quality care improvement.

A Multi Agent Based Approach for Prehospital Emergency Management

PubMed Central

Safdari, Reza; Shoshtarian Malak, Jaleh; Mohammadzadeh, Niloofar; Danesh Shahraki, Azimeh

2017-01-01

Objective: To demonstrate an architecture to automate the prehospital emergency process to categorize the specialized care according to the situation at the right time for reducing the patient mortality and morbidity. Methods: Prehospital emergency process were analyzed using existing prehospital management systems, frameworks and the extracted process were modeled using sequence diagram in Rational Rose software. System main agents were identified and modeled via component diagram, considering the main system actors and by logically dividing business functionalities, finally the conceptual architecture for prehospital emergency management was proposed. The proposed architecture was simulated using Anylogic simulation software. Anylogic Agent Model, State Chart and Process Model were used to model the system. Results: Multi agent systems (MAS) had a great success in distributed, complex and dynamic problem solving environments, and utilizing autonomous agents provides intelligent decision making capabilities.  The proposed architecture presents prehospital management operations. The main identified agents are: EMS Center, Ambulance, Traffic Station, Healthcare Provider, Patient, Consultation Center, National Medical Record System and quality of service monitoring agent. Conclusion: In a critical condition like prehospital emergency we are coping with sophisticated processes like ambulance navigation health care provider and service assignment, consultation, recalling patients past medical history through a centralized EHR system and monitoring healthcare quality in a real-time manner. The main advantage of our work has been the multi agent system utilization. Our Future work will include proposed architecture implementation and evaluation of its impact on patient quality care improvement. PMID:28795061

Individual performance review in hospital practice: the development of a framework and evaluation of doctors' attitudes to its value and implementation.

PubMed

Trebble, T M; Cruickshank, L; Hockey, P M; Heyworth, N; Powell, T; Clarke, N

2013-11-01

Appraisal, or independent performance review (IPR) is used in human resources management in the commercial and public sectors to evaluate the performance of an employee against agreed local organisational expectations and objectives, and to identify their requirements for development and effective management. IPR for NHS consultants may provide essential information for job planning, contribute towards medical appraisal for revalidation, and facilitate productivity and quality improvement. To develop a framework for IPR for consultants, and to determine attitudes on its value, process and content. Information from commercial, public and voluntary sector models and published and other literature sources were used to develop an IPR framework. This was assessed through a three-cycle action research methodology involving qualitative interviews with 22 consultants (predominantly with medical management roles). The domains of the IPR framework included: (1) performance against objectives; (2) behaviour and leadership; (3) talent management; (4) agreed future objectives. A number of themes were identified from the consultant interviews including: ineffective current appraisal systems reflecting a lack of valid performance data and allotted time; a lack of empowerment of medical managers to address performance issues; IPR as a more explicit system, offering value in evaluating doctors performance; and the dependence of successful implementation on the engagement of the Trust executive. IPR may have value for performance evaluation of consultants, contributing toward job planning and complementing medical appraisal. Support by their employing organisation and engagement with medical managers in design and implementation is likely to be essential.

Medication errors in residential aged care facilities: a distributed cognition analysis of the information exchange process.

PubMed

Tariq, Amina; Georgiou, Andrew; Westbrook, Johanna

2013-05-01

Medication safety is a pressing concern for residential aged care facilities (RACFs). Retrospective studies in RACF settings identify inadequate communication between RACFs, doctors, hospitals and community pharmacies as the major cause of medication errors. Existing literature offers limited insight about the gaps in the existing information exchange process that may lead to medication errors. The aim of this research was to explicate the cognitive distribution that underlies RACF medication ordering and delivery to identify gaps in medication-related information exchange which lead to medication errors in RACFs. The study was undertaken in three RACFs in Sydney, Australia. Data were generated through ethnographic field work over a period of five months (May-September 2011). Triangulated analysis of data primarily focused on examining the transformation and exchange of information between different media across the process. The findings of this study highlight the extensive scope and intense nature of information exchange in RACF medication ordering and delivery. Rather than attributing error to individual care providers, the explication of distributed cognition processes enabled the identification of gaps in three information exchange dimensions which potentially contribute to the occurrence of medication errors namely: (1) design of medication charts which complicates order processing and record keeping (2) lack of coordination mechanisms between participants which results in misalignment of local practices (3) reliance on restricted communication bandwidth channels mainly telephone and fax which complicates the information processing requirements. The study demonstrates how the identification of these gaps enhances understanding of medication errors in RACFs. Application of the theoretical lens of distributed cognition can assist in enhancing our understanding of medication errors in RACFs through identification of gaps in information exchange. Understanding the dynamics of the cognitive process can inform the design of interventions to manage errors and improve residents' safety. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Information needs assessment of medical equipment offices based on Critical Success Factors (CSF) and Business System Planning (BSP) methods.

PubMed

Khorrami, F; Ahmadi, M; Alizadeh, A; Roozbeh, N; Mohseni, S

2015-01-01

Introduction: Given the ever-increasing importance and value of information, providing the management with a reliable information system, which can facilitate decision-making regarding planning, organization and control, is vitally important. This study aimed to analyze and evaluate the information needs of medical equipment offices. Methods: This descriptive applied cross-sectional study was carried out in 2010. The population of the study included the managers of statistic and medical records at the offices of vice-chancellor for treatment in 39 medical universities in Iran. Data were collected by using structured questioners. With regard to different kinds of designing information systems, sampling was done by two methods, BSP (based on processes of job description) and CSF method (based on critical success factors). The data were analyzed by SPSS-16. Results: Our study showed that 41% of information needs were found to be critical success factors of managers of office. The first priority of managers was "the number of bed and bed occupancy in hospitals". Of 29 identified information needs, 62% were initial information needs of managers (from the viewpoints of managers). Of all, 4% of the information needs were obtained through the form, 14% through both the form and database, 11% through the web site, and 71% had no sources (forms, databases, web site). Conclusion: Since 71% of the information needs of medical equipment offices managers had no information sources, the development of information system in these offices seems to be necessary. Despite the important role of users in designing the information systems (identifying 62% of information needs), other scientific methods is also needed to be utilized in designing the information systems.

Information needs assessment of medical equipment offices based on Critical Success Factors (CSF) and Business System Planning (BSP) methods

PubMed Central

Khorrami, F; Ahmadi, M; Alizadeh, A; Roozbeh, N; Mohseni, S

2015-01-01

Introduction: Given the ever-increasing importance and value of information, providing the management with a reliable information system, which can facilitate decision-making regarding planning, organization and control, is vitally important. This study aimed to analyze and evaluate the information needs of medical equipment offices. Methods: This descriptive applied cross-sectional study was carried out in 2010. The population of the study included the managers of statistic and medical records at the offices of vice-chancellor for treatment in 39 medical universities in Iran. Data were collected by using structured questioners. With regard to different kinds of designing information systems, sampling was done by two methods, BSP (based on processes of job description) and CSF method (based on critical success factors). The data were analyzed by SPSS-16. Results: Our study showed that 41% of information needs were found to be critical success factors of managers of office. The first priority of managers was “the number of bed and bed occupancy in hospitals”. Of 29 identified information needs, 62% were initial information needs of managers (from the viewpoints of managers). Of all, 4% of the information needs were obtained through the form, 14% through both the form and database, 11% through the web site, and 71% had no sources (forms, databases, web site). Conclusion: Since 71% of the information needs of medical equipment offices managers had no information sources, the development of information system in these offices seems to be necessary. Despite the important role of users in designing the information systems (identifying 62% of information needs), other scientific methods is also needed to be utilized in designing the information systems. PMID:28255389

Improving medication practices for persons with intellectual and developmental disability: Educating direct support staff using simulation, debriefing, and reflection.

PubMed

Auberry, Kathy; Wills, Katherine; Shaver, Carrie

2017-01-01

Direct support professionals (DSPs) are increasingly active in medication administration for people with intellectual and developmental disabilities, thus supplementing nursing and family caretakers. Providing workplace training for DSPs is often the duty of nursing personnel. This article presents empirical data and design suggestions for including simulations, debriefing, and written reflective practice during in-service training for DSPs in order to improve DSPs' skills and confidence related to medication administration. Quantitative study results demonstrate that DSPs acknowledge that their skill level and confidence rose significantly after hands-on simulations. The skill-level effect was statistically significant for general medication management -4.5 ( p < 0.001) and gastrointestinal medication management -4.4 ( p < 0.001). Qualitative findings show a deep desire by DSPs to not just be "pill poppers" but to understand the medical processes, causalities, and consequences of their medication administration. On the basis of our results, the authors make recommendations regarding how to combine DSP workplace simulations and debriefing with written reflective practice in DSP continuing education.

Leadership, management and teamwork learning through an extra-curricular project for medical students: descriptive study.

PubMed

Jorge, Maria Lucia da Silva Germano; Coelho, Izabel Cristina Meister; Paraizo, Mariana Martins; Paciornik, Ester Fogel

2014-01-01

Professionalism in medicine requires preparation for the globalized world. Our objective was to describe a project that introduces medical students to the community, hospital and laboratory activities, thereby allowing them to gain experience in people management, leadership and teamwork. Descriptive study of the process applied at a philanthropic medical school in Curitiba, Paraná. Inclusion of management and leadership practices as part of the medical degree program. The study groups consisted of fifteen students. After six months, any of the participants could be elected as a subcoordinator, with responsibility for managing tasks and representing the team in hospital departments and the community. The activities required increasing levels of responsibility. In medical schools, students' involvement in practical activities is often limited to observation. They are not required to take responsibilities or to interact with other students and stakeholders. However, they will become accountable, which thus has an adverse effect on all involved. The learning space described here aims to fill this gap by bringing students closer to the daily lives and experiences of healthcare professionals. Being a physician requires not only management and leadership, but also transferrable competencies, communication and critical thinking. These attributes can be acquired through experience of teamwork, under qualified supervision from teaching staff. Students are thus expected to develop skills to deal with and resolve conflicts, learn to share leadership, prepare others to help and replace them, adopt an approach based on mutual responsibility and discuss their performance.

Medical Group Structural Integration May Not Ensure That Care Is Integrated, From The Patient's Perspective.

PubMed

Kerrissey, Michaela J; Clark, Jonathan R; Friedberg, Mark W; Jiang, Wei; Fryer, Ashley K; Frean, Molly; Shortell, Stephen M; Ramsay, Patricia P; Casalino, Lawrence P; Singer, Sara J

2017-05-01

Structural integration is increasing among medical groups, but whether these changes yield care that is more integrated remains unclear. We explored the relationships between structural integration characteristics of 144 medical groups and perceptions of integrated care among their patients. Patients' perceptions were measured by a validated national survey of 3,067 Medicare beneficiaries with multiple chronic conditions across six domains that reflect knowledge and support of, and communication with, the patient. Medical groups' structural characteristics were taken from the National Study of Physician Organizations and included practice size, specialty mix, technological capabilities, and care management processes. Patients' survey responses were most favorable for the domain of test result communication and least favorable for the domain of provider support for medication and home health management. Medical groups' characteristics were not consistently associated with patients' perceptions of integrated care. However, compared to patients of primary care groups, patients of multispecialty groups had strong favorable perceptions of medical group staff knowledge of patients' medical histories. Opportunities exist to improve patient care, but structural integration of medical groups might not be sufficient for delivering care that patients perceive as integrated. Project HOPE—The People-to-People Health Foundation, Inc.

Medication management and practices in prison for people with mental health problems: a qualitative study.

PubMed

Bowen, Robert A; Rogers, Anne; Shaw, Jennifer

2009-10-20

Common mental health problems are prevalent in prison and the quality of prison health care provision for prisoners with mental health problems has been a focus of critical scrutiny. Currently, health policy aims to align and integrate prison health services and practices with those of the National Health Service (NHS). Medication management is a key aspect of treatment for patients with a mental health problem. The medication practices of patients and staff are therefore a key marker of the extent to which the health practices in prison settings equate with those of the NHS. The research reported here considers the influences on medication management during the early stages of custody and the impact it has on prisoners. The study employed a qualitative design incorporating semi-structured interviews with 39 prisoners and 71 staff at 4 prisons. Participant observation was carried out in key internal prison locations relevant to the management of vulnerable prisoners to support and inform the interview process. Thematic analysis of the interview data and interpretation of the observational field-notes were undertaken manually. Emergent themes included the impact that delays, changes to or the removal of medication have on prisoners on entry to prison, and the reasons that such events take place. Inmates accounts suggested that psychotropic medication was found a key and valued form of support for people with mental health problems entering custody. Existing regimes of medication and the autonomy to self-medicate established in the community are disrupted and curtailed by the dominant practices and prison routines for the taking of prescribed medication. The continuity of mental health care is undermined by the removal or alteration of existing medication practice and changes on entry to prison which exacerbate prisoners' anxiety and sense of helplessness. Prisoners with a dual diagnosis are likely to be doubly vulnerable because of inconsistencies in substance withdrawal management. Changes to medication management which accompany entry to prison appear to contribute to poor relationships with prison health staff, disrupts established self-medication practices, discourages patients from taking greater responsibility for their own conditions and detrimentally affects the mental health of many prisoners at a time when they are most vulnerable. Such practices are likely to inhibit the integration and normalisation of mental health management protocols in prison as compared with those operating in the wider community and may hinder progress towards improving the standard of mental health care available to prisoners suffering from mental disorder.

Information Management of a Structured Admissions Interview Process in a Medical College with an Apple II System

PubMed Central

O'Reilly, Robert; Fedorko, Steve; Nicholson, Nigel

1983-01-01

This paper describes a structured interview process for medical school admissions supported by an Apple II computer system which provides feedback to interviewers and the College admissions committee. Presented are the rationale for the system, the preliminary results of analysis of some of the interview data, and a brief description of the computer program and output. The present data show that the structured interview yields very high interrater reliability coefficients, is acceptable to the medical school faculty, and results in quantitative data useful in the admission process. The system continues in development at this time, a second year of data will be shortly available, and further refinements are being made to the computer program to enhance its utilization and exportability.

Applying the institutional review board data repository approach to manage ethical considerations in evaluating and studying medical education

PubMed Central

Thayer, Erin K.; Rathkey, Daniel; Miller, Marissa Fuqua; Palmer, Ryan; Mejicano, George C.; Pusic, Martin; Kalet, Adina; Gillespie, Colleen; Carney, Patricia A.

2016-01-01

Issue Medical educators and educational researchers continue to improve their processes for managing medical student and program evaluation data using sound ethical principles. This is becoming even more important as curricular innovations are occurring across undergraduate and graduate medical education. Dissemination of findings from this work is critical, and peer-reviewed journals often require an institutional review board (IRB) determination. Approach IRB data repositories, originally designed for the longitudinal study of biological specimens, can be applied to medical education research. The benefits of such an approach include obtaining expedited review for multiple related studies within a single IRB application and allowing for more flexibility when conducting complex longitudinal studies involving large datasets from multiple data sources and/or institutions. In this paper, we inform educators and educational researchers on our analysis of the use of the IRB data repository approach to manage ethical considerations as part of best practices for amassing, pooling, and sharing data for educational research, evaluation, and improvement purposes. Implications Fostering multi-institutional studies while following sound ethical principles in the study of medical education is needed, and the IRB data repository approach has many benefits, especially for longitudinal assessment of complex multi-site data. PMID:27443407

TransitionRx: Impact of community pharmacy postdischarge medication therapy management on hospital readmission rate.

PubMed

Luder, Heidi R; Frede, Stacey M; Kirby, James A; Epplen, Kelly; Cavanaugh, Teresa; Martin-Boone, Jill E; Conrad, Wayne F; Kuhlmann, Diane; Heaton, Pamela C

2015-01-01

To determine if a community pharmacy-based transition of care (TOC) program that included the full scope of medication therapy management (MTM) services (TransitionRx) decreased hospital readmissions, resolved medication-related problems, and increased patient satisfaction. Prospective, quasi-experimental study. Nine Kroger Pharmacies located in Western Cincinnati. Patients older than 18 years of age and discharged from two local hospitals with a diagnosis of congestive heart failure, chronic obstructive pulmonary disease, or pneumonia. Patients were recruited from two local hospitals and referred to the community pharmacy for MTM services with the pharmacist within 1 week of discharge. Pharmacists reconciled the patients' medications, identified drug therapy problems, recommended changes to therapy, and provided self-management education. At 30 days after discharge, research personnel conducted telephone surveys, using a previously validated survey instrument, to assess hospital readmissions and patient satisfaction. Pharmacist interventions and medication-related problems were documented. A total of 90 patients completed the study. Of these, 20% of patients in the usual care group were admitted to the hospital within 30 days compared with 6.9% of patients in the intervention group (P = 0.019). In the 30 patients who received MTM services from the pharmacist, 210 interventions were made. The overall mean patient satisfaction with the TOC process was not significantly different between patients who were seen by the pharmacist and those who were not seen by the pharmacist. Community pharmacies successfully collaborated with hospitals to develop a referral process for TOC interventions. Patients who received MTM services from the pharmacist experienced significantly fewer readmissions than patients who received usual care.

Computer Assisted Multi-Center Creation of Medical Knowledge Bases

PubMed Central

Giuse, Nunzia Bettinsoli; Giuse, Dario A.; Miller, Randolph A.

1988-01-01

Computer programs which support different aspects of medical care have been developed in recent years. Their capabilities range from diagnosis to medical imaging, and include hospital management systems and therapy prescription. In spite of their diversity these systems have one commonality: their reliance on a large body of medical knowledge in computer-readable form. This knowledge enables such programs to draw inferences, validate hypotheses, and in general to perform their intended task. As has been clear to developers of such systems, however, the creation and maintenance of medical knowledge bases are very expensive. Practical and economical difficulties encountered during this long-term process have discouraged most attempts. This paper discusses knowledge base creation and maintenance, with special emphasis on medical applications. We first describe the methods currently used and their limitations. We then present our recent work on developing tools and methodologies which will assist in the process of creating a medical knowledge base. We focus, in particular, on the possibility of multi-center creation of the knowledge base.

[Risk management from the judicial perspective].

PubMed

Ulsenheimer, Klaus

2003-11-01

The jurisdification of medicine is an unstoppable force that finds its visible expression in a medical liability boom which--apart from the negative impact of legal and out-of-court proceedings on the bond of the doctor-patient relationship--bears considerable economic disadvantages for the providers of care. It is therefore necessary to fight in particular the legally influenced causes of medical liability for which risk management seems to be a suitable, effective tool. As the examples taken from the jurisdiction in the organisational sector will demonstrate, risk management pinpoints the sources of trouble so that we are able to learn from current errors and provide appropriate remedies for the future. Risk management, though, is not a "unique event", but a dynamic, repetitive process that has to be institutionally secured by appointing a risk manager so that the proposals discussed, recommendations and essential measures can actually be implemented.

Quality management of Body Donation Program at the University of Padova.

PubMed

Porzionato, Andrea; Macchi, Veronica; Stecco, Carla; Mazzi, Anna; Rambaldo, Anna; Sarasin, Gloria; Parenti, Anna; Scipioni, Antonio; De Caro, Raffaele

2012-01-01

Quality management improvement has become a recent focus of attention in medical education. The program for the donation of bodies and body parts (Body Donation Program) at the University of Padova has recently been subjected to a global quality management standard, the ISO 9001:2008 certification. The aim of the present work is to show how the above standard is useful in enhancing the efficiency of body donation procedures and the quality and output of medical education. The program is managed by means of the following interlinked procedures: the collection of body donations, death certificates, data, and body parts from living donors; the transportation and identification of cadavers; the management of bodies, body parts, equipment, instruments, purchasing of necessary materials, and setting up anatomical training sessions; the management of preventive and corrective actions; the management of documents and registration; the management of internal and external quality audits; and the review of outcomes and improvement planning. Monitoring indicators are identified in the numbers of donors and of donated body parts per year, education sessions, and satisfaction of learners and donors, as evaluated by questionnaires. The process management approach, the integrated involvement of medical, technical, and administrative staff in defining procedures, and the application of monitoring indicators allow quality improvement in all aspects of the Body Donation Program. Copyright © 2012 American Association of Anatomists.

Proceedings of the AMCP Partnership Forum: Breaking the Link Between Pain Management and Opioid Use Disorder.

PubMed

2015-12-01

Prescription drug misuse and abuse, especially with opioid analgesics, is the fastest growing drug problem in the United States. Addressing this public health crisis demands the coordinated efforts and actions of all stakeholders to establish a process of improving patient care and decreasing misuse and abuse. On September 9, 2014, the Academy of Managed Care Pharmacy (AMCP) convened a meeting of multiple stakeholders to recommend activities and programs that AMCP can promote to improve pain management, prevent opioid use disorder (OUD), and improve medication-assisted treatment outcomes. The speakers and panelists recommended that efforts to improve pain management outcomes and reduce the potential for OUD should rely on demonstrated evidence and best practices. It was recommended that AMCP promote a more holistic and evidence-based approach to pain management and OUD treatment that actively engages the patient in the decision-making process and includes care coordination with medical, pharmacy, behavioral, and mental health aspects of organizations, all of which is seamlessly supported by a technology infrastructure. To accomplish this, it was recommended that AMCP work to collaborate with organizations representing these stakeholders. Additionally, it was recommended that AMCP conduct continuing pharmacy education programs, develop a best practices toolkit on pain management, and actively promote quality standards for OUD prevention and treatment.

Managing complex processing of medical image sequences by program supervision techniques

NASA Astrophysics Data System (ADS)

Crubezy, Monica; Aubry, Florent; Moisan, Sabine; Chameroy, Virginie; Thonnat, Monique; Di Paola, Robert

1997-05-01

Our objective is to offer clinicians wider access to evolving medical image processing (MIP) techniques, crucial to improve assessment and quantification of physiological processes, but difficult to handle for non-specialists in MIP. Based on artificial intelligence techniques, our approach consists in the development of a knowledge-based program supervision system, automating the management of MIP libraries. It comprises a library of programs, a knowledge base capturing the expertise about programs and data and a supervision engine. It selects, organizes and executes the appropriate MIP programs given a goal to achieve and a data set, with dynamic feedback based on the results obtained. It also advises users in the development of new procedures chaining MIP programs.. We have experimented the approach for an application of factor analysis of medical image sequences as a means of predicting the response of osteosarcoma to chemotherapy, with both MRI and NM dynamic image sequences. As a result our program supervision system frees clinical end-users from performing tasks outside their competence, permitting them to concentrate on clinical issues. Therefore our approach enables a better exploitation of possibilities offered by MIP and higher quality results, both in terms of robustness and reliability.

Risk evaluation and mitigation strategies for drugs with abuse liability: public interest, special interest, conflicts of interest, and the industry perspective.

PubMed

Wright, Curtis; Schnoll, Sidney; Bernstein, David

2008-10-01

Risk evaluation and mitigation strategies (REMS) formerly known as Risk Minimization Action Plans (RiskMAPs) are a regulatory technique for dealing with anticipated risks of new medications and are especially important for new drugs with abuse potential. This paper describes the origin and history of risk-management plans for drugs that might be abused, the proper use of these plans in minimizing the risk to the public, and the special difficulties inherent in managing risks for drugs with abuse potential. Drugs with abuse liability are distinctive since the risks inherent in manufacture and distribution include not only risks to patients prescribed the medications, but also risks to the general public including subgroups in the population not intended to get the drug and who receive no medical benefit from the medication. The crafting of risk-management plans intended to protect nonpatient populations is unique for these products. The content, extent, and level of intensity of these plans affect areas of medical ethics, civil liability, and criminal prosecution. The need for risk-management plans for drugs with abuse liability can potentially act as a deterrent to investment and is a factor in decisions concerning the development of new medications for the treatments of pain, ADHD, anxiety disorders, and addictions. This paper provides a framework for moving the process of REMS development forward and criteria for evaluating the probity and adequacy of such programs.

[Judicial institutions of medical experts].

PubMed

Godoy, Roberto Lm

2016-05-01

This article considers the evolutive process that judicial organisms of medical experts have experienced in Argentina since their creation and formulates a proposal for its adequacy and modernization. Due to multiple and various evolutive factors, judicial organisms managing medicolegal expert activities show, nowadays, signals that a structural and dynamic reform is needed. They remain as organizational units of Public Administration and their effectiveness and efficiency depends not only of a scientific criteria but a managing one. The present and future challenge will be their conceptual transformation, from "corporate scientific entities" to "public-service-providing units" within the justice administration system.

Question Builder: Be Prepared for Your Next Medical Appointment

MedlinePlus

... Scientific Peer Review Award Process Post-Award Grant Management AHRQ Grantee Profiles Getting Recognition for Your AHRQ-Funded Study Contracts Project Research Online Database (PROD) Searchable database of AHRQ ...

[Discussion on logistics management of medical consumables].

PubMed

Deng, Sutong; Wang, Miao; Jiang, Xiali

2011-09-01

Management of medical consumables is an important part of modern hospital management. In modern medical behavior, drugs and medical devices act directly on the patient, and are important factors affecting the quality of medical practice. With the increasing use of medical materials, based on practical application, this article proposes the management model of medical consumables, and discusses the essence of medical materials logistics management.

2010 Mississippi Curriculum Framework: Postsecondary Emergency Medical Technician. (Program CIP: 51.0904 - Emergency Medical Technology/Technician)

ERIC Educational Resources Information Center

Briscoe, Lisa; Bryant, Katrina; Galtelli, Mark; Glasson, Kristi; Hall, David; Hood, Brenda; Mahaffey, Libby; McBryde, John; Read, John; Shirley, Gary; Wright, Al

2010-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

2011 Mississippi Curriculum Framework: Postsecondary Diagnostic Medical Sonography Technology. (Program CIP: 51.0910 - Diagnostic Medical Sonography/Sonographer and Ultrasound)

ERIC Educational Resources Information Center

Finch, Wanda; Wilson, Lesa

2011-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

Integrated Electronic Health Record Database Management System: A Proposal.

PubMed

Schiza, Eirini C; Panos, George; David, Christiana; Petkov, Nicolai; Schizas, Christos N

2015-01-01

eHealth has attained significant importance as a new mechanism for health management and medical practice. However, the technological growth of eHealth is still limited by technical expertise needed to develop appropriate products. Researchers are constantly in a process of developing and testing new software for building and handling Clinical Medical Records, being renamed to Electronic Health Record (EHR) systems; EHRs take full advantage of the technological developments and at the same time provide increased diagnostic and treatment capabilities to doctors. A step to be considered for facilitating this aim is to involve more actively the doctor in building the fundamental steps for creating the EHR system and database. A global clinical patient record database management system can be electronically created by simulating real life medical practice health record taking and utilizing, analyzing the recorded parameters. This proposed approach demonstrates the effective implementation of a universal classic medical record in electronic form, a procedure by which, clinicians are led to utilize algorithms and intelligent systems for their differential diagnosis, final diagnosis and treatment strategies.

Measuring nursing essential contributions to quality patient care outcomes.

PubMed

Wolgast, Kelly A; Taylor, Katherine; Garcia, Dawn; Watkins, Miko

2011-01-01

Workload Management System for Nursing (WMSN) is a core Army Medical Department business system that has provided near real-time, comprehensive nursing workload and manpower data for decision making at all levels for over 25 years. The Army Manpower Requirements and Documentation Agency populates data from WMSN into the Manpower Staffing Standards System (Inpatient module within Automated Staffing Assessment Model). The current system, Workload Management System for Nursing Internet (WMSNi), is an interim solution that requires additional functionalities for modernization and integration at the enterprise level. The expanding missions and approved requirements for WMSNi support strategic initiatives on the Army Medical Command balanced scorecard and require continued sustainment for multiple personnel and manpower business processes for both inpatient and outpatient nursing care. This system is currently being leveraged by the TRICARE Management Activity as an interim multiservice solution, and is being used at 24 Army medical treatment facilities. The evidenced-based information provided to Army decision makers through the methods used in the WMSNi will be essential across the Army Medical Command throughout the system's life cycle.

Cost and efficiency lead to increased value for the patient and bottom line for the practice.

PubMed

Dahl, Owen J

2009-01-01

Understanding how much it costs to provide a service is a basic premise of any business. In addition, healthcare is in need of improved processes to provide and increase value to the patient. This can be accomplished by the application of principles called Six Sigma and Lean Management. Today's medical practice leader must be aware of the costs of doing business and be able to apply proven management principles to the processes involved in providing patient care.

The medical decision model and decision maker tools for management of radiological and nuclear incidents.

PubMed

Koerner, John F; Coleman, C Norman; Murrain-Hill, Paula; FitzGerald, Denis J; Sullivan, Julie M

2014-06-01

Effective decision making during a rapidly evolving emergency such as a radiological or nuclear incident requires timely interim decisions and communications from onsite decision makers while further data processing, consultation, and review are ongoing by reachback experts. The authors have recently proposed a medical decision model for use during a radiological or nuclear disaster, which is similar in concept to that used in medical care, especially when delay in action can have disastrous effects. For decision makers to function most effectively during a complex response, they require access to onsite subject matter experts who can provide information, recommendations, and participate in public communication efforts. However, in the time before this expertise is available or during the planning phase, just-in-time tools are essential that provide critical overview of the subject matter written specifically for the decision makers. Recognizing the complexity of the science, risk assessment, and multitude of potential response assets that will be required after a nuclear incident, the Office of the Assistant Secretary for Preparedness and Response, in collaboration with other government and non-government experts, has prepared a practical guide for decision makers. This paper illustrates how the medical decision model process could facilitate onsite decision making that includes using the deliberative reachback process from science and policy experts and describes the tools now available to facilitate timely and effective incident management.

A qualitative study of community nurses' decision-making around the anticipatory prescribing of end-of-life medications.

PubMed

Bowers, Ben; Redsell, Sarah A

2017-10-01

The aim of this study was to explore community nurses' decision-making processes around the prescribing of anticipatory medications for people who are dying. Community nurses frequently initiate the prescribing of anticipatory medications to help control symptoms in those who are dying. However, little is known about their decision-making processes in relation to when they instigate anticipatory prescribing and their discussions with families and General Practitioners. A qualitative interpretive descriptive enquiry. A purposive sample of 11 Community Palliative Nurses and District Nurses working in one geographical area participated. Data were collected between March and June 2016 via audio recorded semi-structured interviews and analysed inductively using Braun and Clarke's thematic analysis. Three themes were identified: (1) Drugs as a safety net. Anticipatory medications give nurses a sense of control in last days of life symptom management; (2) Reading the situation. The nurse judges when to introduce conversations around anticipatory medications, balancing the need for discussion with the dying person and their family's likely response; (3) Playing the game. The nurse owns the decision to initiate anticipatory medication prescribing and carefully negotiates with the General Practitioner. Nurses view pain control through prescribed medication as key to symptom management for dying people. Consequently, they own the role of ascertaining when to initiate discussions with families about anticipatory medicines. Nurses believe they advocate for dying person and their families' needs and lead negotiations with General Practitioners for medications to go into the home. This nurse led care alters the traditional boundaries of the General Practitioners-nurse professional relationship. © 2017 John Wiley & Sons Ltd.

Clinically led performance management in secondary healthcare: evaluating the attitudes of medical and non-clinical managers.

PubMed

Trebble, Timothy M; Paul, Maureen; Hockey, Peter M; Heyworth, Nicola; Humphrey, Rachael; Powell, Timothy; Clarke, Nicholas

2015-03-01

Improving the quality and activity of clinicians' practice improves patient care. Performance-related human resource management (HRM) is an established approach to improving individual practice but with limited use among clinicians. A framework for performance-related HRM was developed from successful practice in non-healthcare organisations centred on distributive leadership and locally provided, validated and interpreted performance measurement. This study evaluated the response of medical and non-clinical managers to its implementation into a large secondary healthcare organisation. A semistructured qualitative questionnaire was developed from themes identified during framework implementation and included attitudes to previous approaches to measuring doctors' performance, and the structure and response to implementation of the performance-related HRM framework. Responses were analysed through a process of data summarising and categorising. A total of 29, from an invited cohort of 31, medical and non-clinical managers from departmental to executive level were interviewed. Three themes were identified: (1) previous systems of managing clinical performance were considered to be ineffective due to insufficient empowerment of medical managers and poor quality of available performance data; (2) the implemented framework was considered to address these needs and was positively received by medical and non-clinical managers; (3) introduction of performance-related HRM required the involvement of the whole organisation to executive level and inclusion within organisational strategy, structure and training. This study suggests that a performance-related HRM framework may facilitate the management of clinical performance in secondary healthcare, but is dependent on the design and methods of application used. Such approaches contrast with those currently proposed for clinicians in secondary healthcare in the UK and suggest that alternative strategies should be considered. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Monitoring evaluation system for high-specialty hospitals].

PubMed

Fajardo Dolci, Germán; Aguirre Gas, Héctor G; Robledo Galván, Héctor

2011-01-01

Hospital evaluation is a fundamental process to identify medical units' objective compliance, to analyze efficiency of resource use and allocation, institutional values and mission alignment, patient safety and quality standards, contributions to research and medical education, and the degree of coordination among medical units and the health system as a whole. We propose an evaluation system for highly specialized regional hospitals through the monitoring of performance indicators. The following are established as base thematic elements in the construction of indicators: safe facilities and equipment, financial situation, human resources management, policy management, organizational climate, clinical activity, quality and patient safety, continuity of care, patients' and providers' rights and obligations, teaching, research, social responsibility, coordination mechanisms. Monitoring refers to the planned and systematic evaluation of valid and reliable indicators, aimed at identifying problems and opportunity areas. Moreover, evaluation is a powerful tool to strengthen decision-making and accountability in medical units.

Evaluating the effectiveness of implementing quality management practices in the medical industry.

PubMed

Yeh, T-M; Lai, H-P

2015-01-01

To discuss the effectiveness of 30 quality management practices (QMP) including Strategic Management, Balanced ScoreCard, Knowledge Management, and Total Quality Management in the medical industry. A V-shaped performance evaluation matrix is applied to identify the top ten practices that are important but not easy to use or implement. Quality Function Deployment (QFD) is then utilized to find key factors to improve the implementation of the top ten tools. The questionnaires were sent to the nursing staff and administrators in a hospital through e-mail and posts. A total of 250 copies were distributed and 217 copies were valid. The importance, easiness, and achievement (i.e., implementation level) of 30 quality management practices were used. Key factors for QMP implementation were sequenced in order of importance as top management involvement, inter-department communication and coordination, teamwork, hospital-wide participation, education and training, consultant professionalism, continuous internal auditing, computerized process, and incentive compensation. Top management can implement the V-shaped performance matrix to determine whether quality management practices need improvement and if so, utilize QFD to find the key factors for improvement.

[Hygiene and security management in medical biology laboratory].

PubMed

Vinner, E; Odou, M F; Fovet, B; Ghnassia, J C

2013-06-01

Risk management in Medical Biology Laboratory (MBL) which includes hygiene and waste management, is an integrated process to the whole MBL organisation. It is composed of three stages: risks factors identification, grading and prioritization, and their evaluation in the system. From the legislation and NF EN ISO 15189 standard's requirements viewpoint, prevention and protection actions to implement are described, at premises level, but also at work station environment's one (human resources and equipments) towards biological, chemical, linked to gas, to ionizing or non ionizing radiations and fire riks, in order not to compromise patients safety, employees safety, and quality results. Then, although NF EN 15189 standard only enacts requirements in terms of prevention, curative actions after established blood or chemical exposure accident are defined.

Selecting practice management information systems.

PubMed

Worley, R; Ciotti, V

1997-01-01

Despite enormous advances in information systems, the process by which most medical practices select them has remained virtually unchanged for decades: the request for proposal (RFP). Unfortunately, vendors have learned ways to minimize the value of RFP checklists to where purchasers now learn little about the system functionality. The authors describe a selection methodology that replaces the RFP with scored demos, reviews of vendor user manuals and mathematically structured reference checking. In a recent selection process at a major medical center, these techniques yielded greater user buy-in and favorable contract terms as well.

The Hepatitis Testing and Linkage-to-Care Data Review Process: An Approach to Ensuring the Quality of Program Data.

PubMed

Mezzo, Jennifer L; Lamia, Tamara L; Danelski, Lisa L; Schipani, Anne Marie; Stokes, Scott A; Jacobs-Ware, Elizabeth D

2016-01-01

CDC's 2012 Hepatitis Testing and Linkage to Care (HepTLC) initiative was a nationally coordinated effort to conduct hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites. This project provided support for data management and monthly data reviews between awardees and a data manager, which facilitated monitoring of awardee progress and regular program improvement opportunities. CDC provided technical assistance to awardees for testing processes and program improvement, including Internet-based data submission, reporting software and data management to awardees, offering assistance with submitting, and reviewing data in real time. We describe how one awardee, AIDS Resource Center of Wisconsin (ARCW), used the data management process to improve data quality, inform testing processes and implementation, and measure and report missing variables from an online database. From October 2012 through July 2014, ARCW performed 2,255 HCV antibody (anti-HCV) tests and 244 HCV ribonucleic acid (RNA) tests as part of the HepTLC initiative. Participants who tested HCV RNA positive (n=189) were referred to medical care. At the end of the study, no records were missing for the anti-HCV test result or HCV RNA test result variables, and only one record was missing for those who were referred to medical care. Regular data review and monitoring by awardees and CDC-supported data managers provided opportunities for data quality and program improvement. Through regular data review, ARCW reduced the amount of missing data and promoted timely follow-up with participants testing positive for HCV to ensure receipt of results and linkage to care. Other programs can adopt a similar data management model.

Ten steps for managing organizational change.

PubMed

Bolton, L B; Aydin, C; Popolow, G; Ramseyer, J

1992-06-01

Managing interdepartmental relations in healthcare organizations is a major challenge for nursing administrators. The authors describe the implementation process of an organization-wide change effort involving individuals from departments throughout the medical center. These strategies can serve as a model to guide effective planning in other institutions embarking on change projects, resulting in smoother and more effective implementation of interdepartmental change.

Standardized quality-assessment system to evaluate pressure ulcer care in the nursing home.

PubMed

Bates-Jensen, Barbara M; Cadogan, Mary; Jorge, Jennifer; Schnelle, John F

2003-09-01

To demonstrate reliability and feasibility of a standardized protocol to assess and score quality indicators relevant to pressure ulcer (PU) care processes in nursing homes (NHs). Descriptive. Eight NHs. One hundred ninety-one NH residents for whom the PU Resident Assessment Protocol of the Minimum Data Set was initiated. Nine quality indicators (two related to screening and prevention of PU, two focused on assessment, and five addressing management) were scored using medical record data, direct human observation, and wireless thigh monitor observation data. Feasibility and reliability of medical record, observation, and thigh monitor protocols were determined. The percentage of participants who passed each of the indicators, indicating care consistent with practice guidelines, ranged from 0% to 98% across all indicators. In general, participants in NHs passed fewer indicators and had more problems with medical record accuracy before a PU was detected (screening/prevention indicators) than they did once an ulcer was documented (assessment and management indicators). Reliability of the medical record protocol showed kappa statistics ranging from 0.689 to 1.00 and percentage agreement from 80% to 100%. Direct observation protocols yielded kappa statistics of 0.979 and 0.928. Thigh monitor protocols showed kappa statistics ranging from 0.609 to 0.842. Training was variable, with the observation protocol requiring 1 to 2 hours, medical records requiring joint review of 20 charts with average time to complete the review of 20 minutes, and the thigh monitor data requiring 1 week for training in data preparation and interpretation. The standardized quality assessment system generated scores for nine PU quality indicators with good reliability and provided explicit scoring rules that permit reproducible conclusions about PU care. The focus of the indicators on care processes that are under the control of NH staff made the protocol useful for external survey and internal quality improvement purposes, and the thigh monitor observational technology provided a method for monitoring repositioning care processes that were otherwise difficult to monitor and manage.

Virtual management of radiology examinations in the virtual radiology environment using common object request broker architecture services.

PubMed

Martinez, R; Rozenblit, J; Cook, J F; Chacko, A K; Timboe, H L

1999-05-01

In the Department of Defense (DoD), US Army Medical Command is now embarking on an extremely exciting new project--creating a virtual radiology environment (VRE) for the management of radiology examinations. The business of radiology in the military is therefore being reengineered on several fronts by the VRE Project. In the VRE Project, a set of intelligent agent algorithms determine where examinations are to routed for reading bases on a knowledge base of the entire VRE. The set of algorithms, called the Meta-Manager, is hierarchical and uses object-based communications between medical treatment facilities (MTFs) and medical centers that have digital imaging network picture archiving and communications systems (DIN-PACS) networks. The communications is based on use of common object request broker architecture (CORBA) objects and services to send patient demographics and examination images from DIN-PACS networks in the MTFs to the DIN-PACS networks at the medical centers for diagnosis. The Meta-Manager is also responsible for updating the diagnosis at the originating MTF. CORBA services are used to perform secure message communications between DIN-PACS nodes in the VRE network. The Meta-Manager has a fail-safe architecture that allows the master Meta-Manager function to float to regional Meta-Manager sites in case of server failure. A prototype of the CORBA-based Meta-Manager is being developed by the University of Arizona's Computer Engineering Research Laboratory using the unified modeling language (UML) as a design tool. The prototype will implement the main functions described in the Meta-Manager design specification. The results of this project are expected to reengineer the process of radiology in the military and have extensions to commercial radiology environments.

Communication of the monitoring and evaluation process through the use of storyboards and story notebooks.

PubMed

Lewis, L C; Honea, S H; Kanter, D F; Haney, P E

1993-10-01

In preparation for the 1993 Joint Commission on Accreditation of Health Care Organizations (JCAHO) survey, Audie L. Murphy Memorial Veterans Hospital Nursing Service was faced with determining the best approach to presenting their Total Quality Improvement/Total Quality Management (TQI/TQM) process. Nursing Service management and staff, Quality Improvement Clinicians, and medical staff used the Storyboard concept and the accompanying Story Notebooks to organize and to communicate their TQI/TQM process and findings. This concept was extremely beneficial, enabling staff to successfully present the multidisciplinary TQI/TQM data to the JCAHO surveyors.

When bad things happen: adverse event reporting and disclosure as patient safety and risk management tools in the neonatal intensive care unit.

PubMed

Donn, Steven M; McDonnell, William M

2012-01-01

The Institute of Medicine has recommended a change in culture from "name and blame" to patient safety. This will require system redesign to identify and address errors, establish performance standards, and set safety expectations. This approach, however, is at odds with the present medical malpractice (tort) system. The current system is outcomes-based, meaning that health care providers and institutions are often sued despite providing appropriate care. Nevertheless, the focus should remain to provide the safest patient care. Effective peer review may be hindered by the present tort system. Reporting of medical errors is a key piece of peer review and education, and both anonymous reporting and confidential reporting of errors have potential disadvantages. Diagnostic and treatment errors continue to be the leading sources of allegations of malpractice in pediatrics, and the neonatal intensive care unit is uniquely vulnerable. Most errors result from systems failures rather than human error. Risk management can be an effective process to identify, evaluate, and address problems that may injure patients, lead to malpractice claims, and result in financial losses. Risk management identifies risk or potential risk, calculates the probability of an adverse event arising from a risk, estimates the impact of the adverse event, and attempts to control the risk. Implementation of a successful risk management program requires a positive attitude, sufficient knowledge base, and a commitment to improvement. Transparency in the disclosure of medical errors and a strategy of prospective risk management in dealing with medical errors may result in a substantial reduction in medical malpractice lawsuits, lower litigation costs, and a more safety-conscious environment. Thieme Medical Publishers, Inc.

Weight loss medications in Canada – a new frontier or a repeat of past mistakes?

PubMed Central

Wharton, Sean; Lee, Jasmine; Christensen, Rebecca AG

2017-01-01

Current methods for the treatment of excess weight can involve healthy behavior changes, pharmacotherapy, and surgical interventions. Many individuals are able to lose some degree of weight through behavioral changes; however, they are often unable to maintain their weight loss long-term. This is in part due to physiological processes that cannot be addressed through behavioral changes alone. Bariatric surgery, which is the most successful treatment for excess weight to date, does result in physiological changes that can help with weight loss and weight maintenance. However, many patients either do not qualify or elect to not have this procedure. Fortunately, research has recently identified changes in neurochemicals (i.e., orexigens and anorexigens) that occur during weight loss and contribute to weight regain. The neurochemicals and hormones may be able to be targeted by medications to achieve greater and more sustained weight loss. Two medications are approved in adjunction to lifestyle management for weight loss in Canada: orlistat and liraglutide. Both medications are able to target physiological processes to help patients lose weight and maintain a greater amount of weight loss than with just behavioral modifications alone. Two other weight management medications, which also target specific physiological processes to aid in weight loss and its maintenance, a bupropion/naltrexone combination and lorcaserin, are currently pending approval in Canada. Nonetheless, there remain significant barriers for health care professionals to prescribe medications for weight loss, such as a lack of training and knowledge in the area of obesity. Until this has been addressed, and we begin treating obesity as we do other diseases, we are unlikely to combat the increasing trend of obesity in Canada and worldwide. PMID:29042804

Managing bundled payments.

PubMed

Draper, Andrew

2011-04-01

Results of Medicare's ACE demonstration project and Geisinger Health System's ProvenCare initiative provide insight into the challenges hospitals will face as bundled payment proliferates. An early analysis of these results suggests that hospitals would benefit from bringing full automation using clinical IT tools to bear in their efforts to meet these challenges. Other important factors contributing to success include board and physician leadership, organizational structure, pricing methodology for bidding, evidence-based medical practice guidelines, supply cost management, process efficiency management, proactive and aggressive case management, business development and marketing strategy, and the financial management system.

Using an Electronic Medication Refill System to Improve Provider Productivity in an Accountable Care Setting.

PubMed

Schoenhaus, Robert; Lustig, Adam; Rivas, Silvia; Monrreal, Victor; Westrich, Kimberly D; Dubois, Robert W

2016-03-01

Even within fully integrated health care systems, primary care providers (PCPs) often lack support for medication management. Because challenges with conducting medication reconciliation, improving adherence, and achieving optimal patient outcomes continue to be prevalent nationally, it is critical that PCPs are provided the resources and support they need to provide high-quality, patient-centered care in an accountable care environment. Sharp Rees-Stealy Medical Group uses a fully electronic medication refill system that allows for a centralized team to manage all incoming requests. Over time, 16 disease-specific protocols were created that allowed the pharmacy team to absorb approximately 80% of incoming refill requests for all enrolled PCPs. The refill clinic assessed all clinic information that a PCP would normally review in order to approve a refill. Tasks performed by the clinical pharmacists included medication reconciliation, dosage adjustment, and coordination of distribution from external mail order and retail pharmacies. In 2014, the number of tasks related to refill management reviewed by the refill/medication therapy management service totaled 302,592, resulting in 140,350 refill authorizations and multiple interventions related to medication use. Physicians have estimated that the service provides between 20 and 30 minutes of time savings per day. Assuming an annual PCP salary of around $200,000, 20 to 30 minutes per day would amount to $33 to $50 saved per day per physician. The savings is even higher when time savings from other clinical staff is included. The development of this electronic medication refill service has provided the following important lessons: (a) organizations rely on a leader or champion to push through process reforms--this program started with reluctant physicians first to determine best practices; (b) the lack of clinical pharmacist profiles within electronic health records (EHR) is a serious concern, since the creation of these profiles may not be easy or timely; and (c) PCPs working within an EHR environment will quickly embrace the idea of a service that can save them up to 30 minutes per day. With PCPs continuing to take on additional population health management tasks in accountable care organizations, pharmacists can provide workload offsets by meaningfully contributing to medication-related care.

Improving quality in Medicaid: the use of care management processes for chronic illness and preventive care.

PubMed

Rittenhouse, Diane R; Robinson, James C

2006-01-01

Care management processes (CMPs), tools to improve the efficiency and quality of primary care delivery, are particularly important for low-income patients facing substantial barriers to care. To measure the adoption of CMPs by medical groups, Independent Practice Associations, community clinics, and hospital-based clinics in California's Medicaid program and the factors associated with CMP adoption. Telephone survey of every provider organization with at least 6 primary care physicians and at least 1 Medi-Cal HMO contract, Spring 2003. One hundred twenty-three organizations participated, accounting for 64% of provider organizations serving Medicaid managed care in California. We surveyed 30 measures of CMP use for asthma and diabetes, and for child and adolescent preventive services. The mean number of CMPs used by each organization was 4.5 for asthma and 4.9 for diabetes (of a possible 8). The mean number of CMPs for preventive services was 4.0 for children and 3.5 for adolescents (of a possible 7). Organizations with more extensive involvement in Medi-Cal managed care used more CMPs for chronic illness and preventive service. Community clinics and hospital-based clinics used more CMPs for asthma and diabetes than did Independent Practice Associations (IPAs), and profitable organizations used more CMPs for child and adolescent preventive services than did entities facing severe financial constraints. The use of CMPs by Medicaid HMOs and the presence of external (financial and nonfinancial) incentives for clinical performance were strongly associated with use of care management by provider organizations. Physician and provider organizations heavily involved in California's Medicaid program are extensively engaged in preventive and chronic care management programs.

Reducing Missed Laboratory Results: Defining Temporal Responsibility, Generating User Interfaces for Test Process Tracking, and Retrospective Analyses to Identify Problems

PubMed Central

Tarkan, Sureyya; Plaisant, Catherine; Shneiderman, Ben; Hettinger, A. Zachary

2011-01-01

Researchers have conducted numerous case studies reporting the details on how laboratory test results of patients were missed by the ordering medical providers. Given the importance of timely test results in an outpatient setting, there is limited discussion of electronic versions of test result management tools to help clinicians and medical staff with this complex process. This paper presents three ideas to reduce missed results with a system that facilitates tracking laboratory tests from order to completion as well as during follow-up: (1) define a workflow management model that clarifies responsible agents and associated time frame, (2) generate a user interface for tracking that could eventually be integrated into current electronic health record (EHR) systems, (3) help identify common problems in past orders through retrospective analyses. PMID:22195201

Toward a process-level view of distributed healthcare tasks: Medication management as a case study.

PubMed

Werner, Nicole E; Malkana, Seema; Gurses, Ayse P; Leff, Bruce; Arbaje, Alicia I

2017-11-01

We aim to highlight the importance of using a process-level view in analyzing distributed healthcare tasks through a case study analysis of medication management (MM). MM during older adults' hospital-to-skilled-home-healthcare (SHHC) transitions is a healthcare process with tasks distributed across people, organizations, and time. MM has typically been studied at the task level, but a process-level is needed to fully understand and improve MM during transitions. A process-level view allows for a broader investigation of how tasks are distributed throughout the work system through an investigation of interactions and the resultant emergent properties. We studied MM during older adults' hospital-to-SHHC transitions through interviews and observations with 60 older adults, their 33 caregivers, and 79 SHHC providers at 5 sites associated with 3 SHHC agencies. Study findings identified key cross-system characteristics not observable at the task-level: (1) identification of emergent properties (e.g., role ambiguity, loosely-coupled teams performing MM) and associated barriers; and (2) examination of barrier propagation across system boundaries. Findings highlight the importance of a process-level view of healthcare delivery occurring across system boundaries. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Development of a service on line advice and information technology management for health].

PubMed

Berrospi Polo, Victor; Rodriguez Abad, Juan; Bobadilla Aguilar, Juan; Di Liberto Moreno, Carlos; Díaz Arroyo, Cecilia; Rafael Quipan, Carlos

2015-10-01

To validate an advisory service and online information technology management for health and helps to make assessment and acquisition processes an informed medical equipment according to the market and the needs of the health institutions. Internet via a technological solution supported ona data base containing systematic and updated information on technical specifications of 25 compared medical equipment, the same reference prices, list of suppliers, agents and / or producers and technical standards are developed. The"virtual" technical assistance was made with the support of a team of specialists in Health Technology Management, the decision makers in the planning, evaluation and procurement of biomedical equipment. The validation of the service was conducted by involving specialists in the field of Health Technology Management, from different disciplines and institutions who worked in health, public and private. They used the service for a period of time to verify its feasibility of use as well as its usefulness for their planning, evaluation and procurement of biomedical equipment. To these experts we applied a survey before and after them about the software developed in this project. We found that it is common to use the internet to search for information on medical equipment.Also,an increase on the view that the application will help in procurement of biomedical equipment(40% to 78%) was observed, it will improve the information system(40% to 89%) and communication among physicians,nurses, planners, engineers and other professionals involved in this process(20% to 78%). There is a need for a technological tool available with such features contribute to technology management in Peru.

VA Construction: Improved Processes Needed to Monitor Contract Modifications, Develop Schedules, and Estimate Costs

DTIC Science & Technology

2017-03-01

address challenges in managing projects to build medical facilities. In response to statutory requirements and additional congressional direction, VA...is outsourcing management of certain such projects to the U.S. Army Corps of Engineers (USACE). As of October 2016, VA had 23 ongoing projects...costing $100 million or more. VA and USACE have entered into interagency agreements for 12 of these 23 projects. The agreements entail USACE’s managing

Forty years of medical education through the eyes of Medical Teacher: From chrysalis to butterfly.

PubMed

Harden, Ronald M; Lilley, Pat; McLaughlin, Jake

2018-04-01

To mark the 40th Anniversary of Medical Teacher, issues this year will document changes in medical education that have taken place over the past 40 years in undergraduate, postgraduate and continuing education with regard to curriculum themes and approaches, teaching and learning methods, assessment techniques and management issues. Trends such as adaptive learning will be highlighted and one issue will look at the medical school of the future. An analysis of papers published in the journal has identified four general trends in medical education - increased collaboration, greater international interest, student engagement with the education process and a move to a more evidence-informed approach to medical education. These changes over the years have been dramatic.

Clinical terminology support for a national ambulatory practice outcomes research network.

PubMed

Ricciardi, Thomas N; Lieberman, Michael I; Kahn, Michael G; Masarie, F E

2005-01-01

The Medical Quality Improvement Consortium (MQIC) is a nationwide collaboration of 74 healthcare delivery systems, consisting of 3755 clinicians, who contribute de-identified clinical data from the same commercial electronic medical record (EMR) for quality reporting, outcomes research and clinical research in public health and practice benchmarking. Despite the existence of a common, centrally-managed, shared terminology for core concepts (medications, problem lists, observation names), a substantial "back-end" information management process is required to ensure terminology and data harmonization for creating multi-facility clinically-acceptable queries and comparable results. We describe the information architecture created to support terminology harmonization across this data-sharing consortium and discuss the implications for large scale data sharing envisioned by proponents for the national adoption of ambulatory EMR systems.

Clinical Terminology Support for a National Ambulatory Practice Outcomes Research Network

PubMed Central

Ricciardi, Thomas N.; Lieberman, Michael I.; Kahn, Michael G.; Masarie, F.E. “Chip”

2005-01-01

The Medical Quality Improvement Consortium (MQIC) is a nationwide collaboration of 74 healthcare delivery systems, consisting of 3755 clinicians, who contribute de-identified clinical data from the same commercial electronic medical record (EMR) for quality reporting, outcomes research and clinical research in public health and practice benchmarking. Despite the existence of a common, centrally-managed, shared terminology for core concepts (medications, problem lists, observation names), a substantial “back-end” information management process is required to ensure terminology and data harmonization for creating multi-facility clinically-acceptable queries and comparable results. We describe the information architecture created to support terminology harmonization across this data-sharing consortium and discuss the implications for large scale data sharing envisioned by proponents for the national adoption of ambulatory EMR systems. PMID:16779116

A new approach to systematization of the management of paper-based clinical pathways.

PubMed

Wakamiya, Shunji; Yamauchi, Kazunobu

2006-05-01

The present study was performed to explore a new approach to systematization of the management of paper-based clinical pathways by developing a new system requiring little capital investment. A new system was developed and incorporated into an existing network at a hospital with a paper-based clinical pathway management system. The effectiveness of this new system was examined by comparing the management efficiency of clinical pathways before and after its introduction, and by comparison of the new system with other such systems currently in place at other medical institutions with regard to efficiency. In addition, the acceptability of the system for other medical institutions was examined by providing free access to the software on the Internet. The development costs of the new system were low. Although the new system has been in place for more than 3 years, no problems have yet been encountered in either the existing network system or in the management system itself. The new system allows the processing of statistics and analysis of circulation or variance automatically, neither of which were possible in the original paper-based system. We provided open access to the system as free software on the Internet, and it has since been downloaded by many medical institutions and enterprises in Japan. This system is very useful for institutions where it is difficult to introduce expensive new systems for systematic management of clinical pathways, such as electronic medical records, because of problems regarding capital or system management, and it may also be useful in other countries.

Developing a framework for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens (MEMORABLE)--a realist synthesis.

PubMed

Maidment, Ian; Booth, Andrew; Mullan, Judy; McKeown, Jane; Bailey, Sylvia; Wong, Geoffrey

2017-07-03

Medication-related adverse events have been estimated to be responsible for 5700 deaths and cost the UK £750 million annually. This burden falls disproportionately on older people. Outcomes from interventions to optimise medication management are caused by multiple context-sensitive mechanisms. The MEdication Management in Older people: REalist Approaches BAsed on Literature and Evaluation (MEMORABLE) project uses realist synthesis to understand how, why, for whom and in what context interventions, to improve medication management in older people on complex medication regimes residing in the community, work. This realist synthesis uses secondary data and primary data from interviews to develop the programme theory. A realist logic of analysis will synthesise data both within and across the two data sources to inform the design of a complex intervention(s) to help improve medication management in older people. 1. Literature review The review (using realist synthesis) contains five stages to develop an initial programme theory to understand why processes are more or less successful and under which situations: focussing of the research question; developing the initial programme theory; developing the search strategy; selection and appraisal based on relevance and rigour; and data analysis/synthesis to develop and refine the programme theory and context, intervention and mechanism configurations. 2. Realist interviews Realist interviews will explore and refine our understanding of the programme theory developed from the realist synthesis. Up to 30 older people and their informal carers (15 older people with multi-morbidity, 10 informal carers and 5 older people with dementia), and 20 care staff will be interviewed. 3. Developing framework for the intervention(s) Data from the realist synthesis and interviews will be used to refine the programme theory for the intervention(s) to identify: the mechanisms that need to be 'triggered', and the contexts related to these mechanisms. Intervention strategies that change the contexts so the mechanisms are triggered to produce desired outcomes will be developed. Feedback on these strategies will be obtained. This realist synthesis aims to develop a framework (underpinned by our programme theory) for a novel multi-disciplinary, multi-agency intervention(s), to improve medication management in community-dwelling older people on complex medication regimens. PROSPERO CRD42016043506.

Mining Clinicians' Electronic Documentation to Identify Heart Failure Patients with Ineffective Self-Management: A Pilot Text-Mining Study.

PubMed

Topaz, Maxim; Radhakrishnan, Kavita; Lei, Victor; Zhou, Li

2016-01-01

Effective self-management can decrease up to 50% of heart failure hospitalizations. Unfortunately, self-management by patients with heart failure remains poor. This pilot study aimed to explore the use of text-mining to identify heart failure patients with ineffective self-management. We first built a comprehensive self-management vocabulary based on the literature and clinical notes review. We then randomly selected 545 heart failure patients treated within Partners Healthcare hospitals (Boston, MA, USA) and conducted a regular expression search with the compiled vocabulary within 43,107 interdisciplinary clinical notes of these patients. We found that 38.2% (n = 208) patients had documentation of ineffective heart failure self-management in the domains of poor diet adherence (28.4%), missed medical encounters (26.4%) poor medication adherence (20.2%) and non-specified self-management issues (e.g., "compliance issues", 34.6%). We showed the feasibility of using text-mining to identify patients with ineffective self-management. More natural language processing algorithms are needed to help busy clinicians identify these patients.

Design and Development of a Clinical Risk Management Tool Using Radio Frequency Identification (RFID)

PubMed Central

Pourasghar, Faramarz; Tabrizi, Jafar Sadegh; Yarifard, Khadijeh

2016-01-01

Background: Patient safety is one of the most important elements of quality of healthcare. It means preventing any harm to the patients during medical care process. Objective: This paper introduces a cost-effective tool in which the Radio Frequency Identification (RFID) technology is used to identify medical errors in hospital. Methods: The proposed clinical error management system (CEMS) is consisted of a reader device, a transfer/receiver device, a database and managing software. The reader device works using radio waves and is wireless. The reader sends and receives data to/from the database via the transfer/receiver device which is connected to the computer via USB port. The database contains data about patients’ medication orders. Results: The CEMS has the ability to identify the clinical errors before they occur and then warns the care-giver with voice and visual messages to prevent the error. This device reduces the errors and thus improves the patient safety. Conclusion: A new tool including software and hardware was developed in this study. Application of this tool in clinical settings can help the nurses prevent medical errors. It can also be a useful tool for clinical risk management. Using this device can improve the patient safety to a considerable extent and thus improve the quality of healthcare. PMID:27147802

Design and Development of a Clinical Risk Management Tool Using Radio Frequency Identification (RFID).

PubMed

Pourasghar, Faramarz; Tabrizi, Jafar Sadegh; Yarifard, Khadijeh

2016-04-01

Patient safety is one of the most important elements of quality of healthcare. It means preventing any harm to the patients during medical care process. This paper introduces a cost-effective tool in which the Radio Frequency Identification (RFID) technology is used to identify medical errors in hospital. The proposed clinical error management system (CEMS) is consisted of a reader device, a transfer/receiver device, a database and managing software. The reader device works using radio waves and is wireless. The reader sends and receives data to/from the database via the transfer/receiver device which is connected to the computer via USB port. The database contains data about patients' medication orders. The CEMS has the ability to identify the clinical errors before they occur and then warns the care-giver with voice and visual messages to prevent the error. This device reduces the errors and thus improves the patient safety. A new tool including software and hardware was developed in this study. Application of this tool in clinical settings can help the nurses prevent medical errors. It can also be a useful tool for clinical risk management. Using this device can improve the patient safety to a considerable extent and thus improve the quality of healthcare.

MEDUCATE trial: effectiveness of an intensive EDUCATional intervention for IT-mediated MEDication management in the outpatient clinic - study protocol for a cluster randomized controlled trial.

PubMed

van Stiphout, F; Zwart-van Rijkom, J E F; Aarts, J E C M; Koffijberg, H; Klarenbeek-deJonge, E; Krulder, M; Roes, K C B; Egberts, A C G; ter Braak, E W M T

2015-05-22

Using information technology for medication management is an opportunity to help physicians to improve the quality of their documentation and communication and ultimately to improve patient care and patient safety. Physician education is necessary to take full advantage of information technology systems. In this trial, we seek to determine the effectiveness of an intensive educational intervention compared with the standard approach in improving information technology-mediated medication management and in reducing potential adverse drug events in the outpatient clinic. We are conducting a multicenter, cluster randomized controlled trial. The participants are specialists and residents working in the outpatient clinic of internal medicine, cardiology, pulmonology, geriatrics, gastroenterology and rheumatology. The intensive educational intervention is composed of a small-group session and e-learning. The primary outcome is discrepancies between registered medication (by physicians) and actually used medication (by patients). The key secondary outcomes are potential adverse events caused by missed drug-drug interactions. The primary and key secondary endpoints are being assessed shortly after the educational intervention is completed. Sample size will be calculated to ensure sufficient power. A sample size of 40 physicians per group and 20 patients per physician will ensure a power of >90 %, which means we will need a total of 80 physicians and 1,600 patients. We performed an exploratory trial wherein we tested the recruitment process, e-learning, time schedule, and methods for data collection, data management and data analysis. Accordingly, we refined the processes and content: the recruitment strategy was intensified, extra measures were taken to facilitate smooth conductance of the e-learning and parts were made optional. First versions of the procedures for data collection were determined. Data entry and analysis was further standardized by using the G-standard database in the telephone questionnaire. ISRCTN registry: ISRCTN50890124 . Registered 10 June 2013.

The complexity of managing COPD exacerbations: a grounded theory study of European general practice

PubMed Central

Risør, Mette Bech; Spigt, Mark; Iversen, R; Godycki-Cwirko, M; Francis, N; Altiner, A; Andreeva, E; Kung, K; Melbye, H

2013-01-01

Objectives To understand the concerns and challenges faced by general practitioners (GPs) and respiratory physicians about primary care management of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). Design 21 focus group discussions (FGDs) were performed in seven countries with a Grounded Theory approach. Each country performed three rounds of FGDs. Setting Primary and secondary care in Norway, Germany, Wales, Poland, Russia, The Netherlands, China (Hong Kong). Participants 142 GPs and respiratory physicians were chosen to include urban and rural GPs as well as hospital-based and out patient-clinic respiratory physicians. Results Management of acute COPD exacerbations is dealt with within a scope of concerns. These concerns range from ‘dealing with comorbidity’ through ‘having difficult patients’ to ‘confronting a hopeless disease’. The first concern displays medical uncertainty regarding diagnosis, medication and hospitalisation. These clinical processes become blurred by comorbidity and the social context of the patient. The second concern shows how patients receive the label ‘difficult’ exactly because they need complex attention, but even more because they are time consuming, do not take responsibility and are non-compliant. The third concern relates to the emotional reactions by the physicians when confronted with ‘a hopeless disease’ due to the fact that most of the patients do not improve and the treatment slows down the process at best. GPs and respiratory physicians balance these concerns with medical knowledge and practical, situational knowledge, trying to encompass the complexity of a medical condition. Conclusions Knowing the patient is essential when dealing with comorbidities as well as with difficult relations in the consultations on exacerbations. This study suggests that it is crucial to improve the collaboration between primary and secondary care, in terms of, for example, shared consultations and defined work tasks, which may enhance shared knowledge of patients, medical decision-making and improved management planning. PMID:24319274

Effectiveness of Telebehavioral Health Program Nurse Case Managers (NCM): Data Collection Tools and the Process for NCM-Sensitive Outcome Measures.

PubMed

Carlson, Judy; Cohen, Roslyn; Bice-Stephens, Wynona

2014-01-01

As a part of our nation's pursuit of improvements in patient care outcomes, continuity of care, and cost containment, the case manager has become a vital member on interdisciplinary teams and in health care agencies. Telebehavioral health programs, as a relatively new method of delivering behavioral health care, have recently begun to incorporate case management into their multidisciplinary teams. To determine the efficacy and efficiency of healthcare programs, program managers are charged with the determination of the outcomes of the care rendered to patient populations. However, programs that use telehealth methods to deliver care have unique structures in place that impact ability to collect outcome data. A military medical center that serves the Pacific region developed surveys and processes to distribute, administer, and collect information about a telehealth environment to obtain outcome data for the nurse case manager. This report describes the survey development and the processes created to capture nurse case manager outcomes. Additionally, the surveys and processes developed in this project for measuring outcomes may be useful in other settings and disciplines.

Intake assessment of problematic use of medications in a chronic noncancer pain clinic

PubMed Central

Pink, Leah R; Smith, Andrew J; Peng, Philip WH; Galonski, Marilyn J; Tumber, Paul S; Evans, David; Gourlay, Doug L; Gordon, Lesley; Bellingham, Geoff A; Nijjar, Satnam S; Picard, Larry M; Gordon, Allan S

2012-01-01

BACKGROUND: The present article outlines the process of instituting an assessment of risk of problematic use of medications with new patients in an ambulatory chronic noncancer pain (CNCP) clinic. It is hoped that the authors’ experience through this iterative process will fill the gap in the literature by setting an example of an application of the ‘universal precautions’ approach to chronic pain management. OBJECTIVES: To assess the feasibility and utility of the addition of a new risk assessment process and to provide a snapshot of the risk of problematic use of medications in new patients presenting to a tertiary ambulatory clinic treating CNCP. METHODS: Charts for the first three months following the institution of an intake assessment for risk of problematic medication use were reviewed. Health care providers at the Wasser Pain Management Centre (Toronto, Ontario) were interviewed to discuss the preliminary findings and provide feedback about barriers to completing the intake assessments, as well as to identify the items that were clinically relevant and useful to their practice. RESULTS: Data were analyzed and examined for completeness. While some measures were considered to be particularly helpful, other items were regarded as repetitive, problematic or time consuming. Feedback was then incorporated into revisions of the risk assessment tool. DISCUSSION: Overall, it is feasible and useful to assess risk for problematic use of medications in new patients presenting to CNCP clinics. CONCLUSION: To facilitate the practice of assessment, the risk assessment tool at intake must be concise, clinically relevant and feasible given practitioner time constraints. PMID:22891193

Incorporating client-server database architecture and graphical user interface into outpatient medical records.

PubMed Central

Fiacco, P. A.; Rice, W. H.

1991-01-01

Computerized medical record systems require structured database architectures for information processing. However, the data must be able to be transferred across heterogeneous platform and software systems. Client-Server architecture allows for distributive processing of information among networked computers and provides the flexibility needed to link diverse systems together effectively. We have incorporated this client-server model with a graphical user interface into an outpatient medical record system, known as SuperChart, for the Department of Family Medicine at SUNY Health Science Center at Syracuse. SuperChart was developed using SuperCard and Oracle SuperCard uses modern object-oriented programming to support a hypermedia environment. Oracle is a powerful relational database management system that incorporates a client-server architecture. This provides both a distributed database and distributed processing which improves performance. PMID:1807732

2007 Mississippi Curriculum Framework: Postsecondary Diagnostic Medical Sonography Technology. (Program CIP: 51.0910 - Diagnostic Medical Sonography/Sonographer and Ultrasound Technician)

ERIC Educational Resources Information Center

Larimore, Crystal; Megginson, Nita; Weekley, Tracy B.

2007-01-01

As the world economy continues to evolve, businesses and industries must adopt new practices and processes in order to survive. Quality and cost control, work teams and participatory management, and an infusion of technology are transforming the way people work and do business. Employees are now expected to read, write, and communicate…

RBAC-Matrix-based EMR right management system to improve HIPAA compliance.

PubMed

Lee, Hung-Chang; Chang, Shih-Hsin

2012-10-01

Security control of Electronic Medical Record (EMR) is a mechanism used to manage electronic medical records files and protect sensitive medical records document from information leakage. Researches proposed the Role-Based Access Control(RBAC). However, with the increasing scale of medical institutions, the access control behavior is difficult to have a detailed declaration among roles in RBAC. Furthermore, with the stringent specifications such as the U.S. HIPAA and Canada PIPEDA etc., patients are encouraged to have the right in regulating the access control of his EMR. In response to these problems, we propose an EMR digital rights management system, which is a RBAC-based extension to a matrix organization of medical institutions, known as RBAC-Matrix. With the aim of authorizing the EMR among roles in the organization, RBAC-Matrix also allow patients to be involved in defining access rights of his records. RBAC-Matrix authorizes access control declaration among matrix organizations of medical institutions by using XrML file in association with each EMR. It processes XrML rights declaration file-based authorization of behavior in the two-stage design, called master & servant stage, thus makes the associated EMR to be better protected. RBAC-Matrix will also make medical record file and its associated XrML declaration to two different EMRA(EMR Authorization)roles, namely, the medical records Document Creator (DC) and the medical records Document Right Setting (DRS). Access right setting, determined by the DRS, is cosigned by the patient, thus make the declaration of rights and the use of EMR to comply with HIPAA specifications.

Asthma Self-Management Goals, Beliefs and Behaviors of Urban African American Adolescents Prior to Transitioning to Adult Health Care.

PubMed

Gibson-Scipio, Wanda; Gourdin, Dustin; Krouse, Helene J

2015-01-01

Adolescence is a unique time of development incorporating a transition from child centered to adult centered health care. This transition period can be particularly challenging for individuals with a chronic disease such as asthma. Inadequate transition planning during adolescence may place an already vulnerable population such as African American adolescents with known health disparities in asthma prevalence, morbidity and mortality at risk for a continuation of poor health outcomes across the lifespan. Central to transition planning for these youth is the core element of developing and prioritizing goals. The purpose of this qualitative study was to explore the asthma self-management goals, beliefs and behaviors of urban African American adolescents prior to transitioning from pediatric to adult health care. A focus group composed of 13 African American adolescents with asthma ages 14-18 years from an urban population was conducted. Responses from transcripts and field notes were reviewed using an iterative process to best characterize asthma self-management goals and beliefs that emerged. Four core themes were identified: 1) medication self-management, 2) social support, 3) independence vs. interdependence, and 4) self-advocacy. Medication self-management included subthemes of rescue medications, controller medications and medication avoidance. The social support theme included three subthemes: peer support, caregiver support and healthcare provider support. Findings suggest that adolescents with asthma form both short term and long term goals. Their goals indicated a need for guided support to facilitate a successful health care transition. Copyright © 2015 Elsevier Inc. All rights reserved.

Enrolling in Medicaid through the National School Lunch Program: outcome of a pilot project in California schools.

PubMed

Cousineau, Michael R; Wada, Eriko O; Hogan, Laura

2007-01-01

California has several health insurance programs for children. However, the system for enrolling into these programs is complex and difficult to manage for many families. Express Lane Eligibility is designed to streamline the Medicaid (called Medi-Cal in California) enrollment process by linking it to the National School Lunch Program. If a child is eligible for free lunch and the parents consent, the program provides two months of presumptive eligibility for Medi-Cal and a simplified application process for continuation in Medi-Cal. For those who are ineligible, it provides a referral to other programs. An evaluation of Express Lane shows that while many children were presumptively enrolled, nearly half of the applicants were already enrolled in Medi-Cal. Many Express Enrolled children failed to complete the full Medi-Cal enrollment process. Few were referred to the State Children's Health Insurance Program or county programs. Express Lane is less useful as a broad screening strategy, but can be one of many tools that communities use to enroll children in health insurance.

Challenges of safe medication practice in paediatric care--a nursing perspective.

PubMed

Star, Kristina; Nordin, Karin; Pöder, Ulrika; Edwards, I Ralph

2013-05-01

To explore nurses' experiences of handling medications in paediatric clinical practice, with a focus on factors that hinder and facilitate safe medication practices. Twenty nurses (registered nurses) from four paediatric wards at two hospitals in Sweden were interviewed in focus groups. The interviews were analysed using content analysis. Six themes emerged from the analysed interviews: the complexity specific for nurses working on paediatric wards is a hindrance to safe medication practices; nurses' concerns about medication errors cause a considerable psychological burden; the individual nurse works hard for safe medication practices and values support from other nurse colleagues; circumstances out of the ordinary are perceived as critical challenges for maintaining patient safety; nurses value clear instructions, guidelines and routines, but these are often missing, variable or changeable; management, other medical professionals, the pharmacy, the pharmaceutical industry and informatics support need to respond to the requirements of the nurses' working situations to improve safe medication practices. Weaknesses were apparent in the long chain of the medication-delivery process. A joint effort by different professions involved in that delivery process, and a nationwide collaboration between hospitals is recommended to increase safe medication practices in paediatric care. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

The Diagnosis and Management of Auditory Processing Disorder

ERIC Educational Resources Information Center

Moore, David R.

2011-01-01

Purpose: To provide a personal perspective on auditory processing disorder (APD), with reference to the recent clinical forum on APD and the needs of clinical speech-language pathologists and audiologists. Method: The Medical Research Council-Institute of Hearing Research (MRC-IHR) has been engaged in research into APD and auditory learning for 8…

A highly scalable information system as extendable framework solution for medical R&D projects.

PubMed

Holzmüller-Laue, Silke; Göde, Bernd; Stoll, Regina; Thurow, Kerstin

2009-01-01

For research projects in preventive medicine a flexible information management is needed that offers a free planning and documentation of project specific examinations. The system should allow a simple, preferably automated data acquisition from several distributed sources (e.g., mobile sensors, stationary diagnostic systems, questionnaires, manual inputs) as well as an effective data management, data use and analysis. An information system fulfilling these requirements has been developed at the Center for Life Science Automation (celisca). This system combines data of multiple investigations and multiple devices and displays them on a single screen. The integration of mobile sensor systems for comfortable, location-independent capture of time-based physiological parameter and the possibility of observation of these measurements directly by this system allow new scenarios. The web-based information system presented in this paper is configurable by user interfaces. It covers medical process descriptions, operative process data visualizations, a user-friendly process data processing, modern online interfaces (data bases, web services, XML) as well as a comfortable support of extended data analysis with third-party applications.

Migration of medical image data archived using mini-PACS to full-PACS.

PubMed

Jung, Haijo; Kim, Hee-Joung; Kang, Won-Suk; Lee, Sang-Ho; Kim, Sae-Rome; Ji, Chang Lyong; Kim, Jung-Han; Yoo, Sun Kook; Kim, Ki-Hwang

2004-06-01

This study evaluated the migration to full-PACS of medical image data archived using mini-PACS at two hospitals of the Yonsei University Medical Center, Seoul, Korea. A major concern in the migration of medical data is to match the image data from the mini-PACS with the hospital OCS (Ordered Communication System). Prior to carrying out the actual migration process, the principles, methods, and anticipated results for the migration with respect to both cost and effectiveness were evaluated. Migration gateway workstations were established and a migration software tool was developed. The actual migration process was performed based on the results of several migration simulations. Our conclusions were that a migration plan should be carefully prepared and tailored to the individual hospital environment because the server system, archive media, network, OCS, and policy for data management may be unique.

Using standard treatment protocols to manage costs and quality of hospital services.

PubMed

Meyer, J W; Feingold, M G

1993-06-01

The current health care environment has made it critically important that hospital costs and quality be managed in an integrated fashion. Promised health care reforms are expected to make cost reduction and quality enhancement only more important. Traditional methods of hospital cost and quality control have largely been replaced by such approaches as practice parameters, outcomes measurement, clinical indicators, clinical paths, benchmarking, patient-centered care, and a focus on patient selection criteria. This Special Report describes an integrated process for strategically managing costs and quality simultaneously, incorporating key elements of many important new quality and cost control tools. By using a multidisciplinary group process to develop standard treatment protocols, hospitals and their medical staffs address the most important services provided within major product lines. Using both clinical and financial data, groups of physicians, nurses, department managers, financial analysts, and administrators redesign key patterns of care within their hospital, incorporating the best practices of their own and other institutions. The outcome of this process is a new, standardized set of clinical guidelines that reduce unnecessary variation in care, eliminate redundant interventions, establish clear lines of communication for all caregivers, and reduce the cost of each stay. The hospital, medical staff, and patients benefit from the improved opportunities for managed care contracting, more efficient hospital systems, consensus-based quality measures, and reductions in the cost of care. STPs offer a workable and worthwhile approach to positioning the hospital of the 1990s for operational efficiency and cost and quality competitiveness.

Relevance of health economics in breast cancer treatment: integration of economics in the management of breast cancer at the clinic level.

PubMed

Jacobs, Volker R; Bogner, Gerhard; Schausberger, Christiane E; Reitsamer, Roland; Fischer, Thorsten

2013-03-01

Since the introduction of the diagnosis-related groups (DRG) system with cost-related and entity-specific flat-rate reimbursements for all in-patients in 2004 in Germany, economics have become an important focus in medical care, including breast centers. Since then, physicians and hospitals have had to gradually take on more and more financial responsibilities for their medical care to avoid losses for their institutions. Due to financial limitations of resources, most medical services have to be adjusted to correlating revenues, which results in the development of a variety of active measures to understand, steer, and optimize costs, resources and related processes for breast cancer treatment. In this review, the challenging task to implement microeconomic management at the clinic level for breast cancer treatment is analyzed from breast cancer-specific publications. The newly developed economic management perspective is identified for different stakeholders in the healthcare system, and successful microeconomic projects and future aspects are described.

Relevance of Health Economics in Breast Cancer Treatment: Integration of Economics in the Management of Breast Cancer at the Clinic Level

PubMed Central

Jacobs, Volker R.; Bogner, Gerhard; Schausberger, Christiane E.; Reitsamer, Roland; Fischer, Thorsten

2013-01-01

Summary Since the introduction of the diagnosis-related groups (DRG) system with cost-related and entity-specific flat-rate reimbursements for all in-patients in 2004 in Germany, economics have become an important focus in medical care, including breast centers. Since then, physicians and hospitals have had to gradually take on more and more financial responsibilities for their medical care to avoid losses for their institutions. Due to financial limitations of resources, most medical services have to be adjusted to correlating revenues, which results in the development of a variety of active measures to understand, steer, and optimize costs, resources and related processes for breast cancer treatment. In this review, the challenging task to implement microeconomic management at the clinic level for breast cancer treatment is analyzed from breast cancer-specific publications. The newly developed economic management perspective is identified for different stakeholders in the healthcare system, and successful microeconomic projects and future aspects are described. PMID:24715837

Medical management of ischemic stuttering priapism: a contemporary review of the literature.

PubMed

Levey, Helen R; Kutlu, Omer; Bivalacqua, Trinity J

2012-01-01

Priapism is defined as a prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process with little information on the pathophysiology of this erectile disorder. Complications from this disorder are devastating due to the irreversible erectile damage and resultant erectile dysfunction (ED). Stuttering priapism, though relatively rare, affects a high prevalence of men with sickle-cell disease (SCD) and presents a challenging problem with guidelines for treatment lacking or resulting in permanent ED. The mechanisms involved in the development of priapism in this cohort are poorly characterized; therefore, medical management of priapism represents a therapeutic challenge to urologists. Additional research is warranted, so we can effectively target treatments for these patients with prevention as the goal. This review gives an introduction to stuttering priapism and its clinical significance, specifically with regards to the patient with SCD. Additionally, the proposed mechanisms behind its pathophysiology and a summary of the current and future targets for medical management are discussed.

Implementation of Single Source Based Hospital Information System for the Catholic Medical Center Affiliated Hospitals

PubMed Central

Choi, Inyoung; Choi, Ran; Lee, Jonghyun

2010-01-01

Objectives The objective of this research is to introduce the unique approach of the Catholic Medical Center (CMC) integrate network hospitals with organizational and technical methodologies adopted for seamless implementation. Methods The Catholic Medical Center has developed a new hospital information system to connect network hospitals and adopted new information technology architecture which uses single source for multiple distributed hospital systems. Results The hospital information system of the CMC was developed to integrate network hospitals adopting new system development principles; one source, one route and one management. This information architecture has reduced the cost for system development and operation, and has enhanced the efficiency of the management process. Conclusions Integrating network hospital through information system was not simple; it was much more complicated than single organization implementation. We are still looking for more efficient communication channel and decision making process, and also believe that our new system architecture will be able to improve CMC health care system and provide much better quality of health care service to patients and customers. PMID:21818432

Palliative Sedation in Patients With Cancer.

PubMed

Maltoni, Marco; Setola, Elisabetta

2015-10-01

Palliative sedation involves the use of sedative medication to relieve refractory symptoms in patients by reducing their level of consciousness. Although it is considered an acceptable clinical practice from most ethical points of view, palliative sedation is still a widely debated procedure and merits better understanding. The relevant medical literature pertaining to palliative sedation was analyzed and reviewed from various technical, relational, and bioethical perspectives. Proportionate palliative sedation is considered to be the most clinically appropriate modality for performing palliative sedation. However, guidelines must be followed to ensure that it is performed correctly. Benzodiazepines represent the first therapeutic option and careful monitoring of dosages is essential to avoid oversedation or undersedation. Proportionate palliative sedation is used to manage and relieve refractory symptoms in patients with cancer during their last days or hours of life. Evidence suggests that its use has no detrimental effect on survival. A different decision-making process is used to manage the withdrawal of hydration than the process used to determine whether proportionate palliative sedation is appropriate. Communication between patients, their relatives, and the health care staff is important during this medical intervention.

Identification of Measures and Indicators for the IT Security of Networked Medical Devices: A Delphi Study.

PubMed

Leber, Stefan; Ammenwerth, Elske

2017-01-01

The networking of medical devices or systems in a hospital network is the foundation for modern medical diagnostics and therapy. This, however, makes possible numerous hazards that could lead to risks for patients, clinical processes or data and information. The aim of the work was to develop a catalogue of measures and indicators for the effective support of the IT risk management process in a health facility. Through a qualitative and quantitative Delphi study among 21 experts, it was possible to identify an initial 51 practice-relevant measures of IT risk management that a hospital should implement. Additionally, 27 indicators were defined which can be used to measure the impact of these measures. Of the 51 measures, 35 were seen as especially important, particularly organizational measures. Of the 27 indicators, six were seen as especially important, particularly indicators to measure networking effectiveness. The study also investigated the impact of the measures on the indicators. A case study is planned to investigate the practicability of the identified measures and indicators.

How drug life-cycle management patent strategies may impact formulary management.

PubMed

Berger, Jan; Dunn, Jeffrey D; Johnson, Margaret M; Karst, Kurt R; Shear, W Chad

2016-10-01

Drug manufacturers may employ various life-cycle management patent strategies, which may impact managed care decision making regarding formulary planning and management strategies when single-source, branded oral pharmaceutical products move to generic status. Passage of the Hatch-Waxman Act enabled more rapid access to generic medications through the abbreviated new drug application process. Patent expirations of small-molecule medications and approvals of generic versions have led to substantial cost savings for health plans, government programs, insurers, pharmacy benefits managers, and their customers. However, considering that the cost of developing a single medication is estimated at $2.6 billion (2013 dollars), pharmaceutical patent protection enables companies to recoup investments, creating an incentive for innovation. Under current law, patent protection holds for 20 years from time of patent filing, although much of this time is spent in product development and regulatory review, leaving an effective remaining patent life of 7 to 10 years at the time of approval. To extend the product life cycle, drug manufacturers may develop variations of originator products and file for patents on isomers, metabolites, prodrugs, new drug formulations (eg, extended-release versions), and fixed-dose combinations. These additional patents and the complexities surrounding the timing of generic availability create challenges for managed care stakeholders attempting to gauge when generics may enter the market. An understanding of pharmaceutical patents and how intellectual property protection may be extended would benefit managed care stakeholders and help inform decisions regarding benefit management.

(How) do we learn from errors? A prospective study of the link between the ward's learning practices and medication administration errors.

PubMed

Drach-Zahavy, A; Somech, A; Admi, H; Peterfreund, I; Peker, H; Priente, O

2014-03-01

Attention in the ward should shift from preventing medication administration errors to managing them. Nevertheless, little is known in regard with the practices nursing wards apply to learn from medication administration errors as a means of limiting them. To test the effectiveness of four types of learning practices, namely, non-integrated, integrated, supervisory and patchy learning practices in limiting medication administration errors. Data were collected from a convenient sample of 4 hospitals in Israel by multiple methods (observations and self-report questionnaires) at two time points. The sample included 76 wards (360 nurses). Medication administration error was defined as any deviation from prescribed medication processes and measured by a validated structured observation sheet. Wards' use of medication administration technologies, location of the medication station, and workload were observed; learning practices and demographics were measured by validated questionnaires. Results of the mixed linear model analysis indicated that the use of technology and quiet location of the medication cabinet were significantly associated with reduced medication administration errors (estimate=.03, p<.05 and estimate=-.17, p<.01 correspondingly), while workload was significantly linked to inflated medication administration errors (estimate=.04, p<.05). Of the learning practices, supervisory learning was the only practice significantly linked to reduced medication administration errors (estimate=-.04, p<.05). Integrated and patchy learning were significantly linked to higher levels of medication administration errors (estimate=-.03, p<.05 and estimate=-.04, p<.01 correspondingly). Non-integrated learning was not associated with it (p>.05). How wards manage errors might have implications for medication administration errors beyond the effects of typical individual, organizational and technology risk factors. Head nurse can facilitate learning from errors by "management by walking around" and monitoring nurses' medication administration behaviors. Copyright © 2013 Elsevier Ltd. All rights reserved.

Towards acute pediatric status epilepticus intervention teams: Do we need "Seizure Codes"?

PubMed

Stredny, Coral M; Abend, Nicholas S; Loddenkemper, Tobias

2018-05-01

To identify areas of treatment delay and barriers to care in pediatric status epilepticus, review ongoing quality improvement initiatives, and provide suggestions for further innovations to improve and standardize these patient care processes. Narrative review of current status epilepticus management algorithms, anti-seizure medication administration and outcomes associated with delays, and initiatives to improve time to treatment. Articles reviewing or reporting quality improvement initiatives were identified through a PubMed search with keywords "status epilepticus," "quality improvement," "guideline adherence," and/or "protocol;" references of included articles were also reviewed. Rapid initiation and escalation of status epilepticus treatment has been associated with shortened seizure duration and more favorable outcomes. Current evidence-based guidelines for management of status epilepticus propose medication algorithms with suggested times for each management step. However, time to antiseizure medication administration for pediatric status epilepticus remains delayed in both the pre- and in-hospital settings. Barriers to timely treatment include suboptimal preventive care, inaccurate seizure detection, infrequent or restricted use of home rescue medications by caregivers and pre-hospital emergency personnel, delayed summoning and arrival of emergency personnel, and use of inappropriately dosed medications. Ongoing quality improvement initiatives in the pre- and in-hospital settings targeting these barriers are reviewed. Improved preventive care, seizure detection, and rescue medication education may advance pre-hospital management, and we propose the use of acute status epilepticus intervention teams to initiate and incorporate in-hospital interventions as time-sensitive "Seizure Code" emergencies. Copyright © 2018 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Implementing a Quality Management System in the Medical Microbiology Laboratory.

PubMed

Carey, Roberta B; Bhattacharyya, Sanjib; Kehl, Sue C; Matukas, Larissa M; Pentella, Michael A; Salfinger, Max; Schuetz, Audrey N

2018-07-01

This document outlines a comprehensive practical approach to a laboratory quality management system (QMS) by describing how to operationalize the management and technical requirements described in the ISO 15189 international standard. It provides a crosswalk of the ISO requirements for quality and competence for medical laboratories to the 12 quality system essentials delineated by the Clinical and Laboratory Standards Institute. The quality principles are organized under three main categories: quality infrastructure, laboratory operations, and quality assurance and continual improvement. The roles and responsibilities to establish and sustain a QMS are outlined for microbiology laboratory staff, laboratory management personnel, and the institution's leadership. Examples and forms are included to assist in the real-world implementation of this system and to allow the adaptation of the system for each laboratory's unique environment. Errors and nonconforming events are acknowledged and embraced as an opportunity to improve the quality of the laboratory, a culture shift from blaming individuals. An effective QMS encourages "systems thinking" by providing a process to think globally of the effects of any type of change. Ultimately, a successful QMS is achieved when its principles are adopted as part of daily practice throughout the total testing process continuum. Copyright © 2018 American Society for Microbiology.

Data bank has operational impact. Proper peer review can protect hospitals from antitrust and defamation suits.

PubMed

Purtell, D L

1990-11-01

The Health Care Quality Improvement Act of 1986 can help protect medical professionals and healthcare facilities from antitrust and defamation claims and other forms of litigation arising from the peer review process. Some hospitals may need to make major changes in their peer review activity as a result of the act. The healthcare entity, not the physicians involved in peer review, has the burden of complying with the provisions of the act. Failure to comply with the act can lead to loss of immunity from damages, fines, and potential exclusion from the Medicare program. The potential for liability has sparked a need for hospitals to reexamine and possibly reorganize medical staff and update procedures and related governing documents. Healthcare entities may consider changes such as implementing a director of medical affairs function, choosing medical staff for multiple-year terms, and centralizing physician review files. In the 1980s many hospitals created quality assurance and risk management programs. Risk managers need to share data with quality assurance personnel, who must in turn share the information with medical staff involved with credentialing, peer review, and medical affairs management. Legal counsel will need to be familiar with the legalities of the act, as well as the hospital's peer review procedures and operations. General legal counsel should oversee coordination of hospital proceedings and assist in educating staff on the legalities of peer review.

MedRapid--medical community & business intelligence system.

PubMed

Finkeissen, E; Fuchs, H; Jakob, T; Wetter, T

2002-01-01

currently, it takes at least 6 months for researchers to communicate their results. This delay is caused (a) by partial lacks of machine support for both representation as well as communication and (b) by media breaks during the communication process. To make an integrated communication between researchers and practitioners possible, a general structure for medical content representation has been set up. The procedure for data entry and quality management has been generalized and implemented in a web-based authoring system. The MedRapid-system supports the medical experts in entering their knowledge into a database. Here, the level of detail is still below that of current medical guidelines representation. However, the symmetric structure for an area-wide medical knowledge representation is highly retrievable and thus can quickly be communicated into daily routine for the improvement of the treatment quality. In addition, other sources like journal articles and medical guidelines can be references within the MedRapid-system and thus be communicated into daily routine. The fundamental system for the representation of medical reference knowledge (from reference works/books) itself is not sufficient for the friction-less communication amongst medical staff. Rather, the process of (a) representing medical knowledge, (b) refereeing the represented knowledge, (c) communicating the represented knowledge, and (d) retrieving the represented knowledge has to be unified. MedRapid will soon support the whole process on one server system.

Use of non-medical methods of labor induction and pain management among U.S. women

PubMed Central

Kozhimanil, Katy Backes; Johnson, Pamela Jo; Attanasio, Laura B.; Gjerdingen, Dwenda K.; McGovern, Patricia M.

2013-01-01

Background There is limited documentation of non-medical methods of labor induction and pain management during childbirth in the U.S. We estimated the prevalence of non-medical interventions for induction and pain management and examined the association between medical and non-medical care during labor. Methods We used a nationally-representative survey of U.S. women who gave birth in 2005 (N=1,382) to examine use of non-medical methods of labor induction and pain management. Using logistic regression, we calculated odds of non-medical and medical interventions to induce labor or mitigate pain, and the odds of medical induction and obstetric analgesia by whether non-medical methods were used. Results Nearly 30% of women used non-medical methods to start labor, and over 70% of women used non-medical pain management. Doula support was the strongest predictor of non-medical methods of labor induction (Adjusted Odds Ratio (AOR) = 3.0) and labor pain management (AOR = 5.7). Use of non-medical pain management was significantly associated with decreased odds of medical pain management (OR = 0.65); this relationship was attenuated with covariate adjustment. Conclusions Non-medical methods to induce labor and manage pain during childbirth are commonly used by U.S. women. Future research should examine effectiveness of these strategies and their influence on medical services use. PMID:24344703

The use of inexpensive computer-based scanning survey technology to perform medical practice satisfaction surveys.

PubMed

Shumaker, L; Fetterolf, D E; Suhrie, J

1998-01-01

The recent availability of inexpensive document scanners and optical character recognition technology has created the ability to process surveys in large numbers with a minimum of operator time. Programs, which allow computer entry of such scanned questionnaire results directly into PC based relational databases, have further made it possible to quickly collect and analyze significant amounts of information. We have created an internal capability to easily generate survey data and conduct surveillance across a number of medical practice sites within a managed care/practice management organization. Patient satisfaction surveys, referring physician surveys and a variety of other evidence gathering tools have been deployed.

Competitive marketing strategies. A challenge for academic practices.

PubMed

Sinioris, M E

1985-01-01

A special challenge has been presented to academic medical practices by the new healthcare environment. While increased competition for patients and resources affects all medical groups, it is the academic practices who are responsible for training the physicians of tomorrow. Not only must they sharpen their students' awareness of the new environment and teach them to incorporate effective management strategies into their practices, but they must set an example in effective management as well. The basic concepts of competitive marketing strategy, along with helpful exhibits, are presented here, and strategies for effectively maximizing position are discussed from the viewpoints of product mix, process market, and financing.

Proposed Industry Best Practices in Development and Marketing of Medical Foods for the Management of Chronic Conditions and Diseases while Awaiting Regulation.

PubMed

Burnett, Bruce; Levy, Robert M

Ideal therapeutics have low toxicity and can effectively manage condition(s) or disease(s). The Food & Drug Administration (FDA) marketing category of therapeutics called “medical foods” (MFs) meets such a definition. Medical foods have existed in Federal law since passage the Orphan Drug Act in 1988, which created a category of nutritional therapeutics separate from drugs. Unfortunately, MFs are not widely understood by the medical community or utilized in all patients who need them due to lack of a FDA-approval process, unclear and contradictory guidance especially with regard for need for an investigational new drug (IND) application, and no clear regulations regarding their development and marketing. The goals of this article are to propose “Best Practices” to guide the medical food industry in the development and marketing of products as well as to serve as a starting point for suggestions regarding further FDA regulation so that therapeutics which are shown to be generally recognized as safe (GRAS), provide food ingredients to meet a distinctive nutritional requirement for a specific condition/disease and are proven effective for the management for that condition/disease can be used to benefit patients who need them.

Biodesign process and culture to enable pediatric medical technology innovation.

PubMed

Wall, James; Wynne, Elizabeth; Krummel, Thomas

2015-06-01

Innovation is the process through which new scientific discoveries are developed and promoted from bench to bedside. In an effort to encourage young entrepreneurs in this area, Stanford Biodesign developed a medical device innovation training program focused on need-based innovation. The program focuses on teaching systematic evaluation of healthcare needs, invention, and concept development. This process can be applied to any field of medicine, including Pediatric Surgery. Similar training programs have gained traction throughout the United States and beyond. Equally important to process in the success of these programs is an institutional culture that supports transformative thinking. Key components of this culture include risk tolerance, patience, encouragement of creativity, management of conflict, and networking effects. Copyright © 2015 Elsevier Inc. All rights reserved.

Implementing a resource management program for accreditation process at the medical laboratory.

PubMed

Yenice, Sedef

2009-03-01

To plan for and provide adequate resources to meet the mission and goals of a medical laboratory in compliance with the requirements for laboratory accreditation by Joint Commission International. The related policies and procedures were developed based on standard requirements for resource management. Competency assessment provided continuing education and performance feedback to laboratory employees. Laboratory areas were designed for the efficient and safe performance of laboratory work. A physical environment was built up where hazards were controlled and personnel activities were managed to reduce the risk of injuries. An Employees Occupational Safety and Health Program (EOSHP) was developed to address all types of hazardous materials and wastes. Guidelines were defined to verify that the methods would produce accurate and reliable results. An active resource management program will be an effective way of assuring that systems are in control and continuous improvement is in progress.

Integration of Evidence Base into a Probabilistic Risk Assessment

NASA Technical Reports Server (NTRS)

Saile, Lyn; Lopez, Vilma; Bickham, Grandin; Kerstman, Eric; FreiredeCarvalho, Mary; Byrne, Vicky; Butler, Douglas; Myers, Jerry; Walton, Marlei

2011-01-01

INTRODUCTION: A probabilistic decision support model such as the Integrated Medical Model (IMM) utilizes an immense amount of input data that necessitates a systematic, integrated approach for data collection, and management. As a result of this approach, IMM is able to forecasts medical events, resource utilization and crew health during space flight. METHODS: Inflight data is the most desirable input for the Integrated Medical Model. Non-attributable inflight data is collected from the Lifetime Surveillance for Astronaut Health study as well as the engineers, flight surgeons, and astronauts themselves. When inflight data is unavailable cohort studies, other models and Bayesian analyses are used, in addition to subject matters experts input on occasion. To determine the quality of evidence of a medical condition, the data source is categorized and assigned a level of evidence from 1-5; the highest level is one. The collected data reside and are managed in a relational SQL database with a web-based interface for data entry and review. The database is also capable of interfacing with outside applications which expands capabilities within the database itself. Via the public interface, customers can access a formatted Clinical Findings Form (CLiFF) that outlines the model input and evidence base for each medical condition. Changes to the database are tracked using a documented Configuration Management process. DISSCUSSION: This strategic approach provides a comprehensive data management plan for IMM. The IMM Database s structure and architecture has proven to support additional usages. As seen by the resources utilization across medical conditions analysis. In addition, the IMM Database s web-based interface provides a user-friendly format for customers to browse and download the clinical information for medical conditions. It is this type of functionality that will provide Exploratory Medicine Capabilities the evidence base for their medical condition list. CONCLUSION: The IMM Database in junction with the IMM is helping NASA aerospace program improve the health care and reduce risk for the astronauts crew. Both the database and model will continue to expand to meet customer needs through its multi-disciplinary evidence based approach to managing data. Future expansion could serve as a platform for a Space Medicine Wiki of medical conditions.

Evaluation of a program to improve diabetes care through intensified care management activities and diabetes medication copayment reduction.

PubMed

Kogut, Stephen J; Johnson, Scott; Higgins, Tara; Quilliam, Brian

2012-05-01

Medication copayment reduction can be integrated with disease management programs to incentivize patient engagement in chronic care management. While disease management programs in diabetes have been evaluated across a range of settings and designs, less is known regarding the effectiveness of copayment reduction as a component of disease management. To evaluate the short-term results of a diabetes-focused disease management program that included copayment reduction, care coordination, and patient goal setting, focusing on rates of evidence-based care processes and all-cause pharmacy and health care costs. Blue Cross Blue Shield of Rhode Island offered large employer groups the opportunity to participate in a diabetes disease management initiative that featured reduced copayments (from $7/$25/$40 for generic, tier 2, and tier 3 drugs, respectively, to $0 for generic and $0-$2 for brand drugs) for diabetes-related medications. In return for the copayment reduction, participants agreed to the following: (a) participate in care coordination with a case manager, (b) have an annual physical examination, (c) have a hemoglobin A1c blood test at least twice annually, and (d) have a low-density lipoprotein cholesterol (LDL-C) test at least once annually. Patients received personalized support provided by a registered nurse and dietician, disease-related education provided by nurses, and intensified case management services, including working with a health coach to establish healthy behavioral change goals. All study subjects were aged 18 years or older and had at least 1 ICD-9-CM code for diabetes and at least 1 claim for an antidiabetic drug during a 12-month measurement period, which was each subject's most recent 12-month period of continuous enrollment from January 1, 2008, through May 31, 2010. Administrative claims data were used to determine the percentage of intervention (participating) and nonintervention (nonparticipating) subjects from among all of the plan's employer groups who received at least once-yearly monitoring of A1c, high-density lipoprotein cholesterol (HDL-C), and LDL-C; medical attention (or drug therapy) for nephropathy; and an eye examination. We conducted multivariate logistic regression analyses to assess the effect of the intervention and other patient characteristics and comorbidities on rates of performance of these care processes, aggregating the 5 processes of care into an "all or none" single composite outcome. We also developed a propensity score-weighted model to attempt to adjust for differences between the intervention and nonintervention groups resulting from the nonrandomized study design. Additionally, we quantified average plan payments to providers less patient copayments (i.e., net plan cost) per patient per year (PPPY) for the 12-month follow-up period and compared these costs for the intervention versus nonintervention groups. The study sample consisted of 9,698 patients with diabetes; 649 (6.7%) of whom participated in the intervention. 9,049 (93.3%) patients were identified by the insurer as patients with diabetes receiving usual care. Patients in the intervention and nonintervention groups were similarly likely to have all 5 recommended processes of care performed (40.1% vs. 38.9%, respectively, P = 0.543). Younger patients received all 5 recommended care processes less frequently than older patients (30.5%, 38.0%, and 47.0% for ages 18-48 years, 49-59 years, and 60 years or older, respectively, P < 0.001); in adjusted analyses, patients aged 60 years or older were approximately twice as likely to receive all 5 care processes compared with patients aged 18-48 years (odds ratio [OR] = 1.97, 95% CI = 1.75-2.21). Users of oral antidiabetic monotherapy were least likely to have these processes of care performed compared with users of multiple oral therapies (OR = 1.23, 95% CI = 1.11-1.36) and insulin (OR = 1.59, 95% CI = 1.41-1.78). PPPY prescription drug costs incurred by the plan were greater for intervention than comparison patients (means [SDs] of $3,139 [$3,426] vs. $2,854 [$3,938], respectively, P < 0.001); and the generic-dispensing ratio was slightly lower (means [SDs] of 62.1% [22.4%] and 65.4% [23.0%], respectively, P < 0.001). There were no significant differences between the intervention and comparison groups in mean [SD] PPPY all-cause medical care costs ($7,475 [$17,601] vs. $8,577 [$22,972], respectively, P = 0.213) or total all-cause costs ($10,613 [$18,590] vs. $11,431 [$24,060], P = 0.666). Patients participating in this incentive program featuring diabetes medication copayment reduction and disease management components did not receive recommended care any more or less frequently than other enrolled members with diabetes. Younger patients and those utilizing oral antidiabetic monotherapy as their drug regimens were less likely to have the recommended processes of care performed. While prescription drug expenditures incurred by the plan were greater for intervention patients, between-group differences in total costs for medications and all-cause medical care were not statistically significant. Further follow-up is required to determine the success of this program over the longer term in promoting quality of care and achieving cost reductions and improved health outcomes.

ChRIS--A web-based neuroimaging and informatics system for collecting, organizing, processing, visualizing and sharing of medical data.

PubMed

Pienaar, Rudolph; Rannou, Nicolas; Bernal, Jorge; Hahn, Daniel; Grant, P Ellen

2015-01-01

The utility of web browsers for general purpose computing, long anticipated, is only now coming into fruition. In this paper we present a web-based medical image data and information management software platform called ChRIS ([Boston] Children's Research Integration System). ChRIS' deep functionality allows for easy retrieval of medical image data from resources typically found in hospitals, organizes and presents information in a modern feed-like interface, provides access to a growing library of plugins that process these data - typically on a connected High Performance Compute Cluster, allows for easy data sharing between users and instances of ChRIS and provides powerful 3D visualization and real time collaboration.

Military pain management in 21st century war.

PubMed

Buckenmaier, Chester C; Griffith, Scott

2010-07-01

Morphine and other opioid drugs have played a major role in austere environment pain management since the Civil War, particularly in the military. While the pre-eminence and success of such medications is without question, their use is accompanied by significant side effects that are undesirable in the most advanced medical settings, and are potentially devastating in the field environment. Recently, there have been significant improvements in pain care for America's wounded service members, along with a shift in how many care providers view pain management. An increasing number of healthcare providers are seeing pain not merely as a symptom, but as a disease process. In addition to dramatically improving care for wounded service members, the evolution in the military's approach to pain is enhancing care for civilians.

Revolutionary advances in medical waste management. The Sanitec system.

PubMed

Edlich, Richard F; Borel, Lise; Jensen, H Gordon; Winters, Kathryne L; Long, William B; Gubler, K Dean; Buschbacher, Ralph M; Becker, Daniel G; Chang, Dillon E; Korngold, Jonathan; Chitwood, W Randolph; Lin, Kant Y; Nichter, Larry S; Berenson, Susan; Britt, L D; Tafel, John A

2006-01-01

It is the purpose of this collective review to provide a detailed outline of a revolutionary medical waste disposal system that should be used in all medical centers in the world to prevent pollution of our planet from medical waste. The Sanitec medical waste disposal system consists of the following seven components: (1) an all-weather steel enclosure of the waste management system, allowing it to be used inside or outside of the hospital center; (2) an automatic mechanical lift-and-load system that protects the workers from devastating back injuries; (3) a sophisticated shredding system designed for medical waste; (4) a series of air filters including the High Efficiency Particulate Air (HEPA) filter; (5) microwave disinfection of the medical waste material; (6) a waste compactor or dumpster; and (7) an onboard microprocessor. It must be emphasized that this waste management system can be used either inside or outside the hospital. From start to finish, the Sanitec Microwave Disinfection system is designed to provide process and engineering controls that assure complete disinfection and destruction, while minimizing the operator's exposure to risk. There are numerous technologic benefits to the Sanitec systems, including environmental, operational, physical, and disinfection efficiency as well as waste residue disinfection. Wastes treated through the Sanitec system are thoroughly disinfected, unrecognizable, and reduced in volume by approximately 80% (saving valuable landfill space and reducing hauling requirements and costs). They are acceptable in any municipal solid waste program. Sanitec's Zero Pollution Advantage is augmented by a complete range of services, including installation, startup, testing, training, maintenance, and repair, over the life of this system. The Sanitec waste management system has essentially been designed to provide the best overall solution to the customer, when that customer actually looks at the total cost of dealing with the medical waste issue. The Sanitec system is the right choice for healthcare and medical waste professionals around the world.

WE-E-12A-01: Medical Physics 1.0 to 2.0: MRI, Displays, Informatics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pickens, D; Flynn, M; Peck, D

Medical Physics 2.0 is a bold vision for an existential transition of clinical imaging physics in face of the new realities of value-based and evidence-based medicine, comparative effectiveness, and meaningful use. It speaks to how clinical imaging physics can expand beyond traditional insular models of inspection and acceptance testing, oriented toward compliance, towards team-based models of operational engagement, prospective definition and assurance of effective use, and retrospective evaluation of clinical performance. Organized into four sessions of the AAPM, this particular session focuses on three specific modalities as outlined below. MRI 2.0: This presentation will look into the future of clinicalmore » MR imaging and what the clinical medical physicist will need to be doing as the technology of MR imaging evolves. Many of the measurement techniques used today will need to be expanded to address the advent of higher field imaging systems and dedicated imagers for specialty applications. Included will be the need to address quality assurance and testing metrics for multi-channel MR imagers and hybrid devices such as MR/PET systems. New pulse sequences and acquisition methods, increasing use of MR spectroscopy, and real-time guidance procedures will place the burden on the medical physicist to define and use new tools to properly evaluate these systems, but the clinical applications must be understood so that these tools are use correctly. Finally, new rules, clinical requirements, and regulations will mean that the medical physicist must actively work to keep her/his sites compliant and must work closely with physicians to ensure best performance of these systems. Informatics Display 1.0 to 2.0: Medical displays are an integral part of medical imaging operation. The DICOM and AAPM (TG18) efforts have led to clear definitions of performance requirements of monochrome medical displays that can be followed by medical physicists to ensure proper performance. However, effective implementation of that oversight has been challenging due to the number and extend of medical displays in use at a facility. The advent of color display and mobile displays has added additional challenges to the task of the medical physicist. This informatics display lecture first addresses the current display guidelines (the 1.0 paradigm) and further outlines the initiatives and prospects for color and mobile displays (the 2.0 paradigm). Informatics Management 1.0 to 2.0: Imaging informatics is part of every radiology practice today. Imaging informatics covers everything from the ordering of a study, through the data acquisition and processing, display and archiving, reporting of findings and the billing for the services performed. The standardization of the processes used to manage the information and methodologies to integrate these standards is being developed and advanced continuously. These developments are done in an open forum and imaging organizations and professionals all have a part in the process. In the Informatics Management presentation, the flow of information and the integration of the standards used in the processes will be reviewed. The role of radiologists and physicists in the process will be discussed. Current methods (the 1.0 paradigm) and evolving methods (the 2.0 paradigm) for validation of informatics systems function will also be discussed. Learning Objectives: Identify requirements for improving quality assurance and compliance tools for advanced and hybrid MRI systems. Identify the need for new quality assurance metrics and testing procedures for advanced systems. Identify new hardware systems and new procedures needed to evaluate MRI systems. Understand the components of current medical physics expectation for medical displays. Understand the role and prospect fo medical physics for color and mobile display devices. Understand different areas of imaging informatics and the methodology for developing informatics standards. Understand the current status of informatics standards and the role of physicists and radiologists in the process, and the current technology for validating the function of these systems.« less

Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients: Need for a Systematic Approach

PubMed Central

Cardone, Katie E.; Manley, Harold J.; St. Peter, Wendy L.; Shaffer, Rachel; Somers, Michael; Mehrotra, Rajnish

2013-01-01

Summary Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model. PMID:23990162

Pharmacist-led admission medication reconciliation before and after the implementation of an electronic medication management system.

PubMed

Sardaneh, Arwa A; Burke, Rosemary; Ritchie, Angus; McLachlan, Andrew J; Lehnbom, Elin C

2017-05-01

To investigate the impact of the introduction of an electronic medication management system on the proportion of patients with a recorded medication reconciliation on admission, the time from admission to when medication reconciliation was performed, and the characteristics of patients receiving this intervention pre-and post-implementation. An electronic medication management system was implemented in an Australian hospital from May to July 2015. A retrospective observational study was conducted in three wards across two phases; pre- (August 2014) and post- (August 2015) implementation. The study sample included every second patient admitted to these wards. A total of 370 patients were included, 179 pre- and 191 post-implementation. The proportion of recorded admission medication reconciliation significantly increased post-implementation in all study wards; coronary care unit (40 vs 68%, p=0.004), gastroenterology ward (39 vs 59%, p=0.015), and the neurology ward (19 vs 45%, p=0.002). The proportion of patients with recorded medication reconciliation within 24h of weekday admissions, or 48-72h of weekend admissions, increased from 47% pre- to 84% post-implementation. Admission medication reconciliation was recorded within a median of 1.0day for weekday admissions pre- and post-implementation (IQR 1.1 vs 0.2, respectively), and 3.5days (IQR 2.0) pre-implementation vs 1.5days (IQR 2.0) post-implementation for weekend admissions. Overall, across both phases pre-and post-implementation, admission medication reconciliation was recorded for patients who were significantly older (median 77 and 71 years, p<0.001), had a higher number of preadmission medications (median 6.5 and 5.0 medicines, p=0.001), and had a longer hospital stay (median 6.5 and 5.1days, p=0.003). A significantly higher proportion of patients with recorded medication reconciliation in the pre-implementation phase experienced polypharmacy (61%, p=0.002), hyperpolypharmacy (15%, p=0.001), and used a high-risk medication (44%, p=0.007). Implementing an electronic medication management system facilitates the medication reconciliation process leading to more high risk patients receiving this service on admission to hospital and in a more timely manner. The impact of electronic medication reconciliation on patient safety and clinical outcomes remains unknown. Copyright © 2017 Elsevier B.V. All rights reserved.

A virtual university Web system for a medical school.

PubMed

Séka, L P; Duvauferrier, R; Fresnel, A; Le Beux, P

1998-01-01

This paper describes a Virtual Medical University Web Server. This project started in 1994 by the development of the French Radiology Server. The main objective of our Medical Virtual University is to offer not only an initial training (for students) but also the Continuing Professional Education (for practitioners). Our system is based on electronic textbooks, clinical cases (around 4000) and a medical knowledge base called A.D.M. ("Aide au Diagnostic Medical"). We have indexed all electronic textbooks and clinical cases according to the ADM base in order to facilitate the navigation on the system. This system base is supported by a relational database management system. The Virtual Medical University, available on the Web Internet, is presently in the process of external evaluations.

A clinical nurse specialist-led intervention to enhance medication adherence using the plan-do-check-act cycle for continuous self-improvement.

PubMed

Russell, Cynthia L

2010-01-01

A clinical nurse specialist-led intervention to improve medication adherence in chronically ill adults using renal transplant recipients as an exemplar population is proposed. Meta-analyses and systematic reviews of chronically ill and transplant patients indicate that patient-specific characteristics not only are poor and inconsistent predictors for medication nonadherence but also are not amenable to intervention. Adherence has not meaningfully improved, despite meta-analyses and systematic narrative reviews of randomized controlled trials (RCTs) dealing with medication nonadherence in acutely and chronically ill persons and RCTs dealing with transplant patients. Interventions with a superior potential to enhance medication adherence must be developed. Use of a clinical nurse specialist-led continuous self-improvement intervention with adult renal transplant recipients is proposed. Continuous self-improvement focuses on improving personal systems thinking and behavior using the plan-do-check-act process. Electronic medication monitoring reports, one of several objective measures of medication adherence, are used by the clinician to provide patient feedback during the check process on medication-taking patterns. Continuous self-improvement as an intervention holds promise in supporting patient self-management and diminishing the blame that clinicians place on patients for medication nonadherence. Using an objective measure of medication adherence such as an electronic monitoring report fosters collaborative patient-clinician discussions of daily medication-taking patterns. Through collaboration, ideas for improving medication taking can be explored. Changes can be followed and evaluated for effectiveness through the continuous self-improvement process. Future studies should include RCTs comparing educational and/or behavioral interventions to improve medication adherence.

A DICOM Based Collaborative Platform for Real-Time Medical Teleconsultation on Medical Images.

PubMed

Maglogiannis, Ilias; Andrikos, Christos; Rassias, Georgios; Tsanakas, Panayiotis

2017-01-01

The paper deals with the design of a Web-based platform for real-time medical teleconsultation on medical images. The proposed platform combines the principles of heterogeneous Workflow Management Systems (WfMSs), the peer-to-peer networking architecture and the SPA (Single-Page Application) concept, to facilitate medical collaboration among healthcare professionals geographically distributed. The presented work leverages state-of-the-art features of the web to support peer-to-peer communication using the WebRTC (Web Real Time Communication) protocol and client-side data processing for creating an integrated collaboration environment. The paper discusses the technical details of implementation and presents the operation of the platform in practice along with some initial results.

Medical hypnotherapy for pain management.

PubMed

Colón, Yvette; Avnet, Mark S

2014-06-01

Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates. Hypnotherapy, its uses and process, and certification and training of hypnotherapy professionals are addressed.

A multi-agent system for monitoring patient flow.

PubMed

Rosati, Samanta; Tralli, Augusta; Balestra, Gabriella

2013-01-01

Patient flow within a healthcare facility may follow different and, sometimes, complicated paths. Each path phase is associated with the documentation of the activities carried out during it and may require the consultation of clinical guidelines, medical literature and the use of specific software and decision aid systems. In this study we present the design of a Patient Flow Management System (PFMS) based on Multi Agent Systems (MAS) methodology. System requirements were identified by means of process modeling tools and a MAS consisting of six agents was designed and is under construction. Its main goal is to support both the medical staff during the health care process and the hospital managers in assuring that all the required documentation is completed and available. Moreover, such a tool can be used for the assessment and comparison of different clinical pathways, in order to identify possible improvementsand the optimum patient flow.

Beauty and the beast--a medical essay.

PubMed

Lawrence, G

1995-12-01

Breast cancer is the most common cancer among women, and the incidence of the cancer is on the rise. However, public education and screening have permitted the detection of this disease at an early stage. This early presentation has open opportunities for physicians to offer therapeutic options tailored both to the individual's disease process and the patient's desires. There is an increased responsibility on the doctor (s) to view an individual's breast cancer as a subset of the disease, for which one or more treatment modalities may be combined. The combination is designed to deliver the best cure rates with the least risk of acute complications and late morbidity. This paper outlines the pathological determinants of breast cancer and their impact on the behavior of the disease. Algorithms are presented to view and manage the patient's overall disease process. The subtleties in the medical literature on the management and clinical results of breast cancer are discussed.

The evolution of a health hazard assessment database management system for military weapons, equipment, and materiel.

PubMed

Murnyak, George R; Spencer, Clark O; Chaney, Ann E; Roberts, Welford C

2002-04-01

During the 1970s, the Army health hazard assessment (HHA) process developed as a medical program to minimize hazards in military materiel during the development process. The HHA Program characterizes health hazards that soldiers and civilians may encounter as they interact with military weapons and equipment. Thus, it is a resource for medical planners and advisors to use that can identify and estimate potential hazards that soldiers may encounter as they train and conduct missions. The U.S. Army Center for Health Promotion and Preventive Medicine administers the program, which is integrated with the Army's Manpower and Personnel Integration program. As the HHA Program has matured, an electronic database has been developed to record and monitor the health hazards associated with military equipment and systems. The current database tracks the results of HHAs and provides reporting designed to assist the HHA Program manager in daily activities.

Workflow management systems in radiology

NASA Astrophysics Data System (ADS)

Wendler, Thomas; Meetz, Kirsten; Schmidt, Joachim

1998-07-01

In a situation of shrinking health care budgets, increasing cost pressure and growing demands to increase the efficiency and the quality of medical services, health care enterprises are forced to optimize or complete re-design their processes. Although information technology is agreed to potentially contribute to cost reduction and efficiency improvement, the real success factors are the re-definition and automation of processes: Business Process Re-engineering and Workflow Management. In this paper we discuss architectures for the use of workflow management systems in radiology. We propose to move forward from information systems in radiology (RIS, PACS) to Radiology Management Systems, in which workflow functionality (process definitions and process automation) is implemented through autonomous workflow management systems (WfMS). In a workflow oriented architecture, an autonomous workflow enactment service communicates with workflow client applications via standardized interfaces. In this paper, we discuss the need for and the benefits of such an approach. The separation of workflow management system and application systems is emphasized, and the consequences that arise for the architecture of workflow oriented information systems. This includes an appropriate workflow terminology, and the definition of standard interfaces for workflow aware application systems. Workflow studies in various institutions have shown that most of the processes in radiology are well structured and suited for a workflow management approach. Numerous commercially available Workflow Management Systems (WfMS) were investigated, and some of them, which are process- oriented and application independent, appear suitable for use in radiology.

[Computers in nursing: development of free software application with care and management].

PubMed

dos Santos, Sérgio Ribeiro

2010-06-01

This study aimed at developing an information system in nursing with the implementation of nursing care and management of the service. The SisEnf--Information System in Nursing--is a free software module that comprises the care of nursing: history, clinical examination and care plan; the management module consists of: service shifts, personnel management, hospital indicators and other elements. The system was implemented at the Medical Clinic of the Lauro Wanderley University Hospital, at Universidade Federal da Paraiba. In view of the need to bring user and developer closer, in addition to the constant change of functional requirements during the interactive process, the method of unified process was used. The SisEnf was developed on a WEB platform and using free software. Hence, the work developed aimed at assisting in the working process of nursing, which will now have the opportunity to incorporate information technology in their work routine.

Surgical Adverse Events, Risk Management, and Malpractice Outcome: Morbidity and Mortality Review Is Not Enough

PubMed Central

Morris, John A.; Carrillo, Ysela; Jenkins, Judith M.; Smith, Philip W.; Bledsoe, Sandy; Pichert, James; White, Andrew

2003-01-01

Objective To review all admissions (age > 13) to three surgical patient care centers at a single academic medical center between January 1, 1995, and December 6, 1999, for significant surgical adverse events. Summary Background Data Little data exist on the interrelationships between surgical adverse events, risk management, malpractice claims, and resulting indemnity payments to plaintiffs. The authors hypothesized that examination of this process would identify performance improvement opportunities overlooked by standard medical peer review; the risk of litigation would be constant across the three homogeneous patient care centers; and the risk management process would exceed the performance improvement process. Methods Data collected included patient demographics (age, gender, and employment status), hospital financials (hospital charges, costs, and financial class), and outcome. Outcome categories were medical (disability: <1 month, 1–6 months, permanent/death), legal (no legal action, settlement, summary judgment), financial (indemnity payments, legal fees, write-offs), and cause and effect analysis. Cause and effect analysis attempts to identify system failures contributing to adverse outcomes. This was determined by two independent analysts using the 17 Harvard criteria and subdividing these into subsystem causative factors. Results The study group consisted of 130 patients with surgical adverse events resulting in total liabilities of $8.2 million. The incidence of adverse events per 1,000 admissions across the three patient care centers was similar, but indemnity payments per 1,000 admissions varied (cardiothoracic = $30, women’s health = $90, trauma = $520). Patient demographics were not predictive of high-risk subgroups for adverse events or litigation. In terms of medical outcome, 51 patients had permanent disability or death, accounting for 98% of the indemnity payments. In terms of legal outcome, 103 patients received no indemnity payments, 15 patients received indemnity payments, four suits remain open, and in eight cases charges were written off ($0.121 million). To date, no cases have been adjudicated in court. Cause and effect analysis identified 390 system failures contributing to the adverse events (mean 3.0 failures per adverse event); there were 4.7 failures per adverse event in the 15 indemnity cases. Five categories of causes accounted for 75% of the failures (patient management, n = 104; communication, n = 89; administration, n = 33; documentation, n = 32; behavior, n = 23). The current medical review process would have identified 104 of 390 systems failures (37%). Conclusions This study demonstrates no rational link between the tort system and the reduction of adverse events. Sixty-three percent of contributing causes to adverse events were undetected by current medical review processes. Adverse events occur at the interface between different systems or disciplines and result from multiple failures. Indemnity costs per hospital day vary dramatically by patient care center (range $3.60–97.60 a day). The regionalization of healthcare is in jeopardy from the burden of high indemnity payments. PMID:12796581

Financing and cash flow management for the medical group practice.

PubMed

Bert, Andrew J

2008-01-01

The expansion of a medical group practice and the addition of ancillary services require a substantial cash outlay. Obtaining proper financing to complete a successful expansion is a process that takes time, and there are critical steps that must be followed. The group's business objectives must be presented properly by developing a business plan detailing the practice and goals associated with the desired expansion. This article discusses some of the key elements that are essential in creating an overall effective business plan for the group medical practice.

Medicalization: Current Concept and Future Directions in a Bionic Society

PubMed Central

Maturo, Antonio

2012-01-01

The article illustrates the main features of the concept of medicalization, starting from its theoretical roots. Although it is the process of extending the medical gaze on human conditions, it appears that medicalization cannot be strictly connected to medical imperialism anymore. Other “engines” of medicalization are influential: consumers, biotechnology and managed care. The growth of research and theoretical reflections on medicalization has led to the proposal of other parallel concepts like pharmaceuticalization, genetization and biomedicalization. These new theoretical tools could be useful in the analysis of human enhancement. Human enhancement can be considered as the use of biomedical technology to improve performance on a human being who is not in need of a cure: a practice that is increasingly spreading in what might be defined as a “bionic society”. PMID:22654387

Establishing a clinical service for the management of sports-related concussions.

PubMed

Reynolds, Erin; Collins, Michael W; Mucha, Anne; Troutman-Ensecki, Cara

2014-10-01

The clinical management of sports-related concussions is a specialized area of interest with a lack of empirical findings regarding best practice approaches. The University of Pittsburgh Medical Center Sports Concussion Program was the first of its kind; 13 years after its inception, it remains a leader in the clinical management and research of sports-related concussions. This article outlines the essential components of a successful clinical service for the management of sports-related concussions, using the University of Pittsburgh Medical Center Sports Concussion Program as a case example. Drawing on both empirical evidence and anecdotal conclusions from this high-volume clinical practice, this article provides a detailed account of the inner workings of a multidisciplinary concussion clinic with a comprehensive approach to the management of sports-related concussions. A detailed description of the evaluation process and an in-depth analysis of targeted clinical pathways and subtypes of sports-related concussions effectively set the stage for a comprehensive understanding of the assessment, treatment, and rehabilitation model used in Pittsburgh today.

Studying Associations Between Heart Failure Self-Management and Rehospitalizations Using Natural Language Processing.

PubMed

Topaz, Maxim; Radhakrishnan, Kavita; Blackley, Suzanne; Lei, Victor; Lai, Kenneth; Zhou, Li

2016-09-14

This study developed an innovative natural language processing algorithm to automatically identify heart failure (HF) patients with ineffective self-management status (in the domains of diet, physical activity, medication adherence, and adherence to clinician appointments) from narrative discharge summary notes. We also analyzed the association between self-management status and preventable 30-day hospital readmissions. Our natural language system achieved relatively high accuracy (F-measure = 86.3%; precision = 95%; recall = 79.2%) on a testing sample of 300 notes annotated by two human reviewers. In a sample of 8,901 HF patients admitted to our healthcare system, 14.4% (n = 1,282) had documentation of ineffective HF self-management. Adjusted regression analyses indicated that presence of any skill-related self-management deficit (odds ratio [OR] = 1.3, 95% confidence interval [CI] = [1.1, 1.6]) and non-specific ineffective self-management (OR = 1.5, 95% CI = [1.2, 2]) was significantly associated with readmissions. We have demonstrated the feasibility of identifying ineffective HF self-management from electronic discharge summaries with natural language processing. © The Author(s) 2016.

New secure communication-layer standard for medical image management (ISCL)

NASA Astrophysics Data System (ADS)

Kita, Kouichi; Nohara, Takashi; Hosoba, Minoru; Yachida, Masuyoshi; Yamaguchi, Masahiro; Ohyama, Nagaaki

1999-07-01

This paper introduces a summary of the standard draft of ISCL 1.00 which will be published by MEDIS-DC officially. ISCL is abbreviation of Integrated Secure Communication Layer Protocols for Secure Medical Image Management Systems. ISCL is a security layer which manages security function between presentation layer and TCP/IP layer. ISCL mechanism depends on basic function of a smart IC card and symmetric secret key mechanism. A symmetry key for each session is made by internal authentication function of a smart IC card with a random number. ISCL has three functions which assure authentication, confidently and integrity. Entity authentication process is done through 3 path 4 way method using functions of internal authentication and external authentication of a smart iC card. Confidentially algorithm and MAC algorithm for integrity are able to be selected. ISCL protocols are communicating through Message Block which consists of Message Header and Message Data. ISCL protocols are evaluating by applying to regional collaboration system for image diagnosis, and On-line Secure Electronic Storage system for medical images. These projects are supported by Medical Information System Development Center. These project shows ISCL is useful to keep security.

Adaptive regulation or governmentality: patient safety and the changing regulation of medicine.

PubMed

Waring, Justin

2007-03-01

This paper explores how current 'patient safety' reforms offer to change the regulation of medicine. Drawing on existing literature, it is argued that this policy agenda represents a new frontier in medical/managerial relations, introducing a disciplinary expertise within the health service that provides managers with the knowledge and legitimacy to survey and scrutinise medical performance, made real through procedures for incident reporting and root-cause analysis. The extent of regulatory change is investigated, drawing on an ethnographic case study of one hospital. It is shown that, as with other organisational and managerial reforms, doctors are resisting managerial prerogatives through seeking to subvert and 'capture' components of reform. I describe this as 'adaptive regulation' to account for how doctors seek to maintain their regulatory monopoly and limit managerial encroachment. It is speculated, however, that this process could signal the future 'modernisation' of medical professionalism where emerging managerial discourses, within the wider context of public sector reform, are increasingly internalised with medical practice and culture. This leads to new and rearticulated forms of self-surveillance, self-management or 'governmentality', ultimately negating the need for external groups to explicitly manage or regulate professional practice.

Identifying the latent failures underpinning medication administration errors: an exploratory study.

PubMed

Lawton, Rebecca; Carruthers, Sam; Gardner, Peter; Wright, John; McEachan, Rosie R C

2012-08-01

The primary aim of this article was to identify the latent failures that are perceived to underpin medication errors. The study was conducted within three medical wards in a hospital in the United Kingdom. The study employed a cross-sectional qualitative design. Interviews were conducted with 12 nurses and eight managers. Interviews were transcribed and subject to thematic content analysis. A two-step inter-rater comparison tested the reliability of the themes. Ten latent failures were identified based on the analysis of the interviews. These were ward climate, local working environment, workload, human resources, team communication, routine procedures, bed management, written policies and procedures, supervision and leadership, and training. The discussion focuses on ward climate, the most prevalent theme, which is conceptualized here as interacting with failures in the nine other organizational structures and processes. This study is the first of its kind to identify the latent failures perceived to underpin medication errors in a systematic way. The findings can be used as a platform for researchers to test the impact of organization-level patient safety interventions and to design proactive error management tools and incident reporting systems in hospitals. © Health Research and Educational Trust.

e_Disease Management. A system for the management of the chronic conditions.

PubMed

Guillén, Sergio; Meneu, Maria Teresa; Serafin, Riccardo; Arredondo, Maria Teresa; Castellano, Elena; Valdivieso, Bernardo

2010-01-01

Disease Management (DM) is a system of coordinated healthcare intervention and communications for populations with conditions in which patient self-care efforts are significant. e-DM makes reference to processes of DM based on clinical guidelines sustained in the scientific medical evidence and supported by the intervention of Information and Telecommunication Technology (ICT) in all levels where these plans are developed. This paper discusses the design and implementation of a e-DM system which meets the requirements for the integrated chronic disease management following the recommendations of the Disease Management Association and the American Heart Association.

A novel key management solution for reinforcing compliance with HIPAA privacy/security regulations.

PubMed

Lee, Chien-Ding; Ho, Kevin I-J; Lee, Wei-Bin

2011-07-01

Digitizing medical records facilitates the healthcare process. However, it can also cause serious security and privacy problems, which are the major concern in the Health Insurance Portability and Accountability Act (HIPAA). While various conventional encryption mechanisms can solve some aspects of these problems, they cannot address the illegal distribution of decrypted medical images, which violates the regulations defined in the HIPAA. To protect decrypted medical images from being illegally distributed by an authorized staff member, the model proposed in this paper provides a way to integrate several cryptographic mechanisms. In this model, the malicious staff member can be tracked by a watermarked clue. By combining several well-designed cryptographic mechanisms and developing a key management scheme to facilitate the interoperation among these mechanisms, the risk of illegal distribution can be reduced.

Performance of Clinical Nurse Educators in Teaching Pharmacology and Medication Management: Nursing Students’ Perceptions

PubMed Central

Ghamari Zare, Zohre; Adib-Hajbaghery, Mohsen

2016-01-01

Background Pharmacological knowledge and medication management skills of student nurses greatly depend on the clinical nurse educators’ performance in this critical issue. However, the Iranian nurse educators’ performance in teaching pharmacology and medication management are not adequately studied. Objectives The current study aimed to investigate the nursing students’ perceptions on the status of clinical pharmaceutical and medication management education. Materials and Methods A cross-sectional study was conducted on all 152 nursing students registered in the seventh and eighth semesters at the Qom and Naragh branches of Islamic Azad University, and Kashan University of Medical Sciences in 2013 - 2014 academic year. The students’ perceptions on the performance of clinical nurse educators in teaching pharmacology and medication management were assessed using a researcher made questionnaire. The questionnaire consisted of 31 items regarding clinical educators’ performance in teaching pharmacology and medication management and two questions about students’ satisfaction with their level of knowledge and skills in pharmacology and medication management. Descriptive statistics was employed and analysis of variance was performed to compare the mean of scores of teaching pharmacology and medication management in the three universities. Results Among a total of 152 subjects, 82.9% were female and their mean age was 22.57 ± 1.55 years. According to the students, instructors had the weakest performance in the three items of teaching pharmacology and medication management based on the students’ learning needs, teaching medication management through a patient-centered method and teaching pharmacology and medication management based on the course plan. The students’ satisfaction regarding their own knowledge and skill of pharmacology and medication management was at medium level. Conclusions Nursing students gave a relatively low score in several aspects of their instructors’ performance regarding teaching pharmacology and medication management. It seems that many clinical nurse educators in the studied settings were incompetent especially in teaching pharmacology and medication management, while these are critical areas and need special attention. PMID:27331055

Performance of Clinical Nurse Educators in Teaching Pharmacology and Medication Management: Nursing Students' Perceptions.

PubMed

Ghamari Zare, Zohre; Adib-Hajbaghery, Mohsen

2016-03-01

Pharmacological knowledge and medication management skills of student nurses greatly depend on the clinical nurse educators' performance in this critical issue. However, the Iranian nurse educators' performance in teaching pharmacology and medication management are not adequately studied. The current study aimed to investigate the nursing students' perceptions on the status of clinical pharmaceutical and medication management education. A cross-sectional study was conducted on all 152 nursing students registered in the seventh and eighth semesters at the Qom and Naragh branches of Islamic Azad University, and Kashan University of Medical Sciences in 2013 - 2014 academic year. The students' perceptions on the performance of clinical nurse educators in teaching pharmacology and medication management were assessed using a researcher made questionnaire. The questionnaire consisted of 31 items regarding clinical educators' performance in teaching pharmacology and medication management and two questions about students' satisfaction with their level of knowledge and skills in pharmacology and medication management. Descriptive statistics was employed and analysis of variance was performed to compare the mean of scores of teaching pharmacology and medication management in the three universities. Among a total of 152 subjects, 82.9% were female and their mean age was 22.57 ± 1.55 years. According to the students, instructors had the weakest performance in the three items of teaching pharmacology and medication management based on the students' learning needs, teaching medication management through a patient-centered method and teaching pharmacology and medication management based on the course plan. The students' satisfaction regarding their own knowledge and skill of pharmacology and medication management was at medium level. Nursing students gave a relatively low score in several aspects of their instructors' performance regarding teaching pharmacology and medication management. It seems that many clinical nurse educators in the studied settings were incompetent especially in teaching pharmacology and medication management, while these are critical areas and need special attention.

Factors Affecting Medical Service Quality.

PubMed

Mosadeghrad, Ali Mohammad

2014-02-01

A better understanding of factors influencing quality of medical service can pinpoint better strategies for quality assurance in medical services. This study aimed to identify factors affecting the quality of medical services provided by Iranian physicians. Exploratory in-depth individual interviews were conducted with sixty-four physicians working in various medical institutions in Iran. Individual, organizational and environmental factors enhance or inhibit the quality of medical services. Quality of medical services depends on the personal factors of the physician and patient, and factors pertaining to the healthcare setting and the broader environment. Differences in internal and external factors such as availability of resources, patient cooperation and collaboration among providers affect the quality of medical services and patient outcomes. Supportive leadership, proper planning, education and training and effective management of resources and processes improve the quality of medical services. This article contributes to healthcare theory and practice by developing a conceptual framework for understanding factors that influence medical services quality.

[Navy medical academy (to the 75th anniversary of establishment)].

PubMed

Chernikov, O G; Zaimagov, S V

2016-02-01

The article is devoted to the history of the creation in 1940 of the Naval Medical Academy on the basis of the 3rd Leningrad Medical Institute and the Institute for sanitary-chemical protection of the People's Commissariat of the USSR. The structure of this institution included, faculties management staff of the medical service, medical and sanitation, Higher Naval Medical School, the Marine Research Institute Medical, higher courses for officers of the medical service, clinical naval hospital. During the period of its activity (1940-1956), the staff of the Naval Medical Academy made a great contribution to the naval medicine and practical public health. The merit of the Academy is not only a beautifully staged academic, medical, research process, but also in the creation of the spirit of the high sea camaraderie, accomplishment and pride for the work which its graduates have dedicated their lives.

Manuka Honey: A Case Study of Severe Atopic Eczematous Dermatitis Reaction to Henna Tattoo.

PubMed

Harrison, Jeanine

Many mainstream medications were derived from plants and originally utilized in patient management well prior to the extensive research and testing processes of current pharmaceutical standards. The evolution of therapeutic management within the pharmaceutical and skin care industry often uses synthetic processing of products with less of a focus on the natural ingredients from which they were originally derived. However, more recently there has been a shift in pharmacological management to include the therapeutic use of more holistic medicines and practices and thus a broadening of the uses of nontraditional medical treatment options. This has been seen in the use of treatments, such as Manuka honey, for skin conditions and dermal injuries. It is often with off-label uses, or conditions resistant to other treatments, that then prompt the use of holistic products and the true value of the product is validated. As with the following case study, the example of the use of Manuka honey on a severe atopic contact dermatitis eczematous reaction provides further documentation and supportive evidence of the potential efficacy of the properties of this particular natural product.

Automatic processing of spoken dialogue in the home hemodialysis domain.

PubMed

Lacson, Ronilda; Barzilay, Regina

2005-01-01

Spoken medical dialogue is a valuable source of information, and it forms a foundation for diagnosis, prevention and therapeutic management. However, understanding even a perfect transcript of spoken dialogue is challenging for humans because of the lack of structure and the verbosity of dialogues. This work presents a first step towards automatic analysis of spoken medical dialogue. The backbone of our approach is an abstraction of a dialogue into a sequence of semantic categories. This abstraction uncovers structure in informal, verbose conversation between a caregiver and a patient, thereby facilitating automatic processing of dialogue content. Our method induces this structure based on a range of linguistic and contextual features that are integrated in a supervised machine-learning framework. Our model has a classification accuracy of 73%, compared to 33% achieved by a majority baseline (p<0.01). This work demonstrates the feasibility of automatically processing spoken medical dialogue.

Redesigning care at the Flinders Medical Centre: clinical process redesign using "lean thinking".

PubMed

Ben-Tovim, David I; Bassham, Jane E; Bennett, Denise M; Dougherty, Melissa L; Martin, Margaret A; O'Neill, Susan J; Sincock, Jackie L; Szwarcbord, Michael G

2008-03-17

*The Flinders Medical Centre (FMC) Redesigning Care program began in November 2003; it is a hospital-wide process improvement program applying an approach called "lean thinking" (developed in the manufacturing sector) to health care. *To date, the FMC has involved hundreds of staff from all areas of the hospital in a wide variety of process redesign activities. *The initial focus of the program was on improving the flow of patients through the emergency department, but the program quickly spread to involve the redesign of managing medical and surgical patients throughout the hospital, and to improving major support services. *The program has fallen into three main phases, each of which is described in this article: "getting the knowledge"; "stabilising high-volume flows"; and "standardising and sustaining". *Results to date show that the Redesigning Care program has enabled the hospital to provide safer and more accessible care during a period of growth in demand.

ISO 15189 accreditation: Requirements for quality and competence of medical laboratories, experience of a laboratory I.

PubMed

Guzel, Omer; Guner, Ebru Ilhan

2009-03-01

Medical laboratories are the key partners in patient safety. Laboratory results influence 70% of medical diagnoses. Quality of laboratory service is the major factor which directly affects the quality of health care. The clinical laboratory as a whole has to provide the best patient care promoting excellence. International Standard ISO 15189, based upon ISO 17025 and ISO 9001 standards, provides requirements for competence and quality of medical laboratories. Accredited medical laboratories enhance credibility and competency of their testing services. Our group of laboratories, one of the leading institutions in the area, had previous experience with ISO 9001 and ISO 17025 Accreditation at non-medical sections. We started to prepared for ISO 15189 Accreditation at the beginning of 2006 and were certified in March, 2007. We spent more than a year to prepare for accreditation. Accreditation scopes of our laboratory were as follows: clinical chemistry, hematology, immunology, allergology, microbiology, parasitology, molecular biology of infection serology and transfusion medicine. The total number of accredited tests is 531. We participate in five different PT programs. Inter Laboratory Comparison (ILC) protocols are performed with reputable laboratories. 82 different PT Program modules, 277 cycles per year for 451 tests and 72 ILC program organizations for remaining tests have been performed. Our laboratory also organizes a PT program for flow cytometry. 22 laboratories participate in this program, 2 cycles per year. Our laboratory has had its own custom made WEB based LIS system since 2001. We serve more than 500 customers on a real time basis. Our quality management system is also documented and processed electronically, Document Management System (DMS), via our intranet. Preparatory phase for accreditation, data management, external quality control programs, personnel related issues before, during and after accreditation process are presented. Every laboratory has to concentrate on patient safety issues related to laboratory testing and should perform quality improvement projects.

Chronic disease management for depression in US medical practices: results from the Health Tracking Physician Survey.

PubMed

Zafar, Waleed; Mojtabai, Ramin

2011-07-01

Chronic care model (CCM) envisages a multicomponent systematic remodeling of ambulatory care to improve chronic diseases management. Application of CCM in primary care management of depression has traditionally lagged behind the application of this model in management of other common chronic illnesses. In past research, the use of CCM has been operationalized by measuring the use of evidence-based organized care management processes (CMPs). To compare the use of CMPs in treatment of depression with the use of these processes in treatment of diabetes and asthma and to examine practice-level correlates of this use. Using data from the 2008 Health Tracking Physician Survey, a nationally representative sample of physicians in the United States, we compared the use of 5 different CMPs: written guidelines in English and other languages for self-management, availability of staff to educate patients about self-management, availability of nurse care managers for care coordination, and group meetings of patients with staff. We further examined the association of practice-level characteristics with the use of the 5 CMPs for management of depression. CMPs were more commonly used for management of diabetes and asthma than for depression. The use of CMPs for depression was more common in health maintenance organizations [adjusted odds ratios (AOR) ranging from 2.45 to 5.98 for different CMPs], in practices that provided physicians with feedback regarding quality of care to patients (AOR range, 1.42 to 1.69), and in practices with greater use of clinical information technology (AOR range, 1.06 to 1.11). The application of CMPs in management of depression continues to lag behind other common chronic conditions. Feedbacks on quality of care and expanded use of information technology may improve application of CMPs for depression care in general medical settings.

An Evaluation of a Clinical Pharmacy-Directed Intervention on Blood Pressure Control

PubMed Central

Kicklighter, Caroline E.; Nelson, Kent M.; Humphries, Tammy L.; Delate, Thomas

Objective To compare short and long term blood pressure control with clinical pharmacy specialist involvement to traditional physician management. Setting A non-profit health maintenance organization in the United States covering approximately 385,000 lives. Methods This analysis utilized a prospective parallel design. Adult patients with a baseline Blood pressure>140/90 mmHg and receiving at least one antihypertensive medication were eligible for the study. Eligible hypertension management patients at one medical office were referred to the office’s clinical pharmacy specialist (intervention cohort) while at another comparable medical office they received usual physician-directed care (control cohort). The primary outcome measure was achievement of a goal BP (<140/90 mmHg) during a six month follow-up. Medical records were also reviewed approximately 1.5 years post enrollment to assess long-term BP control after clinical pharmacy-managed patients returned to usual care. Multivariate analyses were performed to adjust for baseline cohort differences. Results One hundred-thirteen and 111 subjects in the intervention and control cohorts completed the study, respectively. At the end of the follow-up period, clinical pharmacy-managed subjects were more likely to have achieved goal BP (64.6%) and received a thiazide diuretic (68.1%) compared to control subjects (40.7% and 33.3%, respectively) (adjusted p=0.002 and p<0.001, respectively). The proportion of clinical pharmacy-managed subjects with controlled BP decreased to 22.2% after returning to usual care (p<0.001). Conclusion Clinical pharmacy involvement in hypertension management resulted in increased BP control. Loss of long-term control after discontinuation of clinical pharmacy management supports a change in care processes that prevent patients from being lost to follow-up. PMID:25214896

Health care management of sickness certification tasks: results from two surveys to physicians

PubMed Central

2013-01-01

Background Health care in general and physicians in particular, play an important role in patients’ sickness certification processes. However, a lack of management within health care regarding how sickness certification is carried out has been identified in Sweden. A variety of interventions to increase the quality of sickness certification were introduced by the government and County Councils. Some of these measures were specifically aimed at strengthening health care management of sickness certification; e.g. policy making and management support. The aim was to describe to what extent physicians in different medical specialties had access to a joint policy regarding sickness certification in their clinical settings and experienced management support in carrying out sickness certification. Method A descriptive study, based on data from two cross-sectional questionnaires sent to all physicians in the Stockholm County regarding their sickness certification practice. Criteria for inclusion in this study were working in a clinical setting, being a board-certified specialist, <65 years of age, and having sickness certification consultations at least a few times a year. These criteria were met by 2497 physicians in 2004 and 2204 physicians in 2008. Proportions were calculated regarding access to policy and management support, stratified according to medical specialty. Results The proportions of physicians working in clinical settings with a well-established policy regarding sickness certification were generally low both in 2004 and 2008, but varied greatly between different types of medical specialties (from 6.1% to 46.9%). Also, reports of access to substantial management support regarding sickness certification varied greatly between medical specialties (from 10.5% to 48.8%). More than one third of the physicians reported having no such management support. Conclusions Most physicians did not work in a clinical setting with a well-established policy on sickness certification tasks, nor did they experience substantial support from their manager. The results indicate a need of strengthening health care management of sickness certification tasks in order to better support physicians in these tasks. PMID:23701711

Using Lean methodologies to streamline processing of requests for durable medical equipment and supplies for children with complex conditions.

PubMed

Fields, Elise; Neogi, Smriti; Schoettker, Pamela J; Lail, Jennifer

2017-12-12

An improvement team from the Complex Care Center at our large pediatric medical center participated in a 60-day initiative to use Lean methodologies to standardize their processes, eliminate waste and improve the timely and reliable provision of durable medical equipment and supplies. The team used value stream mapping to identify processes needing improvement. Improvement activities addressed the initial processing of a request, provider signature on the form, returning the form to the sender, and uploading the completed documents to the electronic medical record. Data on lead time (time between receiving a request and sending the completed request to the Health Information Management department) and process time (amount of time the staff worked on the request) were collected via manual pre- and post-time studies. Following implementation of interventions, the median lead time for processing durable medical equipment and supply requests decreased from 50 days to 3 days (p < 0.0001). Median processing time decreased from 14min to 9min (p < 0.0001). The decrease in processing time realized annual cost savings of approximately $11,000. Collaborative leadership and multidisciplinary training in Lean methods allowed the CCC staff to incorporate common sense, standardize practices, and adapt their work environment to improve the timely and reliable provision of equipment and supplies that are essential for their patients. The application of Lean methodologies to processing requests for DME and supplies could also result in a natural spread to other paperwork and requests, thus avoiding delays and potential risk for clinical instability or deterioration. Copyright © 2017 Elsevier Inc. All rights reserved.

Physician practice participation in accountable care organizations: the emergence of the unicorn.

PubMed

Shortell, Stephen M; McClellan, Sean R; Ramsay, Patricia P; Casalino, Lawrence P; Ryan, Andrew M; Copeland, Kennon R

2014-10-01

To provide the first nationally based information on physician practice involvement in ACOs. Primary data from the third National Survey of Physician Organizations (January 2012-May 2013). We conducted a 40-minute phone survey in a sample of physician practices. A nationally representative sample of practices was surveyed in order to provide estimates of organizational characteristics, care management processes, ACO participation, and related variables for four major chronic illnesses. We evaluated the associations between ACO participation, organizational characteristics, and a 25-point index of patient-centered medical home processes. We found that 23.7 percent of physician practices (n = 280) reported joining an ACO; 15.7 percent (n = 186) were planning to become involved within the next 12 months and 60.6 percent (n = 717) reported no involvement and no plans to become involved. Larger practices, those receiving patients from an IPA and/or PHO, those that were physician-owned versus hospital/health system-owned, those located in New England, and those with greater patient-centered medical home (PCMH) care management processes were more likely to have joined an ACO. Physician practices that are currently participating in ACOs appear to be relatively large, or to be members of an IPA or PHO, are less likely to be hospital-owned and are more likely to use more care management processes than nonparticipating practices. © Health Research and Educational Trust.

[Life-style of medical personnel dwelling and working in agroindustrial area].

PubMed

Sorokina, M G; Kamaev, I A

2005-01-01

Results of sociological survey of medical personnel of typical agroindustrial area of Novgorod Oblast are presented. Data of self-registration of acute and chronic diseases and self-appraisal of one's health testify higher morbidity and health deterioration during last 3 years. Analysis of demographic characteristics, life-styles and labor conditions revealed complex of major factors impacting individual health and flow-out of professional medical personnel. Both amount of average monthly wage of physicians and paramedics, levels of their family income and welfare and as well degree of their inconsistence with cost of living of able-bodied population are established. Conditions of living and social maintenance, labor and off-labor activity, attitude to one's own health and spread of risk factors were analyzed. Management weaknesses of district and rural patient care institutions were established, including considerable exceeding of hygienic regulations established for medical personnel working load and higher spread of physical, chemical and biological risk factors of working environment harmful for health. Need in further enhancement of management of working process, occupational safety, labor remuneration and in increasing social safety, hygienic and curative activity of medical personnel is justified.

Medical knowledge discovery and management.

PubMed

Prior, Fred

2009-05-01

Although the volume of medical information is growing rapidly, the ability to rapidly convert this data into "actionable insights" and new medical knowledge is lagging far behind. The first step in the knowledge discovery process is data management and integration, which logically can be accomplished through the application of data warehouse technologies. A key insight that arises from efforts in biosurveillance and the global scope of military medicine is that information must be integrated over both time (longitudinal health records) and space (spatial localization of health-related events). Once data are compiled and integrated it is essential to encode the semantics and relationships among data elements through the use of ontologies and semantic web technologies to convert data into knowledge. Medical images form a special class of health-related information. Traditionally knowledge has been extracted from images by human observation and encoded via controlled terminologies. This approach is rapidly being replaced by quantitative analyses that more reliably support knowledge extraction. The goals of knowledge discovery are the improvement of both the timeliness and accuracy of medical decision making and the identification of new procedures and therapies.

Implementing and integrating a clinically driven electronic medical record for radiation oncology in a large medical enterprise.

PubMed

Kirkpatrick, John P; Light, Kim L; Walker, Robyn M; Georgas, Debra L; Antoine, Phillip A; Clough, Robert W; Cozart, Heidi B; Yin, Fang-Fang; Yoo, Sua; Willett, Christopher G

2013-01-01

While our department is heavily invested in computer-based treatment planning, we historically relied on paper-based charts for management of Radiation Oncology patients. In early 2009, we initiated the process of conversion to an electronic medical record (EMR) eliminating the need for paper charts. Key goals included the ability to readily access information wherever and whenever needed, without compromising safety, treatment quality, confidentiality, or productivity. In February, 2009, we formed a multi-disciplinary team of Radiation Oncology physicians, nurses, therapists, administrators, physicists/dosimetrists, and information technology (IT) specialists, along with staff from the Duke Health System IT department. The team identified all existing processes and associated information/reports, established the framework for the EMR system and generated, tested and implemented specific EMR processes. Two broad classes of information were identified: information which must be readily accessed by anyone in the health system versus that used solely within the Radiation Oncology department. Examples of the former are consultation reports, weekly treatment check notes, and treatment summaries; the latter includes treatment plans, daily therapy records, and quality assurance reports. To manage the former, we utilized the enterprise-wide system, which required an intensive effort to design and implement procedures to export information from Radiation Oncology into that system. To manage "Radiation Oncology" data, we used our existing system (ARIA, Varian Medical Systems.) The ability to access both systems simultaneously from a single workstation (WS) was essential, requiring new WS and modified software. As of January, 2010, all new treatments were managed solely with an EMR. We find that an EMR makes information more widely accessible and does not compromise patient safety, treatment quality, or confidentiality. However, compared to paper charts, time required by clinicians to access/enter patient information has substantially increased. While productivity is improving with experience, substantial growth will require better integration of the system components, decreased access times, and improved user interfaces. $127K was spent on new hardware and software; elimination of paper yields projected savings of $21K/year. One year after conversion to an EMR, more than 90% of department staff favored the EMR over the previous paper charts. Successful implementation of a Radiation Oncology EMR required not only the effort and commitment of all functions of the department, but support from senior health system management, corporate IT, and vendors. Realization of the full benefits of an EMR will require experience, faster/better integrated software, and continual improvement in underlying clinical processes.

Description of inpatient medication management using cognitive work analysis.

PubMed

Pingenot, Alleene Anne; Shanteau, James; Sengstacke, L T C Daniel N

2009-01-01

The purpose of this article was to describe key elements of an inpatient medication system using the cognitive work analysis method of Rasmussen et al (Cognitive Systems Engineering. Wiley Series in Systems Engineering; 1994). The work of nurses and physicians were observed in routine care of inpatients on a medical-surgical unit and attached ICU. Interaction with pharmacists was included. Preoperative, postoperative, and medical care was observed. Personnel were interviewed to obtain information not easily observable during routine work. Communication between healthcare workers was projected onto an abstraction/decomposition hierarchy. Decision ladders and information flow charts were developed. Results suggest that decision making on an inpatient medical/surgical unit or ICU setting is a parallel, distributed process. Personnel are highly mobile and often are working on multiple issues concurrently. In this setting, communication is key to maintaining organization and synchronization for effective care. Implications for research approaches to system and interface designs and decision support for personnel involved in the process are discussed.

Football for life versus antidoping for the masses: ethical antidoping issues and solutions based on the extenuating experiences of an elite footballer competing while undergoing treatment for metastatic testicular cancer.

PubMed

Weiler, Richard; Tombides, Dylan; Urwin, Jon; Clarke, Jane; Verroken, Michele

2014-05-01

It is thankfully rare for extenuating circumstances to fully test the processes and procedures enshrined in national and world antidoping authorities' rules and laws. It is also thankfully very rare that a failed drugs test can have some positive implications. Antidoping laws are undoubtedly focused on ensuring fair competition, however, there are occasions when honest athletes discover medical diagnoses through failed antidoping tests. The purpose of this paper is to broadly discuss antidoping considerations encountered, based on the four principles of medical ethics and to propose simple solutions to these problems. Unfortunately, extreme medical circumstances will often test the limits of antidoping and medical processes and with open channels for feedback, these systems can improve. Performance enhancement seems an illogical concept if an athlete's medical treatment and disease are more inherently performance harming than unintended potential doping, but needs to be carefully managed to maintain fair sport.

Football for life versus antidoping for the masses: ethical antidoping issues and solutions based on the extenuating experiences of an elite footballer competing while undergoing treatment for metastatic testicular cancer

PubMed Central

Weiler, Richard; Tombides, Dylan; Urwin, Jon; Clarke, Jane; Verroken, Michele

2014-01-01

It is thankfully rare for extenuating circumstances to fully test the processes and procedures enshrined in national and world antidoping authorities’ rules and laws. It is also thankfully very rare that a failed drugs test can have some positive implications. Antidoping laws are undoubtedly focused on ensuring fair competition, however, there are occasions when honest athletes discover medical diagnoses through failed antidoping tests. The purpose of this paper is to broadly discuss antidoping considerations encountered, based on the four principles of medical ethics and to propose simple solutions to these problems. Unfortunately, extreme medical circumstances will often test the limits of antidoping and medical processes and with open channels for feedback, these systems can improve. Performance enhancement seems an illogical concept if an athlete’s medical treatment and disease are more inherently performance harming than unintended potential doping, but needs to be carefully managed to maintain fair sport. PMID:24668050

A plea for rational mitigation of poor outcomes in the 'off-label use' of medications for the management of pain.

PubMed

Khursheed, Faraz; Ioffe, Julia; Gould, Harry J

2015-02-15

Neuropathic pain is a common and difficult to manage public health problem characterized by frequent treatment failure and high management costs. The variable presentation and response to treatment among patients make it difficult for physicians to apply a single, standardized approach for management. The physician's role in treating neuropathic pain is complex. Clinical decisions must be drawn from personal and shared experience, case reports, and evidence-based, controlled trials performed on selected populations of patients with common, narrowly-defined conditions. Recent advances in our understanding of the mechanisms that underlie the processing of nociceptive stimuli and the perception of pain have led to the increased 'off-label use' of adjuvant medications in an attempt to provide relief for many patients who heretofore have suffered unnecessarily with intractable neuropathic pain. Unfortunately, as with any treatment, sound clinical decisions can occasionally result in an untoward adverse response. It is therefore imperative that potential adverse effects inherent to all medications be considered and weighed against the untoward consequences of withholding treatment prior to incorporating their use in any course of management. This commentary presents a case report that illustrates a particularly devastating consequence that was encountered when a medication was selected for 'off-label use' in the treatment of intractable pain and presents an opinion for consideration in developing guidelines for determining acceptable risk and standard of care based upon rational adherence or deviation from the approved indications offered for the use of a medication at the time of its introduction into practice is granted. Copyright © 2014 Elsevier B.V. All rights reserved.

Implementation of a reimbursed medication review program: Corporate and pharmacy level strategies.

PubMed

MacKeigan, Linda D; Ijaz, Nadine; Bojarski, Elizabeth A; Dolovich, Lisa

In 2006, the Ontario drug plan greatly reduced community pharmacy reimbursement for generic drugs. In exchange, a fee-for-service medication review program was introduced to help patients better understand their medication therapy and ensure that medications were taken as prescribed. A qualitative study of community pharmacy implementation strategies was undertaken to inform a mixed methods evaluation of the program. To describe strategies used by community pharmacies to implement a government-funded medication review service. Key informant interviews were conducted with pharmacy corporate executives and managers, as well as independent pharmacy owners. All pharmacy corporations in the province were approached; owners were purposively sampled from the registry of the pharmacist licensing body to obtain diversity in pharmacy attributes; and pharmacy managers were identified through a mix of snowball and registry sampling. Thematic qualitative coding and analysis were applied to interview transcripts. 42 key informants, including 14 executives, 15 managers/franchisees, and 11 owners, participated. The most common implementation strategy was software adaptation to flag eligible patients and to document the service. Human resource management (task shifting to technicians and increasing the technician complement), staff training, and patient identification and recruitment processes were widely mentioned. Motivational strategies including service targets and financial incentives were less frequent but controversial. Strategies typically unfolded over time, and became multifaceted. Apart from the use of targets in chain pharmacies only, strategies were similar across pharmacy ownership types. Ontario community pharmacies appeared to have done little preplanning of implementation strategies. Strategies focused on service efficiency and quantity, rather than quality. Unlike other jurisdictions, many managers supported the use of targets as motivators, and very few reported feeling pressured. This detailed account of a range of implementation strategies may be of practical value to community pharmacy decision makers. Copyright © 2017 Elsevier Inc. All rights reserved.

Medical Decision-Making Among Adolescents with Neonatal Brachial Plexus Palsy and their Families: A Qualitative Study

PubMed Central

Squitieri, Lee; Larson, Bradley P.; Chang, Kate W-C; Yang, Lynda J-S.; Chung, Kevin C.

2016-01-01

Background Elective surgical management of neonatal brachial plexus palsy is complex, variable, and often individualized. Little is known about the medical decision-making process among adolescents with NBPP and their families faced with making complex treatment decisions. The experiences of these patients and their parents were analyzed to identify key factors in the decision-making process. Patients and Methods Eighteen adolescents with residual NBPP deficits between the ages of 10 to 17 years along with their parents were included in the present study. A qualitative research design was employed involving the use of separate one hour, in person, semi-structured interviews, which were audio recorded and transcribed. Grounded theory was applied by two independent members of the research team to identify recurrent themes and ultimately create a codebook that was then applied to the data. Results Medical decision-making among adolescents with NBPP and their families is multifaceted and individualized, comprised of both patient and system dependent factors. Four codes pertaining to the medical decision-making process were identified: 1) knowledge acquisition, 2) multidisciplinary care, 3) adolescent autonomy, and 4) patient expectations and treatment desires. Overall, parental decision-making was heavily influenced by system dependent factors, while adolescents largely based their medical decision-making on individual treatment desires to improve function and/or aesthetics. Conclusions There are many areas for improving the delivery of information and health care organization among adolescents with NBPP and their families. We recommend the development of educational interdisciplinary programs and decision aids containing evidence-based management guidelines targeted toward primary care providers and patients. We believe that a computer-based learning module may provide the best avenue to achieve maximum penetrance and convenience of information sharing. PMID:23714810

Intractable Headache - The Pain in Your Head that Just Won't Quit

MedlinePlus

... into those things you can control (medications, life-style, triggers) and systematically work through the process of ... for Acute Migraine Headache ABC’s of Headache Trigger Management Abdominal Migraine Migraine Triggers Hypnic Headache Retinal Migraine ...

Recommendations for the nutrition management of phenylalanine hydroxylase deficiency

PubMed Central

Singh, Rani H.; Rohr, Fran; Frazier, Dianne; Cunningham, Amy; Mofidi, Shideh; Ogata, Beth; Splett, Patricia L.; Moseley, Kathryn; Huntington, Kathleen; Acosta, Phyllis B.; Vockley, Jerry; Van Calcar, Sandra C.

2014-01-01

The effectiveness of a phenylalanine-restricted diet to improve the outcome of individuals with phenylalanine hydroxylase deficiency (OMIM no. 261600) has been recognized since the first patients were treated 60 years ago. However, the treatment regime is complex, costly, and often difficult to maintain for the long term. Improvements and refinements in the diet for phenylalanine hydroxylase deficiency have been made over the years, and adjunctive therapies have proven to be successful for certain patients. Yet evidence-based guidelines for managing phenylalanine hydroxylase deficiency, optimizing outcomes, and addressing all available therapies are lacking. Thus, recommendations for nutrition management were developed using evidence from peer-reviewed publications, gray literature, and consensus surveys. The areas investigated included choice of appropriate medical foods, integration of adjunctive therapies, treatment during pregnancy, monitoring of nutritional and clinical markers, prevention of nutrient deficiencies, providing of access to care, and compliance strategies. This process has not only provided assessment and refinement of current nutrition management and monitoring recommendations but also charted a direction for future studies. This document serves as a companion to the concurrently published American College of Medical Genetics and Genomics guideline for the medical treatment of phenylalanine hydroxylase deficiency. Genet Med 16 2, 121–131. PMID:24385075

[Theoretical grounds of a structural and functional model for quality assurance of radiation diagnostics under conditions of development of the modern health care system in Ukraine].

PubMed

Korop, Oleg A; Lenskykh, Sergiy V

2018-01-01

Introduction: Modern changes in the health care system of Ukraine are focused on financial support in providing medical and diagnostic care to the population and are based on deep and consistent structural and functional transformations. They are aimed at providing adequate quality care, which is the main target function and a principal criterion for operation of health care system. The urgency of this problem is increasing in the context of reforming the health care system and global changes in the governmental financial guarantees for the provision of medical services to the population. The aim of the work is to provide theoretical grounds for a structural and functional model of quality assurance of radiation diagnostics at all levels of medical care given to the population under the current health care reform in Ukraine. Materials and methods: The object of the study is organizing the operation of the radiation diagnostic service; the information is based on the actual data on the characteristics of radiation diagnosis at different levels of medical care provision. Methods of systematic approach, system analysis and structural and functional analysis of the operating system of radiation diagnostics are used. Review: The basis of the quality assurance model is the cyclical process, which includes the stages of the problem identifition, planning of its solution, organization of the system for implementation of decisions, monitoring the quality management process of the radiation diagnostics, and factors influencing the quality of the radiation diagnostics service. These factors include the quality of the structure, process, results, organization of management and control of current processes and the results of radiation diagnostics management. Conclusions: The advantages of the proposed model for ensuring the quality of the radiation diagnostics service are its systemacy and complexity, elimination of identified defects and deficiencies, and achievement of profitability through modern redistribution and use of existing resources of the health care system. The results of adequate service quality management activities in radiation diagnostics are the improvement of organizational and economic principles along with legislative regulation, the implementation of a modern system of radiation diagnostics in the state health care at the national and regional levels, the increase of the accessibility, quality and efficiency of the radiation diagnostics service.

Principles and process in the development of the Mayo Clinic's individual and institutional conflict of interest policy.

PubMed

Camilleri, Michael; Gamble, Gail L; Kopecky, Stephen L; Wood, Michael B; Hockema, Marianne L

2005-10-01

In 1995, federal regulations required all academic medical centers to implement policies to manage individual financial conflict of interest. At the Mayo Clinic, all staff are salaried, and all medically related intellectual property from the staff belongs to the clinic. Hence, it was necessary to develop a policy for institutional conflict of interest to complement the policy for individual conflicts of interest. This article addresses the principles and process that led to the development of the Mayo Clinic's policies that guide the management of conflict of interest of individuals and of the institution. Empowered by the Bayh-Dole Act, the Mayo Clinic participates in technology transfer through its entity Mayo Medical Ventures. Individual conflicts of interest arising from such technology transfer are associated with Institutional conflicts because all individual intellectual property belongs to the institution, per clinic policy. This policy addresses conflicts of interest that arise in research, leadership, clinical practice, investments, and purchasing. Associated with the statutory annual disclosure on personal consulting and other relationships with Industry, which are guided by federal regulations, all research protocols or grant applications require financial disclosure on initial submission and in annual progress reports. The clinic's Conflict of Interest Review Board was established to review each disclosure and recommend management of individual and institutional conflicts of interest according to policy.

Automatic Data Processing Equipment (ADPE) acquisition plan for the medical sciences

NASA Technical Reports Server (NTRS)

1979-01-01

An effective mechanism for meeting the SLSD/MSD data handling/processing requirements for Shuttle is discussed. The ability to meet these requirements depends upon the availability of a general purpose high speed digital computer system. This system is expected to implement those data base management and processing functions required across all SLSD/MSD programs during training, laboratory operations/analysis, simulations, mission operations, and post mission analysis/reporting.

Chief medical clinic manager of a university OB/GYN clinic--an innovative job description as management response for increase of profitability, quality of care, and physicians' freedom of action.

PubMed

Jacobs, Volker R; Mallmann, Peter

2010-01-01

Leadership structures in German clinics are adjusting parallel to DRG (diagnose-related groups)-induced economic reorientation of the health care system. A Chief Medical Clinic Manager (CMCM) is a new job description and an innovative approach to combine medical competence and business economics at the operational level of care. The ideal qualification is a medical specialist in the clinical field with practical experience in patient care and leadership as well as in hospital economics and quality control. A CMCM is placed at a superior level in the clinic, with authorizing competence for the entire physician team. Main tasks are cost transparency within the clinic, organizational development by structured processes, and financial and strategic controlling of all business aspects. A CMCM induces change management and financial adjustment of care to reimbursement with maintaining the standard of care. In cooperation with the director of the clinic, a CMCM develops a vision for clinic development, an investment strategy, and a business plan. The success parameters are positive operative results of the clinic, cost-covering care, increased investment rate, employee satisfaction, and implementation of innovations in research and therapy. A CMCM thereby increases financial and organizational freedom of action at the clinic level in a non-profit public health care system.

[Case management process identified from experience of nurse case managers].

PubMed

Park, Eun-Jun; Kim, Chunmi

2008-12-01

The purpose of this study was to develop a substantive theory of case management (CM) practice by investigating the experience of nurse case managers caring for Medical Aid enrollees in Korea. A total of 12 nurses were interviewed regarding their own experience in CM practice. Data were recorded and analyzed using grounded theory. Empowerment was the core category of CM for Medical Aid enrollees. The case managers engaged in five phases as follows, phase of inquiring in advance, building a relationship with the client, giving the client critical mind, facilitating positive changes in the client's use of healthcare services, and maintaining relationship bonds. These phases moved gradually and were circular if necessary. Also, they were accelerated or slowed depending on factors including clients' characteristics, case managers' competency level, families' support level, and availability of community resources. This study helps understand what CM practice is and how nurses are performing this innovative CM role. It is recommended that nurse leaders and policy makers integrate empowerment as a core category and the five critical CM phases into future CM programs.

A concept ideation framework for medical device design.

PubMed

Hagedorn, Thomas J; Grosse, Ian R; Krishnamurty, Sundar

2015-06-01

Medical device design is a challenging process, often requiring collaboration between medical and engineering domain experts. This collaboration can be best institutionalized through systematic knowledge transfer between the two domains coupled with effective knowledge management throughout the design innovation process. Toward this goal, we present the development of a semantic framework for medical device design that unifies a large medical ontology with detailed engineering functional models along with the repository of design innovation information contained in the US Patent Database. As part of our development, existing medical, engineering, and patent document ontologies were modified and interlinked to create a comprehensive medical device innovation and design tool with appropriate properties and semantic relations to facilitate knowledge capture, enrich existing knowledge, and enable effective knowledge reuse for different scenarios. The result is a Concept Ideation Framework for Medical Device Design (CIFMeDD). Key features of the resulting framework include function-based searching and automated inter-domain reasoning to uniquely enable identification of functionally similar procedures, tools, and inventions from multiple domains based on simple semantic searches. The significance and usefulness of the resulting framework for aiding in conceptual design and innovation in the medical realm are explored via two case studies examining medical device design problems. Copyright © 2015 Elsevier Inc. All rights reserved.

[Design and application of implantable medical device information management system].

PubMed

Cao, Shaoping; Yin, Chunguang; Zhao, Zhenying

2013-03-01

Through the establishment of implantable medical device information management system, with the aid of the regional joint sharing of resources, we further enhance the implantable medical device traceability management level, strengthen quality management, control of medical risk.

Laying the Groundwork for Enterprise-Wide Medical Language Processing Services: Architecture and Process

PubMed Central

Chen, Elizabeth S.; Maloney, Francine L.; Shilmayster, Eugene; Goldberg, Howard S.

2009-01-01

A systematic and standard process for capturing information within free-text clinical documents could facilitate opportunities for improving quality and safety of patient care, enhancing decision support, and advancing data warehousing across an enterprise setting. At Partners HealthCare System, the Medical Language Processing (MLP) services project was initiated to establish a component-based architectural model and processes to facilitate putting MLP functionality into production for enterprise consumption, promote sharing of components, and encourage reuse. Key objectives included exploring the use of an open-source framework called the Unstructured Information Management Architecture (UIMA) and leveraging existing MLP-related efforts, terminology, and document standards. This paper describes early experiences in defining the infrastructure and standards for extracting, encoding, and structuring clinical observations from a variety of clinical documents to serve enterprise-wide needs. PMID:20351830

Laying the groundwork for enterprise-wide medical language processing services: architecture and process.

PubMed

Chen, Elizabeth S; Maloney, Francine L; Shilmayster, Eugene; Goldberg, Howard S

2009-11-14

A systematic and standard process for capturing information within free-text clinical documents could facilitate opportunities for improving quality and safety of patient care, enhancing decision support, and advancing data warehousing across an enterprise setting. At Partners HealthCare System, the Medical Language Processing (MLP) services project was initiated to establish a component-based architectural model and processes to facilitate putting MLP functionality into production for enterprise consumption, promote sharing of components, and encourage reuse. Key objectives included exploring the use of an open-source framework called the Unstructured Information Management Architecture (UIMA) and leveraging existing MLP-related efforts, terminology, and document standards. This paper describes early experiences in defining the infrastructure and standards for extracting, encoding, and structuring clinical observations from a variety of clinical documents to serve enterprise-wide needs.

Information broker: a useless overhead or a necessity

NASA Astrophysics Data System (ADS)

Maitan, Jacek

1996-01-01

The richness and diversity of information available over the Internet, its size, convenience of access, and its dynamic growth will create new ways to offer better education opportunities in medicine. The Internet will especially benefit medical training process that is expensive and requires continuous updating. The use of the Internet will lower the delivery cost and make medical information available to all potential users. On the other hand, since medical information must be trusted and new policies must be developed to support these capabilities, technologies alone are not enough. In general, we must deal with issues of liability, remuneration for educational and professional services, and general issues of ethics associated with patient-physician relationship in a complicated environment created by a mix of managed and private care combined with modern information technology. In this paper we will focus only on the need to create, to manage and to operate open system over the Internet, or similar low-cost and easy access networks, for the purpose of medical education process. Finally, using business analysis, we argue why the medical education infrastructure needs an information broker, a third party organization that will help the users to access the information and the publishers to display their titles. The first section outlines recent trends in medical education. In the second section, we discuss transfusion medicine requirements. In the third section we provide a summary of the American Red Cross (ARC) transfusion audit system; we discuss the relevance of the assumptions used in this system to other areas of medicine. In the fourth section we describe the overall system architecture and discuss key components. The fifth section covers business issues associated with medical education systems and with the potential role of ARC in particular. The last section provides a summary of findings.

The use of failure mode and effects analysis to construct an effective disposal and prevention mechanism for infectious hospital waste

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ho, Chao Chung, E-mail: ho919@pchome.com.tw; Liao, Ching-Jong

Highlights: > This study is based on a real case in a regional teaching hospital in Taiwan. > We use Failure mode and effects analysis (FMEA) as the evaluation method. > We successfully identify the risk factors of infectious waste disposal. > We propose plans for the detection of exceptional cases of infectious waste. - Abstract: In recent times, the quality of medical care has been continuously improving in medical institutions wherein patient-centred care has been emphasized. Failure mode and effects analysis (FMEA) has also been promoted as a method of basic risk management and as part of total qualitymore » management (TQM) for improving the quality of medical care and preventing mistakes. Therefore, a study was conducted using FMEA to evaluate the potential risk causes in the process of infectious medical waste disposal, devise standard procedures concerning the waste, and propose feasible plans for facilitating the detection of exceptional cases of infectious waste. The analysis revealed the following results regarding medical institutions: (a) FMEA can be used to identify the risk factors of infectious waste disposal. (b) During the infectious waste disposal process, six items were scored over 100 in the assessment of uncontrolled risks: erroneous discarding of infectious waste by patients and their families, erroneous discarding by nursing staff, erroneous discarding by medical staff, cleaning drivers pierced by sharp articles, cleaning staff pierced by sharp articles, and unmarked output units. Therefore, the study concluded that it was necessary to (1) provide education and training about waste classification to the medical staff, patients and their families, nursing staff, and cleaning staff; (2) clarify the signs of caution; and (3) evaluate the failure mode and strengthen the effects.« less

Enabling System Management through Process Modeling: The Australian Defence Force Recruiting System

DTIC Science & Technology

2006-09-01

or ongoing treatment in the form of medication or support from specialists such as physiotherapy . In fact, in an average work week, there are...289,038 patient consultations with physiotherapists.77 It is logical to extrapolate that this high incidence of medication and physiotherapy treatments... Physiotherapy Services,” Australian Bureau of Statistics, August 31, 1999, 4. 78 Cooper-Stanbury, Mark “Risk Factors: That’s Life,” presentation at

Medicare Disease Management in Policy Context

PubMed Central

Linden, Ariel; Adler-Milstein, Julia

2008-01-01

Interim results of the Medicare health support (MHS) demonstration projects suggest that commercial disease management (DM) is unable to deliver short-term medical cost savings. This is not surprising given the current DM program focus on compliance with process measures that may only lead to cost savings in the long term. A program focused on reducing near-term hospitalizations is more likely to deliver savings during the initial 3-year phase of MHS. If the early trends in MHS are indicative of the final results, CMS will face the decision of whether to abandon commercial DM in favor of other chronic care management strategies. This article supports the upcoming assessment by describing the characteristics of the current commercial DM model that limit its ability to deliver short-term medical cost savings and the changes required to overcome these limitations. PMID:18567239

[Design of an anesthesia and micro-environment information management system in mobile operating room].

PubMed

Wang, Xianwen; Liu, Zhiguo; Zhang, Wenchang; Wu, Qingfu; Tan, Shulin

2013-08-01

We have designed a mobile operating room information management system. The system is composed of a client and a server. A client, consisting of a PC, medical equipments, PLC and sensors, provides the acquisition and processing of anesthesia and micro-environment data. A server is a powerful computer that stores the data of the system. The client gathers the medical device data by using the C/S mode, and analyzes the obtained HL7 messages through the class library call. The client collects the micro-environment information with PLC, and finishes the data reading with the OPC technology. Experiment results showed that the designed system could manage the patient anesthesia and micro-environment information well, and improve the efficiency of the doctors' works and the digital level of the mobile operating room.

Factors associated with skipping breakfast among Inner Mongolia medical students in China.

PubMed

Sun, Juan; Yi, He; Liu, Zhiyue; Wu, Yan; Bian, Jiang; Wu, Yanyan; Eshita, Yuki; Li, Gaimei; Zhang, Qing; Yang, Ying

2013-01-17

Few studies on the breakfast consumption habits of medical students in China have been carried out. The aim of the present study was to determine the prevalence of skipping breakfast and factors associated with skipping breakfast among medical students in Inner Mongolia of China, and to assist in the design of interventions to improve breakfast consumption habits of medical college students in this region. From December 2010 to January 2011 a cross-sectional survey was conducted among medical students in the Inner Mongolia Medical College using a self-administered questionnaire. The prevalence of skipping breakfast in relation to lifestyle habits was described and factors associated with breakfast consumption were identified using multiple logistic regression analysis. The overall prevalence of skipping breakfast was 41.7% and 23.5% for males and females, respectively. The Faculty of Medicine Information Management had the highest breakfast skipping prevalence. Logistic regression models found that the main factors associated with breakfast consumption habits among medical students were gender, class years of education, monthly expenses, faculty, appetite, sleeping quality, and the learning process; monthly expenses, sleeping quality, and the learning process showed a dose-dependent relationship. Breakfast consumption was associated with many factors, most importantly monthly expenses, sleeping quality and the learning process. The prevalence of skipping breakfast is significantly higher compared recently reported figures for medical students in western countries and other areas of China. Improvement of breakfast education should be considered for students in which higher monthly expenses, poor sleeping quality, or a laborious learning process have been identified.

The clinical information system GastroBase: integration of image processing and laboratory communication.

PubMed

Kocna, P

1995-01-01

GastroBase, a clinical information system, incorporates patient identification, medical records, images, laboratory data, patient history, physical examination, and other patient-related information. Program modules are written in C; all data is processed using Novell-Btrieve data manager. Patient identification database represents the main core of this information systems. A graphic library developed in the past year and graphic modules with a special video-card enables the storing, archiving, and linking of different images to the electronic patient-medical-record. GastroBase has been running for more than four years in daily routine and the database contains more than 25,000 medical records and 1,500 images. This new version of GastroBase is now incorporated into the clinical information system of University Clinic in Prague.

Natural language processing: an introduction.

PubMed

Nadkarni, Prakash M; Ohno-Machado, Lucila; Chapman, Wendy W

2011-01-01

To provide an overview and tutorial of natural language processing (NLP) and modern NLP-system design. This tutorial targets the medical informatics generalist who has limited acquaintance with the principles behind NLP and/or limited knowledge of the current state of the art. We describe the historical evolution of NLP, and summarize common NLP sub-problems in this extensive field. We then provide a synopsis of selected highlights of medical NLP efforts. After providing a brief description of common machine-learning approaches that are being used for diverse NLP sub-problems, we discuss how modern NLP architectures are designed, with a summary of the Apache Foundation's Unstructured Information Management Architecture. We finally consider possible future directions for NLP, and reflect on the possible impact of IBM Watson on the medical field.

Natural language processing: an introduction

PubMed Central

Ohno-Machado, Lucila; Chapman, Wendy W

2011-01-01

Objectives To provide an overview and tutorial of natural language processing (NLP) and modern NLP-system design. Target audience This tutorial targets the medical informatics generalist who has limited acquaintance with the principles behind NLP and/or limited knowledge of the current state of the art. Scope We describe the historical evolution of NLP, and summarize common NLP sub-problems in this extensive field. We then provide a synopsis of selected highlights of medical NLP efforts. After providing a brief description of common machine-learning approaches that are being used for diverse NLP sub-problems, we discuss how modern NLP architectures are designed, with a summary of the Apache Foundation's Unstructured Information Management Architecture. We finally consider possible future directions for NLP, and reflect on the possible impact of IBM Watson on the medical field. PMID:21846786

The medication reconciliation process and classification of discrepancies: a systematic review.

PubMed

Almanasreh, Enas; Moles, Rebekah; Chen, Timothy F

2016-09-01

Medication reconciliation is a part of the medication management process and facilitates improved patient safety during care transitions. The aims of the study were to evaluate how medication reconciliation has been conducted and how medication discrepancies have been classified. We searched MEDLINE, EMBASE, CINAHL, PubMed, International Pharmaceutical Abstracts (IPA), and Web of Science (WOS), in accordance with the PRISMA statement up to April 2016. Studies were eligible for inclusion if they evaluated the types of medication discrepancy found through the medication reconciliation process and contained a classification system for discrepancies. Data were extracted by one author based on a predefined table, and 10% of included studies were verified by two authors. Ninety-five studies met the inclusion criteria. Approximately one-third of included studies (n = 35, 36.8%) utilized a 'gold' standard medication list. The majority of studies (n = 57, 60%) used an empirical classification system and the number of classification terms ranged from 2 to 50 terms. Whilst we identified three taxonomies, only eight studies utilized these tools to categorize discrepancies, and 11.6% of included studies used different patient safety related terms rather than discrepancy to describe the disagreement between the medication lists. We suggest that clear and consistent information on prevalence, types, causes and contributory factors of medication discrepancy are required to develop suitable strategies to reduce the risk of adverse consequences on patient safety. Therefore, to obtain that information, we need a well-designed taxonomy to be able to accurately measure, report and classify medication discrepancies in clinical practice. © 2016 The British Pharmacological Society.

[Research of regional medical consumables reagent logistics system in the modern hospital].

PubMed

Wu, Jingjiong; Zhang, Yanwen; Luo, Xiaochen; Zhang, Qing; Zhu, Jianxin

2013-09-01

To explore the modern hospital and regional medical consumable reagents logistics system management. The characteristics of regional logistics, through cooperation between medical institutions within the region, and organize a wide range of special logistics activities, to make reasonable of the regional medical consumable reagents logistics. To set the regional management system, dynamic management systems, supply chain information management system, after-sales service system and assessment system. By the research of existing medical market and medical resources, to establish the regional medical supplies reagents directory and the initial data. The emphasis is centralized dispatch of medical supplies reagents, to introduce qualified logistics company for dispatching, to improve the modern hospital management efficiency, to costs down. Regional medical center and regional community health service centers constitute a regional logistics network, the introduction of medical consumable reagents logistics services, fully embodies integrity level, relevance, purpose, environmental adaptability of characteristics by the medical consumable reagents regional logistics distribution. Modern logistics distribution systems can increase the area of medical consumables reagent management efficiency and reduce costs.

Relationship between quality improvement processes and clinical performance.

PubMed

Damberg, Cheryl L; Shortell, Stephen M; Raube, Kristiana; Gillies, Robin R; Rittenhouse, Diane; McCurdy, Rodney K; Casalino, Lawrence P; Adams, John

2010-08-01

To examine the association between performance on clinical process measures and intermediate outcomes and the use of chronic care management processes (CMPs), electronic medical record (EMR) capabilities, and participation in external quality improvement (QI) initiatives. Cross-sectional analysis of linked 2006 clinical performance scores from the Integrated Healthcare Association's pay-for-performance program and survey data from the 2nd National Study of Physician Organizations among 108 California physician organizations (POs). Controlling for differences in PO size, organization type (medical group or independent practice association), and Medicaid revenue, we used ordinary least squares regression analysis to examine the association between the use of CMPs, EMR capabilities, and external QI initiatives and performance on the following 3 clinical composite measures: diabetes management, processes of care, and intermediate outcomes (diabetes and cardiovascular). Greater use of CMPs was significantly associated with clinical performance: among POs using more than 5 CMPs, we observed a 3.2-point higher diabetes management score on a performance scale with scores ranging from 0 to 100 (P <.001), while for each 1.0-point increase on the CMP index, we observed a 1.0-point gain in intermediate outcomes (P <.001). Participation in external QI initiatives was positively associated with improved delivery of clinical processes of care: a 1.0-point increase on the QI index translated into a 1.4-point gain in processes-of-care performance (P = .02). No relationship was observed between EMR capabilities and performance. Greater investments in CMPs and QI interventions may help POs raise clinical performance and achieve success under performance-based accountability schemes.

Lean techniques for the improvement of patients’ flow in emergency department

PubMed Central

Chan, HY; Lo, SM; Lee, LLY; Lo, WYL; Yu, WC; Wu, YF; Ho, ST; Yeung, RSD; Chan, JTS

2014-01-01

BACKGROUND: Emergency departments (EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called “lean” management. This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to modify the existing process. METHODS: It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage (PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T (hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared. RESULTS: Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed (38.24 minutes; SD 66.35) and blood testing result (mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward (EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program (P<0.05). CONCLUSION: The application of lean management can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction. PMID:25215143

How children and young people construct and negotiate living with medical technology.

PubMed

Kirk, Susan

2010-11-01

Increasing numbers of children need the support of medical technology for their survival and wellbeing, yet little is known about their experiences of living technology-assisted lives. This study aimed to explore how this group of children experience and construct medical technology and its influence on their identity and social relationships. Using a Grounded Theory approach, 28 children/young people aged between 8 and 19 years old and using different types of medical devices were recruited via nursing services in England. Data were collected by in-depth interviews conducted in children's homes. The medical technology occupied an ambivalent position in children's lives being seen as having both an enabling and disabling presence. Children actively engaged in work to incorporate the technology into their lives and bodies by developing strategies to manage their condition, the technology and their identities. This body work appeared to be driven by a desire to 'normalise' their bodies and their lives. Technologies were shaped to integrate them into everyday life and children managed their self-presentation and controlled information about their condition. This work was ongoing, responding to changing social contexts and relationships. For these children the process of 'growing up' involves incorporating disability, illness and technology. This study contributes to knowledge by examining how medical technology is constructed by children whose lives are dependent on it and illuminating the resources and strategies they use to manage their identity and negotiate peer culture interactions and norms. Copyright © 2010 Elsevier Ltd. All rights reserved.

Medication therapy management and complex patients with disability: a randomized controlled trial.

PubMed

Chrischilles, Elizabeth A; Doucette, William; Farris, Karen; Lindgren, Scott; Gryzlak, Brian; Rubenstein, Linda; Youland, Kelly; Wallace, Robert B

2014-02-01

Drug therapy problems, adverse drug events (ADEs), and symptom burden are high among adults with disabilities. To compare the effects of a modified medication therapy management (MTM) program within a self-efficacy workshop versus the workshop alone or usual care on symptom burden among adults with activity limitations. Three-group randomized controlled trial among adults (age 40 and older) with self-reported activity limitations in community practice. 8 weekly Living Well With a Disability (LWD) 2-hour workshop sessions with and without a collaborative medication management (CMM) module. mean number of moderate to very severe symptoms from a list of 11 physical and mental symptoms. Process measures: changes in medication regimens and self-reported ADEs. general linear mixed models (continuous outcomes) and generalized estimating equations (categorical outcomes). Participants had high symptom burden, low physical health, and took many medications. There was a significant increase in ADE reporting in the LWD + CMM group relative to the other 2 groups (Study group × Time P = .014), and there were significantly more changes in medication regimens in the LWD + CMM group (P = .013 LWD only vs LWD + CMM). The oldest third of participants had significantly fewer mean symptoms but received more intense CMM. There was no difference between the LWD-only, LWD + CMM, and usual care groups in symptom burden over time. Pharmacist MTM practices and MTM guidelines may need to be modified to affect symptom burden in a population with physical activity limitations.

Medical Trainees’ Experiences of Treating People With Chronic Pain: A Lost Opportunity for Medical Education

PubMed Central

Rice, Kathleen; Ryu, Jae Eun; Whitehead, Cynthia; Katz, Joel

2018-01-01

Purpose Evidence suggests that physicians’ opinions about patients with chronic pain become progressively negative over the course of medical training, leading to decline in empathy for these patients. Few qualitative studies have focused on this issue, and thus the experiences shaping this process remain unexplored. This study addressed how medical trainees learn about chronic pain management through informal and formal curricula. Method This study adopted a constructive qualitative approach informed by the theoretical lens of the hidden curriculum. Thirteen open-ended interviews were conducted with medical students and residents at various training stages; interviewees had experience treating patients with chronic pain, shadowing the care of these patients, or both. Interviews elicited information about stage of medical training, general descriptions of work, and concrete experiences of managing patients with chronic pain. All interviews were collected in Toronto between June and August 2015. Results Most interviewees described the management of chronic pain as challenging and unrewarding and attributed this at least in part to their perception that pain was subjective. Trainees also recounted that their inability to cure chronic pain left them confused about how to provide care, and voiced a perception that preceptors seemed to view these patients as having little educational value. Conclusions Specifically because chronic pain is subjective and incurable, listening and communication become crucial for patient care. Instead of sheltering trainees, medical educators should be offered the opportunity to reflect on the skills that are required to provide patient-centered care for this population. This approach has the potential to greatly benefit both trainees and patients. PMID:29140917

[Monitoring medication errors in personalised dispensing using the Sentinel Surveillance System method].

PubMed

Pérez-Cebrián, M; Font-Noguera, I; Doménech-Moral, L; Bosó-Ribelles, V; Romero-Boyero, P; Poveda-Andrés, J L

2011-01-01

To assess the efficacy of a new quality control strategy based on daily randomised sampling and monitoring a Sentinel Surveillance System (SSS) medication cart, in order to identify medication errors and their origin at different levels of the process. Prospective quality control study with one year follow-up. A SSS medication cart was randomly selected once a week and double-checked before dispensing medication. Medication errors were recorded before it was taken to the relevant hospital ward. Information concerning complaints after receiving medication and 24-hour monitoring were also noted. Type and origin error data were assessed by a Unit Dose Quality Control Group, which proposed relevant improvement measures. Thirty-four SSS carts were assessed, including 5130 medication lines and 9952 dispensed doses, corresponding to 753 patients. Ninety erroneous lines (1.8%) and 142 mistaken doses (1.4%) were identified at the Pharmacy Department. The most frequent error was dose duplication (38%) and its main cause inappropriate management and forgetfulness (69%). Fifty medication complaints (6.6% of patients) were mainly due to new treatment at admission (52%), and 41 (0.8% of all medication lines), did not completely match the prescription (0.6% lines) as recorded by the Pharmacy Department. Thirty-seven (4.9% of patients) medication complaints due to changes at admission and 32 matching errors (0.6% medication lines) were recorded. The main cause also was inappropriate management and forgetfulness (24%). The simultaneous recording of incidences due to complaints and new medication coincided in 33.3%. In addition, 433 (4.3%) of dispensed doses were returned to the Pharmacy Department. After the Unit Dose Quality Control Group conducted their feedback analysis, 64 improvement measures for Pharmacy Department nurses, 37 for pharmacists, and 24 for the hospital ward were introduced. The SSS programme has proven to be useful as a quality control strategy to identify Unit Dose Distribution System errors at initial, intermediate and final stages of the process, improving the involvement of the Pharmacy Department and ward nurses. Copyright © 2009 SEFH. Published by Elsevier Espana. All rights reserved.

MO-C-BRCD-03: The Role of Informatics in Medical Physics and Vice Versa.

PubMed

Andriole, K

2012-06-01

Like Medical Physics, Imaging Informatics encompasses concepts touching every aspect of the imaging chain from image creation, acquisition, management and archival, to image processing, analysis, display and interpretation. The two disciplines are in fact quite complementary, with similar goals to improve the quality of care provided to patients using an evidence-based approach, to assure safety in the clinical and research environments, to facilitate efficiency in the workplace, and to accelerate knowledge discovery. Use-cases describing several areas of informatics activity will be given to illustrate current limitations that would benefit from medical physicist participation, and conversely areas in which informaticists may contribute to the solution. Topics to be discussed include radiation dose monitoring, process management and quality control, display technologies, business analytics techniques, and quantitative imaging. Quantitative imaging is increasingly becoming an essential part of biomedicalresearch as well as being incorporated into clinical diagnostic activities. Referring clinicians are asking for more objective information to be gleaned from the imaging tests that they order so that they may make the best clinical management decisions for their patients. Medical Physicists may be called upon to identify existing issues as well as develop, validate and implement new approaches and technologies to help move the field further toward quantitative imaging methods for the future. Biomedical imaging informatics tools and techniques such as standards, integration, data mining, cloud computing and new systems architectures, ontologies and lexicons, data visualization and navigation tools, and business analytics applications can be used to overcome some of the existing limitations. 1. Describe what is meant by Medical Imaging Informatics and understand why the medical physicist should care. 2. Identify existing limitations in information technologies with respect to Medical Physics, and conversely see how Informatics may assist the medical physicist in filling some of the current gaps in their activities. 3. Understand general informatics concepts and areas of investigation including imaging and workflow standards, systems integration, computing architectures, ontologies, data mining and business analytics, data visualization and human-computer interface tools, and the importance of quantitative imaging for the future of Medical Physics and Imaging Informatics. 4. Become familiar with on-going efforts to address current challenges facing future research into and clinical implementation of quantitative imaging applications. © 2012 American Association of Physicists in Medicine.

The impact of the different payment options on the medical services clients' satisfaction building process

NASA Astrophysics Data System (ADS)

Skowron, Łukasz; Gąsior, Marcin; Sak-Skowron, Monika

2014-12-01

Both the scientific bodies as well as business practitioners over the past few years have concentrated their efforts in the field of marketing and management primarily around the concept of customer, wanting to know more about him/her and trying to understand their behaviour so that their market activities can more easily be influenced and shaped. In today's market, the customer bases the purchase-decision-making process on choosing a good/service that will give him/her the greatest satisfaction, a subjective, positive experience, which is an emotional reaction to the perceived value. Its level is a result of the comparison between the level of expectations arising from past experience, obtained information and promises, and the perception of experienced situation. In the empirical part of the manuscript, the authors present the main differences in the process of building customer satisfaction and loyalty for two groups of patients: those using prepaid medical services and those who pay for their services each time. Reported results refer to research carried out by the authors between August and October 2012 in the city of Warsaw (Poland) with use of the Structural Equation Modeling analysis. The study was conducted via paper surveys, on a sample of 1590 respondents who were the patients of selected medical organizations. The study demonstrated, using two, separate models, that among aforementioned groups of patients, the evaluation of health services proceeds in quite a different way. This indicates significant implications, of marketing and management character in the field of communication and building long-term patient-organization relationships. Medical establishments wanting to manage effectively their relationships with current and potential customers need to understand the nature of the different groups of patients and be able to adjust the scope and form of marketing activities to their different expectations and preferences.

The challenge of ubiquitous computing in health care: technology, concepts and solutions. Findings from the IMIA Yearbook of Medical Informatics 2005.

PubMed

Bott, O J; Ammenwerth, E; Brigl, B; Knaup, P; Lang, E; Pilgram, R; Pfeifer, B; Ruderich, F; Wolff, A C; Haux, R; Kulikowski, C

2005-01-01

To review recent research efforts in the field of ubiquitous computing in health care. To identify current research trends and further challenges for medical informatics. Analysis of the contents of the Yearbook on Medical Informatics 2005 of the International Medical Informatics Association (IMIA). The Yearbook of Medical Informatics 2005 includes 34 original papers selected from 22 peer-reviewed scientific journals related to several distinct research areas: health and clinical management, patient records, health information systems, medical signal processing and biomedical imaging, decision support, knowledge representation and management, education and consumer informatics as well as bioinformatics. A special section on ubiquitous health care systems is devoted to recent developments in the application of ubiquitous computing in health care. Besides additional synoptical reviews of each of the sections the Yearbook includes invited reviews concerning E-Health strategies, primary care informatics and wearable healthcare. Several publications demonstrate the potential of ubiquitous computing to enhance effectiveness of health services delivery and organization. But ubiquitous computing is also a societal challenge, caused by the surrounding but unobtrusive character of this technology. Contributions from nearly all of the established sub-disciplines of medical informatics are demanded to turn the visions of this promising new research field into reality.

Documentation of pain care processes does not accurately reflect pain management delivered in primary care.

PubMed

Krebs, Erin E; Bair, Matthew J; Carey, Timothy S; Weinberger, Morris

2010-03-01

Researchers and quality improvement advocates sometimes use review of chart-documented pain care processes to assess the quality of pain management. Studies have found that primary care providers frequently fail to document pain assessment and management. To assess documentation of pain care processes in an academic primary care clinic and evaluate the validity of this documentation as a measure of pain care delivered. Prospective observational study. 237 adult patients at a university-affiliated internal medicine clinic who reported any pain in the last week. Immediately after a visit, we asked patients to report the pain treatment they received. Patients completed the Brief Pain Inventory (BPI) to assess pain severity at baseline and 1 month later. We extracted documentation of pain care processes from the medical record and used kappa statistics to assess agreement between documentation and patient report of pain treatment. Using multivariable linear regression, we modeled whether documented or patient-reported pain care predicted change in pain at 1 month. Participants' mean age was 53.7 years, 66% were female, and 74% had chronic pain. Physicians documented pain assessment for 83% of visits. Patients reported receiving pain treatment more often (67%) than was documented by physicians (54%). Agreement between documentation and patient report was moderate for receiving a new pain medication (k = 0.50) and slight for receiving pain management advice (k = 0.13). In multivariable models, documentation of new pain treatment was not associated with change in pain (p = 0.134). In contrast, patient-reported receipt of new pain treatment predicted pain improvement (p = 0.005). Chart documentation underestimated pain care delivered, compared with patient report. Documented pain care processes had no relationship with pain outcomes at 1 month, but patient report of receiving care predicted clinically significant improvement. Chart review measures may not accurately reflect the pain management patients receive in primary care.

[Application of information management system about medical equipment].

PubMed

Hang, Jianjin; Zhang, Chaoqun; Wu, Xiang-Yang

2011-05-01

Based on the practice of workflow, information management system about medical equipment was developed and its functions such as gathering, browsing, inquiring and counting were introduced. With dynamic and complete case management of medical equipment, the system improved the management of medical equipment.

The delicate balance of keeping it all together: Using social capital to manage multiple medications for patients on dialysis.

PubMed

Parker, Wendy M; Ferreira, Kristine; Vernon, Lauren; Cardone, Katie E

Patients with end-stage kidney disease (ESKD) typically have high medication burdens with numerous medications and specialized instructions. Limited data exist regarding ESKD patient perspectives on medication management. Why can some patients self-manage? Which organizational techniques are used? This project sought to determine experiences and attitudes regarding medication management among hemodialysis patients. Group interviews were conducted with adult patients from 3 dialysis facilities. Semi-structured interviews solicited information about medication self-management and views on related services. Interviews were recorded and transcribed and data were analyzed using inductive, thematic coding. Participants reported medication regimens complicated by the dialysis schedule, co-morbid conditions and multiple prescribers. Patients engaged in various coping strategies, including reliance on activating social capital and/or family social support, to manage their medications and health. When described, most thought medication management services would be beneficial, but not necessarily for themselves, despite some having histories of medication mismanagement. Patients on hemodialysis often develop strategies for managing medications that rely heavily on a social network, and strategies may not be discussed with healthcare providers. Social capital is a useful framework for considering patients' lifestyles and support structure when designing a medication regimen. Future research should explore this idea more proactively. Copyright © 2016 Elsevier Inc. All rights reserved.

[Internal audit in medical laboratory: what means of control for an effective audit process?].

PubMed

Garcia-Hejl, Carine; Chianéa, Denis; Dedome, Emmanuel; Sanmartin, Nancy; Bugier, Sarah; Linard, Cyril; Foissaud, Vincent; Vest, Philippe

2013-01-01

To prepare the French Accreditation Committee (COFRAC) visit for initial certification of our medical laboratory, our direction evaluated its quality management system (QMS) and all its technical activities. This evaluation was performed owing an internal audit. This audit was outsourced. Auditors had an expertise in audit, a whole knowledge of biological standards and were independent. Several nonconformities were identified at that time, including a lack of control of several steps of the internal audit process. Hence, necessary corrective actions were taken in order to meet the requirements of standards, in particular, the formalization of all stages, from the audit program, to the implementation, review and follow-up of the corrective actions taken, and also the implementation of the resources needed to carry out audits in a pre-established timing. To ensure an optimum control of each step, the main concepts of risk management were applied: process approach, root cause analysis, effects and criticality analysis (FMECA). After a critical analysis of our practices, this methodology allowed us to define our "internal audit" process, then to formalize it and to follow it up, with a whole documentary system.