The cost of healthcare is steadily increasing, while the health of the national population is declining rapidly. If the United States continues on its current path, a projected 49% of the population will have a chronic disease by the year 2025. Diabetes, in particular, has become a source of 14% of the overall healthcare expenditures. For this reason, Diabetic patients were selected as study candidates for this project. Using the ATOM Learning Model, a study was designed to test the effect of provider engagement on patient engagement and health outcomes. A survey was prepared using the ideas from the American Diabetes Association, Patient Activation Measurements, and Patient Engagement. A scale was made, with the help of a chart published by the European Society of Cardiology, to determine an estimated amount of years that a patient can expect to lose off of their lifespan due to the way they are managing their Diabetes. The survey was then tested in three practices in the Baylor Health Care System where providers then chose whether they wanted to engage with their patients over the survey. An analysis was done to determine whether physician engagement correlated with higher activation scores on the survey. It was determined that physicians who engaged regularly with their patients over the survey had patient averages in higher levels than physicians who never engaged. The results from this study show that physicians who chose to engage with their patients about the survey had patients that feel more confident in managing their disease and understand the importance of doing so. The patients surveyed will also be evaluated in three months to determine if addressing life expectancy caused the patients to improve their Diabetes management. Potentially, this could help reduce the healthcare costs in these three practices and throughout the Baylor Health Care System as a whole.
This study identifies correlations between various measures for patients admitted to the Intensive Care Unit (ICU) during January 20, 2014 and May 31, 2014 who did and did not receive palliative care consultations. Nurses in the ICU would screen patients and assign a score based on medical and social factors in addition to the patients needing assistance in other areas of their life. The attending physician was notified and given the option of accepting a palliative care consultation for patients who were positively screened, deemed by a score of 5 or greater. The ICU and hospital length of stay, average total direct costs per day, hospital mortality, and discharge to hospice rates were all analyzed and compared between the group receiving a palliative care consultation (N=36) and the group that screened positively for a consultation but did not receive one (N=14) to study the differences that receiving a palliative care consultation appeared to have on these measures. Our findings show the average ICU length of stay (LOS) was roughly 6 days shorter and hospital LOS was, on average, 5 days shorter for patients receiving a consultation than for the group of patients who did not receive a palliative care consultation. The total direct costs per day were roughly $103 less in the group receiving a palliative care consultation, suggesting less intensive treatment and life-saving procedures. The rate of discharge to hospice care was significantly higher in the group receiving a consultation, 15 out of 36 patients versus 1 out of 14 patients. However, due to the small sample size and since many patients had only recently been discharged to a Specialized Nursing Facility or Long Term Acute Care; it is not possible to draw firm conclusions on this data alone.
As healthcare becomes more and more complex, the need to streamline processes related to care delivery and to eliminate waste becomes increasingly important. At Baylor University Medical Center in Dallas, Texas, an opportunity to improve the surgery scheduling process was identified, and the workflow was analyzed by members of a Lean Process Improvement team. It was identified that patient preregistration and preadmission testing were both not being carried out in a timely fashion, contributing to lost point-of-service collection opportunities and cancelled cases. By educating staff members and coordinating communication between departments, the team hopes to increase the timeliness of the preregistration and preadmission testing processes, which in turn will boost point-of-service collections.
This report is detailed around the ideas of health information technology, concierge medicine, and the relationship between the two entities. Research was conducted by means of physician interviews; interview with the American Academy of Private Physicians the only nonprofit organization currently supporting concierge practices, and a literature review. The intent through research is to prove or disprove the hypothesis that concierge practices have a different approach to health information technology than traditional medical practices because the two differ in practice requirements. Results indicated that four of six interviewed physicians currently use and are satisfied with their electronic medical record, two of six physicians are associated with an accountable care organization, two of six are associated with a medical franchise, and two of six participate in health information exchanges. However, in stark contrast the AAPP estimates that 70% of physicians currently have an EMR and almost all are extremely dissatisfied. In conclusion, since concierge medicine is a rapidly expanding medical field it requires software specific to its needs. The accessibility of health information technology to concierge physicians is somewhat correlated with the financial assistance of an accountable care organization or a medical franchise. These difficulties within health information technology, both financial and technological need to be addressed and resolved in a concierge friendly manner.
Sepsis is the result of an injurious response of the host to an infection, commonly presenting in the form of severe sepsis or septic shock. In the United States sepsis is a leading cause of in hospital mortality and the highest cause of death in the ICU. Care processes for patients with severe sepsis or septic shock have been developed and proven to be effective, but uptake has been inconsistent in most hospitals to date. The earliest phase of these care processes, known as the 3-Hour Sepsis Bundle, includes measurement of lactate level, collection of blood cultures, and administration of IV antibiotics and IV fluids. Baylor Scott & White Health System (BSWH) recognizes the importance of optimizing the treatment of sepsis through improved sepsis care bundle adherence. The system Sepsis Task Force, in conjunction with the Emergency Medicine and Critical Care Councils, has implemented a multidisciplinary framework of quality improvement (QI) strategies to increase adherence to the 3-Hour Sepsis Bundle in patients with severe sepsis or septic shock presenting to the emergency department. This paper describes the specific experiences of Baylor University Medical Center in implementing a sepsis QI initiative, including impacts on process and outcomes measures associated with the program.