Nursing 3344-3
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Collin County Community College District *
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Course
3344
Subject
Medicine
Date
Dec 6, 2023
Type
docx
Pages
4
Uploaded by MasterMorning11527
Outcomes- Evidence Based Medicine
the use of the best available medical research to inform medical decision making and treatment
Outcomes- Clinical Practice Guidelines
a scientifically determined set of specifications for the provision of care to typical patients in given disease or injury categories
Outcomes- Case management
a system to improve health care treatment for specific patients, typically high-risk or high-cost patients
Sensitivity & Specificity in Outcomes Analysis
Sensitivity: the probability of a positive test (outcome) given the presence of disease/condition
Specificity: the probability of a negative test result given the absence of disease
Controlling Variation & Improving Outcomes
1. Identify high-risk patients
2. Provide resource use incentives
3. Identify and act on outliers
4. Continuously improve
5. Implement disease management programs
6. Provide provider-level information technology
7. Encourage the practice of EBM
8. Involve patients in care process
9. Control capacity
Evidenced-Based Medicine
use of the current best evidence in making clinical decisions about the care of individual
patients by integrating individual clinical expertise with the best available clinical evidence from systematic research...
-improves clinical outcomes and reduce costs
History of EBM
David Sackett- Father of EBM
Gordon Guyatt- coined the term
Little emphasis on patient values and preferences
"Cookbook" medicine
Current Status of EBM
-Growing rapidly
-Advances in research methods
-Many physicians not practicing medicine based on current evidence
-Many published studies are false or have misleading conclusions
What is the chronic care model?
-population based outreach
-treatment sensitive to patient's preferences
-most current EBM is employed
What is a healthcare home?
Care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate and culturally effective
3 Components for success:
1. Individualized and intense caring for patients w/ chronic illness
2. Efficient service provision
3. Careful selection of specialists
Clinical Guidelines
developed to assist physician and patient decisions about appropriate healthcare for specific clinical circumstances
What are some obstacles to the use of guidelines by physicians?
-Lack of knowledge of why guidelines exist for specific conditions
-Lack of familiarity
-Disagreement with guideline recommendation
-Inability to effectively apply due to lack of skill, resource, training
-Lack of trust to improve outcomes
-Resistance to change
-External factors
Clinical guidelines obstacles for patients:
-Patient characteristics
-Difficulty recognizing symptoms and adhering to therapies prescribed
-Complex therapeutic regimes
-Relationship and personal interaction b/w patient and physician
Archimedes Model
A full-scale mathematical simulation of human physiology that can be used to test the effect of diseases and their treatments
Standard and custom care: Model A Separate and Select
-Provides initial sorting by patients themselves
-If the patient doesn't meet the clinical conditions by the provider then the patient will get
referred to a provider who can offer customized care
ex. specialty hospitals or walk in clinics inside a pharmacy or retail clinics
Standard and custom care: Model B Separate and Accomodate
-two methods into one provider organization
-Patients are initially sorted, those who need standard care are cared for by a nurse practitioner using the standard care
-Remaining patients are cared for using custom care
-Nurse practitioner and physician come together in best interest of patient
Standard and custom care: Model C- Modularized
-This is when the clinician goes from the care provider to the one who designs the care for the patient
-A patient who needs multiple departments of care will need a care plan so the clinician designs the care plan
Medicare Value Purchasing Program
-rewards better value, outcomes and innovations instead of merely volume
-Goal is to enhance quality and better experience for patients
What are HC facilities graded on? 3 main categories:
1. Mortality rates & complications
2. HC associated infections
3. Patient safety
4. Patient experience
5. Process
6. Efficiency and cost reduction
1. Quality
2. Patient Experience
3. Cost of care
CMS scores hc facilities based on:
1. Achievement
2. Improvement
Calculation: (clinical processes of care x 70%) + (patient experience x 30%)
Value-based purchasing funding
-Govt holds approx. 2% of all medicare funding for the value-based purchasing program
-Based on facilities scores, they receive funding from the govt
Clinical Decision Support
-Works along with EHRs
-Helps to assist medical professionals in decision making for patients
-Uses the patients medical history, EBM, physician knowledge and the interface
Institute for Clinical Systems Improvement
-Builds a criteria for running tests on patients
-Works hand-in-hand with the patients EHR
Risk Adjustment
Raising or lowering fees to providers based on the basic factors
What is pay for performance?
A logical tool used to expand the use of EBM in the financing system
Medical vs Economic Decision-Making
Need-Based Decision Making: centered solely on what treatment is necessary
Economic Decision Making: based on choice and opportunity cost rather than needs
Public Interest Theory vs Capture Theory
Public Interest Theory: the idea that regulation is instituted for protection of society and not particular interest
Capture Theory: the idea that over time regulation ceases to protect society and is continued in order to serve the regulated entities
Occupational Licensing
-States have the legal right to restrict access to occupations such as medical practice and nursing
-Barrier to entry
-not totally effective in satisfying the public's demand for quality or accountability
-State medical boards continue to restrict the information the public can access regarding licensure actions
Suspension statistics
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-10,000 complaints towards California physicians each year
-80% of claims do not survive an initial review, another 15% are eliminated from further action
-Prosecution only recommended for one in four of remaining cases
-Half of the cases eventually result in disciplinary action
-Approx. .24% of physicians were disciplined
-Males, older practitioners, international graduates, non-board certified, family practice, more likely disciplined
-Having more than one violation doubles probability of license revocation