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A Primer for The Nurse
Joan Bachman, RN, NHA, RHIT, BSBA, FCN Julie Traynor, MS, RN Eric Christofferson, BSN Jeanine (Jenny) Senti, APRN-BC, MS, CNS, IBCLC
Amanda Holland, RN Kelly Hagen, RN
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To increase your understanding of how knowledge of the health system will help you, the nurse, provide patient-centered care to guide each patient toward desired health outcomes.
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A complex system is a system composed of interconnected parts that as a whole exhibit one or more properties (behavior among the possible properties) not obvious from the properties of the individual parts
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The American healthcare system … isn’t. It isn’t a “system.” Patients have multiple providers. These providers rarely interact. The payment system operates in silos. And patient care isn’t coordinated.
http://blogs.ajc.com/health-flock/2012/12/05/breaking-down-healthcare-silos-the-need-of-healthcare-integration/
SILOS SYSTEM
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Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families,
communities, and populations. ANA http://www.nursingworld.org/EspeciallyForYou/What-is-Nursing
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Life-style
Physical abilities
Diagnoses
Treatment options
Income
Family Obligations
Hopes/dreams
Culture
Education
Support systems
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THE PROBLEM “it is in inadequate handoffs that safety often fails first” “nurses are the health care professionals most likely to
intercept errors and prevent harm to patients”
http://www.ahrq.gov/professionals/clinicians- providers/resources/nursing/resources/nurseshdbk/index.html
THE SOLUTION Be aware of the many facets of the System Recognize “how things work” – and why Know who is responsible Realize complexity/barriers – seen by you seen by patient Know that patients may need help to identify sources of
service & make decisions
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1. Review the health care system’s provider types and levels of service, regulation, and reimbursement mechanisms;
2. Investigate your organization’s structure and processes;
3. Describe your position/role within the organizational structure; and
4. Demonstrate your knowledge of the health care system to help a patient (and family) consider and access viable options for achieving personally desired health outcomes.
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COMMUNITY
OUTPATIENT
INPATIENT IN-HOME
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“GENERAL PROVIDERS” – Available to qualified general population
SPECIAL POPULATION PROVIDERS
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Public Health http://www.ndhealth.gov/phsp/
Rural Health Clinics , FQHC
http://www.ndhealth.gov/hf/North_Dakota_Rural_Health_Clinics.htm
WIC http://www.ndhealth.gov/wic/
Home Health Care School Nurses Faith Community
Nurses Foot Clinics
Vaccination Clinics Wellness/Fitness
Centers Social Service/Mental
Health Agencies http://www.nd.gov/dhs/service
s/mentalhealth/
Durable Medical Equipment Suppliers
Pharmacies http://www.legis.nd.gov/events
/2014/04/05/state-board-pharmacy
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Industrial Health – may be limited to certain employees
Shelters/Halfway Houses
Foster Care
Adult Day Care – Respite Care Providers
Group Homes for Physical and Social issues
Community Action Agencies
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Medical Clinics – 305 est (52 RHC, 7 FQHC) (3,679,739 est. visits in only hospital-based clinics in
2012)
Ambulatory Surgery Centers – 12◦ http://cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/downlo
ads/som107ap_l_ambulatory.pdf
Hospitals – (1,702,820 OP visits in 2012)
Physical and Occupational Therapy◦ https://www.ndbpt.org/◦ http://www.ndotboard.com/◦ https://www.ndsbrc.com/◦ http://www.ndsbe.com/
◦
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Audiology and Speech-Language Pathologists http://www.legis.nd.gov/cencode/t43c37.pdf?20140524165810
Dietitian/Nutritionist◦ http://www.legis.nd.gov/cencode/t43c44.pdf?20140605102603
Comprehensive Outpatient Rehabilitation Facility (CORF)
http://cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_k_corf.pdf
Addiction/Mental Health Therapy – 54◦ http://www.nd.gov/dhs/info/pubs/docs/mhsa/nd-licensed-addiction-treatment-programs.pdf◦ http://www.ndbce.org/
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Renal Dialysis Centers (ERSD) – 16◦ http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/Surv
eyCertificationGenInfo/downloads/SCletter09-01.pdf
Diagnostic Services◦ Laboratory
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107c06.pdf
http://www.ndclinlab.com/
◦ Radiology http://cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/dow
nloads/som107ap_d_xray.pdf
◦ Screening – Providers, Practitioners, Pharmacies, Health Fairs
◦ Telehealth – From Providers, Practitioners
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Adult Day Care – Respite Care and In-Home Aging Services◦ http://www.nd.gov/dhs/services/adultsaging/homecare3.html
Reflexologists
http://www.legis.nd.gov/cencode/t43c49.pdf?20140524160717
Massage Therapists http://www.legis.nd.gov/cencode/t43c25.pdf?20140524165633
Hearing Aid Dealers http://www.legis.nd.gov/cencode/t43c33.pdf?20140524165924
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Cardiac and Wellness Centers
Chiropractic Clinics
Pharmacies
Telehealth
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Hospital – 51 (97,028 inpatient admissions; 337,451 ER visits - 2012)
◦ Acute General Critical Access – 37 Swing Bed (LTC) - 37 Prospective Payment – 6
◦ Rehabilitation - 1◦ Long Term Acute Care - 2◦ Acute Psychiatric - 3◦ Acute Special – transplantation - 2
http://www.legis.nd.gov/information/acdata/pdf/33-07-01.1.pdf?20140322170247
Nursing Facility - 80 (12,213 residents in 2012)◦ http://www.legis.nd.gov/information/acdata/pdf/33-07-03.2.pdf?2014032
2170725
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Intermediate Care Facility for Intellectual Disabilities◦
http://www.ndhealth.gov/HF/PDF_files/ICF%20MR/Appendix_J_-_Guidance_to_Surveyors.pdf
Basic Care Facility – 68) (4,152 residents in 2012)◦ http://www.ndhealth.gov/HF/North_Dakota_Basic_Care_Facilities.htm
Assisted Living Facility – 73 (3,195 residents in 2012)◦ http://www.legis.nd.gov/cencode/t50c32.pdf?20140322173003
Hospice – 13◦ http://www.legis.nd.gov/information/acdata/pdf/33-03-15.pdf?20140322
170854
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“Treatment” Centers - (Mental Health/Substance Abuse)◦ http://www.nd.gov/dhs/info/pubs/docs/mhsa/nd-licensed-addiction-treat
ment-programs.pdf
Group Homes◦ http://www.nd.gov/dhs/services/disabilities/
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Home Health – 35◦ http://www.legis.nd.gov/information/acdata/html/33-03.html
Therapy -- Physical, Occupational, Respiratory, Speech/Language◦ http://www.ndsbrc.com/◦ http://www.nd.gov/dhs/services/adultsaging/homecare3.html
Hospice – 13◦ http://www.legis.nd.gov/information/acdata/pdf/33-03-15.pdf?20140322
170854
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SINGLE FACILITY “SYSTEM OF SERVICES” http://jrmcnd.com/
CO-LOCATED FACILITIES http://www.coopermc.com/
“OWNED”/”MANAGED” SYSTEM http://www.altru.org/find-a-location/
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Physicians – Primary and specialty care – 3,323 279 PAs
◦ https://www.ndbomex.org/
Dentists - 455◦ https://www.nddentalboard.org/
Pharmacists◦ https://www.nodakpharmacy.com/
Advanced Practice Nurses – 558 with prescriptive authority◦ https://www.ndbon.org/
Optometrists/Opticians◦ http://www.ndsbopt.org/
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Chiropractors◦ http://ndsbce.org/
Psychologists◦ http://www.ndsbpe.org/
Counselors◦ http://www.ndbce.org/
Addiction Counselors◦ http://www.ndbace.org/
Podiatrists◦ http://www.ndpodiatryboard.org/
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Massage Therapists◦ http://www.ndboardofmassage.com/
Reflexologists http://www.legis.nd.gov/cencode/t43c49.pdf?20140524160717
Massage Therapist http://www.legis.nd.gov/cencode/t43c25.pdf?20140524165633
Audiology and Speech-Language Pathologists http://www.legis.nd.gov/cencode/t43c37.pdf?20140524165810
Hearing Aid Dealers http://www.legis.nd.gov/cencode/t43c33.pdf?20140524165924
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PREVENTIVE ACUTE CARE
REHABILITATIVE CARE CHRONIC CARE
PALLIATIVE CARE
LONG TERM CARE
END OF LIFE CARE
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COMMUNITY SERVICES
WELLNESS CENTERS
MEDICAL CLINIC
HOSPITAL
OUTPATIENT PROVIDERS
THERAPIES
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MEDICAL CLINIC
AMBULANCE – FIRST RESPONDERS – EMERGENCY SERVICES
HOSPITAL
OUTPATIENT PROVIDERS
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CLINIC
HOSPITAL
ESRD
LONG TERM CARE PROVIDERS
IN-HOME
COMMUNITY
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ASSISTED LIVING
BASIC CARE
NURSING FACILITY
IN-HOME
GROUP HOMES
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Personal Care – Family, Private, HCBS (Home & Community Based Services)
Homemaking◦ http://www.nd.gov/dhs/services/adultsaging/homecare3.html
Telehealth
Diagnosis -- Lab draws, Mobile radiology◦ http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107c06.pdf◦ http://cms.hhs.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_d_xra
y.pdf
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GOVERNMENT FORCES LEGISLATURE – LAWS
◦ State agencies – Selected Examples listed here DOH DHS BON BPH BMX
CONGRESS – LAWS◦ FEDERAL AGENCIES –
HHS, FDA, DEA, OSHA, CDC, DOL
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NONGOVERNTEMENTAL GOVERNANCE
GOVERNING BODY(IES) OF PROVIDER/PRACTITIONER
PROFESSIONAL ASSOCIATIONS
PROVIDER ORGANIZATIONS
ACADEMIA
PAYERS OF SERVICE
PUBLIC
PATIENTS/CUSTOMERS
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LICENSURE – STATE -- description of service & enforcement
http://www.nd.gov/
CERTIFICATION – FEDERAL -- MEDICARE/MEDICAID
– description of service/ payment http://www.cms.gov/
Accreditation - The Joint Commission, etc. – no regulatory authority. CMS Contractor
http://www.jointcommission.org/ http://www.thecompliancedoctor.com/#!corf-accreditation/c1jj
b http://www.achc.org/
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APPLICABLE TO PROVIDERS AND PRACTITIONERS ◦ Examples
Letter of Reprimand Warning with Plan of Correction (POC) Disciplinary Action - Notification Civil Money Penalties Limit Scope of Practice Limit Reimbursement Termination of Licensure or Certification Prohibition from Participating (future)
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PRIVATE HEALTH INSURANCE (MUCH BASED ON MEDICARE)
http://www.nd.gov/ndins/
PRIVATE SELF PAY
MEDICARE http://www.cms.gov/
MEDICAID http://www.nd.gov/dhs/services/medicalserv/medicaid/
POPULATION BASED VAMC, IHS, Migrant Health, Public Health
http://www.va.gov/health/vamc/ http://www.ihs.gov/ ttp://bphc.hrsa.gov/about/specialpopulations/
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COVERED SERVICES
PARTICIPATING PROVIDERS/PRACTITIONERS
QUALIFIED PROVIDERS/PRACTITIONERS
PROSPECTIVE PAYMENT SYSTEM
FEE FOR SERVICE – COST-BASED
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PREMIUM
DEDUCTIBLE
MEDICARE PART A
MEDICARE PART B
MEDICARE PART D
CO-PAY
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MEDICAL HOMES◊ The patient-centered medical home is similar to managed care approaches and health maintenance organizations, but asks providers
to focus on improving care rather than managing costs.◊ A continuous relationship with a Personal Physician coordinating
care for both wellness and illness using these Elements: Practice
Management, Health Information Technology, Quality and Safety, Practice-based
Care Team, Care Coordination, Care Management, Practice-based Services,
Access to Care and Information http://www.medicalhomeinfo.org/state_pages/north_dakota.aspx
http://knowledgecenter.csg.org/kc/content/state-initiatives-patient-centered-medical-homes
http://www.transformed.com/MHIQ/scoring.cfm
OVERALL EFFECT OF ACA UNKNOWN. OVERALL COST OF HEALTHCARE PROJECTED TO
INCREASE.
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LEGAL DESCRIPTION◦ Licensure – www.nd.gov◦ Certification – www.cms.gov◦ Accreditation – www.jointcommission.org
ORGANIZATIONAL STRUCTURE ◦ Ownership - Corporation, proprietorship, partnership,
government◦ For Profit/Nonprofit◦ Single site? – Multiple sites?◦ Related Providers
ORGANIZATIONAL GOVERNANCE◦ Who is responsible
MISSION/VISION STATEMENTS ◦ From Organizational materials
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Visual representation of how a firm intends authority, responsibility, and information to flow within its formal organizational structure. It usually depicts different management functions (finance, human resources, marketing, nursing, environment,) and their subdivisions as boxes linked with lines along which decision making power travels downwards and answerability travels upwards. http://www.businessdictionary.com/definition/organization-chart.html
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SERVICES PROVIDED POPULATION SERVED COMMUNITY INVOLVEMENT TEACHING SITE ?
MANAGEMENT TEAM HIRING, ORIENTATION, TRAINING, RETENTION LEVEL OF DECISION-MAKING
POLICIES PROCEDURES/PROCESSES QUALITY ASSESSMENT/PERFORMANCE
IMPROVEMENT
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ORGANIZATIONAL LOCATION - refer to Organizational Chart
INTRA-ORGANIZATIONAL COMMUNICATION◦ Clear Expectations◦ Two-way Interactions
POSITION DESCRIPTION
PATIENT CARE POLICIES
STAFFING PATTERNS
“SYSTEMS” OF TASK ORGANIZATION
CONTRIBUTE TO ORGANIZATIONAL DECISION-MAKING?
4444
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APPLY THE NURSING PROCESS
BE MINDFUL –
USE PERSONAL SKILLS TO INFLUENCE REALIZE YOU ARE PRIMARY TO PATIENTS
REMEMBER THE NURSE IS MOST TRUSTED CARE-GIVER
USE YOUR POSITION TO PROMOTE COORDINATION OF CARE: internal & external
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Demonstrate your knowledge of the health care system to help a patient (and family) consider and access viable options for achieving personally desired health out comes.
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NURSING PROCESS:
a five-part systematic decision-making method focusing on identifying and treating responses of individuals or groups to actual or potential alterations in health. Includes assessment, nursing diagnosis, planning, implementation, and evaluation.
Bexhill-on-Sea, UK, MediLexicon International Ltd © 2004-2014 All rights reserved. http://www.medilexicon.com/medicaldictionary.php?t=61900MediLexicon International Ltd,
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--- a successful Hand-Off is defined as a transfer and acceptance of responsibility for patient care that is achieved through effective communication. It is a real-time process of passing patient specific information from one caregiver to another or from one team of caregivers to another to ensure the continuity and safety of that patient’s care. A hand-off process involves “senders,” the caregivers transmitting patient information and transitioning care of a patient to the next clinician, and “receivers,” the caregivers who accept patient information and care of that patient. http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_HOC_Fact_Sheet.pdf
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Abrupt transitions between settings Brief hospital stays Sudden self-management with minimal preparation Poor communication between care providers
National Perspective Hackbarth, Reischauer, and Miller. Medicare Payment Advisory Committee. 2007
1 in 5 Medicare beneficiaries are readmitted to the hospital within 30 days
1 in 3 beneficiaries are readmitted within 90 days 2 of 3 patients with medical conditions are either rehospitalized or
die one year after discharge 90% of rehospitalizations were unplanned 76% of 30-day readmissions are potentially preventable
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Eric’s detox patient
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MIXED PRIORITIES – PATIENT VS SYSTEM PHYSICAL LIMITATIONS – (hearing, sight) FINANCIAL LEGAL LANGUAGE/CULTURAL/BELIEF SYSTEM EDUCATIONAL GENERATIONAL GEOGRAPHIC NO PRIMARY PROVIDER – REGULAR SOURCE OF
CARE http://www.news-medical.net/health/Disparities-in-Access-to-Health-Care.aspx
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LACK OF INSURANCE LACK OF EMPLOYMENT LACK OF COORDINATED CARE
Multiple providers and levels of service
UNWILLING TO MAKE PERSONAL INVESTMENT LITTLE KNOWLEDGE OF COST OF SERVICE LIMITED UNDERSTANDING OF 3RD PARTY
PAYMENT
INCOMPLETE MEDICAL DOCUMENTATION & CODING
MEDICARE “OBSERVATION” VS “INPATIENT” STATUS Hospital
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ADVANCE DIRECTIVES - OR LACK OF VULNERABLE ADULTS DYSFUNCTIONAL FAMILY DYNAMICS LICENSING LAWS FOR PROVIDERS AND
PRACTITIONERS
MEDICAL ERRORS INCOMPLETE MEDICAL DOCUMENTATION &
CODING
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STEREOTYPING, BIASES LIMITED OR NO ENGLISH ACCESS TO INTERPRETERS TRADITIONAL (Non-Western)
HEALTH BELIEFS AND PRACTICES
ACCESS TO SOCIAL SERVICES LIFE-STYLES DRESS UNCERTAINTY OF CARE-
GIVERS
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STEREOTYPES SOCIAL MEDIA REVERSE MENTORING WORK-LIFE/HABITS TECHNOLOGY FLEXIBILITY PERFORMANCE COMMUNICATION
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TRANSPORTATION WEATHER RURAL & INNER CITY
◦ Limited access to health and community resources◦ Limited technology connections◦ Limited transportation ◦ Limited support services
HOMEBOUND◦ Limited technology capability◦ Limited transportation◦ Limited support services
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Patients and families hate it that we can’t make this work Poor hand-offs lead to delays, lapses in care, adverse drug effects,
and other situations that may be dangerous to health
Ensure transfer of correct information Provide patient support to wellness Track referrals & help resolve problems
Less waste Enormous waste is associated with duplicate testing, unnecessary
referrals, unwanted specialist-to-specialist referrals, and failed transitions from hospitals, EDs, & nursing homes.
Clinical practice will be more rewarding Fewer problems – for patient and for health system Improve the health of the population Encourage personal responsibility for health status
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http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/videos/ts_Sue_Sheridan/Sue_Sheridan-400-300.html
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An established “system” for change in responsibility for patient care
Accurate and complete documentation
Patient Identification, Diagnoses, Events, Anticipated Outcomes
Patient education and understanding
Verbal Communication Verification of available
resources Shared Responsibility (for
the Patient)
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At the heart of this coordination is assessing patients’ and families’ readiness to manage their care and their capability to do so. We should NEVER assume that they can do it all on their own.
ndhcri video
Rural Hospital Transfer Decision-Making:
A Qualitative Approach Patricia Moulton, PhD Mary Wakefield, PhD, RN Alana Knudson, PhD Rob Beattie, MD Marlene Miller, MSW Presentation at the National Rural Health
Association Annual Conference May 9, 2008, New Orleans, Louisiana
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ND Dept of Health --- Health Facilities
◦ http://www.ndhealth.gov/HF/
ND Dept of Health – Children’s Services
◦ http://www.ndhealth.gov/familyhealth/publications/ConnectionDirectory.pdf◦ http://www.ndhealth.gov/cshs/docs/cshs-provider-list.pdf◦ http://nd.bridgetobenefits.org/◦ http://www.ndhealth.gov/cshs/
ND Dept of Human Services Available to all ND Residents Adult Services
◦ https://carechoice.nd.assistguide.net/site/423/useful_links.aspx◦ https://carechoice.nd.assistguide.net/site/371/find_a_service.aspx◦ http://www.acl.gov/www.acl.gov/About_ACL/FederalInitiatives/VeteransCare.as
px◦ http://ndipat.org/
http://www.agingcare.com/Elder-Care◦ http://www.nd.gov/dhs/services/adultsaging/reporting.html◦ http://www.nd.gov/dhs/services/adultsaging/ombudsman.html
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Mental Health and Substance Abuse Treatment Centershttp://findtreatment.samhsa.gov/MHTreatmentLocator/faces/quickSearch.jspx
ND Free Lance Interpreter List http://www.nd.gov/ndsd/outreach/doc/freelance-interpreters.pdf
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◊ ND Long Term Care Association (NDLTCA) - Economic Pulse Report 2012 http://www.ndltca.org/documents/NDLTCA_2012PulseReport-lowres.pdf.
◊ ND Hospital Association (NDHA) – Economic Pulse Report 2012 http://mabu-ndha.taopowered.net/?id=63
◊ An Environmental Scan of Health and Health Care in North Dakota: Establishing the Baselines for Positive Health Transformation. March 2009
http://ruralhealth.und.edu/pdf/escan/vol1-2.pdf
◊ Rural Care Coordination Toolkit. Webinar : Care Coordination in Rural Communities. recorded February 12,
2014 http://www.raconline.org/communityhealth/care-coordination/1/defining- care-coordination
◊ Lin Grensing-Pophal: Leading when You’re Not the Formal Leader. Advance Healthcare Network for Nurses. April 2, 2014
http://nursing.advanceweb.com/Lifestyles-for-Nurses/Lifestyle-for-Nurses/At-Work/When-Youre-Not-the-Formal-Leader.aspx
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2013 Actuarial Report on the Financial Outlook for Medicaid. Report to Congress
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Downloads/medicaid-actuarial-report-2013.pdf
The Care Transitions Program. Health Care Policy & Research University of Colorado School of Medicine. © 2007 Care Transitions Program. Denver Colorado
http://www.caretransitions.org/
CFMC, Medicare Quality Improvement Organization for Colorado, prepared under contract with CMS. © 2013 CFMC
http://www.cfmc.org/integratingcare/default.htm)
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American Association of Critical Care Nurses http://www.aacn.org/dm/csi/finalprojects.aspx?menu=csi
◦ Don't Fumble the Handoff: Tackling Effective Communication - Presentation Communication with Patients and Families South Shore Hospital, Intensive Care Unit (ICU), Boston
◦ Don't Fumble the Handoff: Tackling Effective Communication - Project Summary Communication with Patients and Families South Shore Hospital, Intensive Care Unit (ICU), Boston
◦ Don't Fumble the Handoff: Tackling Effective Communication - Toolkit Communication with Patients and Families South Shore Hospital, Intensive Care Unit (ICU), Boston
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◊ Brian D. Smedley, Adrienne, Y. Stith, and Alan R Nelson, Editors. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health CareCommittee on Understanding and eliminating racial and ethnic disparities in health care. Institute of Medicine. 2009
http://books.google.com/books?hl=en&lr=&id=__uouFvf9z4C&oi=fnd&pg=PR1&dq=language+barriers+to+health+care+coordination&ots=0ZbIrqpOBC&sig=5F3nDqEgrJPJGmUDl1_B6cyz4Yw#v=onepage&q=language%20barriers%20to%20health%20care%20coordination&f=false
◊ A Distinctive System of Health Care Delivery – Jones & Bartlett Publishers (recommended*)
http://www.jblearning.com/samples/076374512x/shi4e_ch01.pdf
◊ V M Arora, J K Johnson, D O Meltzer, H J Humphrey: A Theoretical Framework and Competency-based Approach to Improving Handoffs. Quality Safety. Qual Saf Health Care 2008 17:11014. doi: 1136/qshc.2005.018952
http://qualitysafety.bmj.com/content/17/1/11.full.pdf+html ◊ Quyen Ngo-Metzger MD, MPH*, Michael P. Massagli PhD, Brian R. Clarridge PhD, Michael
Manocchia PhD, Roger B. Davis ScD, Lisa I. Iezzoni MD, MSc and Russell S. Phillips MD Perspectives of Chinese and Vietnamese Immigrants
Article first published online: 17 JAN 2003 DOI: 10.1046/j.1525-1497.2003.20205.x http://onlinelibrary.wiley.com/doi/10.1046/j.1525-1497.2003.20205.x/full
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◊ Beth Ann Swan: A Nurse Learns Firsthand That You May Fend For Yourself After A Hospital Stay. Health Affairs, 31, no.11 (2012):2579-2582. dpo: 10.1377/hlthaff.2012.0516◦ http://content.healthaffairs.org/content/31/11/2579.full.html
◊ Joe Tye (with Dick Schwab). The Florence Prescription. From Accountability to Ownership. Copyright 2009, 2014 by Joe Tye
http://theflorencechallenge.com/
◊ John Kenagy, MD, MPA, ScD, FACS (Slide #42) Designed to Adapt. Leading Healthcare in Challenging
Times. Second River Healthcare Press, 26 Shawnee Way, Suite C, Bozeman, MT 59715. 2009 http://www.designedtoadapt.com/
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Evidence of completion of the four (4) Leadership Modules (Copy of certificate of completion for contact hours).
Complete one project at the end of each of the modules that demonstrates your application of knowledge, skills, abilities, and judgment of the content from each module. (See individual modules for ideas).
Use a format that lends itself to professional presentations:◦ Electronic poster presentation, PowerPoint presentation, videotaped
presentation, evidence of presenting project to a professional group, manuscript for publication, or other method.
Collect all your projects in a portfolio (prefer electronic) and submit at the end of the 4th module.
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Describe your employer organization using the outline provided Define your present position within the employer organization. Perform and document a successful patient handoff noting the
following:◦ 1. The patient’s desired health outcome◦ 2. Assessment of each of the listed barriers◦ 3. Indivisuals/agencies involve in thehandoff (remember the patient).◦ 4. Elements of the handoff (documents, other communication, transportation, etc.)◦ 5. Success (2 weeks after the fact) of the handoff.
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Reflect on the complexity of the overall healthcare system
Reflect on your organization within the system Reflect on your position within your organization Reflect on the result of your patient advocacy
experience
How could a different reality make your experience more successful and satisfying?
What will you do to move toward that different reality?
And so we move into the Change & Innovation Module
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