Assignment: Explore the Organization of Healthcare
Assignment: Explore the Organization of Healthcare ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Explore the Organization of Healthcare Week 2 Assignment: Explore the Organization of Healthcare Instructions Imagine you are presenting at a national healthcare administration conference, and have been selected to hold a seminar for new managers in the healthcare field. Prepare a PowerPoint presentation on the organization of healthcare systems into primary, secondary, and tertiary care organizations. Be sure to address the following: Assignment: Explore the Organization of Healthcare Explain how these three levels complement each other and differ from each other. Determine why there are three levels. Within each level are additional types of healthcare organizations such as community health centers, group practice and health maintenance organizations. Identify and describe at least five of these types. Then, explain how they integrate into the primary, secondary, tertiary structure. Provide specific examples where appropriate. Incorporate appropriate animations, transitions, and graphics as well as speaker notes for each slide. The speaker notes may be comprised of brief paragraphs or bulleted lists. Support your presentation with at least three scholarly resources. In addition to these specified resources, other appropriate scholarly resources may be included. Length: 12-15 slides (with a separate reference slide) Assignment: Explore the Organization of Healthcare Notes Length: 100-150 words for each slide Please search websites for additional help: Bareil, C., Duhamel, F., Lalonde, L., Goudreau, J., Hudson, E., Lussier, M., & Lalonde, G. (2014). Facilitating implementation Mully, A. J. (2013). The global role of health care delivery science: Learning from variation to build health systems that avoid waste and harm. Thomas, C. W., Corso, L., & Monroe, J. A. (2015). The value of the system in public health services and systems research. cousre_8_week_2.docx course_8_week_2_info.pdf Week 2 Assignment: Explore the Organization of Healthcare Instructions Imagine you are presenting at a national healthcare administration conference, and have been selected to hold a seminar for new managers in the healthcare field. Prepare a PowerPoint presentation on the organization of healthcare systems into primary, secondary, and tertiary care organizations. Be sure to address the following: Explain how these three levels complement each other and differ from each other. Determine why there are three levels. Within each level are additional types of healthcare organizations such as community health centers, group practice and health maintenance organizations. Identify and describe at least five of these types. Then, explain how they integrate into the primary, secondary, tertiary structure. Provide specific examples where appropriate. Incorporate appropriate animations, transitions, and graphics as well as speaker notes for each slide. The speaker notes may be comprised of brief paragraphs or bulleted lists. Support your presentation with at least three scholarly resources. In addition to these specified resources, other appropriate scholarly resources may be included. Length: 12-15 slides (with a separate reference slide) Notes Length: 100-150 words for each slide Please search websites for additional help: Bareil, C., Duhamel, F., Lalonde, L., Goudreau, J., Hudson, E., Lussier, M., & Lalonde, G. (2014). Facilitating implementation Mully, A. J. (2013). The global role of health care delivery science: Learning from variation to build health systems that avoid waste and harm. Thomas, C. W., Corso, L., & Monroe, J. A. (2015). Assignment: Explore the Organization of Healthcare The value of the system in public health services and systems research. REVIEW ARTICLE Comparative Health Systems Research among Kaiser Permanente and Other Integrated Delivery Systems: A Systematic Literature Review Jared Lane K Maeda, PhD, MPH; Karen M Lee; Michael Horberg, MD, MAS Perm J 2014 Summer;18(3):66-77 http://dx.doi.org/10.7812/TPP/13-159 Editors note: For more on research and comparative health systems, please see the editorial on page 94: A Commentary on Comparative Health Systems Research among Kaiser Permanente and Other Integrated Delivery Systems: A Systematic Literature Review available at: www.thepermanentejournal.org/issues/2014/summer/5693-kaiser-commentary.html. Abstract Context: Because of rising health care costs, wide variations in quality, and increased patient complexity, the US health care system is undergoing rapid changes that include payment reform and movement toward integrated delivery systems. Well-established integrated delivery systems, such as Kaiser Permanente (KP), should work to identify the specific system-level factors that result in superior patient outcomes in response to policymakers concerns. Comparative health systems research can provide insights into which particular aspects of the integrated delivery system result in improved care delivery. Objective: To provide a baseline understanding of comparative health systems research related to integrated delivery systems and KP. Design: Systematic literature review. Methods: We conducted a literature search on PubMed and the KP Publications Library. Studies that compared KP as a system or organization with other health care systems or across KP facilities internally were included. The literature search identified 1605 articles, of which 65 met the study inclusion criteria and were examined by 3 reviewers. Results: Most comparative health systems studies focused on intra-KP comparisons (n = 42). Fewer studies compared KP with other US (n = 15) or international (n = 12) health care systems. Assignment: Explore the Organization of Healthcare Several themes emerged from the literature as possible factors that may contribute to improved care delivery in integrated delivery systems. Conclusions: Of all studies published by or about KP, only a small proportion of articles (4%) was identified as being comparative health systems research. Additional empirical studies that compare the specific factors of the integrated delivery system model with other systems of care are needed to better understand the system-level factors that result in improved and/or diminished care delivery. Introduction Rising health care costs,1 wide variation in quality,2 and increased patient complexity led to passage of the Affordable Care Act,3 which has resulted in the US health care system undergoing rapid changes. These changes include payment reform (ie, value-based purchasing, bundled payments)4 and movement toward integrated delivery systems, such as accountable care organizations and patient-centered medical homes.5,6 Because the current US health care system performs poorly relative to those of other countries, alternative models of care delivery have been proposed.5,7 Some of the inefficiencies of the current US health care delivery system stem from the growth of new and expensive medical technologies and the fee-for-service payment of physicians.8 Although physicians aim to provide patient care on the basis of scientific evidence, financial considerations may influence their treatment decisions. Assignment: Explore the Organization of Healthcare Replacement of fee-for-service with capitated payment has been proposed as one way to improve the efficiency of health care delivery. However, changing the physician payment structure by itself may not be enough to achieve the desired outcome. Previous research has shown that although prospective payment has slowed the growth of health care spending at the medical group level, similar results have not been achieved among individual or small practices. 8 Physician practices therefore may need to be reorganized and integrated across multispecialty groups and hospitals to be responsive to new payment methods. Thus, health care reform efforts also may need to focus on redesigning integrated systems of care.7 Integrated delivery systems are a model of health care involving an organized, coordinated, and collaborative network that brings together various physicians to deliver coordinated care and a continuum of services to a given patient population. 7 Integrated delivery systems are clinically and fiscally accountable for the health status and outcomes for the population served, and they have systems to manage and to improve clinical outcomes. Key attributes of successful integrated delivery systems have been suggested.7 These attributes include: 1) shared values and goals, 2) patient-centeredness and a focus on population health, 3) coordination of care across a continuum of health care services and settings, 4) physician financial incentives that are aligned with patients goals, 5) use of evidence-based practices, 6) electronic health records (EHR) that are accessible and shared by all physicians to track patients across a continuum, 7) the right mix of primary care and specialist physicians and appropriate medical equipment to serve the given population, and 8) continuous Jared Lane K Maeda, PhD, MPH, is a Research Scientist at the Mid-Atlantic Permanente Research Institute in Rockville, MD. E-mail: [email protected]. Karen M Lee is the former Strategic Initiatives Manager for the Kaiser Foundation Research Institute in Oakland, CA. E-mail: [email protected]. Michael Horberg, MD, MAS, is the Executive Director of Research and Community Benefit for the Mid-Atlantic Permanente Research Institute in Rockville, MD. E-mail: [email protected]. 66 The Permanente Journal/ Summer 2014/ Volume 18 No. 3 REVIEW ARTICLE Comparative Health Systems Research among KaiserAssignment: Explore the Organization of Healthcare Permanente and Other Integrated Delivery Systems: A Systematic Literature Review innovation and learning to improve the value of care. A previous report highlighted that tightly integrated delivery systems with their own health plan may serve as a potential model of high-performing health care systems because the insurance function of these systems allows for greater flexibility and aligned incentives, and helps deliver high-value care.9 More specifically, Kaiser Permanente (KP), the largest nonprofit integrated delivery system in the US, may serve as a model of a high-performing health care system because of several unique aspects. KP serves vario us geographic populations in the US, including California, Colorado, District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, and Washington, with more than nine million active members in 2013. Patients in the KP system receive comprehensive, multidisciplinary health care, including all medical and surgical specialties as well as pharmacy, radiology, and laboratory services. In many geographic Regions, KP owns its hospitals; in the other Regions, KP has contracts with preferred hospitals. The population in KP is representative of the states they serve; data indicate that members overall are similar to the general population regarding age, sex, and race/ethnicity, with only slight underrepresentation of those in lower and higher income and education categories.10-12 Despite these key features, important questions remain about the best practices of integrated delivery systems that achieve superior outcomes. Policymakers are increasingly demanding high-quality research regarding which specific aspects of the integrated delivery model result in superior patient outcomes. For example, there are essential questions regarding how integrated systems are able to coordinate care among different specialties and how the use of information technology and clinical decision support systems are able to support transformational care delivery.7 Consequently, well-established integrated delivery systems, such as KP, should work to identify the specific system-level factors or confluence of factors that improves such services, as well as access, quality, and other such outcomes in an integrated delivery system. Assignment: Explore the Organization of Healthcare The answer to these fundamental questions may serve as a platform to inform and to guide emerging models of care delivery such as accountable care organizations and patient-centered medical homes. Through a better understanding for which key systems and processes in integrated delivery systems work and the mechanisms by which they function, this knowledge may be translated and disseminated to the larger US health care delivery system. Comparative health systems research involves a comparison of the different approaches used by systems to organize and deliver health care services for a given population. Thus, comparative health systems is one area of research that may be able to provide valuable insights to policymakers and practitioners regarding which particular aspects of the integrated delivery system model result in improved care delivery and patient outcomes. In response to policymakers growing interest in this area, KP has embarked on a research agenda for comparative health systems. Therefore, the objective of this literature review was to examine the existing published studies on comparative health systems that relate to integrated delivery systems and KP, to obtain a baseline understanding of the state of comparative health systems research that can provide foundational Figure 1. Identification of articles for inclusion in systematic review. KP = Kaiser Permanente. The Permanente Journal/ Summer 2014/ Volume 18 No. 3 67 REVIEW ARTICLE Comparative Health Systems Research among Kaiser Permanente and Other Integrated Delivery Systems: A Systematic Literature Review knowledge. We also sought to identify, to quantify, and to classify the literature in this area. Methods To gain an understanding of the universe of research studies published on comparative health systems, we conducted a literature search on PubMed and the internal KP Publications Library. The KP Publications Library is a unique, full text searchable database of publications authored or coauthored by KP staff, including investigators, clinicians, and administrators, regardless of journal. The database contains 10,000 records describing journal articles, book chapters, books, letters, and commentaries. The library does not include posters, presentations, or published abstracts. Assignment: Explore the Organization of Healthcare In both literature searches, we sought to include existing studies that compared KP as a system or organization with other health care systems or organizations, or across KP facilities internally, in any topic area. We defined comparative health systems research as any study that compared KP as a system with another health system; any study that compared KPs performance with a state or national benchmark; and any study that compared KPs innovations in care delivery with old or previous models of care. We also included intraKP studies that compared a system of care in or between another KP Region or in or between KP facilities. Any such types of these comparisons between different systems or models of care were defined as the systems of comparison. The search was inclusive of all subject areas, ranging from quality to information technology. We looked for explicit comparisons between KP and similar health care systems. Studies that included aggregated data from KP and other health care systems were excluded because there were no direct system-level comparisons that would allow us to disentangle the different health care systems. In PubMed, the MeSH (Medical Subject Headings) search terms included Kaiser Permanente and comparative health services (n = 258), comparative health systems (n = 34), comparative Table 1. Search terms used in review of Kaiser Permanente Publications Library Set 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Search term Compar*[all fields] AND Formulary[all fields] AND Therapeutics[all fields] {108} Kaiser Permanente[title/abstract] AND Compar*[title/abstract/subject/publication type] {447} Compar*[all fields] AND Formulary Therapeutics[all fields] {2} Compar*[all fields] AND Pharmacy[all fields] AND technology[all fields] {217} Comparative quality[all fields] {14} Compar*[all fields] AND quality[subject] AND assurance[subject] {63} Compar*[all fields] AND Quality[subject] ANDAssignment: Explore the Organization of Healthcare Improvement[subject] {1} Compar*[all fields] AND quality[subject] AND health[subject] AND care[subject] {252} Compar*[all fields] AND Information Technology[all fields] {171} Compar*[all fields] AND electronic[subject] AND health[subject] AND record[subject] {33} Compar*[all fields] AND Clinical integration[all fields] {7} Comparative Performance[all fields] {28} Inter-Regional collection AND Kaiser Permanente[title/abstract] AND compar*[title/ abstract/subject/publication type] {54} Compar*[all fields] AND Care Models[all fields] {177} Compar*[all fields] AND Care Team[all fields] {193} Compar*[all fields] AND Care Team Approach[all fields] {1} Compar*[all fields] AND Multidisciplinary Care Team[all fields] {4} Comparative Effectiveness Research[subject] {13} Comparative Treatment Effectiveness[all fields] {5} Comparative Mortality [all fields] {20} Symbols: Asterisk = wildcard search; brackets = field searched; [all fields] = searching the full text of the publication; braces (at end of rows) = Publications Library total number of articles; and quotation marks = phrase search. 68 integrated systems (n = 14), health services benchmarking (n = 10), health system benchmarking (n = 7), and quality benchmarking (n = 7; Table 1). From the 330 publications, we identified 16 studies involving direct system comparisons, which we categorized into KP to Other US, KP to Other International, and KP to KP (interregional or intraregional KP comparisons). The PubMed search yielded 16 relevant articles that met the criteria of comparative health systems research involving KP (Figure 1). On the basis of PubMed results and additional refinement, we expanded our search to 20 keywords and topics to discover both external and internal comparisons from our KP Publications Library. The KP Publications Library search was used to find additional articles that may have been missed through the PubMed search because of differences in tagged words or keywords, articles that are not indexed, or delays in indexing. We limited the final results from the KP Publications Library to the following criteria: 1) publication type: journal article only (no editorials, letters, and commentaries); 2) abstract: no publications without an abstract unless published in the last two months; and 3) date: no publications before 1995 because of the likelihood of lesser relevance. The comprehensive search using the same 20 search terms in the KP Publications Library generated 1271 unique citations (Table 1).Assignment: Explore the Organization of Healthcare After limiting the search set to the previously stated criteria, 1132 citations required closer review. These studies were manually reviewed, and articles that were previously identified from PubMed were removed. We examined the results, first considering the study title and abstract and then reviewing the full text article, if necessary, to make a determination of appropriateness. Our examination of 1117 KP abstracts and full publications yielded 45 more publications relevant to the topic of comparative health systems research. We also identified 4 publications that were not found through our literature search (because they did not have a KP author listed or had no keyword hits from our search sets) and were The Permanente Journal/ Summer 2014/ Volume 18 No. 3 REVIEW ARTICLE Comparative Health Systems Research among Kaiser Permanente and Other Integrated Delivery Systems: A Systematic Literature Review Table 2. Studies by systems of comparison Author, Year Thorner,55 1978 Systems of comparison KP to US military health care system Rubenstein,57 2002 Topical area Resource use Condition NA Outcomes Ambulatory care and hospital utilization rates among civilian beneficiaries of the military health care system, members of KP, and noninstitutionalized population Team success in developing depression care improvement programs Conclusions Civilian beneficiaries of the military health care system were generally not found to be taking full advantage of their entitlement to health care. KP to VA Quality MHSA Kerr,60 2004 KP to VA and other HMO Quality Diabetes mellitus Quality of diabetes mellitus care Magid,66 2011 KP to VA and US Quality CVD BP control among patients with uncontrolled BP Fishman,59 2004 KP to US Health system performance; resource use; quality NA Cost, quality, and effectiveness of US health care system Kim,61 2004 KP to US Health system performance Diabetes mellitus Diabetes mellitus processes of care Stiefel,64 2008 KP to US Resource use NA Hospital and hospice use for end-of-life care Horberg65 2011 KP to US Quality HIV Quality performance for patients with HIV Wisdom,67 2011 KP to US Data management MHSA Schroeder,69 2012 KP to US Quality Diabetes mellitus; CVD Hazelhurst,68 2012 KP to US FQHCs Quality, HIT Asthma Data management capacity at substance abuse treatment programs Simultaneous control of diabetes mellitus, hypertension, and hyperlipidemia Asthma care quality An infusion of expertise, training, and funding is needed to improve substance abuse treatment programs IT-related systems and data management processes.Assignment: Explore the Organization of Healthcare Individuals who simultaneously achieve multiple treatment goals may provide insight into self-care strategies for individuals with comorbid health conditions. Automated measures of asthma care quality performed well in the HMO, where practice is more standardized. DeCoster,56 1997 KP to Manitoba, Canada, and US Resource use NA Ambulatory care visit rates and procedure rates for 3 surgical procedures Smith,63 2006 KP to Canada and US NA Potentially contraindicated agents in elderly patients Ham,58 2003 KP to UK NHS and US Medicare program HIT/EHR/ CPOE/CDS/ patient safety Resource use NA Hospital utilization Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10
