Value-Based Approaches for Emergency Care in a New Era

Medford-Davis, L. et al. Annals of Emergency Medicine. Published online: January 5 2017

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Although emergency departments (EDs) play an integral role in the delivery of acute unscheduled care, they have not been fully integrated into broader health care reform efforts. Communication and coordination with the ambulatory environment remain limited, leaving ED care disconnected from patients’ longitudinal care.

In a value-based environment focused on improving quality, decreasing costs, enhancing population health, and improving the patient experience, this oversight represents a missed opportunity for emergency care. When integrated with primary and subspecialty care, emergency care might meet the needs of patients, providers, and payers more efficiently than yet realized.

This article uses the Merit-Based Incentive Payment System from the Medicare Access and CHIP Reauthorization Act as a framework to outline a strategy for improving the value of emergency care, including integrating quality and resource use measures across health care delivery settings and populations, encouraging care coordination from the ED, and implementing robust health information exchange systems.

Read the full abstract here

National health organisations publish a shared commitment to quality

The National Quality Board (NQB) has today (21 December) published a new framework that will promote improved quality criteria across all national health organisations for the first time | NHS England

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Image source: NHS England

The new publication provides a nationally agreed definition of quality and guide for clinical and managerial leaders wanting to improve quality.

The approach has been agreed by the national bodies that form the NQB to provide more consistency and to enable the system to work together more effectively.

It is part of work to cut unnecessary red tape by reducing duplication and aligning demands on professionals for information on the quality of services.

The document sets out a range of measures to achieve higher and consistent standards including: the need for a common language that people who use services understand; to ensure commissioners and providers experience a coherent system of assurance, measurement and regulation; that professionals and staff are equipped and empowered to deliver safe, effective, and responsive care; and leaders should create a culture where people feel free to speak up when something goes wrong.

Read the full overview here

Read the full framework here

Children’s Mental Health Funding Not Going Where it Should

YoungMinds analysis reveals that many local health bodies are diverting some of the new funding received for children’s mental health services to other priorities.

In 2015, the government pledged an extra £1.4 billion over five years to “transform” Child and Adolescent Mental Health Services (CAMHS). Research undertaken by YoungMinds into the responses of 199 Clinical Commissioning Groups (CCGs) from Freedom of Information requests has revealed that:

  • Fewer than half of the CCGs who responded were able to provide full information about their CAMHS budgets. If CAMHS services are to improve, there needs to be far greater accountability about where money is being spent.
  • In the first year of extra funding (2015-16), only 36% of CCGs who responded increased their CAMHS spend to reflect their additional government funds. Nearly two-thirds (64%) of CCGs used some or all of the extra money to backfill cuts or to spend on other priorities.
  • In the second year of extra funding (2016-17), only half of CCGs (50%) who responded increased their CAMHS spend to reflect their additional government funds. The other half (50%) are using some or all of the extra money for other priorities.

Read the full news story here

Study on Hospital Administrators’ Beliefs and Attitudes toward the Practice of Evidence-Based Management

Guo, R. et al. (2016) Hospital Topics. 94(3-4) pp. 62-66

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The authors’ purpose was to explore hospital administrators’ beliefs and attitudes toward the practice of evidence-based management (EBMgt) and to identify the needs for EBMgt training programs. A cross-sectional, nonexperimental design was utilized. Survey data were analyzed using descriptive statistics and Spearman’s correlation. The results showed that hospital administrators had positive attitudes toward the practice of EBMgt. There was a significant correlation between attitudes and percentage of healthcare management decisions made using an evidence-based practice approach (p < .01). The study findings suggest EBMgt educational training programs would likely help hospital administrators adopt evidence-based practice in management decision-making.

Read the full abstract here

Health literacy in Europe

van der Heide, I et al. (2016) The European Journal of Public Health. 26(6) pp. 906 – 911

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Background: Health literacy is an important determinant of health, but national health literacy levels are known for only some European countries. This study aims to examine to what extent national health literacy levels can be estimated based on publicly available census data.

Conclusion: Prediction models based on publicly available census data can be used for estimating self-assessed and performance-based health literacy on population level. Observed health literacy levels or better prediction models are required when one is interested in ranking European countries.

Read the full abstract here

What You Should Know About Mumps: A Disease From the Past Makes a Resurgence

Mumps may seem like a contagion relegated to history books, but like many other diseases of the past now preventable with a vaccine, mumps has been making a resurgence | Infection Control Today

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Image source: Paul Duprex – Wellcome Images // CC BY-NC-ND 4.0 

Cases are at 10-year high and are especially common on college campuses across the country. Now the Dallas area is seeing the largest outbreak in Texas in years. Cristie Columbus, MD, vice dean of the Texas A&M College of Medicine’s Dallas campus and an infectious disease specialist, explains what people need to know about the mumps.

What is mumps?: Mumps is caused by a virus, specifically a type of Rubulavirus in the Paramyxovirus family. Before the vaccine was widely introduced in the United States in 1967, nearly every child would become infected. Although cases have declined more than 99 percent since then, outbreaks do still occasionally occur.

What are the symptoms of mumps?: The classic symptom of mumps is swollen salivary glands, which causes puffy cheeks and a swollen jaw that can make it difficult to eat. Other symptoms, which last seven to 10 days, may include a fever, fatigue and head and muscle aches. Some people—possibly as many as 40 percent of those infected—may have only very mild symptoms (if they have any at all), and therefore might not realize they have the disease. Still, they may be able to spread the virus to others.

How long after being infected do symptoms usually appear?: Symptoms can appear between 12 and 25 days after the initial infection, but usually people begin experiencing them 16 to 18 days after they are infected.

Read the full overview here

NHS England announces £101 million of new funding for new care model vanguards

£101 million of new funding to support and spread the work of the new care model vanguards | NHS England

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The vanguards are partnerships of NHS, local government, voluntary, community and other organisations that are implementing plans to improve the healthcare people receive, prevent ill health and save funds.

Considerable progress has been made since the vanguards were launched in 2015 and there is emerging evidence that they are making significant improvements at a local level. This includes reducing pressure on busy GP and A&E services.

In addition to the funding, the vanguards will continue to receive support from NHS England and other national bodies to implement their plans, including how they harness new technology including apps and shared computer systems. They are also receiving help to develop their workforce so that it is organised around patients and their local populations.

Read the full overview here

Transformation fund call to bid

To support the implementation of the Five Year Forward View vision of better health, better patient care and improved NHS efficiency, NHS England has created a transformation fund | NHS England

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The interventions for which transformation funding are available are:

Sustainability and Transformation Plans (STPs) are central to this process and all bids should be explicitly linked to the relevant local STP plans. This process is open to any STP, although individual organisations or alliances may bid on behalf of an STP for this funding; submission of applications must be via STPs.

Read the full overview here

Departmental Overview 2015-16: Department of Health | via @NAOorguk

This Departmental Overview looks at the Department of Health (DH) and summarises its performance during the year ended March 2016 | NAO

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Image source: NAO

This guide is designed to provide a quick and accessible overview of the Department and focuses in particular on where we believe the Department’s performance could be improved, using examples from our published work.

It covers:

  • The department’s responsibilities and how it spends its money
  • Financial management
  • Reported performance
  • Issues identified in NAO reports

Read the full report here

Pressure on NHS beds could risk patient safety

Pressure on beds in the NHS in England has become so acute that on any given day last winter, the equivalent of more than five extra hospitals’-worth of beds had to be brought into service to cope with surges in demand | Nuffield Trust

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Image source: Nuffield Trust

On the single busiest day last winter, an extra 4,390 beds had to be opened, equivalent to more than seven extra hospitals in one day.  And on average, over 95% of beds across English hospitals were occupied every day last winter, despite evidence that once bed occupancy rates exceed 85%-90%, there is an increasing risk of infection (see note 1). Given that pressures on the health service have not lessened over the last 12 months, Trusts will face similarly high bed occupancy rates this winter.

Read the full overview here

Read the full report here