D053

Pediatric Quality Indicators (PDI) -

"focus on potentially preventable complications and iatrogenic events for pediatric patients treated in hospitals and on preventable hospitalizations among pediatric patients" (

•Standard A

- Client Selection, one of the directives states this selection should include "Results of established predictive modeling analysis and/or health risk screening tools indicative of need for case management"

•Patient Safety Indicators (PSI)

- address potentially preventable safety issues, including complications and adverse events.

•Steps in the EBP Process"

1.Assess - the patient and your own knowledge gaps. 2.Ask -a well-built practice question derived from your patient's case. 3.Acquire - the evidence by selecting an appropriate resource and conducting a search. 4.Appraise -the evidence for its validity and applicability to the patient's case. 5.Apply -what you have learned, talk with the patient, and integrate the evidence with your practice expertise and patient preferences. Also, self-evaluate your performance and effectiveness with this patient.

The five conditions are

1.Empowerment: There should be efforts to minimize power differences in the decision making and encourage participation by all involved. 2.Publicity: The framework (process), decisions, and their rationales should be transparent. 3.Relevance: Decisions should be made on the basis of reasons (i.e., evidence, principles, arguments) that "fair-minded" people can agree are relevant. 4.Revisions and appeals: There should be opportunities to revisit, revise, or appeal decisions in light of further evidence. Compliance (enforcement): There should be either voluntary or public regulation of the process

Interdisciplinary rounds :

1.Ensure patient-centered, coordinated care. 2.Review of the patient's current status with input from each team member. 3.Followed by a discussion and clarification of the patient's goals and expected outcomes of care. 4.Finally, a comprehensive plan of care should be developed or modified as appropriate

The key elements of an empathic inquiry approach to SDOH interviewing include:

1.Introduction 2.Creating clear expectations 3.Asking permission 4.Acknowledging sensitive content and supporting autonomy by giving permission to opt-out of any questions 5.Listening with empathy using reflective listening 6.Listening for opportunities to affirm the patient's strengths 7.Summarize 8.Using an open-ended question to ask about the patient's priorities 9.Arranging follow-up 10.Thanking the patient for their time and participation

HIPPA's Title II is where the following rules are covered

: •Privacy Rule •Security Rule •Transactions and Code Sets Rule •National Provider Identifiers Rule •Enforcement Rule

Principlism

: bioethicists base their judgment or resolution of cases on the four ethical principles: respect for autonomy (self-determination), nonmaleficence (do no harm), beneficence (do good), and justice (fairness).

What kind of care approach works the best when integrating behavioral health into primary care?

A multidisciplinary collaborative team

•4. certification

A process by which individuals' pre-acquired knowledge, skills, or competencies are evaluated against predetermined standards.

•certification

A qualification that a health professional may seek in addition to their primary qualifying degree or other credentials.

PACT Model: Patient Aligned Care Team (PACT).

All team members meet daily to discuss patient care, and all have an equal voice in the discussions.

credentialing

Bachelor's Degree in Health Services Coordination

National Transitions of Care Coalition (NTOCC)

Case Management Society of America (CMSA) and Sanofi U.S. to provide tools and guides for patients and their families, health professionals, policymakers, and the media to ease patient transitions between home and healthcare institutions or between institutions

•5. certification

Certified Case Manager (CCM) exam that is available to multidisciplinary healthcare professionals

Providence Health Care (PHC).

Conditions of PCH •Empowerment •Publicity •Relevance •Revision/Appeals •Compliance

Patient-centered medical homes (PCMH) are:

Congruent with primary care principles, partnerships, and collaborations between patients and the healthcare team, and personalized, well-coordinated care that is available where the client is, whether at home or within a healthcare agency. Ensure they are patient-centered, comprehensive, coordinated, accessible, and committed to quality and safety. May be located as a patient's primary hub within a medical neighborhood where information and support may be accessed to encourage the flow of information across and between clinicians and patients, to include specialists, hospitals, home health, long term care, and other clinical providers. •In addition, non-clinical partners like community centers, faith-based organizations, schools, employers, public health agencies, YMCAs, and even Meals on Wheels.

What are common themes in both of these publications?

Create protective environments, empower victims, skills to deal with violence, sector involvement, monitoring and evaluation.

Sociopolitical drivers at the mezzo level impact healthcare through regulatory bodies

Department of Health and Human Services (DHHS), Centers for Medicare and Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA); professional associations such as the American Hospital Association (AHA); educational institutions that prepare healthcare professionals; healthcare agencies such as hospitals

What driver affects the lack of regular health care?

Deportation, lack of insurance and language barriers

•Identify and consider ethical issues that arise in the clinical and organizational healthcare settings; •Explore different approaches to healthcare decision-makingin the medical center and provide recommendations for resolving ethical dilemmas in patient care; •Participate in developing and reviewing the medical center policy when matters of ethics are involved; •Assist in consultations when requested by the ethics consultation service and provide consultation assessment; and •Provide educational programs about bioethical issues, within both the medical center and the wider community

Ethical committee functions:

Karen Ann Quinlan

First Right to Die Case. •1975, 21-year-old Karen Ann Quinlan fell unexpectedly into a coma after a night out with friends during which she had mixed alcohol with Valium. Parents wanted to take her off life support but the medical team did not approve since they feel it is unethical. Gray area legally. •Court decided to appoint the guardian. This gave the family the right to determine her medical treatment, including discontinuing extraordinary means" •An interesting twist to this case was that Karen Ann remained alive for another 10 years, despite the removal of life-support equipment.

five corresponding abilities of populations interact with the dimensions of accessibility to generate access.

Five corollary dimensions of abilities include: 1) Ability to perceive; 2) Ability to seek; 3) Ability to reach; 4) Ability to pay; and 5) Ability to engage.

•3. professional development

Includes certifications; assessment-based certificates; attending conferences, workshops, and in-services; online webinars and activities; reading journal articles and completing continuing education courses.

•Standard 3:

Knowledge stipulated: "The social work case manager shall acquire and maintain knowledge of current theory, evidence-informed practice, sociohistorical context, policy, research, and evaluation methods relevant to case management and the population served and shall use such information to ensure the quality of case management practice"

Standard F -

Outcomes stipulates that the case manager must have used national performance measures for transitional care and care coordination such as those endorsed by the regulatory, accreditation, and certification agencies and health-related professional associations to ultimately enhance quality, efficiency and optimal client experience

•Standard D -

Planning, the case manager should have validated that the case management plan of care is consistent with evidence-based practice, when such guidelines are available and applicable, and that it continues to meet the client's changing needs and health condition •

HIPAA Breach Notification Rule

Requires covered entities to notify affected individuals, HMS, and media or breach of PHI.

mHealth:

Smartphone technology (both the mobile devices and the applications or apps) has led to mHealth evolution.

Social barriers to healthcare

Social class, education, race, gender, LGBT, discrimination.

How does a bill become a law?

The five steps are: 1.Every law starts with an idea 2.The bill is introduced 3.The bill goes to committee 4.Congress debates and votes 5.Presidential action

Suicide Prevalence

The key strategies addressed in this resource include: •Strengthen Economic Supports •Strengthen Access and Delivery of Suicide Care •Create Protective Environments •Teach Coping and Problem-Solving Skills •Identify and Support People at Risk •Lessen Harm and Prevent Future Risk •Sector Involvement •Monitoring and Evaluation

Macro:

The macro environment corresponds to the general level, which includes governmental organizations.

MACRO AND MEZZO TRENDS

The macro push for more value-based care means that the mezzo-level healthcare system is driven to implement changes: •such as collaborative interprofessional teams to provide this complex care within community environments such as medical homes. •care for terminally ill patients may include the request for care that allows them to die with dignity: •While some states have passed this legislation, others have not due to the complex ethical challenges of physician-assisted suicide. "The main reasons cited by a large majority of patients for wanting the lethal prescriptions included loss of autonomy and dignity and an inability to enjoy life. Lack of pain control was cited by 25% of the patients. Most patients (94%) were in-home hospice care when they took the medication and died at home" •

•Mezzo:

The mezzo environment corresponds to the level of the healthcare system.

Micro:

The microenvironment corresponds to the service area level.

Service:

The service environment corresponds to the micro level.

•Access as the opportunity to identify healthcare needs, to seek healthcare services, to reach, to obtain or use health care services, and to actually have a need for services fulfilled.

We conceptualise five dimensions of accessibility: •1) Approachability; •2) Acceptability; •3) Availability and accommodation; •4) Affordability; •5) Appropriateness.

Agency for Healthcare Research and Quality (AHRQ)

Works to promote patient safety, quality, equitable care, and evidence-based practice through research, training, data and measurement, clinical decision support, and resource

•CMS is

a government-affiliated organization that is responsible for the financial aspects of healthcare, but that also has many initiatives to improve healthcare overall, particularly healthcare quality.

Marijuana as medicine

a refers to using the whole, unprocessed marijuana plant or its basic extracts to treat symptoms of illness and other conditions. The U.S. Food and Drug Administration (FDA) has not recognized or approved the marijuana plant as medicine.

•Cognitive biases

affect our thought process in every area of life, from how we form our memories, to how we shape our beliefs, and to how we connect with other people. The patterns of irrationality that represent the various cognitive biases vary in terms of how they affect us and in terms of their scope. Accordingly, cognitive biases can lead to minor issues, such as forgetting a small detail from a past event, or they can lead to more serious issues, such as choosing to reject life-saving treatment due to a misguided belief in a pseudoscientific course of treatment.

•Applied ethics—

also called practical ethics or professional ethics—is the use of general ethical theories, moral reasoning, and professional codes of ethics and conduct to make decisions and solve problems.

APM stands for Alternative-Payment Model,

and it is a temporary and experimental value-based care model. Experimental and temporary value-based care models that are designed to test theories of care.

Netiquette rules:

apply strongly to social media since it is such a global phenomenon that can potentially put any post in the public eye. "Whether in the public or private corners of the internet, conduct yourself online in a manner that is always conducive to your professional success, following established netiquette principles, as well as using social media effectively and responsibly"

•Merit-based improvement programs

are aimed at smaller healthcare providers.

•Personal bias:

can also affect ethical decision making, which can negatively affect interactions and care planning with patients. In this context, bias can be divided into two categories: motivational bias and cognitive bias. •It is important that people engage in self-reflection and notice the biases that influence their values, beliefs, behaviors, and decisions. Biases that interfere with fair and ethical decisions and behaviors need to be addressed in order to provide high-quality care to patients.

•The Internet of Things (IOT)

can be accessed through smartphones but also wearables, smart clothing and buildings, and so on.

Artificial intelligence

depends on complex and powerful supercomputers such as IBM Watson

•High Value:

equitable outcomes for patients and families and quality assurance.

Professional ethics:

in healthcare refers to the personal and disciplinary-specific ethical codes that professionals follow, such as professional medical ethics, nursing ethics, healthcare organizational codes of ethics, and so on

Patient-centered primary care (PCPC)

is a not-for-profit multi-stakeholder membership organization dedicated to advancing an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home. PCPCC's mission is to unify and engage diverse stakeholders in promoting policies and sharing best practices that support growth of high-performing primary care and achieve the 'Quadruple Aim': better care, better health, lower costs, and greater joy for clinicians and staff in delivery of care PCPC is based on these seven shared principles of primary care: •Person and family-centric •Continuous •Comprehensive and equitable •Team-based and collaborative •Coordinated and integrated •Accessible •High value

Bioethics i

is also very predominant in any research that includes human participants. Stem cell research, genetic testing, cloning:

You, Observe, Deliberate, and Act

is another example of a healthcare framework that can help health professionals work through ethical dilemmas. This framework emphasizes the importance of all health employees acting in ethical ways and encourages robust self-reflection and examination as one moves through the ethical decision-making process.

Protecting patient safety:

is to keep data and information private, confidential, and secure. These precautions are even more challenging to implement when mobile devices are used in healthcare, by either providers or patients. Health professionals must be aware and prevent loss or theft of mobile devices, tampering or hacking of mobile data, or intrusions on patient privacy.

"bandwagon" bias

means that people feel a need to conform and act in accordance with others and rely on other people's judgment when deciding how to act

•The Value-Modifier Program, or VMP,

measures the quality and cost of care provided to people with Medicare.

casuistry

on the other hand, bioethicists work on a case-by-case basis, exploring each case's facts, complexity, relevant laws, and unusual circumstances before making a decision.

National Transitions of Care Coalition (NTOCC)

tools to help healthcare professionals, patients, and caregivers establish safer transitions; and resources for practitioners and policymakers to improve transitions Most of these resources are available free of charge and have been accessed extensively within the United States and globally"

Chronic management programs is the Chronic Care Model.

• •This model was first developed in the 1990s by Group Health Research Institute. •To guide high-quality care for people living with chronic illnesses. •The goal of the model is to "support patients to become informed and activated who have the motivation, information, skills, and confidence necessary to effectively make decisions about their health and manage it" •With this program, patients "use effective self-management support strategies that include assessment, goal-setting, action planning, problem-solving, and follow-up" to manage their own health

Paperwork Reduction Act (PRA) of 1980

• (1) reducing the burden of government paperwork on the public; •(2) records management activities; •(3) the privacy of records pertaining to individuals; and (4) reviewing federal government information collection requests.

Socioeconomic barriers to healthcare

• SES (socioeconomic status), income, crowded living conditions, substandard housing, poor diet (food deserts), risky or hazardous jobs, expensive treatments and prescriptions.

Evidence-Based Interventions and Outcomes

•"What Works for Health" database is rated using the following taxonomy: •Scientifically Supported •Some Evidence •Expert Opinion •Insufficient Evidence •Mixed Evidence •Evidence of Ineffectiveness

Stage of Continuous Professional Development (CPD)

•1) Identify and plan: Understand where you've come from, where you are, and where you want to be. •2) Act: on your plan and be open to learning experiences. •3) Reflect: Make the most of your day-to-day learning by routinely reflecting on experience. •4) Apply: Create opportunities where you can translate theory into practice and put your learning to work. •5) Share: Share your learning in communities of practice to generate greater insight and benefit from your community's support. •6) Impact: Measure the overall impact your learning has had on the work you do.

3 studies expert looks at EBP to use.

•1) how many studies •2) Quality of studies •3) Expert agree the treatment worked

What are the six domains of Digital Literacy?

•A useful way to understand how digital literacy in health professions improves practice is to explore a digital capabilities framework. One example of this type of framework divides digital literacy into six key domains of capability: 1.Communication, collaboration, and participation 2.Teaching, learning, and self-development 3.Information, data, and content literacies 4.Creation, innovation, and research 5.Technical proficiency 6.Digital identity, well-being, safety, and security

The ACMA Standards of Practice are clustered into seven areas:

•Accountability •Professionalism •Collaboration •Care Coordination •Advocacy •Resource Management •Certification (ACMA, 2013)

The Initiative helps identify measures that:

•Address high impact measure areas that safeguard public health •Are patient-centered and meaningful to patients •Are outcome-based where possible •Fulfill requirements in programs' statutes •Minimize level of burden for providers •Provide significant opportunity for improvement •Address measure needs for population-based payment through alternative payment models •Align across programs and/or with other payers (Medicaid, commercial payers)

Required safeguards with the security rule

•Administrative safeguards •Technical safeguards •Physical safeguards

•Credentialing

•All health professionals in the United States are expected to have the relevant credentials to perform their roles within the healthcare system. These credentials include the degrees, certificates, licenses, and diplomas they have earned to prepare for their professional role.

Older adults (65 years and older)

•Among older adults, unmet health care needs because of cost were most commonly reported by those with self-care disability and least commonly reported by those with serious difficulty hearing.

Criteria for Trustworthy Guidelines

•Be based on a systematic review of the literature •Be developed by a knowledgeable, multidisciplinary panel of experts and representatives from key affected groups •Consider important patient subgroups and patient values and preferences •Be based on an explicit and transparent process that minimizes distortions, biases, and conflicts of interest •Provide a clear explanation of the logical relationships between alternative care options and health outcomes •Provide ratings of the quality of evidence and the strength of recommendations •Be reconsidered and revised as appropriate when important new evidence needs modification and recommendations

•Brittany Maynard

•Brittany Maynard was a 29-year-old newlywed living in California who discovered that her persistent bad headaches were due to brain cancer. After having surgery to try to remove the tumor, she was told she had stage 4 astrocytoma and only had six months to live. She decided to seek a prescription for a lethal dose of medicine that she could take when she chose to die with dignity. She had to move to Oregon to do so since her home state would not legally allow this, but Oregon had a death with dignity law. Brittany took the lethal dose and ended her own life on November 1, 2014.

•Cassandra Callender

•Cassandra Callender was a 17-year-old teen who was diagnosed with Hodgkin's lymphoma in 2014 and given an 85% estimated chance by her care team that she would survive if she underwent chemotherapy treatment, but she refused because she and her mother wanted to try alternative natural ways to treat her cancer. Her case went to the Supreme Court, which ordered her to receive chemotherapy. She was ordered into the custody of the Connecticut Department of Children and Families to ensure that she received six months of chemotherapy.

Retrospective payments

•Charge based reimbursement (fee for services) • Cost-based reimbursement (allowable cost) •Percentage of charges • •

Systematic Reviews and Clinical Guidelines

•Clinical guidelines are developed to guide the practitioner's decision-making process for treatment. These approaches are incorporated by many healthcare organizations and entities to assist them to avoid untoward events and mitigate risk. •These guidelines are also utilized to provide efficient and cost-effective care by providing the highest quality of outcomes for the most prudent use of resources. •High-quality, evidence-informed clinical practice guidelines (CPGs) offer a way of bridging the gap between policy, best practice, local contexts, and patient choice. Clinical guidelines have been upheld as an essential part of quality medical practice for several decades. Guidelines have a range of purposes, intended to improve effectiveness and quality of care, to decrease variations in clinical practice and to decrease costly and preventable mistakes and adverse events. They generally

Systematic Reviews and clinical practice guidelines in development process:

•Clinical practice guidelines are systematically developed statements that intend to assist clinicians and patients in making decisions about appropriate health care in specific circumstances. Guidelines aim to improve the quality of patient care by encouraging interventions of proven benefit and discouraging the use of ineffective or potentially harmful interventions; to reduce unnecessary variation in practice; to lessen disparities; to empower patients; and to influence public policy.

•Centers for Medicare and Medicaid website provide a wealth of resources on provider compliance for healthcare organizations obtaining Medicare and Medicaid funding:

•Compliance-Related Resources •Educational Products •Compliance Articles •Outreach and Education Task •Best Practices on Safeguarding Medical Identity •Video resources •Fraud and Abuse-Related Resources •Educational Products •Prevention, Detection, and Reporting Readings •Waste and Abuse Trainings

Organization Ethic Committee Serve 3 important role

•Consult on difficult clinical decisions •Guide professional staff in making ethical decisions and educating hospitals personnel about these policies •Guide professional staff

•Patient and family -Centric: Care is customized, a partnership, focuses on the whole person.

•Continuous: Dynamic, trusting, enduring relationships that give perspective. •Comprehensive and equitable: Appropriate clinical and supportive services tailored to SDOH. •Team Based and collaborative: All work together dynamically toward common goals, outcomes. •Coordinated and integrated: Supported in navigating the system, communicating across services, engaged in transitions of care.

Access to health care consists of four components:

•Coverage: facilitates entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health status. •Services: Having a usual source of care is associated with adults receiving recommended screening and prevention services. •Timeliness: ability to provide health care when the need is recognized. Workforce: capable, qualified, culturally competent providers"

Team Huddles

•Daily mini-rounds where teams touch base and co-plan care of the day. •Taking the time to come together to communicate about how to improves patient awareness in the unit and decreases chaos caused by poor communication. Learn, plan, work, troubleshoot, communicate, collaborate, interact, build relationships, and learn about each other's roles together.

Every healthcare office, clinic, hospital, or other healthcare setting needs to put processes in place to be compliant. These include:

•Develop policies and procedures for data backup and recovery. •Back up your data on a regular, frequent basis and ensure you can retrieve exact copies of ePHI and restore any lost data. . •Establish acceptable but aggressive recovery time objectives (RTOs) and recovery point objectives (RPOs) and develop a disaster recovery plan that meets these objectives. •Periodically test your disaster recovery plan to be sure it works before a real disaster happens. •Perform an annual risk assessment to determine whether your systems and data are a security risk and how vulnerable you are to attack. •Develop a data breach response plan to identify who is responsible for what when a breach occurs, and how to communicate with individuals whose PHI was compromised, handle the media, minimize further data loss, and remediate the breach. •Encrypt ePHI data in transit and at rest. •Ensure HCO business associates and service providers meet HIPAA and HITECH security requirements

Key social determinants of health that work together to either support health or put health at risk:

•Economic stability such as income adequacy and debt levels •Location and condition of neighborhoods and physical environments such as homes •Education and literacy levels •Food security and nutrition •Community and social context, support •Healthcare access, insurance coverage, available services

SDOH related concerns did you notice?

•Economic stability—the patient was worried about bills, his own work hours were unreliable, and he said he hoped his wife would return to work. •Social support—the patient does have support from his mother but feels responsible for taking care of his wife and child, with little social support for himself. •Education—the patient states he is a dishwasher in a restaurant, which suggests that his education is not high.

Health Care Ethics Committees have addressed sone or all of three functions:

•Education •Policy development •Review •Guideline recommendations Case review \Consultation

What are some ways that social norms for violence can be addressed or treated?

•Empowerment-based training, Social-emotional learning programs, Healthy relationship programs.

Risk Assessment

•Ensure the organization is compliant with HIPAA requirements in terms of physical, technical, and administrative safeguards

The overall purpose of the ACA is to:

•Establish healthcare reform •More access to affordable quality health insurance •Reduce the growth in U.S. health care spending. •Expand the affordability, quality, and availability of private and public health insurance through consumer protections, regulations, subsidies, taxes, insurance exchanges, and other reforms. •it changed how physicians and hospitals are paid, shifting toward more value-based payments. It required reducing wasteful and expensive readmissions and encouraged efficient redesign of care.

Examples of specific care coordination activities include:

•Establishing accountability and agreeing on responsibility. •Communicating/sharing knowledge. •Helping with transitions of care. •Assessing patient needs and goals. •Creating a proactive care plan. •Monitoring and follow-up, including responding to changes in patients' needs. •Supporting patients' self-management goals. •Linking to community resources. Working to align resources with patient and population needs.

Providence Health Care (PHC).

•Ethical and legal scopes of practice for health service coordinators and all health professionals are focused on specific aspects of safe, patient-centered, compassionate, and culturally competent care.

Culture is a fundamental factor of healthcare:

•Every encounter and interaction with patients, families, and co-workers is colored by culture. •Culture includes a person's racial, ethnic, and religious heritage. •Culture also represents a person's lifestyle choices, the social groups to which they belong, and the organizational and professional cultures within which they work.

What are the principles of patient-centered collaborative culturally competent care to all patients to provide meaningful care that really makes a difference for patients. These principles include:

•Everyone has a need to be heard and to be understood. •All people really care about is being cared about. •Family is an extension of the patient. •Words can harm, and words can heal. •Physical touch is a powerful force that can be destructive or healing. •Non-verbal cues are powerful. •Spirituality is important to nearly everyone. Allow the patient and family as much control as possible.

The Role of Evidence-Based Practice (EBP)

•Evidence-based care and practice integrate the best scientifically-based research and strategies to guide treatment interventions and improve patient outcomes. •It incorporates an approach to clinical practice that involves the systematic search for and appraisal of the most relevant evidence to diagnose and treat •These best practices must be incorporated into the individual practitioner's own clinical skillset •They must take into account the patient's preferences and values

•Recommended ways to reduce the impact of implicit or unconscious biases include:

•Focus on seeing people as individuals. Rather than focusing on stereotypes to define people, spend time considering them on a more personal, individual level. •Work on consciously changing your stereotypes. If you do recognize that your response to a person might be rooted in biases or stereotypes, try to consciously adjust your response. Adjust your perspective. Try seeing things from another person's point of view. How would you respond if you were in their same position? What factors might contribute to how a person acts in a particular setting or situation

•Patient-centered collaborative culturally competent care to all encounters with patients can help health services coordinators provide meaningful care that really makes a difference for patients. These principles include:

•Foundational skills relevant to all principles (represented by the acronym PREP): •Preparation: Establish the right frame of mind and plan before seeing the patient. •Respect: Show respect since patients are vulnerable and need our assistance. •Environment: Create a comfortable setting for the patient and family. •Presentation: Represent the profession and the work we do.

•Quadrant IV: Unethical and Illegal

•Health professionals "fall into this quadrant when they deliberately commit acts that are criminal, morally corrupt, and socially unacceptable. •Examples include preparing inflated fee schedules, submitting fraudulent reports, and issuing inflated patient or client bills"

Six types of disabilities:

•Hearing (serious difficulty hearing); •Vision (serious difficulty seeing); •Cognition (serious difficulty concentrating, remembering, or making decisions); •Mobility (serious difficulty walking or climbing stairs); •Self-care (difficulty dressing or bathing); or •Independent living (difficulty doing errands alone)

CMSA Standard M: Cultural Competency

•How demonstrated: •Evidence of communicating in an effective, respectful, and sensitive manner, and in accordance with the client's cultural and linguistic context •Assessments, goal setting, and development of a case management plan of care to accommodate each client's cultural and linguistic needs and preference of services •Identifying appropriate resources to enhance the client's access to care and improve health care outcomes, which may include the use of interpreters and health educational materials that apply language and format demonstrative of understanding the client's cultural and linguistic communication patterns, including but not limited to speech volume, context, tone, kinetics, space, and other similar verbal/non-verbal communication patterns •The pursuit of professional education to maintain and advance one's level of cultural competence and effectiveness while working with diverse client populations

Goals of Environmental Analysis

•Identify and analyze current issues and changes that affect a company •Detect and analyze weak signals of issues and changes that will affect a company •Speculate on future issues and changes that will have an impact •Classify and order issues and changes outside a company •Provide information for the development of a company's mission, vision, values, goals, and strategy •Foster strategic thinking

ACMA Transition of Care Standards

•Identify patients at risk for poor transitions •Complete a comprehensive assessment •Perform and communicate a medicine reconciliation •Establish a dynamic care management plan that addresses all settings throughout the continuum of care Communicateessentialcaretransitionsinfotokeystakeholders

8 steps of decision making

•Identify the ethical issue •Gut: What do you feel you should do? •Facts: Find out the facts •Values: Who will be affected by the decision made? •Options: What are alternatives? •Choice: What is the best choice? •Justification: What is the reason you chose this? •Hindsight: What could you have done differently to avoid it getting to an ethical issue?

IDEA Ethical Decision

•Identify the facts •Determine relevant ethical principles •Explore the Options •Act of Decision

Prevention Quality Indicators (PQI)

•Identify the issues of access to outpatient care •Follow up after hospital discharge Use datatoidentifyadmissionthatmightbeavoidedthroughaccesstoavoidoutpatient

Continuous Professional Development (CPD) activities that support them in achieving the following:

•Improve and provide quality patient care—"will embody an ethical commitment to ensuring the health and patient safety; •Work in interprofessional teams—"team-based learning and training will be central to promote coordination and collaboration, helping them to learn with, from, and about one another;" •Employ evidence-based practice—"new knowledge generated by health research, providing rich sources of information in learning. Advances in health care can be made when research identifies and fills knowledge gaps •Apply quality improvement—"all professionals in health care should aim for continuous improvement of their performance to deliver the best patient care" •Use health informatics—"modern health information technologies provide an unprecedented opportunity for capturing and rapidly analyzing real-time data at the point of care to help clinicians manage data, improve safety, make informed clinical decisions, and access information or community resources"

Which collaborative strategy directly supports a patient with evidence-based options to consider their choices and personal preferences?

•In shared decision-making, a team member(s) meets with the patient to discuss choices related to their health, presents them with evidence-based options, and explores patient values and preferences to support them to make the best decision for their health and lifestyle.

The ACA supports Patient-Centered Medical Homes (PCMHs), also known as "health homes," and Accountable Care Organizations (ACOs). To succeed, these models must establish:

•Integrated care teams of health professionals; •Care coordination and information sharing; Health information technology (for example, quality improvement tracking of treatment outcomes).

Behavioral health integration

•Involves patient-centered care team, behavioral health generalist •A common barrier to integrated care is a lack of knowledge and comfort with prescribing psychiatric medications. •screening all patients for other health (including behavioral health) conditions in addition to the presenting problem. •Measuring the quality and outcomes of care are central components to all integration initiatives. •Care coordination •Clinical Pathways •One of the most significant cultural shifts when providing integrated care is moving from a focus on individual patient outcomes to population-based care. •Coordinated plan of care Self-Care

What are Shared Care Plans?

•Is a patient-centered health record designed to facilitate communication among members of the care team, including the patient and providers. •Combines both medical and behavioral health care (treatment) plans to encourage a team approach to care. •The patient often has a copy or has electronic access to it and can add to it over time. •Are considered living documents that are revised and continue as needs and goals change. Patient's perspective, such as: "My Next Steps.

Sociopolitical Drivers:

•It is what impacts the environment, society, and population of healthcare. •Macro sociopolitical drivers logically begin with an understanding of social and population trends. •Baby Boomer generation •Frail older persons with comorbid conditions

•Janet Adkins

•Janet Adkins was a 54-year-old woman from Oregon in 1990 living with Alzheimer's disease who decided she did not want to continue to live with the cognitive deterioration this disease would bring. •She approached Dr. Jack Kevorkian in Michigan to assist her in dying, using his "suicide machine," which pumped a powerful barbiturate and potassium chloride mixture into her bloodstream and led to a massive heart attack. •Legal charges were laid against Kevorkian for her murder but were dismissed by District Court. This landmark case became a controversial topic of debate about euthanasia and the right of terminally ill people to choose to end their own lives. It is worth noting that Dr. Kevorkian did spend several years in prison for assisting the suicide of another patient with ALS a few years later.

Challenges to Access Healthcare

•Limited appt availability office hours. •Unable Access to convenient care; Telehealth allows a patient to receive medical treatment without being beholden to an office schedule that does not fit the patient's needs. •Clinicxian Shortage in rural areas • geographic barriers and travel distances still beleaguer rural residents. •LIMITED EDUCATION ABOUT CARE SITES •oUT of pocket expences

•Case Management Society of America (CMSA) (2016) Standards • 2016 Standards reflect recent changes in the industry, which resonate with current practice. Some of these changes include the following:

•Minimizing fragmentation •application of evidence-based guidelines in practice •promote collaborative care coordination •navigating transitions of care, and •incorporating adherence guidelines and other standardized practice tools.

Specialized skills, knowledge, and competencies professional case managers apply throughout the case management process.

•Motivational interviewing and positive relationship-building; •Effective written and verbal communication; •Negotiation and brokerage of services; •Cost-conscious allocation of resources; knowledge of contractual health insurance or risk arrangements; •Client activation, empowerment, and engagement; •the ability to effect change, perform ongoing evaluation and critical analysis; •the skill to plan, organize, and manage competing priorities effectively.

•Nancy Cruzan

•Nancy Cruzan was also a young woman in her 30s who became comatose after a car accident and was maintained by a feeding tube in 1983. Her parents requested that the feeding tube be removed and that Nancy be allowed to die naturally. •Cruzan decision, the federal government enacted the Patient Self-Determination Act that requires hospitals, nursing facilities, hospices, home health care programs, and health maintenance organizations to inform patients about their right to make forward-looking care and treatment decisions through the use of advance directives.

Prospective payments

•Negotiated/established prior to the service •Diagnostic group and severity index • Hospital-acquired conditions are not reimbursement •Medicare are now penalizing readmissions

What is netiquette?

•Netiquette, Writer Virginia Shea wrote these important guidelines: •Remember the human—this is the Golden Rule of internet communications. Always be aware that you are talking to a person, not a device. Therefore, the same rules of courtesy apply. •Adhere to the same standards of behavior online that you follow in real life •Know where you are in cyberspace—netiquette varies from domain to domain. What is acceptable in a chat room may not be appropriate in a professional forum so "lurk before you leap". •Respect other people's time and bandwidth •Make yourself look good online—spelling and grammar count! Always write thoughtful posts and keep your language clean. •Share expert knowledge •Help keep flame wars under control •Respect other people's privacy •Don't abuse your power •Be forgiving of other people's mistakes

Care coordination involves

•Organizing patient care activities •Sharing information among all of the participants involved in patient care to achieve safer and more effective care. •Communicate ahead of time patient needs and preferences •Information is used to provide safe, appropriate, and effective care to the patient.

The guiding principles of Models of Care were based on the following (ACI, 2013):

•Patient-centric •Flexible and accessible •Supportive integrative care •Referral driven •Standardized and •Measured based on outcomes.

•Value-based systems:

•Phase I: Integration into practice workflow and culture. Value-based care is a cultural practice and should be consistently incorporated into health coordination service delivery. •Phase II: Shared-Decision Making. Developing a culture that involves patients and care providers in the treatment decision-making process. This will give the patient a voice in their healthcare treatment and decisions. Phase III: Accountability for Outcomes: The current value-based treatment model is grounded in professional competence and a high level of responsibility. Health coordinators are governed by checks and balance systems that promote evaluation throughout patient engagement processes

Physical barriers to healthcare

•Poor environmental conditions, service quality and availability, geography (rural), lack of research. •Patients who are physically unable to drive, who face financial barriers, or who otherwise cannot obtain transportation to the clinician office often go without care.

•All three of these components ensure that evidence-based practice is applied within a patient-centered collaborative milieu. EBP incorporates:

•Practice Expertise: The provider's experience and judgement from past experience with similar patients or situations, as well as knowledge the provider has gained in the past, are important for applying the evidence to practice. •Research Evidence: Reliable scientific studies that relate to the patient's condition or needs provide evidence on past treatments, diagnoses, processes, and procedures that can be considered and used to inform practice. •Patient Preferences and Values: Patient input is critical for informed, shared decision-making about the best care for each unique patient. The final decision should consider all the evidence and match the patient's values and choices.

Integration of services

•Primary caregivers, behavioral or mental health practitioners, and other specialists as needed are all available in one place. •Care is more seamless, in an environment where the patient feels more comfortable.

Inpatient Quality Indicators (IQI)

•Provide quality measures of quality care inpatient •Mortality and use of volume procedures

An interprofessional collaborative team:

•Providers in diverse professions collaborate to developing a method of ongoing communication with each other, patients and family •To produce a management plan that addresses components

Regulation domains:

•Quality reporting •New models of care and value based payments •Meaningful use of HER •Hospital conditions of participations •Program Integrity •Fraud and abuse •Privacy and Security Rules •Post acute care •Billing and coverage verification requirements

Social Determinents of Health:

•Racial discrimination •Codified racism like redlining has also been linked to maternal health disparities and poorer COVID-19 infection rates and outcomes. •Access to health services means the timely use of personal health services to achieve the best health outcomes" •Access to health services requires three distinct steps: •Entering the healthcare system (usually through insurance coverage) •Accessing a location where needed healthcare services are provided (geographic availability) •Finding a healthcare provider whom the patient trusts and can communicate with (personal relationship).

oung adults (18-44 years)

•Receipt of a routine check-up during the past 12 months was most often reported by young adults with a mobility disability. •Among young adults, unmet health care needs because of cost were most commonly reported by those with independent living disability and least commonly reported by those with serious difficulty hearing.

Trauma-informed approaches to care

•Recovery focused •Informed consent •Evidence-informed practice •Social determinants of health •Motivation-based treatment •Cultural competency and safety

•Recommendations also reinforced the need for evidence-based decision making as well as the following:

•Redesign of care processes based on best practices •Use of information technologies to improve access to clinical information and support clinical decision making •Knowledge and skills management •Development of effective teams •Coordination of care across patient conditions, services, and settings over time •Incorporation of performance and outcome measurements for improvement and accountability.

•The 5 Rs of Cultural Humility were developed as a tool for health professionals to apply to their practice. Here are the 5 Rs:

•Reflection- approach every encounter with humility and understanding that there is always something to learn from everyone. •Respect- treat every person with the utmost respect and strive to preserve dignity at all times. •Regard- hold every person in their highest regard while being aware of and not allowing unconscious biases to interfere in any interactions. •Relevance- expect cultural humility to be relevant to the patient and apply this practice to every encounter. Resiliency- embody the practice of cultural humility to enhance personal resilience and globally focused compassion."

•The DSM-5 has three sections (American Psychiatric Association, n.d.):

•Section I is a description of the DSM-5 and the new information that has been implemented since the most recent publication (DSM-4). •Section II: Provides codes, descriptions, and origins of neurodevelopmental disorders and psychological disorders: •Schizophrenia and psychotic disorders •Bipolar, depressive, anxiety, obsessive-compulsive, trauma and stress-related disorders, dissociative, somatic symptoms, feeding and eating, sexual dysfunctions, sleep, elimination, gender, disruptive, and conduct disorders. •Substance related disorders, personality, neurocognitive disorders, and impulse control disorders. •Section III: Is a review of emerging measures and models such as personality disorders and disorders based on trends: •Social media addictions •Online dating disturbances • Fascination with negativity •Cyberbullying

HIPAA Basics: Privacy rules

•Sets national standards for the use and disclosure of protected health information (PHI)

What are Integrated Care Plans (ICP)?

•Similar to shared care plans in that they are developed by the entire integrated care team in consultation with the patient and family. •Focus is on the whole spectrum of patient needs that are addressed by one team, •Mental health and/or substance use are combined with chronic health physical needs; or multiple chronic conditions combined with old age.

Many macro-, mezzo-, and micro-level organizations including health professionals are looking for ways to address issues of social inequities and remove barriers that negatively impact the health status and quality of life of many Americans. Common barriers identified include:

•Social—sociocultural needs, language needs, gender, and LGBT needs •Socioeconomic—access to insurance, dollar amounts of copayments, cost of medications, access to nutritious food, conditions of the environment, income levels, housing •Physical—physical restraints (disability, age, mental health); access to healthcare facilities (geography, proximity, transportation); access to health professionals (clinician availability); or virtual care (technology, networks access)

Culturally Responsive Evaluation and Treatment Planning

•Step 1: Engage clients. •Step 2: Familiarize clients and their families with treatment and evaluation processes. •Step 3: Endorse collaboration in interviews, assessments, and treatment planning. •Step 4: Integrate culturally relevant information and themes. •Step 5: Gather culturally relevant collateral information. •Step 6: Select culturally appropriate screening and assessment tools. •Step 7: Determine readiness and motivation for change. •Step 8: Provide culturally responsive case management. •Step 9: Incorporate cultural factors into treatment planning.

Providence Health Care

•Step by step, fair process to help guide healthcare providers and administrators in working through ethical issues encountered in healthcare. •4 steps of PCH: •IDEA •Identify the facts •Determine relevant ethical principles •Explore the Options •Act

Key points in suicide prevention:

•Suicide is associated with several risk and protective factors. Suicide, like other human behaviors, has nosingle determining cause. Individual level: history of depression and other mental illnesses, hopelessness, substance abuse, certainhealth conditions, previous suicide attempt, violence victimization and perpetration, and genetic andbiological determinants Relationship level: high conflict or violent relationships, sense of isolation and lack of social support, family/loved one's history of suicide, financial and work stress Community level: inadequate community connectedness, barriers to health care (e.g., lack of access toproviders and medications) Societal level: availability of lethal means of suicide, unsafe media portrayals of suicide, stigma associatedwith help-seeking and mental illness.

Examples of broad care coordination approaches include:

•Teamwork. •Care management. •Medication management. •Health information technology. Patient-centered medical home.

Healthcare Access for People with Disabilities

•The Americans with Disabilities Act of 1990 (ADA) is the federal civil rights law that prohibits discrimination against individuals with disabilities in everyday activities, including medical services. •Among other things, these statutes together require health care organizations to: •Provide equal services to individuals with disabilities, •Make reasonable modifications in policies and practices to provide equal access, Provide auxiliary aids and services when necessary to provide effective communication."

Care Transitions Intervention Program (CTI)

•The Care Transitions Intervention Program (CTI) combines elements of person-centered care, health coaching, self-management, and transition care. •A 4-week program with the patients that has complex care needs and family caregivers receive specific tools and work with a Transitions Coach •To learn self-management skills that will ensure their needs are met during the transition from hospital to home. •This is a low-cost, low-intensity evidence-based intervention comprised of a home visit and three phone calls"

IDEA Ethical Decision-Making Framework

•The Framework can be used to guide decision-making and actions about ethical issues that arise from the bedside to the boardroom. •The framework addresses two general types of ethical decisions that lie across a continuum: clinical and organizational

Key principles of this approach to care include:

•The healthcare system's mission, vision, values, leadership, and quality-improvement drivers are aligned to patient-centered goals. •Care is collaborative, coordinated, and accessible. The right care is provided at the right time and in the right place. •Care focuses on physical comfort as well as emotional well-being. •Patient and family preferences, values, cultural traditions, and socioeconomic conditions are respected. •Patients and their families are an expected part of the care team and play a role in decisions at the patient and system level. •The presence of family members in the care setting is encouraged and facilitated. •Information is shared fully and in a timely manner so that patients and their family members can make informed decisions" (Massachusetts Medical Society, 2017, p. 1).

Middle-aged adults (45-64 years)

•The lowest percentages of middle-aged adults reporting having health insurance coverage and a usual source of health care were among those with vision disability. •Among middle-aged adults, unmet health care needs because of cost were most commonly reported by those with vision disability and least commonly reported by those with serious difficulty hearing.

•Standard 6. Service Planning, Implementation, and Monitoring outlined:

•The social work case manager shall collaborate with clients to plan, implement, monitor, and amend individualized services that promote clients' strengths, advance clients' well-being, and help clients achieve their goals. Case management service plans shall be based on meaningful assessments and shall have specific, attainable, measurable objectives

•Standard 8. Interdisciplinary and Interorganizational Collaboration also stated:

•The social work case manager shall promote collaboration among colleagues and organizations to enhance service delivery and facilitate client goal attainment

process of external analysis

•This implies that healthcare leaders and professionals must be aware of the present and possible external concerns, trends, and events that may have an influence on the business, as well as be able to perceive new opportunities that these changes may offer. •From an organizational perspective •can also be done both informally and formally by individual or teams of health professionals.

•Quadrant II: Ethical and Illegal

•This is an uncomfortable extreme state and one to be avoided, yet it may present itself within the practice or community setting. •An example was the arrest of healthcare professionals who protested when North Carolina did not approve Medicaid expansion in 2013. In the protestors' view, civil disobedience was necessary to protest the loss of benefits (such as preventive care) for their poor patients. Other practice-related examples could be assisted suicide for terminal patients or abortion for a young rape victim in states where they are illegal.

•Quadrant I: Ethical and Legal

•This is the ideal state—where actions and decisions made by HSC with their patients and care team are both ethical and legal and benefit the patient.

Quadrant III: Unethical and Legal

•This quadrant is a gray area that leaves room for unethical behavior as long as it is legal. •Examples include uncaring, though not overtly rude or discriminatory, rough behavior toward a patient that could be considered legal but definitely not ethical. Or if a patient requests an alternative treatment that is legal but seems counterproductive to their care team and raises concerns for the patient's health and well-being. Another would be to charge a lot of money for an essential drug since it is legal to do so, even though it means that the drug would be too expensive for low-income patients, making it unethical. Obviously, unethical behavior is not acceptable in health professionals and must be avoided to maintain codes of ethics and standards of practice.

HIPAA Titles The HIPAA Act is a legislated law that consists of five important titles:

•Title I: Protects health insurance coverage for workers and their families that change or lose their jobs. It limits new health plans' ability to deny coverage due to a pre-existing condition. •Title II: Prevents health care fraud and abuse; medical liability reform; administrative simplification that requires the establishment of national standards for electronic health care transactions and national identifiers for providers, employers, and health insurance plans. •Title III: Guidelines for pre-tax medical spending accounts; provides changes to health insurance law and deductions for medical insurance. •Title IV: Guidelines for group health plans; provides modifications for health coverage. Title V: Governs company-owned life insurance policies; it makes provisions for treating people without United States Citizenship and repealed the financial institution rule to interest allocation rules

•National Quality Forum (NQF)

•Together with many different disciplines to work together to improve quality measurement in an unbiased and rigorous way to measure standards and interventions of care and the outcomes they produce.

•HHS has adopted four types of standards to make electronic communications more efficient:

•Transactions for pharmacy and health care administrative information, including claims •Operating rules to support the standard transactions •Unique identifiers for health plans, providers, and employers •Code sets for clinical diagnoses and procedures •These standards are sometimes called electronic data interchange, or EDI, standards

Ways to make EBP normal in Healthcare

•Understand the data •Look at your resources •Define goals •Identify preferences •Adjust your approach and consider both technical and human elements involved.

•The case management process is carried out within the ethical and legal realms of a case manager's scope of practice, using critical thinking and evidence-based knowledge" (CMSA, 2016, p. 18).

•Validated that the case management plan of care is consistent with evidence-based practice when such guidelines are available and applicable and that it continues to meet the client's changing needs and health condition •Applied evidence-based adherence guidelines, standardized tools, and proven care processes. These can be used to measure the client's preference for and understanding of: •The proposed case management plan of care and needed resources; •Motivation to change and demonstrate healthy lifestyle behavior; and •Importance of availability of engaged client, family or family caregiver •Application of evidence-based guidelines and practices, when appropriate, in recommending resource allocation and utilization options •Proficiency in the application of research-related and evidence-based practice tools and terminologies

•Certification

•a credential that a health professional may seek in addition to their primary qualifying degree or other credentials. For example, a health service coordinator may seek certification in a specialty (e.g., palliative care) in addition to his or her degree. • generally administered by national boards •individuals' pre-acquired knowledge, skills, or competencies are evaluated against predetermined standards. •The focus is on an assessment that is independent of a specific class, course, or another education or training program.

What are Integrated Care Plans (ICP)?

•a living document that captures information and decisions regarding how a care team intends to (and does) deliver evidence-based, coordinated, continuous and person-centered care to a particular patient over time and across professionals and settings. •are used to organize and monitor integrated care delivery. Incorporate elements of the following tools: •Clinical guidelines (i.e., standards of care based on evidence); •Treatment plans (i.e., goals of treatment, treatment options, possible side effects, and •Expected length of treatment (for a particular phase of care such as systemic treatment or survivorship); •Disease pathways (i.e., the sequence of assessments and interventions for patients with a particular diagnosis); and •Personalized care plans (i.e., care goals and interventions are developed jointly with the patient)"

Health in All Policies

•approach to improving population health advocates for consideration of the health implications of public policies across all sectors. •health of migrant populations, who are affected by both general and migrant-specific policies in the destination country.

Health in All Policies

•approach to improving population health advocates for consideration of the health implications of public policies across all sectors. •health of migrant populations, who are affected by both general and migrant-specific policies in the destination country. migrant-specific policies include those pertaining to entry (visa and entry criteria), resettlement (dispersal policies), short-term integration (language classes), long-term integration (anti-discriminatory policies in the labor market, democratic participation, and citizenship policies), and forced and voluntary return migration (deportation procedures).

Core Measures

•are a set of care or treatment standards identified by the Centers for Medicare and Medicaid Services (CMS) •The Joint Commission (TJC) that have been shown through best scientific evidence to decrease the risk of complications, prevent recurrences, and improve patient clinical outcomes overall. •On a monthly or quarterly basis, each healthcare facility collects compliance data on these measures and reports the data to the CMS, the TJC, or both. •These compliance data sets are used to measure the quality of care provided to patients in a health care setting. •The overall goal of the core measures program is to ensure that the right patient receives the best care in a timely manner every time. The core measures program was designed to remove variation from care processes, increase collaboration across the continuum of care, and enhance the quality of patient care

Interprofessional Treatment Plans:

•are also done by an engaged team of health professionals with a patient. •Treatment plans can be developed in response to any condition, but they most commonly apply to behavioral or addiction treatment •Patients interact with a central case manager (a health care coordinator could fill this role) as well as a team of other specialists and programs. •The treatment plans would be developed by this cohesive team and be monitored throughout time until recovery occurs.

Social determinants of health

•are critical macro drivers that affect the health of every individual, whether positively or negatively. • They include factors like socioeconomic status, education, neighborhood, and physical environment, employment, and social support networks, as well as access to healthcare

National CLAS Standards:

•are intended to advance health equity, improve quality and help eliminate health care disparities by establishing a blueprint for organizations to deliver effective, understandable and respectful services at every point of patient contact

Integrated Care:

•both physical primary care along with behavioral care, are often provided by a collaborative patient-centered, interprofessional team. •individuals receive a continuum of preventive and restorative mental health and addiction services •increasing access to behavioral health services through referral processes or co-location; the system of care delivery is transformed. •Involves patient-centered care team, behavioral health generalist

Care Transitions Programs •Community-based Care Transitions Program (CCTP).

•care transition programs that support patients and ease their transition from the hospital back to their home or to other healthcare facilities.

Patient-centered collaborative care

•creates a culture and an environment that feels comfortable and empowering to all involved, including healthcare providers. •Health service coordinators can function in an important role to help act on collaborative decisions made; coordinate planning, scheduling, and implementation of tests and treatments; enhancing patient education; connecting patients to resources; and so on.

Challenges Facing Rural Communities and the Roadmap to Ensure Local Access to High-quality, Affordable Care

•economic fluctuations, increased regulatory burden, and the opioid epidemic.

Comprehensive Addiction and Recovery Act (CARA) CARA

•establishes a comprehensive, coordinated, balanced strategy through enhanced grant programs that expand prevention and education efforts while also promoting treatment and recovery. •the launch of a medication-assisted treatment •intervention demonstration program for combatting the opioid crisis.

Evidence-Based Professional Certifications

•healthcare coordinator has worked in the field for a year or more. •require that the health professional has gained work-related experience in the field of focus, •has studied for the exam using recommended resources, and some require a set amount of continuing education courses •Many certification programs also offer workshops or boot camps where candidates can learn and review relevant content with experts and peers.

Shared decision-making

•is a key component of patient-centered health care. •Tool that collaborative interprofessional teams can use to support patients and their families to make the best decisions and choices and to feel cared for and respected. •Clinicians and patients work together to make decisions and select tests, treatments, and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.

•Cultural Humility

•is a process that incorporates the best of cultural awareness, sensitivity, and competence but goes further by urging health providers to go deeper, be more reflective, and be open to developing continuously over the long term. •requires a commitment to lifelong learning, exercising self-reflection and critique, being comfortable with not knowing, and recognizing the dynamics of power and privilege. •involves examining your own values, beliefs, experiences, and biases through self-reflection and lifelong inquiry, and being curious and open to learning about clients' values, beliefs, and experiences in order to develop mutual understanding, successful partnerships, and cultural safety

What is your understanding of Trauma Informed Care?

•is a promising model for organizational change in health, behavioral, health, and other settings that promote resilience in staff and patients

Cultural awareness

•is an initial acknowledgment of cultural difference •is becoming familiar with common values, beliefs, rituals, religions, taboos, and social practices of various cultural groups. •Being aware includes knowledge and facts about culturally related disease incidences, tendencies, and risks.

Administrative Simplification

•is another aspect of HIPAA that impacts all healthcare organizations that process electronic payments and exchange healthcare information. •Health care providers, health plans, payers, and other HIPAA-covered entities must comply with Administrative Simplification. The requirements apply to all providers who conduct electronic transactions, not just providers who accept Medicare or Medicaid. •Enforcing Administrative Simplification requirements is essential to ensuring the healthcare community reaps the benefits of standardized transactions and reduced administrative costs

ESFT (explanatory, social risk, fears, therapeutic contracting) model

•is another culturally competent model developed by Quality Interactions that health services coordinators can use to gain further understanding of their patient's preferences and needs. Take a moment to explore the following infographic, which outlines the ESFT technique.

Community Health Experience Model (CHEM)

•is another updated generational value-based healthcare system. •created new opportunities for healthcare providers called health ecosystems that are supported by teamwork, collaboration with other healthcare entities and patients.

•IHI Patient Safety Essentials Toolkit

•is intended to support health providers to give the best care possible to every patient. Documents on improving teamwork and communication, tools to help you understand the underlying issues that can cause errors, and valuable guidance about how to create and maintain reliable systems. Institute for Healthcare Improvement

The Joint Commission

•is one of the leading organizations for healthcare setting accreditation, health facility and provider certification, and quality metric development and monitoring. •Hospital care, but now includes diverse care settings including home care, ambulatory care, and behavioral care accreditations, and Primary Care Medical Home certification.

•Cultural Competence

•is the ability to provide care that reflects sound knowledge and understanding of a person's culture, while also respecting and honoring the uniqueness of the individual. •It prompts action on a patient's behalf and helps the patient-professional relationship become a partnership. •describes the ability to provide care to patients with diverse values, beliefs, and behaviors, including tailoring health care delivery to meet patients' social, cultural and linguistic needs. A key component to new care delivery models, such as patient-centered medical homes and accountable care organizations, is the ability to engage and educate patients about their health status.

•Conscientious objection (CO)

•is the refusal to perform a legal role or responsibility because of personal beliefs. •In health care, conscientious objection involves practitioners not providing certain treatments to their patients, based on reasons of morality or 'conscience

Integrated care:

•it is vital that all members of the care team have access to the same information and can build upon the shared care plan. Team members must act in coordination toward a common goal to provide quality integrated care and avoid errors

Rural Experience has challenges to quality healthcare access due to barriers such as:

•low patient volume, •challenging payer mixes through Medicare and Medicaid, complex patient needs, •geographic isolation, and •healthcare workforce shortages.

Consensus measures

•means to assess a healthcare organization's performance as they execute these transitions

Value-based care

•pay for performance •Medicare program is reimbursing its participating providers. •providers are monetarily rewarded for the quality of care they give to their patients. •move from an insurance system based on volume to a system based on the quality of care •Medicaid and private insurers have only lightly implemented value-based care reimbursement models.

Chronic Care Programs

•promote person-centered, continuing care for people with chronic illnesses are also advancing across the nation using principles of person-centered, collaborative, integrative, medical home and neighborhood, and self-management approaches. •Medicare Physician Fee Schedule (PFS) for CCM services furnished to Medicare patients with multiple chronic conditions •primary care providers and healthcare organizations to develop chronic care programs to support their patients

Health in All Policies has five key elements for policy developers to consider:

•promoting health and equity, •supporting intersectoral collaboration, •creating co-benefits for multiple partners, •engaging stakeholders, •and creating structural or process change.

Value-based care has three aims:

•provide better care for individuals; •provide better care for populations; and •lower healthcare costs while increasing quality.

EBP-based interventions

•provide well-researched and expert-reviewed choices for both health providers and their patients. •self-management and becoming aware that the treatments and interventions offered to them should be evidence-based. •This is one reason the EBP process includes patient values and preferences as part of the process. •EBP is not meant to provide generalized care: it is intended to support clinical expertise and patient choices to result in EBP-supported individualized or personalized care for each patient.

Shared decision-making

•provides a process for bringing evidence into the consultation and incorporating it into discussions with the patient, •Incorporating evidence and discussions about patient's values and preferences. •also help reduce the unwarranted variation in care •can provide the opportunity for resolving this mismatch between clinician and patient expectations and the demonstrated benefits and harms of screening, tests and interventions. •reduce the inappropriate use of tests and treatments, such as those that are not beneficial or will case substantial risks or harms.

•The Pathway of Unconscious or Implicit Bias image

•reminds us that it is possible to categorize according to social group in ever interaction with another person •These feelings may influence one's perceptions about and behavior toward the other person—manifestations of bias. •Some feelings may be open and acknowledged (explicit and conscious), and other feelings may be outside of awareness (unconscious or implicit). •Is activated, behavior that is consonant with their expressed helpful beliefs about themselves as egalitarian persons (overt behavior) is accompanied by behavior that reflects the unconscious bias as well (inadvertent behavior).

Oregon's Death With Dignity Act

•requires that patients have a life expectancy of fewer than 6 months; •prescribers have an MD or DO degree and are licensed to practice in the state; •patients must be capable of making and communicating their health-care decisions; •attending physicians must inform patients of alternatives to the lethal prescription, including comfort care, hospice, and adequate pain control; and patients must make three separate requests for the lethal medications"

•Cultural Sensitivity

•responses and expectations that respect common traits of a particular culture without mentally assigning values of "good" or "bad" and actions that are taken to not offend people of a particular cultural group— •for instance, not making eye contact or touching a client of a particular culture without permission.

HIPAA Basics: Security rules

•safeguards that health professionals must implement to protect the confidentiality, integrity, and availability of electronic protected health information. Safeguards that covered entities and their business associates must use to protect confidentiality, integrity and ePHI.

Project RED (Re-Engineered Discharge) Program

•that provided extra information and support with the goal of reducing readmissions back to the hospital. The interventions include •a reinforced discharge teaching, •a post-hospital care plan, •follow-up care with the patient via telephone, virtual patient advocates that engage with patients about their post-discharge self-care plans connecting with the patient's primary care provider.

EBP explores

•the value and return on investment (ROI) of applying EBP in general as opposed to applying EBP specifically to a particular patient or group of similar patients (a population). •For instance, one could search for evidence on the value of care coordination, or of patient-centered medical homes - both by the outcomes that are recognized and the return on investing in EBP (resources, time, training, etc.).

National Patient Safety Foundation merged with the Institute for Healthcare Improvement (IHI)

•to combine their talents and resources to promote patient safety and improve the quality of healthcare •Strong focus on research, education (including an Open School for health professionals), certification, and boosting outcomes.

CMS introduced a new initiative called "Meaningful Measures.

•to determine the greatest priority for quality assessment and improvement. •It comprises focusing on the most critical core issues for providing high-quality care and increasing individual outcomes. •Serve as the link between CMS strategic goals and particular measures/initiatives that illustrate how we are achieving high-quality outcomes for our beneficiaries. •They are concrete quality issues that highlight the most important issues for high-quality treatment and better patient outcomes. •To gather and measure important data while also decreasing the number of reporting required

An opioid crisis has become a central driver of policy and regulation that targets two main agendas:

•to reduce the number of prescription opioids given to patients for pain management •to increase control of street drugs such as heroin, fentanyl, and carfentanil. •Current treatment for heroin and other synthetic heroin-like compounds includes the prescription of synthetic opioid medications like Methadone and Buprenorphine that act as a partial agonist at opioid receptors to help people cope with withdrawal symptoms.

2 ways to achieve coordinated care:

•using broad approaches that are commonly used to improve health care delivery •using specific care coordination activities.

Shared decision-making is especially important in these types of situations:

•• when there is more than one reasonable option, such as for screening or a treatment decision •• when no one option has a clear advantage •• when the possible benefits and harms of each option affect patients differently

Health Care Access Findings

••Researchers looked at the responses, given by people with disabilities, to four healthcare access questions: •Health insurance coverage; •Usual health care provider; •Receipt of a routine check-up; and •Cost barrier to health care need. They found that, for each disability type, having health insurance coverage, a usual health care provider, and receiving a routine check-up increased with age, while having an unmet health care need because of cost decreased with age.