SCARCE: Stewardship Curriculum and Audit for Residents to Cultivate Efficiency
|
|
- Sophia Hall
- 8 years ago
- Views:
Transcription
1 SCARCE: Stewardship Curriculum and Audit for Residents to Cultivate Efficiency The development and assessment of a novel CanMEDS Manager curriculum to improve resident test-ordering efficiency Andrew Burke, Chris Hillis, Jason Cheung, John Neary, Leah Hillier, Shuoyan Ning, Carol Mantle, John You, Parveen Wasi
2 Disclosures I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization.
3 Introduction to SCARCE CanMEDS Manager Role 1 : Allocate finite health resources appropriately Consider efficiency alongside effectiveness Need for Teaching Waste Reduction to Residents: 1/3 of all healthcare costs non-contributory to care 2 Diagnostic testing is most wasteful area: >54%! 3 Current Resident Test-Ordering Practices: Efficient practice is not highly valued Little formal instruction on appropriate practices 4 1. Frank JR, et al. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada; Institute of Medicine. The Healthcare Imperative: Lowering Costs and Improving Outcomes. Washington, DC: National Academies Pr; Miyakis S et al. Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy. Postgrad Med J 2006; 82: Dine CJ, et al. Educating physicians-in-training about resource utilization and their own outcomes of care in the inpatient setting. J Grad Med Educ 2010; Jun;2(2):
4 Unnecessary Investigations at HHS Percentage of Unnecessary Investigations (%)
5 Goal of Study Clinical Question Will the SCARCE Curriculum and Audit reduce unnecessary investigations ordered by housestaff on the Clinical Teaching Unit? Key Points Explain the SCARCE Curriculum Methodology of double-blind prospective controlled trial Impact of SCARCE on practice patterns and healthcare costs
6 Methodology
7 Session 1: Appropriate Use of Investigations Prospective Cohort Trial Large Group Format 60 minutes Session 2: Investigation Practices Feedback Audit Small Group Format 60 minutes Pre (Wk 1) Intervention (Wk 2) Post (Wk 3) Hamilton General CTU Housestaff (CC, PGY1, PGY2) Monitor Investigations SCARCE Curriculum and Audit Monitor Investigations Juravinski Hospital CTU Housestaff (CC, PGY1, PGY2) Monitor Investigations Usual Teaching Monitor Investigations
8 SCARCE Curriculum Appropriate Use of Investigations Clinical reasoning to increase yield Mrs. EV: 68F w DVT on LMWH LOS 64 days = 71 Normal INRs Costs of investigations to system Case-based examples and quality improvement
9 SCARCE Audit Feedback on Investigation Practices Trained clinician reviews housestaff orders Assessment of whether investigations are necessary Peer-review and reflection
10 Outcome Assessment Investigation Adjudication Unnecessary Investigation 5,6 : Admission and Progress Notes Evidence-Based Criteria for Investigations Reviewers given all documentation available at time of order Highly unlikely to contribute to diagnosis Highly unlikely to change management Redundant or unreasonable frequency Unreasonably low pre-test probability Admission and Ward Investigations Risk of investigation outweighs benefit Duplicated assessment: Blinded Senior Resident and Staff Physician 5. van Walraven C & Naylor D. Do we know what inappropriate laboratory utilization is? JAMA. 1998;280: Verstappen W et al. Effect of a pactice-based strategy on test ordering performance of primary care physicians: a randomized trial. JAMA. 2003; 289:
11 Results
12 Baseline Characteristics Housestaff Characteristics SCARCE Site Control Site Total no Clinical Clerks no (%) 5 (29) 6 (35) PGY-1 no (%) 9 (53) 8 (47) PGY-2 no (%) 3 (18) 3 (18) Patient Characteristics Total number Age - yr Female (%) Mean Day of admission
13 Investigations Reviewed 283 Admitted Patients 78 Pts < Day 3 of Admit 205 Eligible Patients 64 Patients with Investigations 264 Investigations Electrolytes 35 Creatinine 29 CBC 26 Urea 23 Calcium 20 Magnesium17 Phosphate16 Albumin16 AST/ALT 13 Chest X-ray 11 Misc 60
14 Housestaff Investigation Ordering Practices: SCARCE vs. Control Percentage of Unnecessary Investigations Week PRE 1 Week Control SCARCE Curriculum Received by Housestaff
15 Housestaff Investigation Ordering Practices: SCARCE vs. Control *Absolute decrease of 13.9% ( ) Percentage of Unnecessary Investigations * Week PRE 1 Week POST Control SCARCE Curriculum Received by Housestaff *p<0.01
16 Investigation Profile of SCARCE Housestaff Investigations/ Patient-Day 4 3 * Week PRE 1 Week 3 POST 2 * 1 0 Total Unnecessary Necessary Investigation Type
17 Discussion Cost Implications of SCARCE: Direct savings of $24.51/patient-day Hamilton Health Sciences: >$2,000,000 annually Starting a Culture of Efficiency and Cost Control: Educating trainees to allocate finite resources Collaborating with a wide group of stakeholders Limitations to SCARCE Trial: Documentation-based reviews Length of follow-up (future study)
18 Acknowledgements SCARCE Collaborators: Dr. Parveen Wasi Dr. John You Dr. John Neary Carol Mantle Dr. Chris Hillis Dr. Jason Cheung Dr. Shuoyan Ning Leah Hillier Funding: MOHLTC Collaboration Initiative Statistical Support: CLARITY Research Group Dr. Eleanor Pullenayegum Dr. Stephen Walter
19 Thank you!
20 Classification of Unnecessary Investigations 5,6 Excessive Frequency/Redundancy eg. Repeat LFTs after normal day 1 & 2 Very Low Pre-test Probability eg. Urea if volume & kidneys normal No Change to Management eg. PTT if on warfarin No Change to Diagnosis eg. D-dimer in high suspicion PE
21 Agreement Between Independent Assessors Pair A Pair B Proportion Agreement Kappa Bias 0.01 <0.01
22 References 1. Institute of Medicine. The Healthcare Imperative: Lowering Costs and Improving Outcomes. Washington, DC: National Academies Pr; Miyakis S et al. Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy. Postgrad Med J 2006; 82: Reinhardt UE. Fees, volume and spending at Medicare. 24 December Accessed at on May 13, Dine CJ, et al. Educating physicians-in-training about resource utilization and their own outcomes of care in the inpatient setting. J Grad Med Educ 2010; Jun;2(2): van Walraven C & Naylor D. Do we know what inappropriate laboratory utilization is? JAMA. 1998;280: Verstappen W et al. Effect of a practice-based strategy on test ordering performance of primary care physicians: a randomized trial. JAMA. 2003; 289:
23 Future Directions Longer Term: SCARCE Effectiveness at week 8 Crossover CTU Sites Implement SCARCE into Regular Curriculum Faculty Investigation Ordering Practices Faculty Development
24 Determining Unnecessary Investigations Highly unlikely to contribute to diagnosis Highly unlikely to change management Redundancy or unreasonable frequency Unreasonably low pre-test probability of abnormal result Risk of investigation greatly outweighs benefit
25 Results Investigation Profile Before and After SCARCE SCARCE Week 1 SCARCE Week 3 P value Control Week 1 Control Week 3 P value Investigations Investigation/pt/day Unnecessary inv/pt/day Necessary inv/pt/day SCARCE resulted in a significant decrease in total investigations per patient per day This change was driven by a decrease in unnecessary investigations
The Value of Improoperative Diagnostic Tests, Treatments and Procedures
The Value of Improving Appropriate Diagnostic Tests, Treatments and Procedures Presented by: Dr. Eric Bohm & Dr. Thomas Mutter On behalf of the Project Team Disclosure of Potential for Conflict of Interest
More informationPRACTICE BRIEF. Preventing Medication Errors in Home Care. Home Care Patients Are Vulnerable to Medication Errors
PRACTICE BRIEF FALL 2002 Preventing Medication Errors in Home Care This practice brief highlights the results of two home health care studies on medication errors. The first study determined how often
More informationDiagnostic Imaging Management
Diagnostic Imaging Management Frequently Asked Questions (FAQ) from Providers Updated August 1, 2013 Program Overview Q1. What is AIM Specialty Health SM (AIM)? A1. AIM Specialty Health SM (AIM) is a leading
More informationIntroduction of a Dedicated Admissions Nurse to Improve Access to Care for Surgical Patients
Introduction of a Dedicated Admissions Nurse to Improve Access to Care for Surgical Patients Editor s Note: In Introduction of a Dedicated Admissions Nurse to Improve Access to Care for Surgical Patients
More informationTrauma Center Alcohol Screening. Michael Mello, MD, MPH Injury Prevention Center at Rhode Island Hospital /Hasbro Children s Hospital
Trauma Center Alcohol Screening and Intervention Michael Mello, MD, MPH Injury Prevention Center at Rhode Island Hospital /Hasbro Children s Hospital Disclosures I have no affiliations, sponsorship, financial
More informationThrombosis and Hemostasis
Thrombosis and Hemostasis Wendy Lim, MD, MSc, FRCPC Associate Professor, Department of Medicine McMaster University, Hamilton, ON Overview To review the important developments in venous thromboembolism
More informationLiterature Search Strategy
E Literature Search Strategy In order to review the most relevant scientific literature available, the committee and staff regularly conducted thorough searches of several online bibliographic data bases,
More information2014 Information on Awards and Research
2014 Information on Awards and Research Postgraduate Medical Education Office Contents Information is available on the Postgraduate Medical Education website: http://www.fhs.mcmaster.ca/postgrad and on
More informationInpatient or Outpatient Only: Why Observation Has Lost Its Status
Inpatient or Outpatient Only: Why Observation Has Lost Its Status W h i t e p a p e r Proper patient status classification affects the clinical and financial success of hospitals. Unfortunately, assigning
More informationCHOOSING WISELY UK. Professor Dame Sue Bailey OBE DME Chair Academy of Medical Royal Colleges
CHOOSING WISELY UK Professor Dame Sue Bailey OBE DME Chair Academy of Medical Royal Colleges THE ACADEMY OF MEDICAL ROYAL COLLEGES Membership - All UK and Ireland Colleges and Faculties Faculty of Dental
More informationAmerican Academy of Neurology Section on Neuroepidemiology Resident Core Curriculum
10/01/01 American Academy of Neurology Section on Neuroepidemiology Resident Core Curriculum A Curriculum for Clinical Neuroepidemiology and Evidence-based Neurology 1. Introduction and Justification The
More informationADMINISTRATIVE MANUAL Policy and Procedure
ADMINISTRATIVE MANUAL Policy and Procedure TITLE: Point of Care Testing NUMBER: CH 30-111 (Laboratory Diagnostic Bedside Testing) Effective Date: January 2014 Page 1 of 6 Applies To: Holders of Administrative
More informationGlossary of Methodologic Terms
Glossary of Methodologic Terms Before-After Trial: Investigation of therapeutic alternatives in which individuals of 1 period and under a single treatment are compared with individuals at a subsequent
More informationCanMEDS 2015: From Manager to Leader
Royal College of Physicians and Surgeons of Canada 774 Echo Drive Ottawa, ON K1S 5N8 Canada Toll free 1-800-668-3740 TEL 613-730-8177 FAX 613-730-8262 WEB royalcollege.ca EMAIL canmeds@royalcollege.ca
More informationPulmonary Embolism Treatment Update
UC SF Pulmonary Embolism Treatment Update Jeffrey Tabas, MD Professor UCSF School of Medicine Emergency Department San Francisco General Hospital sf g h Disclosure No Financial Relationships to Disclose
More informationObservation Coding and Billing
How do you get paid? Observation Coding and Billing Michael Ross MD FACEP President, Society of Chest Pain Centers Medical Director, Chest Pain Center and Observation Medicine Associate Professor, Department
More informationMartin C. Were, MD, MS. Regenstrief Institute, Inc. Indiana University School of Medicine BHI Lecture Series May 13, 2008
Using an Informatics Tool to Improve Implementation of Recommendations by Consultants Martin C. Were, MD, MS. Regenstrief Institute, Inc. Indiana University School of Medicine BHI Lecture Series May 13,
More informationApril Stouder, MHS, PA-C Julie Daniel-Yount, MHS, PA-C
April Stouder, MHS, PA-C Julie Daniel-Yount, MHS, PA-C Disclosures None Learning Objectives Describe the educational benefits and challenges created by increased utilization of electronic health records
More informationHome Dialysis Benchmarks Workgroup. Peritoneal Dialysis (PD)
Home Dialysis Benchmarks Workgroup Peritoneal Dialysis (PD) Medical Knowledge Fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social behavioral
More informationDVT/PE Management with Rivaroxaban (Xarelto)
DVT/PE Management with Rivaroxaban (Xarelto) Rivaroxaban is FDA approved for the acute treatment of DVT and PE and reduction in risk of recurrence of DVT and PE. FDA approved indications: Non valvular
More informationQuality and peer review The Canadian perspective
Disclosure Quality and peer review The Canadian perspective Co-founder and shareholder in Real Time Medical Inc. MIR Barcelona October 11, 2013 David A Koff MD FRCPC Chief and Chair Radiology at McMaster
More informationMastery Learning of Clinical Skills
2012 ICRE Conference Northwestern University Feinberg School of Medicine Mastery Learning of Clinical Skills William C. McGaghie, PhD Diane B. Wayne, MD No Conflicts of Interest Objectives Recognize variation
More informationThe Evaluation of Cancer Control Interventions in Lung Cancer Using a Canadian Cancer Risk Management Model
The Evaluation of Cancer Control Interventions in Lung Cancer Using a Canadian Cancer Risk Management Model WK Evans, M Wolfson, WM Flanagan, J Shin, FF Liu JR Goffin, K Asakawa, N Mittmann, L Fairclough
More informationUse of Novel Oral Anticoagulants (NOACs) and the new DAWN modules at Scripps
Use of Novel Oral Anticoagulants (NOACs) and the new DAWN modules at Scripps Cheryl Ea, Pharm D. Anticoagulation Services Scripps Clinic and Scripps Green Hospital La Jolla, California Pharmacist Management
More information*Explain strategies that support utilization management in a health care setting.
Deborah Cutts, Chief Quality Officer 1 Chris Rovinski-Wagner, Coach Captain Discuss utilization management in the context of variation in health care delivery. Explain strategies that support utilization
More informationEDUCATIONAL PLANNING TOOL:
EDUCATIONAL PLANNING TOOL: Designing a Continuing Medical Education (CME) Activity This planning tool has been designed to lead you through the educational planning process and facilitate the collection
More informationTHE CITY OF VIRGINIA BEACH AND THE SCHOOL BOARD OF THE CITY OF VIRGINIA BEACH
THE CITY OF VIRGINIA BEACH AND THE SCHOOL BOARD OF THE CITY OF VIRGINIA BEACH OPTIMA November 7, 2013 TABLE OF CONTENTS Executive Summary... 1 Process Overview... 4 Areas of Testing... 5 Site Visit Selection...
More informationUNIFORM HEALTH CARRIER EXTERNAL REVIEW MODEL ACT
Model Regulation Service April 2010 UNIFORM HEALTH CARRIER EXTERNAL REVIEW MODEL ACT Table of Contents Section 1. Title Section 2. Purpose and Intent Section 3. Definitions Section 4. Applicability and
More informationFuture of Medical Education in Canada Postgraduate Project. Public Report. www.afmc.ca/fmecpg. A Health Canada funded project 1
Future of Medical Education in Canada Postgraduate Project Public Report www.afmc.ca/fmecpg A Health Canada funded project 1 Introduction The Future of Medical Education in Canada Postgraduate Project
More informationAssessment-Driven Continuing Professional Development
Assessment-Driven Continuing Professional Development Implications for Physicians, Assessors, Regulators and Certifying Colleges Author: Dr. Kevin Imrie Date: April 7, 2014 Conflict of Interest Declaration
More informationOvernight ICU Physician Coverage: Do We Need to Stay in Hospital 24-7?
Overnight ICU Physician Coverage: Do We Need to Stay in Hospital 24-7? Allan Garland, MD, MA Associate Professor of Medicine and Community Health Sciences University of Manitoba Introduction There are
More informationUnderstanding Diseases and Treatments with Canadian Real-world Evidence
Understanding Diseases and Treatments with Canadian Real-world Evidence Real-World Evidence for Successful Market Access WHITEPAPER REAL-WORLD EVIDENCE Generating real-world evidence requires the right
More informationSpecific Standards of Accreditation for Residency Programs in Orthopedic Surgery
Specific Standards of Accreditation for Residency Programs in Orthopedic Surgery 2012 INTRODUCTION A university wishing to have an accredited program in Orthopedic Surgery must also sponsor an accredited
More informationCustom Report Data Elements: IT Database Fields. Source: American Hospital Association IT Survey
Custom Report Data Elements: IT Database Fields Source: American Hospital Association IT Survey TABLE OF CONTENTS COMPUTERIZED SYSTEM IMPLEMENTATION... 4 Bar Coding... 4 Computerized Provider Order Entry...
More informationMedication Error. Medication Errors. Transitions in Care: Optimizing Intern Resources
Transitions in Care: Optimizing Intern Resources DeeDee Hu PharmD, MBA Clinical Specialist Critical Care and Cardiology PGY1 Program Director Memorial Hermann Memorial City Medical Center Medication Error
More informationQUESTIONS FOR The Commonwealth Medical College
Page 1 QUESTIONS FOR The Commonwealth Medical College PROCESS OF CURRICULUM REDESIGN Why did you redesign your curriculum? What were your goals? What was the timeframe? What lessons were learned while
More information2012 EDITORIAL REVISION NOVEMBER 2013 VERSION 3.1
Specific Standards of Accreditation for Residency Programs in Orthopedic Surgery 2012 EDITORIAL REVISION NOVEMBER 2013 VERSION 3.1 INTRODUCTION A university wishing to have an accredited program in Orthopedic
More informationOfficial Audit Report Issued July 27, 2015
Official Audit Report Issued July 27, 2015 (MassHealth) Review of Radiology Claims Submitted by Baystate Mary Lane Hospital For the period January 1, 2013 through December 31, 2014 State House Room 230
More informationBest Practices in Claims Management. Use of treatment guidelines and clinical logic for preauthorization and claims adjudication
Best Practices in Claims Management Use of treatment guidelines and clinical logic for preauthorization and claims adjudication The need for standards in claims processing Indian health insurance companies
More informationMedical Information Systems
Medical Information Systems Introduction The introduction of information systems in hospitals and other medical facilities is not only driven by the wish to improve management of patient-related data for
More informationTHIS PAGE INTENTIONALLY LEFT BLANK
THIS PAGE INTENTIONALLY LEFT BLANK KUL BHUSHAN GUPTA, M.D. LUCAS COUNTY TABLE OF CONTENTS Title Page Independent Accountants Report... 1 Compliance Report... 3 THIS PAGE INTENTIONALLY LEFT BLANK Independent
More informationResearch Into Care: Identifying Barriers and Gaps in Care. AAFP National Research Network Robert Graham Center Wilson D. Pace, MD
Research Into Care: Identifying Barriers and Gaps in Care AAFP National Research Network Robert Graham Center Wilson D. Pace, MD AAFP National Research Network The AAFP National Research Network is a nationwide
More informationAddressing forecasted oncologist shortage: A Cancer Education Program for Pharmacy Students (CEPPS)
Addressing forecasted oncologist shortage: A Cancer Education Program for Pharmacy Students (CEPPS) Dr. Department of Pharmacy Practice State University of New York School of Pharmacy and Pharmaceutical
More informationMar. 31, 2011 (202) 690-6145. Summary of proposed rule provisions for Accountable Care Organizations under the Medicare Shared Savings Program
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE
More informationLearning Objectives. Introduction to Reconciling Medication Information. Background. Elements of Performance NPSG.03.06.01
Pharmacy Evaluation of Medication Reconciliation Initiated in the Emergency Department Manuel A. Calvin, Pharm.D. PGY1 Pharmacy Resident Saint Francis Hospital, Tulsa, OK OSHP Annual Meeting Residency
More informationElectronic Health Record-based Interventions for Reducing Inappropriate Imaging in the Clinical Setting: A Systematic Review of the Evidence
Department of Veterans Affairs Health Services Research & Development Service Electronic Health Record-based Interventions for Reducing Inappropriate Imaging in the Clinical Setting: A Systematic Review
More informationWILL EQUITY BE ACHIEVED THROUGH HEALTH CARE REFORM? John Z. Ayanian, MD, MPP
WILL EQUITY BE ACHIEVED THROUGH HEALTH CARE REFORM? John Z. Ayanian, MD, MPP Brigham and Women s Hospital Harvard Medical School Harvard School of Public Health BWH Patient-Centered Outcomes Seminar April
More informationNew Oral Anticoagulants. How safe are they outside the trials?
New Oral Anticoagulants How safe are they outside the trials? Objectives The need for anticoagulant therapy Indications for anticoagulation Traditional anticoagulant therapies Properties of new oral anticoagulants
More informationQuantifying the effects of electronic health record systems in hospitals
Quantifying the effects of electronic health record systems in hospitals Prof Johanna Westbrook Health Informatics Research & Evaluation Unit The University of Sydney Approaches to answer four research
More informationPRINCIPLES OF ORGANIZING A NEUROLOGY RESIDENCY PROGRAM. Ralph F. Józefowicz, M.D. University of Rochester, NY
PRINCIPLES OF ORGANIZING A NEUROLOGY RESIDENCY PROGRAM Ralph F. Józefowicz, M.D. University of Rochester, NY The following twelve principles should be kept in mind when organizing a Neurology residency
More informationJoint Position on the Disclosure of Clinical Trial Information via Clinical Trial Registries and Databases 1 Updated November 10, 2009
Joint Position on the Disclosure of Clinical Trial Information via Clinical Trial Registries and Databases 1 Updated November 10, 2009 The innovative pharmaceutical industry 2 is committed to the transparency
More informationMEDICARE PAYMENTS FOR DIAGNOSTIC RADIOLOGY SERVICES IN EMERGENCY DEPARTMENTS
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL MEDICARE PAYMENTS FOR DIAGNOSTIC RADIOLOGY SERVICES IN EMERGENCY DEPARTMENTS Daniel R. Levinson Inspector General April 2011 OEI-07-09-00450
More information1. Executive Summary Problem/Opportunity: Evidence: Baseline Data: Intervention: Results:
A Clinical Nurse Leader led multidisciplinary Heart Failure Program: Integrating best practice across the care continuum to reduce avoidable 30 day readmissions. 1. Executive Summary Problem/Opportunity:
More informationThe electronic health record (EHR) has been a game-changer for CDI specialists.
Physician queries and the use of prior information: Reevaluating the role of the CDI specialist WHITE PAPER Summary: The following white paper examines the issue of whether to use information from a prior
More informationOutline. Advanced Practice Providers in the Intensive Care Unit. Why utilize APPs in the ICU? 5/30/2013
Outline Advanced Practice Providers in the Intensive Care Unit Thomas Farley MS, NP Assistant Clinical Professor UCSF School of Nursing Why utilize APPs in the ICU Recent publications General review of
More informationREMINDER: Please ensure all stroke and TIA patients admitted to hospital are designated as "Stroke Service" in Cerner.
ACUTE STROKE CLINICAL PATHWAY QEH/HH PCH KCMH Souris Western Stewart Memorial O'Leary PATIENT ID INCLUSION CRITERIA* All patients admitted to hosptial with a suspected diagnosis of acute ischemic stroke
More informationLearning Objectives. Using Epic to Conduct Clinical Research A Series of Pediatric Case Studies. Disclosures. Medical Informatics is...
Using Epic to Conduct Clinical Research A Series of Pediatric Case Studies David C Kaelber, MD, PhD, MPH, FAAP, FACP Internal Medicine and Pediatrics Physician Chief Medical Informatics Officer MetroHealth
More informationBUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM?
BUNDLING ARE INPATIENT REHABILITATION FACILITIES PREPARED FOR THIS PAYMENT REFORM? Uniform Data System for Medical Rehabilitation Annual Conference August 10, 2012 Presented by: Donna Cameron Rich Bajner
More informationNovel Anticoagulation Agents DISCLOSURES. Objectives ATRIAL FIBRILLATION TRIALS. NOAC Comparison 6/12/2015
Novel Anticoagulation Agents DISCLOSURES James W. Haynes, MD Department of Family Medicine Univ of TN Health Science Center (Chattanooga) Objectives Understand mechanism of action behind the NOAC agents
More informationProfessional Responsibilities in Undergraduate Medical Education
COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO P O L I C Y S TAT E M E N T # 1-1 2 Professional Responsibilities in Undergraduate Medical Education APPROVED BY COUNCIL: REVIEWED AND UPDATED: PUBLICATION
More informationClinical Study Design and Methods Terminology
Home College of Veterinary Medicine Washington State University WSU Faculty &Staff Page Page 1 of 5 John Gay, DVM PhD DACVPM AAHP FDIU VCS Clinical Epidemiology & Evidence-Based Medicine Glossary: Clinical
More informationComprehensive Utilization Management
Comprehensive Utilization Management aruplab.com/um Information in this brochure is current as of July 2015. All content is subject to change. Please contact ARUP Client Services at (800) 522-2787 with
More informationEMR Systems and the Conduct of Clinical Research. Daniel E Ford, MD, MPH Vice Dean for Clinical Investigation Johns Hopkins School of Medicine
EMR Systems and the Conduct of Clinical Research Daniel E Ford, MD, MPH Vice Dean for Clinical Investigation Johns Hopkins School of Medicine Clinical Research Environment Research protocols are becoming
More information2nd Global Summit Healthcare Fraud: Prevention is better than cure. 25-26 October 2012 Beaumont Estate, Old Windsor, UK
2nd Global Summit Healthcare Fraud: Prevention is better than cure 25-26 October 2012 Beaumont Estate, Old Windsor, UK Healthcare Fraud: Prevention is better than cure - Fraus omnia corrumpit Fraud negates
More informationHaslemere Health Centre & Grayshott Surgery Commissioning Data Quality Audit Report
Haslemere Health Centre & Grayshott Surgery Commissioning Data Quality Audit Report October 2010: Results from historic analysis This report covers the findings of a pilot which we were commissioned to
More informationElectronic health records: underused in the ICU?
Electronic health records: underused in the ICU? Christopher W. Seymour, MD MSc Assistant Professor of Critical Care Medicine Core Faculty Member, CRISMA Center University of Pittsburgh School of Medicine
More informationA Comparison of Hemorrhagic and Ischemic Strokes among Blacks and Whites:
A Comparison of Hemorrhagic and Ischemic Strokes among Blacks and Whites: A Population-Based Study That Will Demonstrate Issues Surrounding EHR Access and Research Brett Kissela, MD, MS Professor Vice-Chair
More informationClinical Nurse Leader Informational Paper
Association of California Nurse Leaders 1 2 Clinical Nurse Leader Informational Paper DRAFT 3 4 5 6 7 8 9 10 Background In 2006, the Professional Practice Committee and the Regional Taskforce South hosted
More informationAdding IV Amiodarone to the EMS Algorithm for Cardiac Arrest Due to VF/Pulseless VT
Adding IV Amiodarone to the EMS Algorithm for Cardiac Arrest Due to VF/Pulseless VT Introduction Before the year 2000, the traditional antiarrhythmic agents (lidocaine, bretylium, magnesium sulfate, procainamide,
More informationOverview of the TJC/CMS VTE Core Measures
Overview of the TJC/CMS VTE Core Measures CMS Specification Manual 4.2 January 1, 2013 June 30, 2013 Victoria Agramonte, RN, MSN Project Manager, IPRO VTE Regional Learning Sessions NYS Partnership for
More informationAGS REHABILITATION/ POST-HOSPITAL CARE OF THE GERIATRIC FRACTURE PATIENT. Egan Allen, MD University of Rochester
AGS REHABILITATION/ POST-HOSPITAL CARE OF THE GERIATRIC FRACTURE PATIENT Egan Allen, MD University of Rochester THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading change. Improving
More informationHow To Teach Health Care Policy To Radiation Oncology
Teaching and Assessing Systems-Based Practice: A Pilot Course in Health Care Policy, Finance, and Law for Radiation Oncology Residents James D. Mitchell, MD Preeti Parhar, MD Ashwatha Narayana, MD Abstract
More information4/9/2015. Risk Stratify Our Patients. Stroke Risk in AF: CHADS2 Scoring system JAMA 2001; 285: 2864-71
Anticoagulation in the 21 st Century Adam Karpman, D.O. Saint Francis Medical Center/Oklahoma State University Medical Center Disclosures: None Atrial Fibrillation Most common arrhythmia in clinical practice.
More informationGuidance on adverse drug reactions
Guidance on adverse drug reactions Classification of adverse drug reactions Adverse drug reactions are frequently classified as type A and type B reactions. An extended version of this classification system
More informationProf. Dr. med. Roland Bingisser Head of Clinical Emergency Medicine University Hospital Basel. making?
Pathway decision making Prof. Dr. med. Roland Bingisser Head of Clinical Emergency Medicine University Hospital Basel What s published in decision making? Huge body of evidence: Adherence to guideline-
More informationThere must be an appropriate administrative structure for each residency program.
Specific Standards of Accreditation for Residency Programs in Radiation Oncology 2015 VERSION 3.0 INTRODUCTION The purpose of this document is to provide program directors and surveyors with an interpretation
More informationAccountable Care Organizations: Evidence is Essential for Success
Accountable Care Organizations: Evidence is Essential for Success Susan A. Levine, DVM, PhD Senior Vice President, Health Technology Research and Consulting Winifred S. Hayes, PhD President and CEO 157
More informationClinical Decision Support
Goals and Objectives Clinical Decision Support What Is It? Where Is It? Where Is It Going? Name the different types of clinical decision support Recall the Five Rights of clinical decision support Identify
More informationGoals and Objectives Pediatric Surgery PGY 1 MCVH
Goals and Objectives Pediatric Surgery PGY 1 MCVH PGY-1 Clinical Duties and Privileges Lines of Supervision During the PGY-1 each resident begins his/her clinical experience in the General Surgery Residency
More informationIntensive Rehabilitation Service & Community Treatment Team
Intensive Rehabilitation Service & Community Treatment Team Caroline O Donnell Integrated Care Director North East London Foundation Trust Carol White Deputy Integrated Care Director North East London
More informationSubcommittee on PCCM improvement
Subcommittee on PCCM improvement Principles of Care Coordination Comprehensive services linked by an "integrator." Payments reflect patient complexity Current PCCM PCP office serves as care coordinator
More informationEMR Tools as Agents of Change
EMR Tools as Agents of Change Elizabeth Clark, MD Division of Geriatrics Albert Einstein College of Medicine Amy R. Ehrlich, MD Division of Geriatrics Albert Einstein College of Medicine Paul Douglas Ossman,
More informationAlberta Electronic Health Record Regulation Section 5 Framework September 2011 Version 1.1
Alberta Electronic Health Record Regulation Section 5 Framework September 2011 Version 1.1 Acknowledgements The College of Physicians & Surgeons of Alberta thanks the following stakeholders for their valuable
More informationAMA Position Statement. Competency-based training in medical education
Competency-based training in medical education 2010 1. Scope The AMA has developed this position statement in response to growing debate in the medical profession about the potential impact of competency-based
More informationBig Data Analytics in Healthcare In pursuit of the Triple Aim with Analytics. David Wiggin, Director, Industry Marketing, Teradata 20 November, 2014
Big Data Analytics in Healthcare In pursuit of the Triple Aim with Analytics David Wiggin, Director, Industry Marketing, Teradata 20 November, 2014 Agenda The Triple Aim Population Health in Russia The
More informationAdvanced Clinical Decision Support & Acute Kidney Injury
Advanced Clinical Decision Support & Acute Kidney Injury Dr Jamie Coleman Senior Lecturer in Clinical Pharmacology and Honorary Consultant Physician eprescribing & CDS in Birmingham, UK Jamie Coleman 1
More informationCompetency Based Education in Geriatrics Opportunities for the Inter-professional Team
Competency Based Education in Geriatrics Opportunities for the Inter-professional Team Roger Wong, BMSc, MD, FRCPC, FACP Clinical Professor, Division of Geriatric Medicine Associate Dean, Postgraduate
More informationDiagnosis and Treatment of VTE in the ER
UHN ER Conference Nov 3, 2015 Diagnosis and Treatment of VTE in the ER Bill Geerts Thromboembolism Program, Sunnybrook HSC Professor of Medicine, University of Toronto National Lead, VTE Prevention, Canadian
More informationQ. I am already a Bupa recognised provider, why is Bupa asking me to join a network?
30 APRIL 2014 Bupa Audiology Networks Q&A Bupa Network Q. I am already a Bupa recognised provider, why is Bupa asking me to join a network? A. We want our customers s to have easy access to quality and
More informationDIAGNOSTIC MEDICAL SONOGRAPHY *ACCREDITED DIPLOMA PROGRAM
2014-2015 DIAGNOSTIC MEDICAL SONOGRAPHY *ACCREDITED DIPLOMA PROGRAM A GREAT CAREER AWAITS YOU Are you fascinated by the inner workings of the human body? Consider becoming a sonographer. The Canadian National
More informationHome Health Care Today: Higher Acuity Level of Patients Highly skilled Professionals Costeffective Uses of Technology Innovative Care Techniques
Comprehensive EHR Infrastructure Across the Health Care System The goal of the Administration and the Department of Health and Human Services to achieve an infrastructure for interoperable electronic health
More informationAnthem Blue Cross and Blue Shield (Anthem) CLAIMS XTEN TM RULES Version 4.4 Effective December 8, 2012
Rules Edit logic Example Suppted After Hours 99050 not Reimbursable with Preventive Diagnosis This will deny 99050 (services provided when the office is usually closed) when billed with a preventive diagnosis
More informationICD-10-CM The Case for Moving Forward
A Health Data Consulting White Paper 1056 6th Ave S Edmonds, WA 98020-4035 206-478-8227 www.healthdataconsulting.com ICD-10-CM The Case for Moving Forward Joseph C Nichols MD Principal 23 March 2012 THE
More informationLung Cancer Multidisciplinary Meeting Toolkit. National Lung Cancer Working Group
Lung Cancer Multidisciplinary Meeting Toolkit National Lung Cancer Working Group September 2014 Contents Introduction 1 Multidisciplinary meetings 1 Toolkit for implementing high-quality lung cancer MDMs
More informationEQR PROTOCOL 4 VALIDATION OF ENCOUNTER DATA REPORTED BY THE MCO
OMB Approval No. 0938-0786 EQR PROTOCOL 4 VALIDATION OF ENCOUNTER DATA REPORTED BY THE MCO A Voluntary Protocol for External Quality Review (EQR) Protocol 1: Assessment of Compliance with Medicaid Managed
More informationDeveloping Optimal Search Strategies for Detecting Sound Clinical Prediction Studies in MEDLINE
Developing Optimal Search Strategies for Detecting Sound Clinical Prediction Studies in MEDLINE Sharon S.-L. Wong, MSc, Nancy L. Wilczynski, MSc, R. Brian Haynes, MD, PhD, Ravi Ramkissoonsingh, MA, for
More informationMEDICAL ONCOLOGY PROFILE
MEDICAL ONCOLOGY PROFILE Medical oncology is a subspecialty of internal medicine, is closely associated with hematology and deals with tumors occurring in all organ systems. It is a varied, multidisciplinary
More informationSince the release of the Institute of Medicine s report To err is human, 1 there
Will Electronic Order Entry Reduce Health Care Costs? Since the release of the Institute of Medicine s report To err is human, 1 there has been growing interest in electronic order entry as a tool for
More informationCOM Compliance Policy No. 3
COM Compliance Policy No. 3 THE UNIVERSITY OF ILLINOIS AT CHICAGO NO.: 3 UIC College of Medicine DATE: 8/5/10 Chicago, Illinois PAGE: 1of 7 UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE CODING AND DOCUMENTATION
More informationDefining your PICO Question. In: Patient or Problem or Risk Factor EXAMPLE: Does: Treatment A or Exposure A EXAMPLE: EXAMPLE: Outcome of interest
Defining your PICO Question P = The Patient or Population Who will be the focus? EXAMPLE: In: Patient or Problem or Risk Factor I = Intervention or Exposure What is the Exposure or Treatment of interest?
More information