The Quality of Stroke Care Doesn t Stop at Discharge. Judith F Dillon, MSN, MA, RN Kathy Morrison, MSN, RN, CNRN

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "The Quality of Stroke Care Doesn t Stop at Discharge. Judith F Dillon, MSN, MA, RN Kathy Morrison, MSN, RN, CNRN"

Transcription

1 The Quality of Stroke Care Doesn t Stop at Discharge Judith F Dillon, MSN, MA, RN Kathy Morrison, MSN, RN, CNRN

2 Objectives Describe the development and implementation of a comprehensive outpatient stroke program. Discuss how to expand quality improvement from acute hospitalization to out-patient stroke clinic. Review outcomes, as well as successes, challenges, and lessons learned.

3 Imperative to Act Nearly two-thirds of Medicare beneficiaries discharged after ischemic stroke died or were re-hospitalized within one year Comorbidities were common HTN- 76.9% CAD- 32.5% Diabetes- 28.1% History of Atrial Fibrillation or Flutter- 23.7% Causes of rehospitalizations within one year Cerebrovascular disease- 11.4% Cardiovascular % Non-Cardiovascular- 73.7% Fonarrow G et al. Stroke. Epub Dec16, 2010

4 One Year Mortality after First Stroke age 40 and younger: 21% of men and 24% of women ages 40 69: 14% of white men, 20% of white women, 19% of black men and 19% of black women age 70 and older: 24% of white men, 27% of white women, 25% of black men and 22% of black women

5 Challenge Need to better understand causes of secondary events such as death and readmission following a stroke Need to develop post discharge care strategies aimed at minimizing these secondary complications In 2013, Patient Protection and Affordable Care Act will financially penalize hospitals for high readmission rates.

6 Continuum of Care

7 Transitional Care

8 Wagner s Model of Chronic Care Illness

9 PROTECT A coordinated stroke treatment program to prevent recurrent thromboembolic events Program Treatment Goals: 1. Antithrombotic therapy 2. Statin therapy 3. Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy 4. Thiazide diuretic therapy 5. Smoking cessation advice 6. American Heart Association diet 7. Exercise counseling 8. Stroke education Preventing Recurrence Of Thromboembolic Events through Coordinated Treatment (PROTECT) Ovbiagele et al. Neurology. October 2004

10 PROTECT RESULTS High adherence rates (80-100%) at 90 days to the medication regimen 83% of smokers were still not smoking Successes related to the prompt initiation of evidence-based, guideline-recommended care in eligible patients Ovbiagele et al. Neurology. October 2004

11 Funding $100, grant from CDC for Prevention Awarded July, 2010 for 1 year Utilization: Part-time stroke nurse Part-time data entry personnel Educational materials Office supplies Laptop U.S. SENATOR ROBERT P. CASEY, JR. FISCAL 2010 APPROPRIATIONS

12 Penn State Stroke Population 2010 Gender: 53% male, 47% female Age: 53% over age 65 Race: 92% Caucasian 4% African American 3% Hispanic 35% arrive as transfers from surrounding hospitals

13 Discharge Disposition 2010 Residence PTA: Home: 92% ECF: 8% Discharge Disposition: Home: 42% Rehab: 30% ECF: 11% LTCH: 5% Expired: 15%

14 Severity Scores 2010 Ischemic Stroke Patients Average NIHSS on Admission in 2010 Average NIHSS on Discharge in 2010 Home Rehab Skilled Nursing Facility (SNF) LTCH Score 0-4 = mild impairment 5-14= moderate impairment 15-20= moderate/severe impairment 21-42= severe stroke Death 21.6

15 Goals for Stroke Care Steps to success Monitor Stroke Recovery Reduce Recurrent Stroke Decrease Secondary Complications Promote Health Reduce Cost Continuous Quality Outcome Measures Standardize Care

16 Follow up Begins at Discharge Discharge letter Resource Guide Stroke Education Tools for self management Community resources Stroke Support Invitation Phone call for High Risk patients Clinic Follow-up Appointments

17 Project BOOST- All Patients Goal : To identify patients who have high risk of complications at discharge that may result in negative outcomes, including hospital readmissions Improve Hospital Discharge Process: Increase patient understanding Decrease Medication errors Decease stress on caregiver Decrese admission rates Decrease care cost Vision: Reduce 30 day readmissions Improve patient satisfaction Improve flow of information Identify high risk patients and target intervention Society for Hospital Medicine s Project BOOST

18 Criteria for Early Phone Calls (Discharge Bundle) Discharged home Non-elective admission in past 6 months New Coumadin 5 or more new meds Inability to teach back Absence of caregiver Poorly controlled diabetes Poorly controlled HTN Hospital Goal: Reduce Hospital Readmissions

19 Data Reports and Outcomes Modified Rankin Scale Barthel Index NIHSS Score Recurrent Events Goal Status : Mortality Antiplatelet Treatment Complications Anticoagulant Treatment Atrial Fibrillation Hypertension Body Mass Index Hyperlipidemia Waist Circumference Diabetes Carotid Artery Disease Tobacco Education Rehabilitation Compliance Bundled Score

20 Electronic Tool Best Practice Guidelines

21

22 Multidisciplinary Team Approach Providers Schedulers Discharge process Clinic Process Appointments Medical Assistants role Nurse 0.5 hr Provider 1.0 hr Data Collection Missed appointments IT reports QI reporting PDCA Data Management

23 Nurse s Role How long do MD s allow their patients to speak uninterrupted? A. 1 minute B. 2 minutes C. 90 seconds D. 23 seconds Marvel et al JAMA, 281;

24 Nurse s Role On average, when not interrupted, how long will patients spend presenting an initial concern to their MD? A. 4 minutes B. 120 seconds C. 90 seconds D. 5 minutes Langewitz et al BMJ, 325;

25 Patient Engagement Utilization of trained nurses to educate, coach, assess progress, and answer questions Enable patient self-management between visits Knowledge of signs and symptoms of stroke, when to call 911, and understanding risk factors Self monitoring of clinical parameters completed by patients at home Compliance with plan of care & discussion of solutions to non-compliance issues Risk factor modification: medications, diet, exercise, smoking cessation

26 Caregiver Support Families care for 74% of stroke survivors after discharge to home Depression prevalence: 52% Mortality risk: 63% higher Stress in family caregiver impedes rehab and is leading cause of institutionalization of stroke survivors Comprehensive Overview of Nursing & Interdisciplinary Rehabilitation Care of the Stroke Patient. Stroke

27 Provider s Role Neuro Assessment Medication Adjustments Research Opportunities Referrals Education Devices addressed Therapies Driving Depression Sexual activity

28 Resources Stroke Education Resource Guide BP tracker log $5 dollar gift cards for stop smoking F.A.S.T. Magnet Stroke magazines: Stroke Connect Stroke Smart

29 Communication Monthly staff meetings clinic staff Quarterly meetings residents Quarterly updates for stroke core team Quarterly QI meetings Individual meetings with key players Educational sessions clinic staff Team building strategies Bulletin Board Incentives

30 Follow-up 30 Day Clinic Phone Chart UTR % 19% 13% 17% % 11% 11% 21% Letter/Questionnaire sent to patients who did not come for either 30-day or 90-day clinic visit. 90 day Clinic Phone Chart UTR Letter % 26% 11% 16% % 16% 7% 28% 5% Early phone calls: 2 nd half 2011 = 11 cases 8 cases New warfarin therapy 1 case Non-compliant history 1 case New diabetes diagnosis/therapy 1 case unscheduled admission during previous 6 months

31 Compliance day: 45% were non-compliant BP checks: 23% Diet: 9% Exercise: 49% Smoking: 21% Glucometer: 2% Medications: 2% 90 day: 46% non-compliant BP checks: 25% Exercise: 44% Smoking: 22% Glucometer: 2% Medications: 2%

32 Outcomes Complications 30 day 90 day Depression Falls Pneumonia Seizures UTI Readmissions 30 day 90 day TIA 10.9% 2.7% 16% 10.8% Ischemic 6.7% 6.3% 13.1% 5.5% Lichtman, Leifheit-Limson, Jones, et al. 6.5% % 30% Predictors of Hospital Readmissions After Stroke.Stroke AHRQ. Transitions of Care April 2011.

33 Disposition 2010 PTA Discharge 30 day 90 day Home 92% 42% 70% 82% Rehab 0 30% 11% 3% ECF 8% 11% 5% 5% LTCH 0 5% 7% 3% Death/Hospice % 4% 4% Unknown % 3% 2011 PTA Discharge 30 day 90 day Home 91% 56% 69% 78% Rehab 0 24% 10% 2% ECF 9% 6% 7% 7% LTCH 0 2% 4% 1% Death/Hospice % 6% 3% Unknown % 9%

34 Rehabilitation Services 30 Days Not indicated Ischemic Strokes Completed Ongoing 58% 9% 38% 27% 23% Home-based Inpatient ECF Outpatient 12% 33%

35 Rehabilitation Services 90 Days Not Indicated Ischemic Strokes Completed Ongoing 42% 18% 26% 69% 5% 8% Home-based Inpatient ECF Outpatient 32%

36 Rehabilitation Challenges 70% of first year costs acute inpatient hospital stay The lack of long-term benefits of shortterm rehabilitation suggest that therapy should be extended to home or subacute care settings. CMS looking at WHO s ICF as framework for documenting care and determining payment across the continuum Miller, Murray, Richards et al. Comprehensive Over view of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient. Stroke Duncan, Zorowitz, Bates et al. Management of Adult Stroke Rehabilitation Care. Stroke 2005.

37 14 NIHSS Scores Ischemic strokes Admission Discharge 30 Day 90 Day

38 Modified Rankin Scores Discharge Discharge 30 day 30 day 90 day Pre Admit Pre Admit day

39 Just when we thought we had all our ducks in a row

40 Patient Satisfaction Scores Question Nursing team addressed my concerns/questions to my satisfaction. Physician team addressed my concerns/questions to my satisfaction. Very Satisfied/Satisfied Scores % 92% 96% 96% I am satisfied with the therapy I received. 94% 95% My pain was well managed. 89% 94% I was given information about my medications including the importance of taking as prescribed. I was given information about my stroke/tia, signs/symptoms, when to call 911 and risk factors. 88% 81% 91% 76%

41 Successes Electronic Tool Establishment of 30 Minute Nurse Visit Patient Education Scheduling Guidelines Standardization of Process Partnership between Inpatient & Outpatient Collaboration of Stroke Team Staff Patient Satisfaction Surveys

42 Challenges Quality Data IT Reports Patients Lost to Follow-up Clinic Staff & Provider Turnover Documentation Nursing Physician MA Quality Data

43 Lessons Learned Essentials for Success User-friendly Tool Information Technology Support Clinic Flow and Patient Data Management Nursing Leadership Staff Education Administrative Support Team Approach Communication Change is Constant

44 Next Steps Tracking patient-specific patterns Comparison of outcomes for clinic visit vs phone call follow-up mrs knowledge compliance Tracking therapy patterns/outcomes Expansion of tool/model to PCP & other specialty practices

45 We

46

47 Questions

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012

Stroke: Major Public Health Burden. Stroke: Major Public Health Burden. Stroke: Major Public Health Burden 5/21/2012 Faculty Prevention Sharon Ewer, RN, BSN, CNRN Stroke Program Coordinator Baptist Health Montgomery, Alabama Satellite Conference and Live Webcast Monday, May 21, 2012 2:00 4:00 p.m. Central Time Produced

More information

Stroke Transitions of Care. Hospital Environment to Home

Stroke Transitions of Care. Hospital Environment to Home Stroke Transitions of Care Hospital Environment to Home Disclosures NONE Objectives Understand the importance of effective transitional care from the acute hospital to home in the stroke population Discuss

More information

Out of Sight, Out of Mind? Post Acute Strategies for Stroke Care Disclosures

Out of Sight, Out of Mind? Post Acute Strategies for Stroke Care Disclosures Out of Sight, Out of Mind? Post Acute Strategies for Stroke Care Kathy Morrison, MSN, RN, CNRN, SCRN Alicia Richardson, MSN, RN, ACCNS-AG Kari Moore, MSN, AGACNP-BC Disclosures Kathy Morrison Kari Moore

More information

2013 ACO Quality Measures

2013 ACO Quality Measures ACO 1-7 Patient Satisfaction Survey Consumer Assessment of HealthCare Providers Survey (CAHPS) 1. Getting Timely Care, Appointments, Information 2. How well Your Providers Communicate 3. Patient Rating

More information

Patient and Hospital Characteristics Associated with Assessment For Rehabilitation During Hospitalization for Acute Stroke

Patient and Hospital Characteristics Associated with Assessment For Rehabilitation During Hospitalization for Acute Stroke Patient and Hospital Characteristics Associated with Assessment For Rehabilitation During Hospitalization for Acute Stroke Lead Author: Janet Prvu Bettger, ScD, FAHA Duke University ; janet.bettger@duke.edu

More information

Care Coordination. The Embedded Care Manager. Presented by Thomas Decker, MD Mary Finnegan, BSN, M.Ed

Care Coordination. The Embedded Care Manager. Presented by Thomas Decker, MD Mary Finnegan, BSN, M.Ed Care Coordination The Embedded Care Manager Presented by Thomas Decker, MD Mary Finnegan, BSN, M.Ed Goals of Care Management The goals of care Management are consistent with the Triple Aim: Improve population

More information

Get With The Guidelines - Stroke PMT Special Initiatives Tab for Ohio Coverdell Stroke Program CODING INSTRUCTIONS Effective 10-24-15

Get With The Guidelines - Stroke PMT Special Initiatives Tab for Ohio Coverdell Stroke Program CODING INSTRUCTIONS Effective 10-24-15 Get With The Guidelines - Stroke PMT Special Initiatives Tab for Ohio Coverdell Stroke Program CODING INSTRUCTIONS Effective 10-24-15 Date and time first seen by ED MD: The time entered should be the earliest

More information

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION

Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION Presented by Kathleen S. Wyka, AAS, CRT, THE AFFORDABLE CA ACT AND ITS IMPACT ON THE RESPIRATORY C PROFESSION At the end of this session, you will be able to: Identify ways RT skills can be utilized for

More information

Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations

Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations 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 information

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Methodology: 8 respondents The measures are incorporated into one of four sections: Highly

More information

Re: CMS-1345-P; Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Proposed Rule

Re: CMS-1345-P; Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations; Proposed Rule Department of Health and Human Services Attention: CMS 1345 P P.O. Box 8013, Baltimore, MD 21244 8013 Re: CMS-1345-P; Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations;

More information

HealthCare Partners of Nevada. Heart Failure

HealthCare Partners of Nevada. Heart Failure HealthCare Partners of Nevada Heart Failure Disease Management Program 2010 HF DISEASE MANAGEMENT PROGRAM The HealthCare Partners of Nevada (HCPNV) offers a Disease Management program for members with

More information

OBJECTIVES AGING POPULATION AGING POPULATION AGING IMPACT ON MEDICARE AGING POPULATION

OBJECTIVES AGING POPULATION AGING POPULATION AGING IMPACT ON MEDICARE AGING POPULATION OBJECTIVES Kimberly S. Hodge, PhDc, MSN, RN, ACNS-BC, CCRN- K Director, ACO Care Management & Clinical Nurse Specialist Franciscan ACO, Inc. Central Indiana Region Indianapolis, IN By the end of this session

More information

ALBERTA PROVINCIAL STROKE STRATEGY (APSS)

ALBERTA PROVINCIAL STROKE STRATEGY (APSS) ALBERTA PROVINCIAL STROKE STRATEGY (APSS) Stroke Systems of Care Key Components APSS Pillar Recommendations March 28, 2007 1 The following is a summary of the key components and APSS Pillar recommendations

More information

Achieving Quality and Value in Chronic Care Management

Achieving Quality and Value in Chronic Care Management The Burden of Chronic Disease One of the greatest burdens on the US healthcare system is the rapidly growing rate of chronic disease. These statistics illustrate the scope of the problem: Nearly half of

More information

Leveraging EHR Data Reporting Anita Christie, RN MHA CPHQ MA Department of Public Health

Leveraging EHR Data Reporting Anita Christie, RN MHA CPHQ MA Department of Public Health Improve Population Health Outcomes Leveraging EHR Data Reporting Anita Christie, RN MHA CPHQ MA Department of Public Health Massachusetts ehealth Institute MBI MASSACHUSETTS BROADBAND INSTITUTE MeHI MASSACHUSETTS

More information

Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology

Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology Demonstrating Meaningful Use Stage 1 Requirements for Eligible Providers Using Certified EMR Technology The chart below lists the measures (and specialty exclusions) that eligible providers must demonstrate

More information

High Rehospitalization Rates: Evaluation and Impact

High Rehospitalization Rates: Evaluation and Impact High Rehospitalization Rates: Evaluation and Impact May 29, 2009 Denise Remus, PhD, RN Chief Quality Officer, BayCare Health System BayCare Health System BayCare is the largest full-service, community-based

More information

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, post-polio syndrome, rheumatoid arthritis, lupus

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, post-polio syndrome, rheumatoid arthritis, lupus TIRR Memorial Hermann is a nationally recognized rehabilitation hospital that returns lives interrupted by neurological illness, trauma or other debilitating conditions back to independence. Some of the

More information

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, postpolio syndrome, rheumatoid arthritis, lupus

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, postpolio syndrome, rheumatoid arthritis, lupus TIRR Memorial Hermann is a nationally recognized rehabilitation hospital that returns lives interrupted by neurological illness, trauma or other debilitating conditions back to independence. Some of the

More information

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence

Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Guidelines Secondary Stroke Prevention Luke Bradbury, MD 10/4/14 Fall WAPA Conferfence Stroke/TIA Nearly 700,000 ischemic strokes and 240,000 TIAs every year in the United States Currently, the risk for

More information

Stroke Rehab Across the Continuum of Care in Quinte Region

Stroke Rehab Across the Continuum of Care in Quinte Region Stroke Rehab Across the Continuum of Care in Quinte Region Adrienne Bell Smith Manager of Rehab Therapies QHC Karen Brown Manger Client Services, Hospital Access South East CCAC Disclosure of Potential

More information

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, postpolio syndrome, rheumatoid arthritis, lupus

Neurodegenerative diseases Includes multiple sclerosis, Parkinson s disease, postpolio syndrome, rheumatoid arthritis, lupus TIRR Memorial Hermann is a nationally recognized rehabilitation hospital that returns lives interrupted by neurological illness, trauma or other debilitating conditions back to independence. Some of the

More information

Clinical Quality Measure Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW

Clinical Quality Measure Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW Clinical Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW NQF 0105 PQRS 9 NQF 0002 PQRS 66 Antidepressant Medication Management Appropriate Testing for Children with Pharyngitis (2-18 years)

More information

Best Practices in Managing Patients With Chronic Obstructive Pulmonary Disease (COPD)

Best Practices in Managing Patients With Chronic Obstructive Pulmonary Disease (COPD) Best Practices in Managing Patients With Chronic Obstructive Pulmonary Disease (COPD) Harvard Vanguard Medical Associates Case Study Organization Profile Founded in the 1960s, Harvard Vanguard Medical

More information

Nurse Transition Coach Model: Innovative, Evidence-based, and Cost Effective Solutions to Reduce Hospital Readmissions

Nurse Transition Coach Model: Innovative, Evidence-based, and Cost Effective Solutions to Reduce Hospital Readmissions Nurse Transition Coach Model: Innovative, Evidence-based, and Cost Effective Solutions to Reduce Hospital Readmissions Leslie Becker RN, BS Jennifer Smith RN, MSN, MBA Leslie Frain MSN, RN Jan Machanis

More information

Developing a Stroke Aftercare Program

Developing a Stroke Aftercare Program Developing a Stroke Aftercare Program Anna Maria Dunn, MD Associate Clinical Professor Rutgers Robert Wood Johnson Medical School, NJ Director of PM&R Services RWJUH JFK Johnson Rehabilitation Institute

More information

ISSUED BY: TITLE: ISSUED BY: TITLE: President

ISSUED BY: TITLE: ISSUED BY: TITLE: President CLINICAL PRACTICE GUIDELINE PROFESSIONAL PRACTICE TITLE: Stroke Care Rehabilitation Unit DATE OF ISSUE: 2005, 05 PAGE 1 OF 7 NUMBER: CPG 20-3 SUPERCEDES: New ISSUED BY: TITLE: Chief of Medical Staff ISSUED

More information

Managing Patients with Multiple Chronic Conditions

Managing Patients with Multiple Chronic Conditions Best Practices Managing Patients with Multiple Chronic Conditions Advocate Medical Group Case Study Organization Profile Advocate Medical Group is part of Advocate Health Care, a large, integrated, not-for-profit

More information

Risk Tools in Predicting Rehospitalization from Home Care. VNAA Best Practice for Home Health

Risk Tools in Predicting Rehospitalization from Home Care. VNAA Best Practice for Home Health Risk Tools in Predicting Rehospitalization from Home Care VNAA Best Practice for Home Health Learning objectives The participant will be able to: Discuss the need for risk assessment for home health patients

More information

Responses to Questions on Protection of Medicare Beneficiaries

Responses to Questions on Protection of Medicare Beneficiaries www.alz.org Public Policy Office 202 393 7737 p 1212 New York Avenue, NW 866 865 0270 f Suite 800 Washington, DC 20005-6105 The Honorable Max Baucus Chairman Senate Finance Committee The Honorable Orrin

More information

Hospital-Based Sub-Acute Stroke Care and Secondary Prevention. Timothy Lukovits,, M.D.

Hospital-Based Sub-Acute Stroke Care and Secondary Prevention. Timothy Lukovits,, M.D. Hospital-Based Sub-Acute Stroke Care and Secondary Prevention Timothy Lukovits,, M.D. Volunteer group members Shalini Bansil,, MD Summit NJ Ji Chong,, MD, NYC, NY Srinath Kadimi,, M.D. Fairfield, CT Steve

More information

Cardiac Rehab and Primary Care: Avoiding Losses in Care Transitions. Neville Suskin Heart & Stroke Clinical Update 2012

Cardiac Rehab and Primary Care: Avoiding Losses in Care Transitions. Neville Suskin Heart & Stroke Clinical Update 2012 Cardiac Rehab and Primary Care: Avoiding Losses in Care Transitions Neville Suskin Heart & Stroke Clinical Update 2012 1 Disclosure Med. Director SJHC CR Co-principal of Lawson e-cr application LCVIS SJHC

More information

1. Executive Summary Problem/Opportunity: Evidence: Baseline Data: Intervention: Results:

1. 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 information

See page 331 of HEDIS 2013 Tech Specs Vol 2. HEDIS specs apply to plans. RARE applies to hospitals. Plan All-Cause Readmissions (PCR) *++

See page 331 of HEDIS 2013 Tech Specs Vol 2. HEDIS specs apply to plans. RARE applies to hospitals. Plan All-Cause Readmissions (PCR) *++ Hospitalizations Inpatient Utilization General Hospital/Acute Care (IPU) * This measure summarizes utilization of acute inpatient care and services in the following categories: Total inpatient. Medicine.

More information

RED, BOOST, and You: Improving the Discharge Transition of Care

RED, BOOST, and You: Improving the Discharge Transition of Care RED, BOOST, and You: Improving the Discharge Transition of Care Jeffrey L. Greenwald, MD, SFHM Massachusetts General Hospital - Clinician Educator Service Co-Investigator Project RED & Project BOOST The

More information

Chapter Three Accountable Care Organizations

Chapter Three Accountable Care Organizations Chapter Three Accountable Care Organizations One of the most talked-about changes in health care delivery in recent decades is Accountable Care Organizations, or ACOs. Having gained the attention of both

More information

Background. Does the Organization of Post- Acute Stroke Care Really Matter? Changes in Provider Supply. Sites for Post-Acute Care.

Background. Does the Organization of Post- Acute Stroke Care Really Matter? Changes in Provider Supply. Sites for Post-Acute Care. Does the Organization of Post- Acute Stroke Care Really Matter? Pamela W. Duncan, PhD, FAPTA University of Florida Brooks Center for Rehabilitation Studies Department of Veteran Affairs Rehabilitation

More information

An Integrated, Holistic Approach to Care Management Blue Care Connection

An Integrated, Holistic Approach to Care Management Blue Care Connection An Integrated, Holistic Approach to Care Management Blue Care Connection With health care costs continuing to rise, both employers and health plans need innovative solutions to help employees manage their

More information

Coventry Health Care of Florida. Special Needs Plan (SNP) Model of Care Annual Training

Coventry Health Care of Florida. Special Needs Plan (SNP) Model of Care Annual Training Coventry Health Care of Florida Special Needs Plan (SNP) Model of Care Annual Training 1 Course Overview The Centers for Medicare and Medicaid (CMS) require all contracted medical providers to receive

More information

on a daily basis. On the whole, however, those with heart disease are more limited in their activities, including work.

on a daily basis. On the whole, however, those with heart disease are more limited in their activities, including work. Heart Disease A disabling yet preventable condition Number 3 January 2 NATIONAL ACADEMY ON AN AGING SOCIETY Almost 18 million people 7 percent of all Americans have heart disease. More than half of the

More information

Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Summary. http://www.cms.gov/ehrincentiveprograms/

Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Summary. http://www.cms.gov/ehrincentiveprograms/ Medicare & Medicaid EHR Incentive Program Meaningful Use Stage 1 Requirements Summary 2010 What are the Requirements of Stage 1 Meaningful Use? Basic Overview of Stage 1 Meaningful Use: Reporting period

More information

KIH Cardiac Rehabilitation Program

KIH Cardiac Rehabilitation Program KIH Cardiac Rehabilitation Program For any further information Contact: +92-51-2870361-3, 2271154 Feedback@kih.com.pk What is Cardiac Rehabilitation Cardiac rehabilitation describes all measures used to

More information

AGS 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 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 information

New York State Nursing Home Quality Pool. New York State Department of Health May 2, 2012

New York State Nursing Home Quality Pool. New York State Department of Health May 2, 2012 New York State Nursing Home Quality Pool New York State Department of Health May 2, 2012 1 Overview First meeting in January discussed performance measurement for the Quality Pool Materials were sent to

More information

Homeward Bound. Amanda Melvin, MSW Emily Hartman, BSN, RN Tiffany Curtis, BSN, RN, CRRN Cindy Regan, MSN, RN - BC

Homeward Bound. Amanda Melvin, MSW Emily Hartman, BSN, RN Tiffany Curtis, BSN, RN, CRRN Cindy Regan, MSN, RN - BC Homeward Bound Amanda Melvin, MSW Emily Hartman, BSN, RN Tiffany Curtis, BSN, RN, CRRN Cindy Regan, MSN, RN - BC Objectives Identify and differentiate the levels of stroke rehabilitation care. Identify

More information

Hospital to Physician Office to Home: A Respiratory Led Program Across the Continuum of Care

Hospital to Physician Office to Home: A Respiratory Led Program Across the Continuum of Care Hospital to Physician Office to Home: A Respiratory Led Program Across the Continuum of Care Charley P. Starnes, RRT, RCP Clinical Respiratory Specialist- COPD Education Important Milestones July 2011-

More information

Organization of Rehabilitation and Post-Acute Care

Organization of Rehabilitation and Post-Acute Care Organization of Rehabilitation and Post-Acute Care Inaugural Meeting of NECC Boston, MA - September 13, 2006 Janet Prvu Bettger, ScD University of Pennsylvania Department of Physical Medicine and Rehabilitation

More information

AVAILABILITY AND ACCESSIBILITY OF CARDIAC REHABILITATION SERVICES IN LOW- AND MIDDLE-INCOME COUNTRIES QUESTIONNAIRE

AVAILABILITY AND ACCESSIBILITY OF CARDIAC REHABILITATION SERVICES IN LOW- AND MIDDLE-INCOME COUNTRIES QUESTIONNAIRE AVAILABILITY AND ACCESSIBILITY OF CARDIAC REHABILITATION SERVICES IN LOW- AND MIDDLE-INCOME COUNTRIES QUESTIONNAIRE To be completed by Staff Cardiologists at an adult cardiac institute/department. INSTRUCTIONS:

More information

Improving Quality of Care for Medicare Patients: Accountable Care Organizations

Improving Quality of Care for Medicare Patients: Accountable Care Organizations DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Improving Quality of Care for Medicare Patients: FACT SHEET Overview http://www.cms.gov/sharedsavingsprogram On October

More information

Provider Manual. Section 18.0 - Case Management and Disease Management

Provider Manual. Section 18.0 - Case Management and Disease Management Section 18.0 - Case Management and Disease Management 18.1.1 Introduction 18.2.1 Scope 18.3.1 Objectives 18.4.1 Procedures Case Management 18.4.1-A. Referrals 18.4.1-B. Case Management Mercy Maricopa Acute

More information

TORONTO STROKE FLOW INITIATIVE - Outpatient Rehabilitation Best Practice Recommendations Guide (updated July 26, 2013)

TORONTO STROKE FLOW INITIATIVE - Outpatient Rehabilitation Best Practice Recommendations Guide (updated July 26, 2013) Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals: Timely access to geographically located acute stroke unit care with a dedicated interprofessional team

More information

FL PR Stroke Registry Goals

FL PR Stroke Registry Goals 20 th Annual Stroke Belt Consortium Meeting FL PR Goals To evaluate for disparities in stroke performance metrics by Race and ethnicity Geographic regions in Florida and Puerto Rico To investigate t the

More information

Medical Necessity & Charting Guidelines

Medical Necessity & Charting Guidelines Medical Necessity & Charting Guidelines 1 In most cases we are told the rules up front - or will be told if we ask Like most games, the one who knows the rules the best WINS 4 2 Nationally Recognized Industry

More information

Cardiovascular Endpoints

Cardiovascular Endpoints The Malmö Diet and Cancer Study Department of Clinical Sciences Malmö University Hospital Lund University The Malmö Diet and Cancer Study CV-cohort Cardiovascular Endpoints End of follow-up: 31 Dec * Report:

More information

Blood Pressure Classification. Blood Pressure Classification

Blood Pressure Classification. Blood Pressure Classification Blood Pressure Classification Blood Pressure Classification BP Classification SBP mmhg DBP mmhg Normal

More information

Kaiser Permanente of Ohio

Kaiser Permanente of Ohio Kaiser Permanente of Ohio Chronic Disease Management Program March 11, 2011 Presenters: Amy Kramer and Audrey L. Callahan 1 Objectives 1. Define the roles and responsibilities of the Care Managers in the

More information

Rehabilitation Pilot Project

Rehabilitation Pilot Project Rehabilitation Pilot Project Chair: Joel Stein, MD, Columbia University Medical Center Vice-Chair: Alyse Sicklick, MD, Gaylord Hospital Additional Project Leads: Janet Prvu Bettger, ScD, Duke University

More information

Stroke Care First week

Stroke Care First week Stroke Care First week Florence Nightingale (1820 1910) Stroke Unit Dedicated personnel trained in stroke management Stepwise guidelines supported by explicit checklists Continuous monitoring available

More information

Maximizing Limited Care Management Resources to Improve Clinical Quality and Ensure Safe Transitions

Maximizing Limited Care Management Resources to Improve Clinical Quality and Ensure Safe Transitions Maximizing Limited Care Management Resources to Improve Clinical Quality and Ensure Safe Transitions Scott Flinn MD Deborah Schutz RN JD Fritz Steen RN Arch Health Partners A medical foundation formed

More information

Long-Term Acute Care Hospitals

Long-Term Acute Care Hospitals Long-Term Acute Care Hospitals What are they? What services do they offer? Presented by: Maxi Adams MBA, BSN, RN LTACH STACH LTACH = Long-Term Acute Care Hospital STACH = Short-Term Acute Care Hospital

More information

in LOVE with LIFE CaroMont Health s Path to Accountable Care: A Pathway to Health

in LOVE with LIFE CaroMont Health s Path to Accountable Care: A Pathway to Health CaroMont Health s Path to Accountable Care: A Pathway to Health Betty Herbert, Director Managed Care May 17, 2011 CaroMont Health System Gaston Memorial Hospital, with 435 beds Courtland Terrace, a 96-bed

More information

Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment

Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment Person-Centered Nurse Care Management in Home Based Care: Impact on Well-Being and Cost Containment Donna Zazworsky, RN, MS, CCM, FAAN Vice President: Community Health and Continuum Care Carondelet Health

More information

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management

Medical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.9 Case Management Services G.12 Special Needs Services

More information

Reducing Hospital Readmissions & The Affordable Care Act

Reducing Hospital Readmissions & The Affordable Care Act Reducing Hospital Readmissions & The Affordable Care Act The Game Has Changed Drastically Reducing MSPB Measures Chuck Bongiovanni, MSW, MBA, NCRP, CSA, CFE Chuck Bongiovanni, MSW, MBA, NCRP, CSA, CFE

More information

Disclosure. Meaningful use 2009. Objectives. Meaningful use. Fundamentals of Transitions of Care (TOC)

Disclosure. Meaningful use 2009. Objectives. Meaningful use. Fundamentals of Transitions of Care (TOC) 47 th Annual Meeting August 2-4, 2013 Orlando, FL Fundamentals of Transitions of Care (TOC) Rebecca R. Prevost, B.S., Pharm.D., PSO Medication Safety Officer Florida Hospital Disclosure I do not have a

More information

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs

Idaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs Idaho Health Home State Plan Amendment Matrix: Summary Overview This matrix outlines key program design features from health home State Plan Amendments (SPAs) approved by the Centers for Medicare & Medicaid

More information

International Hospital Inpatient Quality Measures

International Hospital Inpatient Quality Measures I-Acute Myocardial Infarction (I-AMI) I-AMI-1 Aspirin at Arrival Aspirin received within 24 hours of arrival to the hospital for patients having an acute myocardial infarction (AMI). I-AMI-2 Aspirin Prescribed

More information

CURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab

CURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab CURRENT AND FUTURE TRENDS IN POST ACUTE CARE The Value and Role of Acute Inpatient Rehab Robert S. Djergaian, M.D. Medical Director Banner Good Samaritan Rehabilitation Institute Stewardship Profitability

More information

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions...

CHAPTER 535 HEALTH HOMES. Background... 2. Policy... 2. 535.1 Member Eligibility and Enrollment... 2. 535.2 Health Home Required Functions... TABLE OF CONTENTS SECTION PAGE NUMBER Background... 2 Policy... 2 535.1 Member Eligibility and Enrollment... 2 535.2 Health Home Required Functions... 3 535.3 Health Home Coordination Role... 4 535.4 Health

More information

HEART FAILURE NATIONAL HOSPITAL INPATIENT QUALITY MEASURES. Measure Short Name. Adult Smoking Cessation Advice/Counseling

HEART FAILURE NATIONAL HOSPITAL INPATIENT QUALITY MEASURES. Measure Short Name. Adult Smoking Cessation Advice/Counseling Release Notes: Measure Information Form Version 2.6 HEART FAILURE NATIONAL HOSPITAL INPATIENT QUALITY MEASURES Set Measure ID # HF-2 Discharge Instructions Evaluation of LVS Function ACEI or ARB for LVSD

More information

Connect4 Patients CCCM Primary Care Community. Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM

Connect4 Patients CCCM Primary Care Community. Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM Connect4 Patients CCCM Primary Care Community Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM September 17, 2015 Objectives: Describe innovative care management

More information

Nancy L. Wilson Department of Medicine-Geriatrics Houston Center for Quality of Care& Utilization Studies Texas Consortium of Geriatric Education

Nancy L. Wilson Department of Medicine-Geriatrics Houston Center for Quality of Care& Utilization Studies Texas Consortium of Geriatric Education 1 Nancy L. Wilson Department of Medicine-Geriatrics Houston Center for Quality of Care& Utilization Studies Texas Consortium of Geriatric Education Centers Care for Elders Governing Council Acknowledge

More information

Hypertension Best Practices Symposium

Hypertension Best Practices Symposium essentia health: east region 1 Hypertension Best Practices Symposium RN Hypertension Management Pilot Essentia Health: East Region Duluth, MN ORGANIZATION PROFILE Essentia Health is an integrated health

More information

May 9, 2013. FaithAnn Amond, RN Navigator Care Central Ellis Medicine

May 9, 2013. FaithAnn Amond, RN Navigator Care Central Ellis Medicine A Systems Approach to Diabetes Care Hospital to Home. Improving Care Transitions and Outcomes Helen Hayes Hospital West Haverstraw, NY James Desemone, MD Director of Medical Staff Quality Diabetes and

More information

Stroke Rehabilitation Triage Severe Strokes

Stroke Rehabilitation Triage Severe Strokes The London Stroke Rehab Data Base Project Robert Teasell MD FRCPC Professor and Chair-Chief Department of Phys Med Rehab London Ontario Retrospective Data Bases In stroke rehab limited funding for clinical

More information

Attachment A Minnesota DHS Community Service/Community Services Development

Attachment A Minnesota DHS Community Service/Community Services Development Attachment A Minnesota DHS Community Service/Community Services Development Applicant Organization: First Plan of Minnesota Project Title: Implementing a Functional Daily Living Skills Assessment to Predict

More information

CHAPTER 17: HEALTH PROMOTION AND DISEASE MANAGEMENT

CHAPTER 17: HEALTH PROMOTION AND DISEASE MANAGEMENT CHAPTER 17: HEALTH PROMOTION AND DISEASE MANAGEMENT HEALTH SERVICES AND PROGRAMS The Plan s Health Promotion and Disease Management Department seeks to improve the health and overall well-being of our

More information

Cardiovascular Endpoints

Cardiovascular Endpoints The Malmö Diet and Cancer Study Department of Clinical Sciences Skåne University Hospital, Malmö Lund University The Malmö Diet and Cancer Study CV-cohort Cardiovascular Endpoints End of follow-up: 30

More information

STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE

STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE STROKE PREVENTION AND TREATMENT MARK FISHER, MD PROFESSOR OF NEUROLOGY UC IRVINE CASE REPORT: ACUTE STROKE MANAGEMENT 90 YEAR OLD WOMAN, PREVIOUSLY ACTIVE AND INDEPENDENT, CHRONIC ATRIAL FIBRILLATION,

More information

INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS. Karen Unholz, RN, BSN

INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS. Karen Unholz, RN, BSN INTRO TO THE MICHIGAN PIONEER ACO 101: THE BASICS Karen Unholz, RN, BSN Origins of the Accountable Care Organization ACOs originated from the Patient Protection and Affordable Care Act (Healthcare Reform)

More information

Texas Medicaid Managed Care and Children s Health Insurance Program

Texas Medicaid Managed Care and Children s Health Insurance Program Texas Medicaid Managed Care and Children s Health Insurance Program External Quality Review Organization Summary of Activities and Trends in Healthcare Quality Contract Year 2013 Measurement Period: September

More information

Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014

Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014 Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: February 19, 2014 Introduction The Office of Mental Health (OMH) licensed and regulated Assertive Community

More information

Should Bioprostheses be Anticoagulated?

Should Bioprostheses be Anticoagulated? Should Bioprostheses be Anticoagulated? Hartzell V. Schaff, MD AATS 2013 Heart Valve Summit Chicago, IL September 26-28, 2013 2012 MFMER slide-1 Guidelines for AC of Bioprostheses 1. ASA - Class I indication

More information

Community Care of North Carolina

Community Care of North Carolina Community Care of North Carolina CCNC Transitional Care Management Jennifer Cockerham, RN, BSN, CDE Director, Chronic Care Programs & Quality Management 1 Chronic Care Population Within the NC Medicaid

More information

David Eubanks, RN, MSN Billie Papasifakis, RN-BC, MSN, AACC. Describe model of care most appropriate

David Eubanks, RN, MSN Billie Papasifakis, RN-BC, MSN, AACC. Describe model of care most appropriate THE BRIDGE PROGRAM David Eubanks, RN, MSN Billie Papasifakis, RN-BC, MSN, AACC Pamela Teenier, RN, MBA, COC-C, C HCS-D HCSD 1 Objectives Describe model of care most appropriate for a Bridge program from

More information

Service delivery interventions

Service delivery interventions Service delivery interventions S A S H A S H E P P E R D D E P A R T M E N T O F P U B L I C H E A L T H, U N I V E R S I T Y O F O X F O R D CO- C O O R D I N A T I N G E D I T O R C O C H R A N E E P

More information

Clinical pathway concept - a key to seamless care

Clinical pathway concept - a key to seamless care SECTION 5: PATIENT SAFETY AND QUALITY ASSURANCE 1 Clinical pathway concept - a key to seamless care Audrey Janoly-Dumenil, Hôpital Edouard Herriot, CHU Lyon Marie-Camille Chaumais, Hôpital Antoine Béclère,

More information

Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013

Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013 Assertive Community Treatment (ACT) Providing Health Home Care Management Interim Instruction: December 6, 2013 Introduction The OMH licensed and regulated Assertive Community Treatment Program (ACT) will

More information

Stroke/VTE Quality Measure Build for Meaningful Use Stage 1

Stroke/VTE Quality Measure Build for Meaningful Use Stage 1 Stroke/VTE Quality Measure Build for Meaningful Use Stage 1 Presented by Susan Haviland, BSN RN Senior Consult, Santa Rosa Consulting Meaningful Use Quality Measures Centers for Medicare and Medicaid Services

More information

Support for Presentation

Support for Presentation Purpose of Activity The purpose of this presentation is to demonstrate how Athens Regional Home Health successfully implemented remote telemonitoring as a part of a comprehensive disease management program

More information

The GRACE Model Geriatric Resources for Assessment and Care of Elders

The GRACE Model Geriatric Resources for Assessment and Care of Elders Evidence-Based Care Transition Programs AoA, CMS, VA Grantee Meeting The GRACE Model Geriatric Resources for Assessment and Care of Elders Steven R. Counsell, MD Mary Elizabeth Mitchell Professor and Director,

More information

AHA/ASA Support Network. Anne Vigil, MSN, RN SLUCare Cardiac Rehabilitation American Heart Association Volunteer

AHA/ASA Support Network. Anne Vigil, MSN, RN SLUCare Cardiac Rehabilitation American Heart Association Volunteer AHA/ASA Support Network Anne Vigil, MSN, RN SLUCare Cardiac Rehabilitation American Heart Association Volunteer Overview The Support Network establishes AHA/ASA as a trusted source for patients, families

More information

Psychiatrists and Reporting on Meaningful Use Stage 1. August 6, 2012

Psychiatrists and Reporting on Meaningful Use Stage 1. August 6, 2012 Psychiatrists and Reporting on Meaningful Use Stage 1 August 6, 2012 Quick Overview Functional Measures Providers (tracked by NPI) must report on 15 core objectives and associated measures and 5 objectives

More information

Stakeholder s Report. 2525 SW 75 th Ave Miami, Florida 33155 305.262.6800 www.westgablesrehabhospital.com

Stakeholder s Report. 2525 SW 75 th Ave Miami, Florida 33155 305.262.6800 www.westgablesrehabhospital.com 212 Stakeholder s Report 2525 SW 75 th Ave Miami, Florida 33155 35.262.68 www.westgablesrehabhospital.com PROFILE REPORT For more than 25 years, West Gables Rehabilitation Hospital has made a mission of

More information

Case Management and Care Coordination:

Case Management and Care Coordination: HEALTH MANAGEMENT CUP recognizes the importance of promoting effective health management and preventive care for conditions that are relevant to our populations, thereby improving health care outcomes.

More information

Table e-1: Description of the three participating centres Umeå, Sweden Dublin, Ireland Barcelona, Spain Population-based study with single

Table e-1: Description of the three participating centres Umeå, Sweden Dublin, Ireland Barcelona, Spain Population-based study with single Table e-1: Description of the three participating centres Umeå, Sweden Dublin, Ireland Barcelona, Spain Population-based study with single Study setting stroke centre in a Population study small city,

More information

EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA

EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA EXPANDING THE EVIDENCE BASE IN OUTCOMES RESEARCH: USING LINKED ELECTRONIC MEDICAL RECORDS (EMR) AND CLAIMS DATA A CASE STUDY EXAMINING RISK FACTORS AND COSTS OF UNCONTROLLED HYPERTENSION ISPOR 2013 WORKSHOP

More information

Kick off Meeting November 11 13, 2015. MERCY CLINIC EAST COMMUNITIES Management of Patients with Heart Failure (HF)

Kick off Meeting November 11 13, 2015. MERCY CLINIC EAST COMMUNITIES Management of Patients with Heart Failure (HF) Kick off Meeting November 11 13, 2015 MERCY CLINIC EAST COMMUNITIES Management of Patients with Heart Failure (HF) Team Composition Justin Huynh, MD Internal Medicine, Physician Champion Mary Laubinger,

More information

2012 Physician Quality Reporting System:

2012 Physician Quality Reporting System: DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services R Official CMS Information for Medicare Fee-For-Service Providers 2012 Physician Quality : Medicare Electronic Health Record

More information