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sexta-feira, 26 de setembro de 2014

Paving Clinical Pathways Using a trusted change management model to establish standardized, evidence-based care across the continuum


Using a trusted change management model to establish standardized, evidence-based care across the continuum


by Leigh A. Resnick, M.H.A., R.R.T.

Healthcare spending was estimated to top $2.8 trillion in the United States1
in 2013, according to U.S.
News and World Report. Increased spending occurs due to multiple factors, namely variation in care.
Cost drivers include overtreatment (or defensive medicine), advances in technology and individuals 
living longer with chronic diseases. In inpatient settings, care variation leads to adverse health outcomes 
and longer hospital stays.
Creating and implementing clinical pathways is an effective way to curb healthcare spending.
Clinical pathways are structured, multidisciplinary plans of care surrounding an intervention. The 
pathway provides an evidence-based and detailed step-by-step treatment course arranged in an 
algorithm, guideline or protocol, which is accompanied by a timeframe or criteria-based progression.2
The concept of reducing variation through standardization was first demonstrated in the engineering 
field as early as 1950. It was later adopted by healthcare in the 1980s.3
A study of six health organizations in Italy showed pathway use resulted in reduced variation in 
aspects such as length of stay, testing and therapeutic prescriptions.4
This study also found that patients suffering from heart failure showed decreased mortality and reduced outcome variation when treated using pathways. After implementing the care pathway, health outcomes for left ventricular assessment, a clinical core process, increased from 40% of patients receiving the assessment to 100%.5
Total inpatient mortality decreased from more than 17% to less than 5%, with the same effect observed in readmissions rates. Before the use of the pathways, readmissions occurred for about 7% of patients.
Post-intervention, this decreased to less than 3%.
Although pathways are not a new concept, there remains a wide bandwidth of provider 
acceptance. In Liverpool, England, two reports were published focusing on provider perception of 
clinical pathways. These reports focused on the Liverpool Care Pathway (LCP), which were used 
throughout the United Kingdom and developed to enhance end-of-life treatment with the goal of 
allowing patients to die with dignity.6
This care pathway was developed in the 1990s as concerns grew within the U.K. medical community that end-of-life care was fragmented and not provided consistently throughout the nation, resulting in patients who were not being treated according to best hospice practices.7
Patients may have spent their final days suffering from pain, hunger and possibly 
dehydration. The controversy over LCP arose from reports stating patients were placed on the pathway 
without their or their family’s knowledge. The reports also alleged that other patients may have been 
enrolled too soon (imminent death was not near).8
Published studies validated the effectiveness of the LCP as a standard to treat patients. Issues 
regarding the perception of its use remained, however. Relatives and clinicians were unaware their 
family member or patient remained on the pathway for weeks without review or reevaluation of care, 
according to Mark Pickering, M.D.9
The reports implanted fear in the general public about end-of-life care using the LCP. Physicians were less likely to place their patients on the LCP in light of public 
concern.

Cookbook medicine?

Aside from concerns over how patients are treated once a pathway is initiated, some medical providers 
feel that standardization leads to “cookbook” medicine or medical care that is prescriptive and restricts 
creativity, intuition and clinical judgment. Although some physicians feel standardization will stifle 
innovation, the optimal way to treat patients is through standardized care models, according to an
article published in Modern Healthcare.10 Kedar Mate, M.D., vice president of the Institute for 
Healthcare Improvement, stated that standardizing parts, processes and individual roles results in a 
reduction of errors and patient harm.11
Creating pathways involves the collaboration of individuals from diverse backgrounds, such as 
physicians, nurses, case managers, pharmacists and others. The tactical development of pathways must 
be supported through a change management model that ensures successful development, 
implementation and sustainability of pathways. Understanding why transformation efforts fail improves 
the likelihood of developing a successful pathway. John Kotter, professor at the Harvard Business School 
and head of research at Kotter International, identifies eight reasons why transformation efforts fail in 
Table 1.12






This systematic change management approach addresses the common reasons initiatives fail 
and ensures diverse groups can meet goals and deliver high-quality outcomes with limited resistance.
When starting any initiative, there first must be a sense of urgency—a reason that suggests the status 
quo is more dangerous than the unknown. Along with urgency comes a guiding coalition of like-minded 
individuals that can be leveraged to initiate momentum away from the current state. Having a clear and 
communicable vision provides an end point or destination for individuals. During the implementation or 
change journey, several barriers and obstacles may arise. Frustration occurs when these roadblocks are 
not removed. Leadership must be willing and committed to resolve them as they occur. Generating short-term wins injects bursts of energy in teams, rewarding quick turnarounds and small gains amidst a 
larger effort.

Changing the culture

Although short-term wins are important to maintain momentum, it is critical not to declare victory too 
soon. Progress must be celebrated, but teams must focus on the end goal. Lastly, sustainability occurs 
when changes are hardwired into an organization’s culture. The future state resembles the initial vision, 
and individuals incorporate the implemented changes in their daily responsibilities.
Although data supports the use of clinical pathways, medical providers may remain resistant to 
adopt this approach. To position a pathway effort for success, a systematic change management model 
should be applied. As discussed, Kotter’s model provides a framework for shaping, communicating, 
executing and hardwiring change. This model can be adapted for the effective creation and 
implementation of clinical pathways. 

References: 

http://rube.asq.org/health/2014/09/change-management/paving-clinical-pathways.pdf?utm_content=&utm_source=email&utm_medium=email&utm_campaign=editorial_hcu_092514

sábado, 20 de setembro de 2014

PROSTHETIC ARM MOVES AFTER MUSCLE CONTRACTION DETECTED



cato_passive_diagram

DEKA is a robotic, prosthetic arm that will allow amputees to perform complex movements and tasks. It has just received FDA approval.
Electrodes attached to the arm detect muscle contractions close to the prosthesis, and a computer translates them into movement.  Six “grip patterns” allow wearers to drink a cup of water, hold a cordless drill or pick up a credit card or a grape, among other functions.
DARPA‘s Justin Sanchez believes that DEKA “provides almost natural control of upper extremities for people who have required amputations.”  He claims that “this arm system has the same size, weight, shape and grip strength as an adult’s arm would be able to produce.”

http://blog.applysci.com/

LESS INVASIVE ALZHEIMER’S NEUROSTIMULATION

restoration

A less invasive neurostimulation device for Alzheimer’s patients is being reviewed by the FDA.  SONS —  Sphenoid and Olfactory Nerve Stimulation System — is a nose catheter that targets nerve trunks and stimulate brain structures that control memory and cognition.   Requiring an outpatient procedure,  small, adjustable and targeted electrical impulses will be delivered through the nasal cavity to access up to 32 nerve trunks that stimulate the brain.
Deep Brain Stimulation has been commercialized as an effective treatment option for some neurological diseases, especially Parkinson’s.   The implanted devices, however,  require complicated and risky brain surgery. SONS might be an interesting alternative.
http://blog.applysci.com/

VIRTUAL REALITY MOVEMENT TRAINING FOR AMPUTEES

AR-309039966


CAREN, developed at the University of South Florida, helps those with limb loss and prosthetics improve basic function, symmetry and walking efficiency.  It is also a tool for researchers to study ways to improve mobility and balance.
Wearing a safety harness and walking on a  treadmill in the room-sized system, participants of a recent study engaged in audio-visual balance games, explored virtual environments, and used an avatar to simulate activities fro on a surround screen.
CAREN’s interactive games allow for physical rehabilitation, combined with cognitive tasks, such as requiring someone to dig for objects in a virtual world while still walking on a treadmill. Distraction gait training could help  balance, mobility and coordination in PTSD, traumatic brain injury or stroke patients.
Boat driving, walking in a combat environment or mountain hiking  can be simulated. Visual tracking technology allows researchers to evaluate a patient’s gait or performance in real time, and immediately adjust the system to customize the rehab/training process.

THE ASYMMETRY INSIDE YOUR BODY


The outside of your body is symmetrical, but the inside is anything but. Get ready to learn more about symmetry, asymmetry, and why they happen in this It’s Okay to Be Smart video.
We are symmetrical on the outside, as are most animals, and there is an evolutionary reason for this — symmetry seems to be an indicator of good genes; thus, it influences mate selection. But symmetry is only skin deep. The heart, stomach, and spleen are on the left side of the body, while the liver is on the right. Even organs that may seem symmetrical, aren’t. For example, the left lung has only two lobes, but the right has three lobes. The brain is also not entirely symmetrical: the left and right lobes have some different functions.
Not everyone is asymmetrical in the same way. About 1 in every 20,000 people has a genetic condition known as situs inversus, which means that the organs are on the opposite side of the body than what is normal. In general, this condition is not associated with any negative effects.
Why are our insides asymmetrical? Researchers have discovered that which side is left and which side is right is determined as early as the embryonic stage, when cilia in certain cells start to move in unison, pointing toward what will become the organism’s left side.
Watch the video to learn more about how our internal asymmetry develops and what it means for us.


Alzheimer: vídeo de 1 minuto mostra como são os sintomas

Uma associação que cuida e presta informações a pacientes com Alzheimer na Holanda, a “Alzheimer Nederland” produziu uma campanha publicitária de 1 minuto em que mostra a rotina de uma senhora que apresenta, gradativamente, sintomas demenciais.
O objetivo da campanha é a prevenção e a identificação dos sintomas em fases iniciais da doença.
Confiram.


http://www.contioutra.com/