Case Studies in Reducing Regulatory Duplication in Managed Care

Case Studies in Reducing Regulatory Duplication in Managed Care PDF Author: Allan Baumgarten
Publisher:
ISBN: 9781929008407
Category : Health maintenance organizations
Languages : en
Pages : 36

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Book Description

Case Studies in Reducing Regulatory Duplication in Managed Care

Case Studies in Reducing Regulatory Duplication in Managed Care PDF Author: Allan Baumgarten
Publisher:
ISBN: 9781929008407
Category : Health maintenance organizations
Languages : en
Pages : 36

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Book Description


Closing the Quality Gap

Closing the Quality Gap PDF Author: Kaveh G. Shojania
Publisher:
ISBN: 9781587632594
Category : Disaster hospitals
Languages : en
Pages : 7

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Book Description


Health Systems Improvement Across the Globe

Health Systems Improvement Across the Globe PDF Author: Jeffrey Braithwaite
Publisher: CRC Press
ISBN: 1317123271
Category : Technology & Engineering
Languages : en
Pages : 621

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Book Description
Following on from 2015’s Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries, this book encompasses a global perspective on healthcare while shifting the focus from reform to showcasing success stories of healthcare systems worldwide. It provides explanations of why various facets of healthcare systems work well in different contexts and offers the reader alternative models for consideration. The book features contributions from 60 countries, going much further than the common practice of focusing on affluent Western nations, to provide a comprehensive exploration of the success of healthcare systems globally. The majority of literature on health-sector improvement attempts to address the problems within systems, relating the errors that can and do occur, for example, and offering solutions and preventative strategies. This book of country case studies will approach the enhancement of health systems, patient safety and the quality of care in a new and innovative way, comprehensively surveying and synthesizing the success stories of healthcare systems around the world, utilizing Hollnagel’s Safety-II approach to acknowledge the importance of exploring what goes right, what works well, and why it works. These success stories may include reference to macro, meso or micro levels of healthcare systems, various sectors (e.g., aged care, acute care or primary care), or specific programs or projects. Health System Improvement Across the Globe: Success Stories from 60 Countries is unprecedented in terms of both reach and positive emphasis, and as such will be instrumental in changing ways of thinking about and guiding health-sector improvement.

Registries for Evaluating Patient Outcomes

Registries for Evaluating Patient Outcomes PDF Author: Agency for Healthcare Research and Quality/AHRQ
Publisher: Government Printing Office
ISBN: 1587634333
Category : Medical
Languages : en
Pages : 385

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Book Description
This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

Engineering a Learning Healthcare System

Engineering a Learning Healthcare System PDF Author: National Academy of Engineering
Publisher: National Academies Press
ISBN: 0309120640
Category : Medical
Languages : en
Pages : 340

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Book Description
Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system-one that increasingly is more effective, more efficient, safer, and higher quality-is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.

The Healthcare Imperative

The Healthcare Imperative PDF Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309144337
Category : Medical
Languages : en
Pages : 852

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Book Description
The United States has the highest per capita spending on health care of any industrialized nation but continually lags behind other nations in health care outcomes including life expectancy and infant mortality. National health expenditures are projected to exceed $2.5 trillion in 2009. Given healthcare's direct impact on the economy, there is a critical need to control health care spending. According to The Health Imperative: Lowering Costs and Improving Outcomes, the costs of health care have strained the federal budget, and negatively affected state governments, the private sector and individuals. Healthcare expenditures have restricted the ability of state and local governments to fund other priorities and have contributed to slowing growth in wages and jobs in the private sector. Moreover, the number of uninsured has risen from 45.7 million in 2007 to 46.3 million in 2008. The Health Imperative: Lowering Costs and Improving Outcomes identifies a number of factors driving expenditure growth including scientific uncertainty, perverse economic and practice incentives, system fragmentation, lack of patient involvement, and under-investment in population health. Experts discussed key levers for catalyzing transformation of the delivery system. A few included streamlined health insurance regulation, administrative simplification and clarification and quality and consistency in treatment. The book is an excellent guide for policymakers at all levels of government, as well as private sector healthcare workers.

Transition to Diagnosis-Related Group (DRG) Payments for Health

Transition to Diagnosis-Related Group (DRG) Payments for Health PDF Author: Caryn Bredenkamp
Publisher: World Bank Publications
ISBN: 1464815216
Category : Medical
Languages : en
Pages : 69

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Book Description
This book examines how nine different health systems--U.S. Medicare, Australia, Thailand, Kyrgyz Republic, Germany, Estonia, Croatia, China (Beijing) and the Russian Federation--have transitioned to using case-based payments, and especially diagnosis-related groups (DRGs), as part of their provider payment mix for hospital care. It sheds light on why particular technical design choices were made, what enabling investments were pertinent, and what broader political and institutional issues needed to be considered. The strategies used to phase in DRG payment receive special attention. These nine systems have been selected because they represent a variety of different approaches and experiences in DRG transition. They include the innovators who pioneered DRG payment systems (namely the United States and Australia), mature systems (such as Thailand, Germany, and Estonia), and countries where DRG payments were only introduced within the past decade (such as the Russian Federation and China). Each system is examined in detail as a separate case study, with a synthesis distilling the cross-cutting lessons learned. This book should be helpful to those working on health systems that are considering introducing, or are in the early stages of introducing, DRG-based payments into their provider payment mix. It will enhance the reader's understanding of how other countries (or systems) have made that transition, give a sense of the decisions that lie ahead, and offer options that can be considered. It will also be useful to those working in health systems that already include DRG payments in the payment mix but have not yet achieved the anticipated results.

To Err Is Human

To Err Is Human PDF Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309068371
Category : Medical
Languages : en
Pages : 312

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Book Description
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine

The Learning Healthcare System

The Learning Healthcare System PDF Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309133939
Category : Medical
Languages : en
Pages : 374

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Book Description
As our nation enters a new era of medical science that offers the real prospect of personalized health care, we will be confronted by an increasingly complex array of health care options and decisions. The Learning Healthcare System considers how health care is structured to develop and to apply evidence-from health profession training and infrastructure development to advances in research methodology, patient engagement, payment schemes, and measurement-and highlights opportunities for the creation of a sustainable learning health care system that gets the right care to people when they need it and then captures the results for improvement. This book will be of primary interest to hospital and insurance industry administrators, health care providers, those who train and educate health workers, researchers, and policymakers. The Learning Healthcare System is the first in a series that will focus on issues important to improving the development and application of evidence in health care decision making. The Roundtable on Evidence-Based Medicine serves as a neutral venue for cooperative work among key stakeholders on several dimensions: to help transform the availability and use of the best evidence for the collaborative health care choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and, ultimately, to ensure innovation, quality, safety, and value in health care.

Preventing Regulatory Capture

Preventing Regulatory Capture PDF Author: Daniel Carpenter
Publisher: Cambridge University Press
ISBN: 1107036089
Category : Business & Economics
Languages : en
Pages : 531

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Book Description
Leading scholars from across the social sciences present empirical evidence that the obstacle of regulatory capture is more surmountable than previously thought.