Paper series (United Hospital Fund of New York)
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Responding to changes in health care financing, government policy, technology, and clinical judgment, and the rise of managed care, hospitals are shifting services from inpatient to outpatient settings and moving them into the community. Institutions are evolving into integrated delivery systems, developing the capacity to provide a continuum of coordinated services in an array of settings and to share financial risk with physicians and managed care organizations. Over the past several years, hospitals in New York City have shifted considerable resources into ambulatory care. ⋯ Many of the components vital to high-quality ambulatory care can take years to develop, and significant investments of capital. Increased primary care capacity, new specialty group practices, state-of-the-art equipment for diagnosis and treatment, advanced information technology to manage and coordinate care and link services at multiple locations, and highly trained clinical and support staff all require strong commitment and support from a team of senior management executives and medical staff leaders, sufficient staffing resources, and outside expertise. Once the infrastructure is in place, hospitals must continue to reach out to their communities, helping people to understand the health care system and use it effectively.
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Pap Ser United Hosp Fund N Y · Nov 1996
Reshaping inpatient care: efficiency and quality in New York City hospitals.
Between 1992 and 1995, the United Hospital Fund engaged two groups of New York City hospitals in collective efforts to address crucial issues of length of stay and patient-centered care; the three-year, $1.1-million Length of Stay Initiative, which supported projects in seven New York City hospitals to identify and change practices that unnecessarily prolong inpatient stays; and the two-year, $700,000 Patient-Centered Care Consortium, through which 15 hospitals surveyed patients and received grants and technical support to design, implement, and evaluate improvements in meeting patients' expressed needs for more personalized care. Specific strategies and interventions developed and tested through the Length of Stay Initiative included continuous quality improvement programs to reduce delays and prevent duplication of diagnostic tests; clinical pathways to reduce unnecessary and inefficient variations in the treatment of common conditions and diseases; and a variety of other techniques, such as work redesign, diagnostic-specific clustering of patients, interdisciplinary design teams, and interdisciplinary rounds. ⋯ Through their projects in the Length of Stay Initiative and Patient-Centered Care Consortium the participating hospitals learned some important lessons about what it takes to increase efficiency, improve the quality of patient care, and provide better service to patients. Strong leadership, institutional support, the involvement of medical staff, an interdisciplinary approach, an investment in staff training, the ability to work through resistance to change, systems and support for collecting performance data, and ways to evaluate how well improvements work were found to be especially key.
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Pap Ser United Hosp Fund N Y · Nov 1995
Meeting patients' needs: quality care in a changing environment.
Recent surveys of patients in New York and Cleveland, among other cities, indicate that there is substantial room for improvement in meeting patients' needs and preferences, particularly in the areas of emotional support, coordination of care, discharge preparation, and the involvement of family and friends. Hospitals are using a variety of techniques to improve patient care and organizational efficiency in this challenging environment. ⋯ Key elements of successful hospital reengineering efforts have included: - the involvement and commitment of senior management and other key stakeholders, particularly physicians, nurses, and union representatives; - investment in staff training and retraining, and the redesign of staff evaluation and compensation systems; - timely, unit-specific measures of patient satisfaction and the clinical quality of care; - consistent and frequent internal communication between staff and leadership; and - treatment that emphasizes communication among caregivers, patients, and their family members. Several basic issues need to be addressed if hospitals are to offer technically sophisticated medical care that is also responsive to their patients' personal needs, including: - variations among patients regarding the amount of information they want and need, and the amount of involvement they want in their care; - the means by which patients will get information about their medical care, and who will provide any additional support that may be needed by non-English-speaking or socioeconomically disadvantaged patients; and - the specific changes in medical practice and hospital processes that will promote the involvement of patients in their care.
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Pap Ser United Hosp Fund N Y · Aug 1994
Better jobs, better care: building the home care work force.
This paper focuses on providing quality care in the paraprofessional home care industry. Despite government policies that have encouraged home-based care for 20 years, home health care still remains relegated to second-class status by the rest of the health care industry. Home care is unique because it relies primarily on paraprofessional care delivered by a home care aide working alone, essentially as a guest in the client's home. ⋯ Unfortunately this model is not typically reflected in current paraprofessional home health care practice. Part III Building the home care service around home care aide requires redesigning the paraprofessinal's job in 5 ways: 1. Make work pay, by providing a minimum of $7.50 per hour and a decent benefits package.(ABSTRACT TRUNCATED AT 400 WORDS)
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Emergency department overcrowding may not be so much a result of inappropriate use of the emergency department as it is a problem of the unavailability and inaccessibility of primary care services in the community. The prevailing theory that people use the emergency department because they cannot afford care elsewhere does not hold true. The vast majority of patients surveyed as part of the Emergency Services Initiative had some type of coverage, primarily Medicare or Medicaid. ⋯ Changing staff behavior is often as challenging as changing patient behavior. Pre-project planning and communication about purpose, scope, and procedures are necessary if projects are to begin and continue smoothly. Ongoing evaluation is also key.