The Healthcare Imperative Lowering Costs and Improving Outcomes: Workshop Series Summary (2010) / Chapter Skim
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18 Delivery System Efficiency
18 Delivery System Efficiency
Pages 535-546
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From page 535... ...
Greater use of LIPs, which include advance practice registered nurses, allied health professionals such as physical therapists and occupational therapists, pharmacists, and clinical social workers, can translate into significant efficiencies. Naylor also provides insight into existing barriers to expanding the use of LIPs and offers several policy recommendations to
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From page 536... ...
. It summarizes the evidence base that demonstrates cost savings and performance improvements by maximizing the existing healthcare workforce, including licensed independent practitioners and physician assistants (PAs)
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, clinical nurse specialists, nurse midwives, and nurse anesthetists -- and allied health professionals such as physical and occupational therapists, pharmacists, and clinical social workers. LIPs practice in a variety of settings, including health centers and clinics, primary care practices, hospitals, and community-based services.
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From page 538... ...
. This review also confirmed improved outcomes among those served by nurse midwives (e.g., increased spontaneous vaginal births, reduced lengths of stay for infants, and lower costs)
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Aim Interrupt cycles of Reduce functional Improve adherence to repeated, unnecessary difficulties, fear of prescription medication hospitalizations among falling, and home therapy among patients chronically ill elders hazards and enhance with heart failure self-efficacy and adaptive coping in older adults with chronic conditions Model Comprehensive in- A 6-month Protocol-based description hospital planning and multicomponent home- intervention including home follow-up and based intervention a baseline medication ongoing telephone consisting of five history of all prescription support for an occupational therapy and over-the-counter average of 2 months contacts (four 90- drugs and dietary post-discharge; minute visits and one supplements taken by TCM emphasizes 20-minute telephone patients, an assessment continuity of medical contact) and one of patient medication care between physical therapy knowledge and skills, hospital and primary visit (90 minutes)
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Population Cognitively intact Community-dwelling Low-income patients served older adults with two persons aged 70 and 50 years of age or older or more risk factors, older by modifying with heart failure including history of behavioral and recent hospitalizations, environmental multiple chronic contributors to conditions or functional decline medications, and poor self-health ratings Primary Advanced practice Physical and Registered pharmacist provider registered nurse occupational therapists of care or service Clinical Reduction in all-cause Reduced mortality Significant improvements outcomes readmission rates rates among the in medication through 1 year older adults with adherence, although post-dischargea functional difficulties effects dissipated in Improvements in Decreased deficits post-intervention physical health, in activities of 3-month follow-up functional status, daily living and period and quality of life instrumental Fewer emergency Enhancement of activities of daily department visits and patient and family living hospitalizations caregiver satisfaction Improved self sufficiency and use of adaptive strategies Economic Reductions of nearly Decreased costs -- Reduced annual direct outcomes $5,000 per patient in incremental cost- healthcare costs by total (i.e., physician, effectiveness ratio of nearly $3,000 hospital, home health) $16,000 per quality healthcare costsa adjusted life-year (QALY)
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From page 541... ...
Additionally, payment reform that emphasizes the team as the payment unit and reinforces the team's accountability for individual and population health should be supported. Equitable payment for the same services should be the expectation reflected in payment policy, and reimbursement should incentivize replication rather than prohibition of the spread of evidence-based models of care, such as the Transitional Care Model and other interventions profiled in Table 18-1.
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should be supportive of these directions in their funding decisions. Conclusion Based on the underlying assumption that patients deserve access to healthcare professions with the most appropriate skills and training to provide the necessary care, this paper provides the evidentiary rationale, real-life examples, and policy solutions to maximize the existing LIP and PA workforce and achieve higher-value health care.
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From page 543... ...
Because those who receive care and pay for care cannot effectively determine where to get care, the overall level of care is tragically lower than it needs to be and its costs are astronomically high. How then do we move in a direction of patients making informed choices that are to their own immediate benefit and, because they bolster the best providers and diminish the worst, have societal benefit as well?
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From page 544... ...
However, if we want bona fide reform that successfully increases quality and affordability (and hence access) , we have to start rewarding great providers at the expense of the low performers so that the money we put into the system gets well spent, not squandered.
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2008. 22 national organizations join together to commission a study of the impact of advanced practice registered nurses on healthcare quality, safety, and effectiveness.
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