Regionalizing Emergency Care Workshop Summary (2010) / Chapter Skim
Currently Skimming:
5 Governance and Accountability
5 Governance and Accountability
Pages 65-82
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 65... ...
He said that day 2 would focus on key strategies for moving the idea of regionalization forward, and doing so in a way that is effective, sustainable, creates a more efficient and resilient health care system, and improves patient outcomes. The second day began with a presentation by Ricardo Martinez, M.D., former administrator of the National Highway Traffic Safety Administration (NHTSA)
|
From page 66... ...
" Martinez concluded that if you can't change the market, and you can't change the basic funding issues, "maybe what you need to do is change the model, so that all the other players see the benefit." We are talking about emergency care coordination and emergency care patients, "yet we have been focusing [only] on a small part of that.
|
From page 67... ...
"I would argue that these emergency care systems do that." But, he added, emergency care and emergency physicians are currently excluded from the health information technology money. "We chose not to be involved," he said.
|
From page 68... ...
ValuJet became Figure 5-1 AirTran. Change the name and start over -- bring new people into the fold and begin to do things differently."R01701 He proposed using the term "Integrated editable vectors -- Networks of Care." even inset images are vector THE STATE'S ROLE IN REGIONALIZATION Bob Bass, executive director of the Maryland Institute for EMS Systems, said that grant programs were initiated to promote regionalization at the old U.S.
|
From page 69... ...
This helps to ensure that rather than just regions or regionalization, there is a systems approach that includes all of these elements, which are critically important to success and good outcomes. OPERATION REGIONALIZATION Dia Gainor, chief of the Emergency Medical Services Bureau for the State of Idaho and past-president of the National Association of EMS Officials, said that governance and accountability are "the core issue at hand" when considering what would be necessary to achieve regionalized and accountable emergency care systems.
|
From page 70... ...
To fully realize this vision, great effort will need to be placed on reviewing and overhauling state EMS laws throughout the nation. Many are now 35 years old, and health care has evolved dramatically over that time.
|
From page 71... ...
BUILDING "SYSTEMNESS" Greg Mears, medical director for the North Carolina Office of Emergency Medical Services, said that North Carolina's trauma system was born out of the 1966 National Academy of Sciences publication Accidental Death and Disability: The Neglected Disease of Modern Society and the 1973 EMS Act. The system is now very mature, he said (see Box 5-1)
|
From page 72... ...
; however, that model "had issues [and it] created some division among the health care community." He said "the stroke legislation was successful once we started from a local perspective and built up to a regional approach, instead relying on a top-down model." He noted that North Carolina's STEMI system of care is now used as a model by the AHA and has been very successful using a more regional approach.
|
From page 73... ...
Information has to flow well." Measuring performance improvement, increasing transparency, and peer pressure all drive the concept of "systemness." But system-building still occurs one patient at a time, Mears said. AUDIENCE DISCUSSION Neurosurgeon Alex Valadka said it seems clear that one of the major lessons here is that there needs to be a combination of strong leadership with collaboration and buy-in -- people willing to work together.
|
From page 74... ...
patients who don't need to come here." Racht commented that a proposal that did come up later was about rotating that function, on a calendar basis, through the various facilities and cardiovascular groups so that the patient load would be shared. Defining Terms Panel chairman Bob Bailey asked if someone on the panel would clearly define the terms region, regionalization, system, and catchment area.
|
From page 75... ...
You have interoperable communications, where you have real-time situational awareness, where you know what's happening in the system, who has capacity, what is happening day-to-day, or during a mass casualty incident. You have data that is interoperable, exchangeable, and addresses a continuum of care -- not just prehospital, not just hospital, but care in its entirety -- the concept that [Racht]
|
From page 76... ...
"For many offices of EMS, their principal function is to license ambulances, it's not about building a system." But in places like Maryland, North Carolina, and Idaho, Bass noted, "the state offices have managed to hang in there and have been appropriately supported by their states and have created an environment in which this regionalization can occur, with a systems approach, with all of these different elements."
|
From page 77... ...
Regionalization of Pediatric Services Jeffrey Upperman, from Children's Hospital in Los Angeles, asked Mears if he would expand on his earlier comments about pediatric regionalization. In pediatrics, Upperman said, resources are typically focused on the 0-4 or 0-5 age range (especially relating to congenital anomalies)
|
From page 78... ...
The next layer is to require that system to communicate with all of the hospitals in their referral area and with their specialty centers, including the trauma centers, PCI centers, and stroke centers (the state has no pediatric trauma centers)
|
From page 79... ...
to the next level? " Replicating Successful State Models David Sklar, from the University of New Mexico Health Sciences Center, said "Yesterday we heard a lot about how regionalization has improved care in a variety of areas and also how there are multiple barriers to overcome.
|
From page 80... ...
How can it be engendered? " Bass responded that Maryland has struggled recently with respect to STEMI care.
|
From page 81... ...
. a judicious level of higher common denominator needs to get implemented nationally." But Racht added, "The most important reference material for an elected official is the morning paper.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.