Support services for vulnerable patients by a multidisciplinary team in an emergency department

Introduction: Individuals with poor social determinants of health aremore likely to receive improper healthcare. Frequent Users (FUs) ofEmergency Departments (ED) (defined as >4 visits in the previous12 months) represent a subgroup of vulnerable patients presentingwith specific medical and social needs. They usually account for highhealthcare costs by overusing the healthcare system. In 2008-2009,FUs accounted for 4% of our ED patients but 17% of all our ED visits.Methods: We conducted a prospective cohort of patients admitted toour ED with vulnerabilities in ≥3 specific domains (somatic or mentaldiseases, risk behaviors, social determinants of health, and healthcareuse). Patients were either directly identified by a multidisciplinary team(two nurses, one social worker, one physician) or referred to that teamby the ED staff during opening hours from July 1st 2010 to April 30th2011.Results: 127 patients were included (67% males), aged 43 years (SD15); 65% were migrants. They had a median of 6 ED visits (interquartilerange (IQR) 8-1) in the previous 12 months, representing a total of 697visits. The most frequently affected domains during the index visit were:71% somatic, 61% psychiatric, 75% risk behaviors, 97% social and84% healthcare use issues. Each case required a median of 234minutes (IQR 300-90) dedicated to assess their outpatient network(99% of the patients), to set up an ambulatory medical follow-up (43%)or a meeting with social services (40%).Conclusions: Vulnerability affected ED patients in more than onedomain. Vulnerable patients have complex needs that were difficult toaddress in the time-pressured ED setting. Although ED consultationoffers immediate access to medical care, EDs are dedicated more foracute short-term somatic care. Caring for a growing number ofvulnerable patients requires a different type of management. Limitedevidence shows that multidisciplinary case-management interventionshave demonstrated positive outcomes in terms of reducing ED useand costs, and improvement of patient's medical and social outcomes.A randomized trial of case-management is underway to confirm theresults of observational studies.

Hearing Aids and Audiological Services Funding Summary - Fiscal Year 2009

An annual report from the Early Hearing Detection and Intervention section of the Iowa Department of Public Health stating the number of children receiving audiological services, the dollars spent and the insrance coverage of the children that received either services or equipment.

Hearing Aids and Audiological Services Funding Summary - Fiscal Year 2010

An annual report from the Early Hearing Detection and Intervention section of the Iowa Department of Public Health stating the number of children receiving audiological services, the dollars spent and the insrance coverage of the children that received either services or equipment.

Impact of a program to prevent incivility towards and assault of healthcare staff in an ophtalmological emergency unit: study protocol for the PREVURGO On/Off trial.

BACKGROUND: The emergency department has been identified as an area within the health care sector with the highest reports of violence. The best way to control violence is to prevent it before it becomes an issue. Ideally, to prevent violent episodes we should eliminate all triggers of frustration and violence. Our study aims to assess the impact of a quality improvement multi-faceted program aiming at preventing incivility and violence against healthcare professionals working at the ophthalmological emergency department of a teaching hospital. METHODS/DESIGN: This study is a single-center prospective, controlled time-series study with an alternate-month design. The prevention program is based on the successive implementation of five complementary interventions: a) an organizational approach with a standardized triage algorithm and patient waiting number screen, b) an environmental approach with clear signage of the premises, c) an educational approach with informational videos for patients and accompanying persons in waiting rooms, d) a human approach with a mediator in waiting rooms and e) a security approach with surveillance cameras linked to the hospital security. The primary outcome is the rate of incivility or violence by patients, or those accompanying them against healthcare staff. All patients admitted to the ophthalmological emergency department, and those accompanying them, will be enrolled. In all, 45,260 patients will be included in over a 24-month period. The unit analysis will be the patient admitted to the emergency department. Data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and patients will not be blinded. DISCUSSION: The strengths of this study include the active solicitation of event reporting, that this is a prospective study and that the study enables assessment of each of the interventions that make up the program. The challenge lies in identifying effective interventions, adapting them to the context of care in an emergency department, and thoroughly assessing their efficacy with a high level of proof.The study has been registered as a cRCT at clinicaltrials.gov (identifier: NCT02015884).

Department of Human Services Proposal for State Mental Health Institute Closure and Consolidation, December 15, 2009

The Department’s recommendation for closure and consolidation is based on an analysis of the existing programs, persons served, physical plant costs, expenses and renovation/infrastructure costs for relocation, and review of the draft report from the MHI Task Force. Further detail surrounding the analysis used to drive the recommendation is found under the Recommendations section, beginning on page 12 of this report. In response to the legislative requirement to recommend closure and consolidation of an MHI, the Department recommends the closure of the Mount Pleasant Mental Health Institute with consolidation of its programs and operational beds at the Independence Mental Health Institute. With this recommendation, Independence MHI will add beds to accommodate the 15 adult psychiatric beds, 14 dual diagnosis beds, and 50 substance abuse treatment beds now located at the Mount Pleasant MHI. This relocation will take an estimated six months from the time statutory authority and corresponding appropriations are received.

Annual Report of the Hawk-I Board to The Governor, General Assembly and Council on Human Services, 2009

Congress established the State Children's Health Insurance Program (SCHIP) with passage of the Balanced Budget Act of 1997, which authorized $40 billion for the SCHIP program through Federal Fiscal Year (FFY) 2007. Under the program, a federal block grant was awarded to states to provide health insurance to children from families with income about Medicaid eligibility levels.

Brain injury program to ensure greater access to community-based services, July 11, 2006

More than 2,200 Iowans each year experience a traumatic brain injury that requires hospitalization. Of those, more than 750 will experience long-term disability as a result. According to a 2000 CDC report, there are an estimated 50,000 such individuals living in Iowa – a number similar to the population of Ames. As part of an enterprise-wide effort to ensure that all Iowans, including those with brain injuries, have access to quality healthcare, Governor Tom Vilsack signed the Brain Injury Services program bill on May 23. The bill will allow the Iowa Department of Public Health (IDPH) to implement a one-of-a-kind program to help those with brain injuries and their families in navigating and maximizing the Iowa community-based service system.

Hearing Aids and Audiological Services Funding Summary - Fiscal Year 2011

An annual report from the Early Hearing Detection and Intervention section of the Iowa Department of Public Health stating the number of children receiving audiological services, the dollars spent and the insrance coverage of the children that received either services or equipment.

Hearing Aids and Audiological Services Funding Summary - Fiscal Year 2012

An annual report from the Early Hearing Detection and Intervention section of the Iowa Department of Public Health stating the number of children receiving audiological services, the dollars spent and the insrance coverage of the children that received either services or equipment.

Maternal and Child Health Services Title V Block Grant State Narrative for Iowa Application for 2013 Annual Report for 2011

Key factors that provide context for the state's Maternal and Child Health (MCH) annual report and state plan are highlighted in this overview. This section briefly outlines Iowa's demographics, population changes, economic indicators and significant public initiatives. Major strategic planning efforts affecting development of program activities are also identified.

Hearing Aids and Audiological Services for Children Questions & Answers,

Question and Answer information for Children with hearing problems, with hearing aids and audiological services.

Review of Iowa Department of Human Services Drug Testing Process, December 2008

This report outlines the current drugs testing practices and using these practices for testing requirements.

Application of European accounting standards to the public healthcare sector: a comparative study on the application of the European System of Accounts ESA-95 to healthcare centres in the United Kingdom, France and Germany

This report aims to analyse how European accounting standards (European System of Accounts ESA-95) are interpreted and applied to the public healthcare sector, from the standpoint of comparative law. Specifically, the study focuses on the application of ESA-95 to healthcare centres in the United Kingdom, France and Germany, with the aim of reaching useful conclusions for the Public Companies and Consortia (EPIC, for their initials in Catalan) in the Catalan Public Healthcare System.

Chronic disease management: a qualitative study investigating the barriers, facilitators and incentives perceived by Swiss healthcare stakeholders.

BACKGROUND: Chronic disease management has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. While Switzerland faces the same challenge, such initiatives have only emerged recently in this country. The aim of this study is to assess their feasibility, in terms of barriers, facilitators and incentives to participation. METHODS: To meet our aim, we used qualitative methods involving the collection of opinions of various healthcare stakeholders, by means of 5 focus groups and 33 individual interviews. All the data were recorded and transcribed verbatim. Thematic analysis was then performed and five levels were determined to categorize the data: political, financial, organisational/ structural, professionals and patients. RESULTS: Our results show that, at each level, stakeholders share common opinions towards the feasibility of chronic disease management in Switzerland. They mainly mention barriers linked to the federalist political organization as well as to financing such programs. They also envision difficulties to motivate both patients and healthcare professionals to participate. Nevertheless, their favourable attitudes towards chronic disease management as well as the fact that they are convinced that Switzerland possesses all the resources (financial, structural and human) to develop such programs constitute important facilitators. The implementation of quality and financial incentives could also foster the participation of the actors. CONCLUSIONS: Even if healthcare stakeholders do not have the same role and interest regarding chronic diseases, they express similar opinions on the development of chronic disease management in Switzerland. Their overall positive attitude shows that it could be further implemented if political, financial and organisational barriers are overcome and if incentives are found to face the scepticism and non-motivation of some stakeholders.

Maternal and Child Health Services Title V Block Grant State Narrative for Iowa Application for 2015 Annual Report for 2013, September 21, 2014

Key factors that provide context for the state's Maternal and Child Health (MCH) annual report and state plan are highlighted in this overview. This section briefly outlines Iowa's demographics, population changes, economic indicators and significant public initiatives. Major strategic planning efforts affecting development of program activities are also identified.