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1、April 14, 2005,Medical Review of NC, Inc.,1,Pneumonia careControversies and Challenges,Meera Kelley MD Clinical Coordinator, MRNC, Inc. The QIO for the Carolinas,April 14, 2005,Medical Review of NC, Inc.,2,Overview,Issues with the indicators Other broad challenges Discussion,April 14, 2005,Medical R
2、eview of NC, Inc.,3,PN-1 Oxygenation assessment PN-2 Pneumococcal vaccination PN-3b Blood cultures PN-4 Adult smoking cessation advice PN-5 Antibiotic timing PN-5a Initial antibiotic w/in 8 h hospital arrival PN-5b Initial antibiotic w/in 4 h hospital arrival PN-6a Initial antibiotic selection ICU P
3、N-6b Initial antibiotic selection Non ICU PN-7 Influenza vaccination,April 14, 2005,Medical Review of NC, Inc.,4,PN-1 Oxygenation assessment,Inadequate oxygen (hypoxemia) is common in severe pneumonia and is a known mortality risk factor. Giving supplemental oxygen has been shown to decrease mortali
4、ty among patients with pneumonia.,April 14, 2005,Medical Review of NC, Inc.,5,Controversies (4) CD000422-”pneumococcal vaccination does not prevent pneumonia or death in adults”,April 14, 2005,Medical Review of NC, Inc.,21,Controversies tell them only what they need to know show how we can make thei
5、r life better,April 14, 2005,Medical Review of NC, Inc.,24,Communicating your message effectively-tips,Start planning your presentation by determining your goal-what do you want them to do when the leave? They will be more enthusiastic if they have a clear, well defined, but limited role to play,Apr
6、il 14, 2005,Medical Review of NC, Inc.,25,Communicating your message effectively-tips,Acknowledge their challenges “We recognize how busy you are as it is and want this to ultimately make your life better.” Offer to help “We will do as much of the work as possible, but we need your input” Ensure you
7、 will be responsive to feedback “We would like to try this for 3 months and want you to let us know what you think”,April 14, 2005,Medical Review of NC, Inc.,26,Communicating your message effectively,Step #1 tell the story of the positive future Step #2 convey to audience how taking the action will
8、give THEM the future they want Step # 3 call to action-ask for commitment of first step Mark Walton, Center for Leadership Communication, Chapel Hill,April 14, 2005,Medical Review of NC, Inc.,27,Message to physiciansWe understand that their day-to-day life is overwhelming,April 14, 2005,Medical Revi
9、ew of NC, Inc.,28,Patient care,Billing,Accurate coding,Interruptions,Phone calls,Pharmaceutical reps,Formularies,Insurance status,Health care plans,Office administration,Other patients,Prior authorizations,Clinical practice guidelines,Drug interactions/effects,Beepers/Pages,29,Systematically review
10、each drug for potential side effects and interactions during 20 minute visit (new drug approvals FDA 2003; 42, 2002; 92 ) Systematically recall each step of the best practice for each clinical syndrome may encounter (National Guidelines Clearinghouse summaries Feb 2005; 1444 summaries) July 2004; 13
11、29),30,April 14, 2005,Medical Review of NC, Inc.,31,April 14, 2005,Medical Review of NC, Inc.,32,We can. But we cannot ensure that,Bypass, balloon, or stent a heart blockage dissolve a clot for a heart attack transplant a heart provide ventilator and BP support for pneumonia treat resistant bacteria
12、 such as MRSA, VRE, DRSP,the antibiotic is given 1 hr prior to CABG (47.6% US) the patient gets an aspirin on discharge (84% US) heart failure patient assess LVF (70% US) flu shot history assessed, given (14% US) penicillin allergic patient doesnt get penicillin,April 14, 2005,Medical Review of NC,
13、Inc.,33,We have revolutionized what we do, without changing how we do it. We have advanced the product without changing the process. Contrast: FedEx, EBay, Amazon, Starbucks,April 14, 2005,Medical Review of NC, Inc.,34,Who is responsible for improving the system?,April 14, 2005,Medical Review of NC,
14、 Inc.,35,How do we ensure the right treatment for the right patient at the right time, no more, no less?,Tell the doctors to just do it?,April 14, 2005,Medical Review of NC, Inc.,36,Skills of physicians,assess patients direct major aspects of therapy perform specific interventions communicate with p
15、atients,April 14, 2005,Medical Review of NC, Inc.,37,To make best, most efficient, most effective use of physicians skills, need to protect time and touch of the patient-physician interaction. Alice G. Gosfield, J.D., Snyder, 9/12/03,April 14, 2005,Medical Review of NC, Inc.,38,Clinical information
16、patients history, and key aspects of care for their conditions-must be present and readily utilized during the patient-physician encounter,April 14, 2005,Medical Review of NC, Inc.,39,Physicians take the lead,There is no indication that the practice of medicine is getting less complex. Spend time today to save time tomorrow.,April 14, 2005,Medical Review of NC, Inc.,40,Old paradigm Maintain knowledge-rely on memory Individualize Encourage variation Avoid “cookbook”, Avoid crutches, pocket-fill
